Vietnamese Americans and Health Literacy

According to the National Assessment of Adult Literacy (NAAL),

53% of adults have intermediate health literacy
21% of adults have basic health literacy
14% of adults have below basic health literacy

This leaves only 12% of adults with proficient health literacy, which, as defined by Healthy People 2010, is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.  [Health literacy] requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations [such as filling out forms, understanding informational materials, abiding by prescription instructions, and calculating premiums/copays/deductibles].”

With such high percentages of health-illiterate adults, low health literacy is definitely a public concern.  As a matter of fact, this problem costs the United States’ economy approximately $238 billion annually, according to the Washington Post.  What are the factors contributing to this?  Does race or ethnicity play a role?  What about educational attainment or age?  Where do Vietnamese Americans stand in the health literacy spectrum?

Based on the information presented in the NAAL, age had relatively little correlation to health literacy amongst adults under the age of 65, whereas the statistics in regards to educational attainment were much more distinctive.  Only 1% of adults with less than a high school degree are proficient in health literacy, but the rate increases to 30% for adults who have obtained at least a bachelor’s degree.  Nonetheless, this means that even high school and college graduates can have limited health literacy.

In terms of race and ethnicity, health literacy is an issue for all groups although the rates do vary.  “White” had the highest rate of proficiency followed by “Other” (which includes Asians, Native Americans, and multi-racial adults).  “Black” and “Hispanic” stood predominantly on the other end of the scale.

In regards to Vietnamese Americans, specific data are not available.  However, one can reasonably deduce from the above statistics that older Vietnamese adults most likely have a higher rate of health illiteracy, and no doubt, Vietnamese adults with limited English proficiency—such as those who have recently immigrated to America or those without educational opportunities—are also in a similar situation.

One obvious factor is language barrier.  If the patient does not fully comprehend what is being said, then the patient’s ability to report important and accurate health history or the physician’s ability to understand and assimilate patient’s information is compromised.  The use of professional or the patient’s own interpreters is currently the most common method to handle the situation.  However, these alternatives clearly compromise the patients’ confidentiality.  There are also medical-legal issues involved with the latter.  Bilingual medical employees who can directly provide care for the patients would solve the dilemma, but are there enough healthcare professionals who are fluent in both English and Vietnamese to meet the demand?

Another issue is culture.  According to a survey by The Commonwealth Fund, “Asian Americans” are more likely than “White” to “feel that they are treated with disrespect when receiving health care, to experience barriers to access to care such as lack of insurance or not having a regular doctor, and to feel they would receive better care if they were of a different race of ethnicity.”  This may lead patients to skip necessary medical tests, end up in the emergency room more often, or have a harder time managing their overall health.  Studies from the Journal of the Royal Society of Medicine showed that “patients forget up to 80% of what their doctor tells them as soon as they leave the office, and nearly 50% of what they do remember is recalled incorrectly.”  One clear example is that of a diabetic man who diligently practiced injecting insulin into an orange while staying in the hospital.  Weeks later, the same man was readmitted to the hospital due to high blood sugar readings. As the story unfolded, the man was injecting the insulin into an orange and then consuming the fruit instead of injecting himself with insulin.

It seems that health literacy and its relationship to health promotion and health maintenance have not been emphasized enough.  With the healthcare system moving towards a patient-centric plan as part of an overall effort to improve healthcare quality as well as to reduce healthcare costs, it is important not only for patients to be proactive in their healthcare-related decisions but also for proficiently health literate individuals to aid the less health-literate.  Perhaps healthcare and social service professionals can collaborate to construct more linguistically and culturally appropriate solutions for the less educated, newly immigrated, or older Vietnamese American populations.