A Look at Health Literacy and Health Decisions Among Youth Living in Guatemala City

Background and Purpose:

Health literacy (HL) is recognized as an important health construct that is highly correlated with various health-related outcomes. Organizations such as the Institute of Medicine and the Agency for Healthcare Research and Quality have issued reports on the topic, and practitioners and academics alike have been engaged in its operationalization and improvement for decades. Notwithstanding the amount of attention dedicated to this concept, there is a dearth of HL research being conducted among adolescent populations, particularly those outside of the United States. In line with Manganello’s framework for studying HL among youth, this study was designed to: 1) describe the HL status of youth living in Guatemala City using the Newest Vital Sign assessment; and 2) identify links between HL and harmful health decisions that could lead to negative health outcomes.

Methods:

Youth in Guatemala City were recruited from 10 schools (US equivalent of junior high schools) to participate in a cross-sectional health study looking at health literacy and health decisions. Study participants (N=210) ranged in age from 10-16 years (mean=12.1), and the majority were male (54.7%). The Newest Vital Sign, a validated instrument for assessing HL among youth in Guatemala, was used to assess health literacy. Logistic regressions using HL as a predictor of substance use were used to assess the connection between HL and harmful health decisions.

Results:

The average participant answered between 2 and 3 NVS questions correctly, placing them between the high likelihood of limited health literacy and possibility of limited health literacy categories. Overall, well over two-thirds of the participants were found to have less than adequate HL. HL and parent education were both strong predictors of increased alcohol use (p< .01), but were not significant predictors of self-reported cigarette or marijuana use.

Conclusions and Implications:

Due to inadequate availability of the internet and limited access to health systems in developing countries such as Guatemala, along with these findings that suggest very low HL among youth, it can be assumed that without additional health training these youth will not be prepared to meet their own health needs as adults. These findings are particularly concerning given the specific HL barriers present in Guatemala. According to the World Health Organization, Guatemala has just 9 physicians per 100,000 people, which is 11 fewer per 100,000 than their regional average, and 216 fewer per 100,000 than the US. Compounding this problem of accessibility to knowledgeable health care professionals is that more than a third of children who start 1^st grade in Guatemala do not reach the last grade of their primary education. Health care providers, including doctors, social workers, hospitals, health organizations and health advocates in Guatemala need to recognize that low HL is a pressing health issue among youth, and appears to be connected to some harmful heath behaviors. Steps should be taken ensure accurate health information is available and conveyed in a manner that is easily understood.