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Health literacy is defined by the CDC as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
In today’s world, health literacy is crucial for community members and health professionals, alike, to make everyday decisions and achieve health equity.
However, many underserved and racial/ethnic communities around the country face barriers to health equity including access to health care, financial instability, and housing/transportation insecurity endangering their health.
That is why Jason Rosenfeld, DrPH, MPH, and Melanie Stone, DrPH (c), MPH, MEd are helping build Health Confianza – a partnership between UT Health San Antonio, The University of Texas San Antonio, and the San Antonio Metropolitan Health District – to provide education, workforce training, health information, and resources to local residents.
Origins of Health Confianza
The COVID-19 pandemic greatly affected many, especially people of color.
With many communities experiencing health inequities and misinformation, there is a need for public outreach and education to better help the population make health decisions, said Melanie Stone, co-investigator for Health Confianza and assistant director for Community Service Learning at the Center for Medical Humanities and Ethics at UT Health San Antonio.
“9 out of 10 Americans experience low health literacy at some time or another,” Stone said. “Some people experience it consistently, while others, who may normally have high health literacy, will experience it situationally, such as when they receive a troubling medical diagnosis.”
The public must be able to have trust and confidence – “confianza,” in Spanish – in the messages they get from their healthcare providers, Stone said.
This is Health Confianza’s mission.
“We aim to reach different levels, from directly working with community members, to the front-line providers, all the way to the organizational level,” Stone said.
Health Confianza, launched in 2021 thanks to a grant to the San Antonio Metropolitan Health District from the Office of Minority Health, part of the U.S. Department of Health and Human Services. The program continues work launched by the city- and countywide COVID-19 Community Response and Equity Coalition.
The Health Confianza program targets 22 ZIP codes on the East, West, and South sides of San Antonio to encourage health literacy to address healthcare access and utilization, ultimately promoting health and reducing health disparities, said Dr. Jason Rosenfeld, implementing director for Health Confianza and assistant director of Global Health Education at the Center for Medical Humanities and Ethics at UT Health San Antonio.
“We designed a multi-level strategy to increase the availability of access to and use of vital health information and services amongst African Americans and Hispanics in San Antonio,” Rosenfeld said.
Establishing ‘Confianza’ in the System
Confidence and trust in the healthcare system and health-affirming messages are exactly what Health Confianza is about.
“The primary goal, help people make the best decisions for themselves,” Rosenfeld said.
With that in mind, Health Confianza’s strategy focuses on three main areas:
- Community with the goal of improving understanding and trust through free health literacy programs like Community Health Clubs, local peer groups that learn, problem solve and take action together, and the Ambassador Program, which offers webinars and workshops to students, neighborhood associations, and other natural community leaders.
- Healthcare Workers by improving interpersonal communication between them and the individuals they serve through training and workshops like the ECHO tele-mentoring program where peers can share support, guidance, and feedback.
- Organizations through resources like the Pledge Program, where organizations make a pledge to improve health literacy through mentorship, resources, training, technical assistance, and expertise to be able to make substantial changes to make their services more health literate.
“If we just focused on the community, then we put the onus on the community to have to change, which is not fair. It’s actually a system-wide change that needs to happen so that healthcare providers acknowledge the perspective of the community that they serve in and don’t dismiss them because they don’t say the right words or utilize traditional healing practices prior to coming to the medical facility,” Rosenfeld said.
Health Confianza’s Pledge Program
Health Confianza provides a multitude of resources for organizations in San Antonio.
This includes its innovative Pledge Program, which aims to help San Antonio health and social service organizations that are interested in becoming more health literate organizations.
“We are the bridge between health services and our community members,” Angelita Negrón, community health program manager for Empower House, an organization that participates in the Pledge Program told Texas Public Radio. “For us it is very important to go over all of our processes and provide the best information for our families … so they can decide what they want to do in order to get the services they need.”
