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Striving for Effective Promotion of Health Literacy in Rural Honduran Communities

  • May 8, 2015
  • Blog
Kara Faktor, Researcher, Fulbright U.S. Student Program, Honduras

Kara Faktor, Researcher, Fulbright U.S. Student Program, Honduras

Kara graduated from Brandeis University in 2014 with a B.S. in Neuroscience, Biology, and Hispanic Studies. She is currently living in Honduras for 10 months conducting public health research through the Fulbright U.S. Student Program.

‘A seat at last’ is the thought that entered the mind of one Honduran woman as she reached the tarp overhang that shielded her from the afternoon sun. She found a seat in one of the plastic chairs outside of the community schoolroom serving as a makeshift pharmacy for the mobile medical clinic. Since 6 a.m. she had waited outside the school’s metal gate for precious moments with a foreign physician. Now, having consulted with the physician and awaiting her prescription from the pharmacy, she took her seat beneath the tarp. A nurse stood presenting health information pictured on an easel at the front of the assembled chairs. Yet, the nurse’s presentation was much more than a time-filler for patients waiting to receive medications. Rather, health education embodies the crux of efforts to promote health literacy in rural Honduran communities.

While medications may resolve symptoms of a current illness, they frequently fail to address underlying causes of recurring illnesses. For this reason, promoting health literacy through education constitutes an essential part of foreign aid. Health literacy is defined by the World Health Organization (WHO) as the “…ability of individuals to gain access to, understand and use information in ways which promote and maintain good health…” (Nutbeam 2006). In Honduras, medical NGOs endeavor to enable individuals to gain access to and understand health information through an educational charla, or presentation. However, promoting use of the health information is better facilitated by medical NGOs through training community health workers (CHWs) who can teach and model good health behaviors.

Emphasis placed on health literacy by the WHO has been mirrored in comments of Honduran healthcare professionals. For six months, I have conducted research in Honduras regarding the perspective of local healthcare providers on the effectiveness of foreign aid in meeting the health needs of rural communities. In 43 interviews with Honduran physicians and nurses who work for medical NGOs and government-run clinics, the importance of providing health education to facilitate changes in health behaviors was frequently expressed. Illnesses identified by interviewees as being the most prevalent are diarrhea, vector-borne diseases, and respiratory diseases—the majority of which are preventable.

During the interviews, Honduran physicians highlighted the importance of content and delivery in designing educational charlas. Due to the low fundamental literacy levels in many rural communities, medical terms should be avoided and images should be employed to facilitate a more thorough understanding. In fact, visual learning has been shown to aid comprehension of health information. (Nienkamp 2006).

Careful selection of the health topics is vital. When asked to identify the most crucial health issues to address in a charla, six interviewees commented on the importance of considering seasonal fluctuations in the prevalence of certain diseases, like diarrhea, dengue, and chikungunya. Thus, specific topics should be addressed during times when they are most relevant in the lives of community members.

Several public sector healthcare professionals noted that too much information presented in one day without reinforcement diminishes patient understanding. Thus, developing strategies, like training CHWs, for strategic reinforcement of health behaviors initially taught at the mobile clinic is key for NGOs. CHWs are able to educate and model health practices in the context of a daily routine when learners are more receptive than after a tiresome day at a mobile clinic.

Fundamental to reinforcement of health information is identifying how to best motivate individuals to apply information in their lives—information that often counters daily practices commonly reinforced across generations. Since CHWs are respected community members, they carry more influence in changing health practices and eliminating taboos. According to a public sector nurse, the CHWs “se aplican (los nuevos hábitos de salud) en sus familias y hacen un efecto multiplicador porque le dicen al vecino…le comentan a un amigo y asi poco a poco ya se van informando todos” (apply [new health habits] in their families and cause a multiplicative effect because they tell a neighbor…comment to a friend, and in this way little by little they inform everyone).

Training CHWs is a form of popular education, an education style that invites interaction and leads to health behavior improvements. For CHWs, training “validates what participants already know and do…and supports participants to work collectively to change their reality” (Wiggins 2011). Educational charlas have the potential to provide individuals with access to and understanding of health information—two essential attributes of health literacy. Yet, to fully achieve health literacy, and eradicate underlying causes of common diseases, individuals must apply the information. In this respect, CHWs trained by NGOs play a central role in modeling health behaviors as integral members of the rural communities. Thus, the critical importance of promoting health literacy through foreign aid cannot be denied—and for the Honduran woman listening thoughtfully at the mobile clinic, health education just might be life changing.