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

Background and Purpose:

Health literacy (HL) is the ability to read, understand, and use health information to meet one’s health goals. Low HL is a major public health concern with serious human and economic implications. Unfortunately, in developing countries little is known about HL, and there are often no educational programs to promote it. Some of HL challenges facing developing countries include limited access to health professionals, poorly equipped education and health care systems, and reduced availability of the internet. While culturally-tailored interventions specifically targeting HL are not likely to appear in Guatemala for some time due to more pressing challenges such as human trafficking and widespread violence, there are intervention programs currently being implemented that focus on related health topics. One such program is the Keepin’ it REAL (KiR) substance use prevention program. This study explored the influence of an already existing substance use intervention (KiR) on the HL of youth living in Guatemala City.

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 HL 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 (NVS), a validated instrument for assessing HL among youth in Guatemala, was used to assess HL, while the culturally-adapted version of KiR was used to assess substance use attitudes and behavior.

Results:

T-test results indicated that students who went through the substance use prevention program had significantly higher scores on the HL assessment than their peers. The magnitude of the difference was strong, with an effect size of 1.10. While the KiR program did not specifically teach HL skills such as literacy, numeracy, and comprehension, on average those in the intervention group scored 17%  higher on the NVS. One other variable of interest (parent education) also demonstrated significant differences between the two groups, with those in the treatment group having more highly educated parents on average. The effect size of this difference was moderate at 0.48.

Conclusions and Implications:

In order to ensure healthy development for all youth we must be willing to look outside of the US and take on a global perspective. With inadequate healthcare availability, limited internet access, and a historically problematic education system that continues to struggle despite international support, the human and economic need for HL education in Guatemala is clear. The findings of this study provide an initial step towards understanding how HL might be promoted using resources that are already available. The unanticipated alternative HL benefits of the KiR program suggest that other health programs available in Guatemala – and other low-resource developing countries - may also have unforeseen positive value. With international public health interventions often costing hundreds of thousands of dollars, these finding suggest the possibility of a unique cost-effective approach to improving HL.