Organizations participating in the Pledge Program created a team of “health literacy champions” who self-assessed their policies, practices, navigation, communication, culture, and language. Stone then worked with each organization to use the assessment results to create both short and long-term actions to include in an Organizational Health Literacy Plan that will be developed over the course of an 8-month learning collaborative.
One team member also has the opportunity to complete an online IHA Health Literacy Certificate program to help sustain their health literacy work.
Stone also emphasized how impactful it can be for organizations to change their practices to make it easier for clients to access and use their information and services.
“In the long run, improving health literacy at the community-based organizational level will increase health equity for our community members. So, I think it’s an ethical obligation,” Stone said.
Health Confianza’s Scholar Projects
Health Confianza has also provided opportunities through scholar projects led by faculty-mentored health professional students, residents, and fellows in partnership with community organizations.
“These projects serve as incubators of health literacy innovation,” Stone said.
“Opportunities to engage in community-based projects helps promote service-oriented professional identity formation in our students. So, if we can get, for example, a student involved during their first two years of medical school, working with people in the community, they start to understand the context of real-world health issues before they even begin their clinical rotations. At the same time, organizations benefit by being able to enhance their health education and services for their clients and patients,” Stone said.
Results from the project will be shared during Health Confianza’s summer symposium on June 9, 2023.
For more information on these projects and grants visit Health Confianza’s scholar projects page.
Health Confianza’s Impact
The program has reached nearly 10,000 people through community events, training opportunities, and vaccine clinics.
“We’ve reached just over 8,700 people through any of our different strategies. So if we just look at our community facing events, which includes vaccine clinics and community health fairs, we’ve reached over 7,100 people,” Rosenfeld said.
Rosenfeld also mentioned that Health Confianza has participated in about 189 local events, reaching about 1,500 people with those trainings, physicians, nurses, community health workers, and social workers among others.
Health Confianza has helped healthcare workers via both in-person and virtual trainings with programs like ECHO.
Through these virtual trainings, Health Confianza has helped not only those within the San Antonio community, but others across the world.
“What’s been exciting as you get onto one of these, these virtual ECHO series, and we’ve had folks calling in from Canada, we’ve had somebody participating in our community health worker training from Mexico,” Rosenfeld said. “And while we’re targeting our specific community here, folks around the country around the state and around the world have caught wind of what we’re doing, and they want to participate.”
Stronger Together with Health Confianza
Rosenfeld also attributes the success of the program to both the partnerships with various businesses and the program team.
“Over the course of the past year and a half we have built strong partnerships with over 40 health organizations, social service organizations, housing organizations, faith-based institutions, and school districts, including San Antonio Independent School District, to conduct these trainings and get people involved in our program to develop and disseminate vital health information,” Rosenfeld said.
Stone has been delighted at the enthusiasm of both traditional and non-traditional healthcare organizations to participate in the brand-new Pledge Program. Organizations have already been asking when they can sign up for the next round.
“I think the success is really due to the motivation of the staff at these organizations to provide effective programs that are of high quality,” Stone said. “They want to do the best that they can for their patients and their clients.
While the grant funding for Health Confianza will end in June, the program and its team is looking to sustain the organization moving forward through partnerships and finding grant opportunities.
“I feel like we’ve had this unique opportunity to work in a space that is really important. To help people understand that just because it’s online doesn’t necessarily mean it’s true. And that there are a lot of resources out there for folks, valuable members of our community that they can go to get trusted, accurate, reliable information,” Rosenfeld said.
For resources, a complete list of programs, and ways to get involved with Health Confianza, visit their website.
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By The Numbers
This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.
The stories are intended for educational and informative purposes. References to specific policymakers, individuals, schools, policies, or companies have been included solely to advance these purposes and do not constitute an endorsement, sponsorship, or recommendation. Stories are based on and told by real community members and are the opinions and views of the individuals whose stories are told. Organization and activities described were not supported by Salud America! or the Robert Wood Johnson Foundation and do not necessarily represent the views of Salud America! or the Robert Wood Johnson Foundation.