Introduction
Edison, a community in Middlesex County in New Jersey (NJ), is bordered by South Plainfield, Piscataway, Highland Park, New Brunswick, and East Brunswick; Fords, Iselin, and Colonia in Woodbridge township; and Scotch Plains township in Union County. Figure 1 shows the position of Edison township and some of its neighbors. The population is 98,700, and the three key ethnic groups include Asians 48.68%, Whites 35.33 %, and African Americans 8.17% (USCB, n.d.). In the community, 57.5% speak other languages, 42.5% speak English; Indo-European languages are most common and spoken by 28.05% of the population (USCB, n.d.). Based on data from the 2019 ACS, 55.53% of Edison’s population have completed a Bachelor’s degree or a higher equivalent, 19.49 % have completed a high school program, and 3.38% have not completed primary education (USCB, n.d.). Edison’s socio-economic status is high, with a median household income of $110,961 per year. However, Edison is still characterized by poverty, with households with senior adults and individuals below 18 years accounting for 6.8% of the poverty level (USCB, n.d.). Edison’s employment rate in the public sector is 12% which is among the lowest in Middlesex, 13.4%. Most communities have their strengths and weaknesses; one community problem in Edison is health literacy.
Statement of the Problem
Health literacy impairs a community’s aim of achieving its health goals. According to Walters et al. (2020), health literacy refers to a considerable percentage of the population not possessing appropriate skills, knowledge, and understanding to navigate health and social care information and community services. As a result, individuals are likely to adopt poor lifestyle choices that may contribute to the occurrence of medical conditions such as obesity (Duplaga, 2020), incurring additional medical expenses (Schaffler et al., 2018; Palumbo, 2017), and increased health complications for patients with critical medical conditions due to poor management choices (Fabbri et al., 2018; Jandorf et al., 2019). The prevalence of these outcomes is based on the level of health literacy within a community attributed to the existing social interventions. According to the Community Health Needs Assessment (CHNA) report by the Robert Wood Johnson University Hospital (RWJUH, 2019), Edison township is one the regions in Middlesex with the highest numbers of individuals with limited English proficiency at 16.9% compared to 16.4% in Middlesex County and 12.2% in New Jersey. For a community where most health information is published in English, the percentage of individuals with limited English proficiency understanding these contents is very low. Harris et al. (2017) associate low health literacy with limited English proficiency, resulting in greater health risks. With Edison recording a significant percentage of people with limited English literacy, the situation is expected to be familiar with many people illustrating low health literacy. The community assessment illustrates how the Edison administration can improve health literacy by implementing evidence-based strategies such as involving the public and tailoring communication from identified social determinants such as socio-economic level and education.
Impact of Low Health Literacy on a Community
Studies reveal that health literacy is a growing area of concern in public health and that improving a community’s health people goals depends on improving its rates. For instance, Swartz et al. (2018) discover that basic health literacy can help trauma patients avoid incidences leading to traumatic episodes. This implies that basic health literacy can lower the prevalence of health conditions by equipping individuals with the knowledge for understanding and controlling them. After diagnosis, physicians prescribe a care plan for patients to prevent the effects of a medical condition. Luckenbaugh and Moses (2019) find that worse medical outcomes for patients discharged from critical care are low health literacy. Understanding physician directives in managing vital health conditions is also a significant impact of low health literacy, leading to adverse health outcomes. Fabbri et al. (2018) link low health literacy to increased hospitalization and mortality among patients with heart failure. Such medical conditions are delicate and require collaboration between physicians and patients to promote positive outcomes. However, low health literacy impairs effective communication as patients will not understand doctor instructions and succeed in self-management. Chisholm-Burns et al. (2018) also associate low health literacy with increased adverse outcomes among solid-organ transplantation patients. Another impact of low health literacy is its role in increasing healthcare costs. Individuals with low health literacy are likely to make mistakes in establishing the best care plan or purchasing the proper medications, leading them to spend more money on managing their condition. According to Palumbo (2017), these individuals are at a higher risk of their health problems exacerbating, which force them to spend increased funds to receive quality health care.
Discussion of Problem and Relationship to the Population
Health outcomes in a society are determined by non-medical factors called social determinants of health. Social determinants may vary between different communities, but they are mainly related to individuals’ conditions, work, and age. Edison’s population characteristics revealed three vital social determinants of low health literacy: socio-economic level, education, and English proficiency.
