Communication Currents

The roughly 20 percent of U.S. children who live in rural areas are more likely to experience chronic illness, unfilled medical needs, and poverty. While many previous studies have examined the health literacy of adult caregivers to understand children’s health literacy, this study differs from those by incorporating children themselves to assess children’s health literacy. In a new article in NCA’s Journal of Applied Communication Research, Sarah A. Aghazadeh and Linda Aldoory assess the potential of a school-based intervention to improve health literacy among rural children. 

Health Literacy 

According to existing scholarship, “Health literacy is defined as ‘the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions.’” In other words, people with higher health literacy are more likely to make healthy decisions, such as regularly brushing one’s teeth or eating fruits and vegetables. 

Health literacy can be influenced by income, one’s level of education, and other factors. For children, eligibility for free or reduced lunch at school is one indicator of low-income and is correlated with lower health literacy. Children can develop healthy habits in childhood that they carry through adulthood. By improving children’s health literacy, Aghazadeh and Aldoory are hopeful that curriculum-based interventions can improve children’s health outcomes and reduce the health disparities between urban and rural areas.  

The Health Literacy Program 

School interventions can help address children’s health literacy. Such interventions often occur after school, rather than during the instructional portion of the day. In this study, the authors explored a health literacy intervention that was integrated into existing curricula during the school day, ensuring that all students received access to the programming.  Aghazadeh and Aldoory argue that incorporating programming into existing curricula is more effective than “adding-on” a health literacy program and avoids overburdening teachers.

The intervention, developed by a team of communication, health, and education experts, was implemented at two rural schools in a Mid-Atlantic state. Although both schools were rural, they differed significantly in other respects. One school was a Title I school; it receives federal funding because some of the students are low-income. At that school, about 65 percent of students received free or reduced-cost lunches, and about 38 percent of the students were white. The second school had fewer students who received free or reduced-cost lunches (30 percent) and a higher proportion of white students (80 percent). The four lesson plans were designed to be used in second- and third-grade classes. The team designed the lesson plans to address “(1) using health information to better health, (2) understanding influence of media and culture on health, (3) making healthy decisions, (4) developing interpersonal communication skills, and (5) communicating to advocate health.” Each lesson plan met Common Core Standards and was about 7 to 10 days long. Prior to participating in the program, the students completed a survey, which showed a lower health literacy average for children at the lower-income and more racially diverse school.

Results 

After the intervention, students answered another survey. This survey showed that students’ health literacy had increased and that there was not a significant difference in health literacy between the two schools after the lessons, even though the student bodies at the two schools were socioeconomically and racially disparate. Aghazadeh and Aldoory argue that “the teacher-led philosophy behind lesson plan construction was a key to the success of the project.” In essence, because local teachers were involved in designing and creating the lesson plans, they could adapt them to the needs of their students. Aghazadeh and Aldoory suggest that this is a model that could be used in other schools. 

The results also showed that health literacy programs can be successful with students as young as seven years old. Aghazadeh and Aldoory note that this is significant because health-literate children can improve their own long-term health and potentially even the health of their families. Furthermore, the results were successful within a rural county, which is significant because of the health disparities between rural and non-rural counties.