The ABCs of Health Literacy

Most of us know what literacy means: it’s someone’s ability to read, write, and understand. Health literacy, or the capability to read, understand, and use healthcare information to make decisions is often less clear. Even if health literacy might be a foreign concept for many, it is one of the most important determinants of our health. Studies suggest that low health literacy results in higher risk of hospitalization, longer hospital stays, less compliance with recommended treatments, higher baseline illness when seeking care for the first time, individuals making more mistakes with their medication, and is attributed to excess deaths.

Low health literacy is often associated with elderly individuals, non-native English speakers, people who have low education levels, racial and ethnic minorities, and individuals with low income levels. The majority of our nation’s farmworkers have these barriers. They are predominantly non-native English speakers with low education and income levels. Even though there is very little information documenting the health literacy of farmworkers specifically, it is clear they suffer a disproportionate burden. To combat the issues farmworkers are facing when trying to understand health information, AFOP’s Health & Safety Programs uses health literacy standards to make health messages as understandable as possible.

Cultural and linguistic sensitivity are just the tip of the iceberg when giving accurate health information to farmworkers. Presenting materials to a low health literacy audience should also include the following steps:

  • Placing the most important information at the beginning of a section, to ensure retention
  • “Chunking,” or breaking down complex and lengthy information into understandable, smaller chunks
  • Using plain language, which includes using monosyllabic words and short sentences
  • Defining technical terms
  • Using at least a 12 point font
  • Avoiding abbreviations
  • Leaving plenty of white space around the text
  • Verbal communication of information

All of Health & Safety Programs’ trainings are full of images farmworkers can identify with and are available in English and Spanish. The words we use are also culturally sensitive: on par with the education level of farmworkers, their geographic background (for example using Mexican Spanish instead of Argentinian Spanish), and incorporate slang or “Spanglish” for maximum comprehension by farmworkers. Proyecto Sol, AFOP’s heat stress prevention program, is a perfect example of how to create materials that meet farmworkers’ health literacy needs. The flipchart, our main tool for presenting the information to farmworkers, is based on accurate images of farmworkers. Very little text is used in the flipchart itself; instead, trainers use their cultural and linguistic knowledge to inform farmworkers about heat stress prevention while using pictoral representations in the flipchart for maximum retention. Supplemental materials used in Proyecto Sol are also health literacy conscious, such as the printed materials, which are bilingual and use plain language. The images are compelling and easy to understand. Action steps on how to prevent heat stress are clearly defined and information is ordered according to importance.

It is important to remember that it is not enough to just give farmworkers information on health and safety issues that affect them. The information provided needs to be mindful of their health literacy levels with an emphasis on cultural and linguistic sensitivity. Only then can farmworkers make informed decisions on their own health and protect themselves and their families from dangerous pesticides and heat as they work in the fields. For more information about AFOP Health & Safety Programs’ health materials, please contact Valentina Stackl at

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