Patient health literacy and knowledge about the COVID-19 pandemic falls along sociodemographic lines, further evidence of the fact that the social determinants of health (SDOH) dictate an individual’s ability to be and stay healthy, according to new research from the Harvard Kennedy School.
More specifically, individual knowledge about COVID-19 and health behaviors were dependent upon individual race, sex, and age.
Black people, males, and individuals younger than age 55 were less likely to know how the novel coronavirus spreads and the key symptoms of the disease.
Additionally, individuals in those populations were less likely to engage in key healthy behaviors known to prevent COVID-19 spread, including regular handwashing and adherence to stay-at-home or better-at-home orders, the researchers found.
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Nearly three months into the widespread COVID-19 pandemic and it has become clear that there are stark racial health disparities when it comes to the disease. The latest research from the Brookings Institution showed that, when adjusted for age, black Americans are dying at a rate that is 3.6 times higher than their white peers. For Hispanic patients, that number comes in at 2.5 times the death toll for white patients.
Most experts agree these health disparities stem from decades of institutional racism that has limited patient access to care for black and Hispanic patients. A number of factors, such as proximity, affordability, and trust, make it difficult for people of color to access healthcare, increasing the likelihood that these individuals may develop a chronic illness. In the context of COVID-19, this makes people of color more susceptible to adverse infection outcomes.
However, little data has emerged about the impact that patient health literacy and education, personal beliefs, and healthy behaviors have affected health disparities and exposure risk.
“Historically, such efforts have had difficulty making inroads into socially marginalized groups,” the researchers said with reference to public health messaging. “For example, rates of smoking and obesity are higher among lower socioeconomic status groups, and trust in health care is lower among racial minorities.”
“This raises concerns that the response to COVID-19 will be hampered by differences in knowledge, beliefs, and behaviors among racial/ethnic minorities, groups with low socioeconomic status, or groups with differing political orientations in the population,” the study authors wrote.
Using survey data from across the nation, the researchers collected information about individual beliefs, COVID-19 knowledge and health literacy, and healthy behaviors for just over 5,000 adult individuals living in COVID-19 hotspots.
On the whole, differences in those measures emerged for black patients, men, and individuals under age 55. Black patients were 9.4 percentage points less likely than white respondents to know how the virus can spread, for example. Male respondents were 5.1 percentage points less likely to know this information than female respondents, while younger patients were 10.3 percentage points less likely to know about virus spread than those over age 55.
Similar trends emerged when looking at healthy behavior. Black patients, men, and younger people were more likely to leave their homes throughout stay-at-home orders, for example.
This trend may be less tied to defiance or limited awareness than it is to other social factors, like employment. Younger workers and black individuals may not enjoy the flexibility to work from home throughout the pandemic, making it more difficult to comply with stay-at-home orders.
Although the study did not look at the factors that may have led to these gaps in patient knowledge and health literacy, the researchers did emphasize that the results paint a path forward for public health education.
“Strikingly, knowledge and behaviors were closely related; groups in which behaviors put people more at risk for disease were also groups in which knowledge of appropriate behaviors are weakest,” the researchers said. “These findings suggest that greater efforts to communicate risk and safe practices to racial/ethnic minorities and younger people may be particularly crucial moving forward.”
It should be clear that limited health literacy or knowledge about COVID-19 is not usually the fault of the patient or individual. Particularly among traditionally underserved patients, such as ethnic minorities or immigrants, public health messaging can be inaccessible.
For example, most messaging is offered foremost in English, although many organizations are working to incorporate Spanish and other languages in their messaging.
However, there are a number of other factors to look at when assessing an accessible public health message.
For one, the pandemic has taken away many of the main sources for individuals to get their public health education. Schools are out of session, which means teachers and other trusted educators are not there to provide this kind of information to children, who then take these classroom lessons home to their families.
Workplace wellness programs and primary care providers are also not as present to reinforce and deliver public health messaging to patients.
Additionally, public health messaging is only as effective as a population will heed the advice. And if the population does not trust the messenger, as is often the case for low-income or traditionally marginalized people, they may not act on COVID-19 information.
Going forward, public health messaging that is inclusive needs to push outside traditional boundaries. Leaning on community health organizations and partners, public health agencies can connect with traditionally marginalized populations where they are at and chip away at the trust issues that have long eroded patient engagement.
Source: PatientEngagement HIT