A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum

Abstract

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.

Evaluation of an Australian Health Literacy Program Delivered in Adult Education Settings

“…By contrast, a recent study from Taiwan reported no differences in health literacy at 6 months but reduced emergency department visits and hospitalizations (Tsai, Lee, & Yu, 2018). However, our findings are consistent with studies that integrate health literacy into ESL programs that show improvements in knowledge and functional health literacy (Chen et al, 2015; Soto Mas, Ji, Fuentes, & Tinajero, 2015; Soto Mas, Schmitt, Jacobson, & Myers, 2018). Earlier studies (Elder et al, 1998; Elder et al, 2000 reported changes in cardiovascular risk factors at 3 months after a health literacy intervention, although these changes were not sustained at 6 months.…”

Community health literacy outcome measurement practices: A scoping review of recent interventions

“…At the individual level, FHL was assessed substantially more ( n = 18 17 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ) than communicative ( n = 9 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 46 ) or critical HL ( n = 9 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 46 ) across the studies sampled.…”

“…Objective instruments were the most commonly used in the studies ( n = 13 10 , 16 , 17 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 42 , 43 ), with subjective instruments less frequently used across the studies ( n = 10 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 47 , 48 ). Few objective and subjective instruments were used ( n = 2 44 , 49 ).…”

“…This preference appears to form standard practice, despite previous indications of a convergence towards all‐encompassing HL measurement. 5 While this is not problematic if interventions intend to focus exclusively on FHL, this review indicates that, while a large portion of studies incorporated FHL‐specific outcomes which reflect their proposed intervention aims, 29 , 32 , 33 , 34 , 35 , 43 , 44 others utilised interventions with aims relating to the improvement of HL in general—implying an intended improvement across multiple HL levels—but only incorporated direct outcomes targeting FHL. 17 , 28 , 42 These practices indicate that, while the majority of studies successfully apply FHL outcomes in reference to their intervention aims, research may struggle to identify appropriate direct HL evaluations beyond the functional level, ignoring the assessment of potentially relevant HL skills.…”

Health Literacy and Migrant Communities in Primary Health Care

“…In fact, many adult migrants do not have access to appropriate health information, and often face difficulties in managing health issues. They are confronted to health staff with inadequate cultural skills and have difficulties managing and understanding the highly complex health systems ( 26 ). Additionally, access to health care can be hampered by different barriers, such as the inability to provide guidance in the health system, previous experiences in the health system, existing expectations regarding care, language and cultural barriers, financial resources and beliefs associated with health ( 27 ).…”