Higher levels of low health literacy in the United States are common among senior adults above 65 years. However, studies reveal that low health literacy levels are higher in low socio-economic populations (Hickey et al., 2018; Stormacq et al., 2018). According to the 2019 ACS, 6.8% of Edison’s poverty level comprises senior adults aged 65 years and above and households with children under 18 years (USCB, n.d.). Although a significant percentage of the population makes above $46,262 per year, 8.1% of individuals live in poverty (USCB, n.d.). This rate is almost equal to the poverty level in Middlesex, which is 8.8% (USCB, n.d.). According to Stormacq et al. (2018), the low socio-economic level is a predictor of poverty and low income, associated with increased levels of low health literacy.
Health literacy is also associated with higher levels of low education within society. Low education level depicts a situation in which a significant percentage of society has a below-average knowledge of basic information necessary for daily life. Quality health requires an individual to possess the right knowledge to understand key medical concepts relating to medication, management, and control of a medical condition and retrieve and access vital information related to their health. Based on the 2019 ACS, 8% of the adult population in Edison did not complete primary education, which is among the highest in Middlesex (11%) (USCB, n.d.). Nutbeam et al. (2017) conclude that for an individual to understand key medical interventions, they need to have basic educational knowledge regarding the said medical situation to reduce the prevalence of high-risk outcomes.
Understanding medical interventions, including observing the right medication rely on an individual’s ability to understand the language used to communicate this information. Language barrier impairs the efficacy of medical instruction since there is poor communication between physicians and patients (Squires, 2018). Based on the 2019 ACS, 42.5% of the population speak English instead of 57.5% who speak other languages (USBS, n.d.). The widely spoken languages in Edison are Indo-European languages spoken by 28.05% of the population (USCB, n.d.). Edison’s low English proficiency is 16.9%, the highest in Middlesex (16.4%) (RWJUH, 2019). This means that a significant proportion of the population is likely to experience poor health outcomes since they do not understand most medical terminology, effective medication usage, and applying management measures effectively.
Recommendations for Practice
Improving health literacy in Edison township depends on the application of evidence-based strategies. Based on the findings, these strategies emerge from public health, adult education, and communication. Simple strategies such as simplifying written material and using videos are also practical recommendations for improving health literacy.
Involving the affected public
Research reveals that involving the public in developing communication items is a reliable approach to improving health outcomes within a community. Encouraging public participation allows the affected population to provide their recommendations while developing community policies for improving health literacy (Amoah, 2018; Loignon et al., 2018; Pitts & Freeman, 2021; Sak et al., 2017). Moreover, health practitioners need to apply proven principles for health literacy design in areas commonly accessed by the public. For instance, some studies reveal the role of pictorials in increasing public understanding of taking medication (Jones et al., 2019; Sarzynski et al., 2019). This intervention will be effective in helping people with limited English proficiency to understand key medical terminology, symptoms, and prescriptions. The Edison administration can collaborate with the New Jersey 2-1-1, a 24/7 information line available for Edison residents to get any assistance. Such a collaboration would ask the organization to create a public feedback portal whereby residents can call and provide recommendations about improving the township’s health infrastructure. This would encourage active public participation from people of all backgrounds. Moreover, the administration can avail the number of languages spoken in Edison to the JFK Medical Center which will provide free interpretation and translation for individuals with limited English proficiency.
Tailoring communication for the targeted population
Research reveals that targeted communication techniques can promote health literacy as they personalize strategies for individual management of medical conditions in patients with low health literacy. These approaches are tailored to address the health needs of unique populations, such as those with limited English proficiency (Chen et al., 2018; Taira et al., 2019). Additionally, improved communication programs are tailored for individuals with unique characteristics, such as those with physical and mental impairments (Smith & Wightman, 2019; Narita et al., 2018) and the elderly (Buller et al., 2018; Piasecka-Robak, 2021). These tailored strategies help individuals with special needs improve their medication compliance and promote effective medical outcomes in medication and controlling a health condition. Edison’s Senior Citizen Services can introduce a program for improved communication with senior citizens who fall among the low socio-economic levels population. Collaborating with the Comfort Keepers organization can provide in-home care for seniors to address medical instances and keep them up to date with their health. Additionally, the Alliance Center for Independence in Edison can rely on government assistance in supporting and promoting the independence of individuals living with disabilities and their families.
Conclusion and Recommendations
This assessment highlights the importance of Edison improving its health literacy to meet the 2030 Healthy People goals. Based on evidence from previous literature, communities can mitigate this problem through government-public interventions supported by community organizations. The assessment finds low socio-economic level, education, and low English proficiency to be key social determinants to the prevalence of the issue and provide recommendations to mitigate it. These recommendations emphasize the importance of accessing accurate, meaningful, and complete health information for a community’s development. Achieving the 2030 Healthy People goals requires collective public and government action. This community assessment reveals the importance of implementing community-based practices to promote health literacy by addressing poverty and educational attainment. This is possible if Edison manages to mobilize local organizations involved in health and community services to work together to address the issue.
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