A Systematic Review of Environmental Health Literacy

Background/Purpose

The complex intersection of socio-economic, natural, and built environment influences the health of individuals and populations. These impact those who are most vulnerable perpetuating further socio-economic inequalities and health burdens. To mitigate environmentally driven health disparities and improve access to healthy environments, particularly for those who are most vulnerable, requires a critical reflection within the local communities and cultural contexts (Chinn 2011; Sykes et al. 2013). Educating people about environmental health risks can help reduce disproportionate health burdens, build community resilience, and empower the people to advocate for their better health and wellbeing. Few studies have looked at the larger effect of cultural context on general understanding among the people of environmental health risks (Finn & O’Fallon, 2015).Given that the critical health literacy can result in better health outcomes (Chinn, 2011), the objective of this study is to explore existing studies on environmental health literacy and “what assessment tools exist on environmental health literacy?” “Did any study use critical cultural lens on environmental health literacy?” This study will present results from a systematic review conducted on environmental health literacy. Based on the study findings, policy, research and practice implications will be explored.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review focused on studies from 1986 (initiation of the Ottawa charter for Health Promotions) to 2019. It used “environmental health literacy”, “culture”, “environmental health education” as key words with inclusion criteria of peer-reviewed articles, quantitative, mixed methods, and systematic reviews. Articles were excluded if they were non-English studies, qualitative studies, dissertations, and books, conceptual papers. Several databases, including, Google scholar, PubMed, selected EBSCO, ProQuest, Medline, CINAHL, AMED, ASSIA, IBSS and ISI Web of Knowledge were explored. Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool was used for scoring of articles.

 Results

The search resulted in 398 articles of which 45 met the inclusion criteria. Final review resulted in n=6 articles for the study. Of those, mostly focused on community and school-based education; majority of the studies just recommended use of environmental health literacy and only one mentioned cultural approach. Out of the six articles, only one used an assessment tool and  reported Cronbach alpha. Only, two studies focused on Latinos and African Americans, none were conducted in the developing nations. Other than those focused on indigenous population, few researchers use the critical cultural perspective for collective knowledge generation on environmental health risks.

Discussion/Conclusion/Implications

This review highlights that only a handful of quantitative research exists on environmental health literacy. Assessment of past research show that health literacy is effective in motivating individuals to gain more knowledge and efficacy about the environmental health risks. This review concludes that social workers should consider environmental health literacy within the broader environmental justice and the social determinants of health practice, research and policy, and utilize critical cultural and structural factors in educating people about environmental health risks and related socio-economic inequalities.