Digital Health Literacy, a Health Equity Tool for Vulnerable Patient Communities
After an alarming need came to light for agricultural workers in Merced County, California, health advocates saw a clear need for action. What medical experts found for patients with uncontrolled diabetes and who contract COVID-19 is their bodies can go through increases in existing inflammation and suppressed immune responses. This phenomenon helps explain why those with diabetes were 12 times more likely to die of COVID-19 early in the pandemic before treatments were known or vaccines were available.
To address high rates of diabetes and hypertension within California’s rural central valley, researchers at the Center for Information Technology Research in the Interest of Society & the Banatao Institute (CITRIS) at the University of California launched Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity (ACTIVATE). This pioneering program is spearheaded by Dr. Katherine Kim, Principal Consumer Health Informatics and Health Scientist at MITRE and Dr. David Lindeman, Director of Citrus Health, and in partnership with Livingston Community Health, the University of California CITRIS network, technology distributors, community-based organizations, and government agencies.
Addressing Virtual Care Disparities
ACTIVATE is a telehealth program designed to serve a vulnerable, underserved population with little access to quality healthcare services. In Merced County, many are low-income, undocumented, LatinX agricultural workers with limited English proficiency.
“So many things conspire against farmworkers with these diseases from getting what they need,” said Kim. With barriers to in-person care like lost wages and lack of transportation, telehealth isn’t just a nice thing to have for healthcare – it’s a necessity. But even virtual visits can pose issues for agricultural workers when they deal with things like struggles with data costs, unreliable internet access, and low technology literacy.
Within Merced County, Livingston Community Health is launching the first full-spectrum ACTIVATE program based on patient requests with the plan for many other community health centers across the state to follow. The program provides patients with digital health technology and teaches them how to measure their own health data and connect to healthcare professionals. Depending on their specific needs, participating patients are given phones, tablets and connected health monitoring equipment like glucometers or blood pressure machines. They also receive health education and digital literacy training from community health workers and medical assistants with the appropriate cultural and linguistic skills to engage with the patients.
The goal of the program is to empower patients to integrate digital health into their lives, so they can learn how to take control of their health and see better health outcomes. Rosa Pavey, a bilingual nurse and health coach at Livingston points out, “We take for granted that our patients, just because they have the diagnosis, that they know everything about their health, and they don’t know.”
By integrating telehealth and digital health technology in Merced County’s community healthcare, ACTIVATE addresses virtual care disparities for patients with limited English proficiency. Researchers in a recent study concluded that patients with limited English proficiency needed increased access to technologies and virtual platforms, interpreters integrated into virtual platforms, and virtual care that addresses privacy concerns.
Supporting Digital Health Literacy With an Inclusive Approach
To support this groundbreaking initiative, the Health Equity Emissary Team (HEET) produced a series of animations to educate prospective patients on digital health and the ACTIVATE program. “The success and reach of this program rests on digital health literacy,” said HEET Chairwoman, Natividad Chen. “So, it was especially important for us to create animations that were inclusive and accessible to this vulnerable community.”
Designed with Merced County patients in mind, the animations aim to educate through warm-hearted, visual storytelling without any confusing medical jargon. The characters were designed to represent patient demographics and be gender, body-size, and age inclusive. Moreover, the animations were produced in English and Spanish with multiple language subtitles including Hmong and Punjabi. From start to end, the team considered the audience’s socio-cultural backgrounds to address their unique needs.
The HEET is thrilled to support CITRUS and the University of California Berkeley in a program that is breaking new ground in the digital health community healthcare space. By educating and empowering LatinX agricultural workers in rural California to take charge of their own health, the ACTIVATE project aligns with HEET’s mission to address the needs of underserved, diverse health communities. “We are excited and honored to support a pioneering program that is integrating technology with community healthcare to promote health equity,” said Chen.
By contributing to the ACTIVATE project, the HEET is moving the needle forward in promoting health equity and diversity in healthcare communications.
“We hope these animations not only serve to reach ACTIVATE patients, but also inspire the general public on the potential of digital health to promote health equity.”
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Sources
Aswita Tan-McGrory, MBA, MSPH, Lee H. Schwamm, MD, Christopher Kirwan, PhD, Joseph R. Betancourt, MD, MPH, Esteban A. Barreto, PhD, MA. Addressing Virtual Care Disparities for Patients With Limited English Proficiency. The American Journal of Managed Care website. Accessed February 29, 2022. https://www.ajmc.com/view/addressing-virtual-care-disparities-for-patients-with-limited-english-proficiency
Aisling Carroll. UC Davis Co-Launches High-Touch Telehealth Program in the Central Valley for Agricultural Workers. California Association of Public Hospitals and Health Systems website. Accessed February 29, 2022.
https://caph.org/2021/05/26/ucdavis-launches-telehealth/
Drew Danielle Belsky. Representing Diverse Bodies in Medical Illustration. Platypus website. Accessed February 29, 2022. https://blog.castac.org/2019/10/representing-diverse-bodies-in-medical-illustration/
