Community health literacy impacts personal health status, study shows

University of Hawaiʻi at Mānoa
Kathleen Russell, (808) 956-5451
Director of Planning, Office of Public Health Studies
Posted: Oct 16, 2013

Public Health's Tetine Sentell, PhD, and collaborator Wei Zhang, PhD of Sociology
Public Health's Tetine Sentell, PhD, and collaborator Wei Zhang, PhD of Sociology

In some communities in Hawaiʻi, 35.99% of residents report low health literacy, which means that they may struggle to understand basic health information. In other communities, only 5.37% report low health literacy. According to a recent study at the University of Hawaiʻi at Mānoa' s Office of Public Health Studies, led by Dr. Tetine Sentell, these percentages matter for individual health.  Those who live in communities where many people report low health literacy have, on average, worse health than people who live in communities where few residents report low health literacy.

The study of 11,779 individuals within 37 communities in Hawaiʻi found that each percentage increase of average low health literacy within a community was associated with an approximately 2% increase in poor self-reported health for individuals in that community. This was regardless of individual health literacy, age, gender or access to health insurance. “From previous work, we already knew that almost 20% of adults in Hawaiʻi reported low health literacy and that low individual health literacy was associated with poorer personal health status,” said Sentell. “What our new study found is that community health literacy also matters to your personal health status. Health literacy is an important factor at both the individual and community level.”

Primary-care providers, community health centers and public health facilities should, therefore, consider and address health literacy at both community and individual levels.  Said Dr. Sentell, “We were surprised at the community variation in low health literacy and how important it was to individual health. We know in Hawaiʻi that the community context is important to health in many ways. This study shows that a large increase in health literacy across enough individual members of a community could provide community-wide health benefits. There is increasing funding with relevance for social health factors, including efforts supported by the Affordable Care Act.”

This study was a product of an interdisciplinary collaboration between UHM's Department of Public Health Sciences, Dr. Wei Zhang of the Department of Sociology and Kay Baker of the Hawaiʻi Department of Health.

The article is published in the Journal of General Internal Medicine (JGIM), the official journal of the Society of General Internal Medicine.  It promotes improved patient care, research and education in primary care, general internal medicine, and hospital medicine.  Its articles focus on clinical medicine, epidemiology, prevention, health-care delivery, curriculum development, and some non-traditional themes. JGIM offers early publication on to reach a broad audience, with online access to abstracts and full articles rapidly growing each year.  Learn more about JGIM at

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