Working With Local Communities to Improve Health Literacy: Tea Chat
Health literacy is more than just accessing and understanding health information; it’s also about encouraging positive health-seeking behaviors. In this chat, WI-HER’s Emmanuel Ssegawa and Harriet Komujuni discuss why health literacy is essential, how barriers to health literacy have been addressed in various initiatives—from early antenatal care to HIV viral load suppression—and how our partners and local communities have used WI-HER’s iDARE™ methodology to encourage health literacy and ultimately improve health outcomes.
According to Harriet, “Applying the iDARE methodology would really be a good approach to address [health literacy], because it helps identify the right problem using the data, it helps you design the right solution working within the community, but it also helps you follow through the cascade of applying, recording and expanding, and this helps you ground the interventions with evidence for implementation and the results that are attained.”
We invite you to listen to the conversation here.
Transcript of the health literacy tea chat:
Speakers:
Emmanuel Segawa (ES)
Harriet Komujuni (HK)
ES: Welcome to our tea chat. Colleagues at WI-HER working across the globe sit and discuss a number of topics. At these chats, we invite you to listen and share your thoughts in the comments section.
I am Emmanuel Segawa, a Senior Youth & Gender Advisor at WI-HER. This morning, I am joined by my colleague Harriet Komujuni, also a Senior Youth & Gender Advisor with WI-HER. Harriet is based in Uganda, and she’s working on a USAID Uganda Social and Behaviour Change Activity.
Both of us are here in Kampala this morning discussing Health Literacy Month. In commemoration of Health Literacy Month, we will discuss how health literacy has been promoted and applied in our work in Uganda. If you want to know what health literacy is, it refers to the cognitive and social skills that determine people’s motivation and ability to access, understand, and use information in ways that promote and maintain good health.
However, according to [the] CDC, personal health literacy is the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others. It also:
- Emphasizes people’s ability to use health information rather than understand it
- Focuses on the ability to make “well-informed” decisions rather than “appropriate” ones
- Acknowledges that organizations have a responsibility to address health literacy, and,
- Incorporates a public health perspective
Now for the organizational definition, it acknowledges that health literacy is connected to health equity, and health equity is simply attaining the highest level of health for all people. Therefore, we will achieve health equity when everyone has the opportunity to be as healthy as possible.
In this conversation this morning, we’ll discuss personal health literacy and highlight how our efforts, through WI-HER’s iDARE methodology, promote health literacy in our activities
You may wonder what iDARE is; iDARE is WI-HER’s innovative and results-based methodology. This simple but science-based methodology, iDARE, enables stakeholders—whether governments, service providers, civil society organizations, or community members—to assess their existing local system, identify gaps, barriers, and inequities, and then design, test, and address these barriers and scale local solutions.
Harriet, I know that you’ve been involved in a number of activities in Uganda, and I’d like to know something about health literacy: how have you tackled health literacy in your work?
3:07 – HK: Thank you, Emma. Just like you mentioned, we’ve been involved in a number of activities, really trying to promote the uptake of positive behaviors to improve health outcomes. In particular, in terms of health literacy, we’ve applied [the] iDARE methodology that you just mentioned, to identify influencers, recruit them into a team, orient them, train them, and have had them apply this methodology within the community, really, to try and disseminate information, disseminate knowledge, and build the capacity of the communities to make the decisions that they ought to make through the different health behaviors.
HK: In my work, we’ve been trying to improve [the] uptake of vaccination among children under 12 months, as well as improving ANC attendance among pregnant mothers, especially the past ANC, because that’s what the National Information says, that we have a gap in when, when we look at the national data, we have our target as a country is 50% of all mothers attending ANC should be able to attend ANC within the past 12 weeks of pregnancy. We’ve applied the iDARE methodology and health literacy information and ways of spreading information and reaching the communities to try and improve [the] uptake of those positive behaviors for a better, healthier outcome. Thank you, Emma.
4:27 – ES: Thank you so much, Harriet. I know our listeners are enjoying this! I would like to know, because we know health literacy is usually affected by moral factors, and I’m interested in the gender equity and social inclusion factors. What are some of the GESI challenges you have faced or identified when promoting health literacy at the community level?
4:53 – HK: Thank you. One of the big issues that we’ve really experienced around gender, as we all know, [is that] gender is really socially defined, and so this is greatly grounded in our sociocultural norms within the different settings that you operate. This uptake…there are some sticky norms that we have within the different regions of this country. For instance, it is mentioned in one of the regions, which is the western region, that pregnancy should be a secret, so it should never be exposed within the first 12 weeks. So for this matter, much as they have the information of the importance and the need to access ANC within the first 12 weeks, they don’t go to these facilities, because socially, the norm is you don’t expose the pregnancy within the first 12 weeks. So that has affected, really uptake of the literacy or the information that we give them within those communities.
HK: And the other thing, just like most of the African countries, because I found this in the literature that I’ve read, but also from experience, there is still an issue in terms of control and access to resources. The women can access the resources, but they do not control the resources. What do I mean—within a family, the woman can access the different property: you have the chicken, you have a cat, or you can access that, but they don’t have the control, because they [cannot] decide when to sell this and get, for example, money for transport, go to facilities, even when they have all this information. So this becomes a little difficult.
HK: And then the other thing, they can access the radios. They can access the TV, but they may not have control [over] when to put what—when to switch it on, [or] when to switch it off. And that really affects how much information they receive, when they receive it, because sometimes the information runs on those different channels. The women do not have the right to switch it on, or even to use it, so that alone really affects how they get this information.
HK: The other issue is the power dynamics, definitely; the man makes all the decisions, when to go to the facility. When does the woman take a family planning of their choice, actually, they may not even have the choice—the man decides which one he feels is convenient for him. These are some of the gender dynamics that we test. The women do not make a decision as they feel they would have made those decisions.
HK: And then the other thing is really around the education levels; the men have had higher access to education than the women, meaning they can easily dissect this information. They can easily digest it, [and] they can easily understand it, compared to the women. But then the other big one is the social inclusion aspect; most of the information that we have, most of the materials that we have, most of the communication that we are passing out there, does not pay attention to persons with disability, especially the hearing and the seeing impairments. Persons are not really supported within this area of access to information, and that has been one of the challenges that we are facing in terms of social inclusion. Yeah, briefly, that’s it. Over. Thank you so much.
7:59 – ES: Thank you so much for sharing this, and I know this is a real, usual problem. Will you help and let us know: how have you tackled this to ensure you get to your goals?
8:13 – HK: So Emma, asyou know how we operate within our country, we normally work with what we call implementing partners. So that has not been different from how we’ve done this work. We’ve worked with implementing partners to really reach out to the communities. We work with civil society organizations. So partnership has been one of them because you take one side of the coin, which really in addressing the barriers, and the partner takes the other. So that really helps in mitigating the effects of the gender dynamics. But then also, we worked with the community, locally made solutions, [and] local-led design, which builds ownership, and a sense of belonging. This improves sustainability. We’ve applied that as one of the other approaches to address it, but the big one also is applying the iDARE methodology. So this methodology has really been helpful. The right influencers are identified, the right communities are targeted, and the right solutions are really co-designed with a sense of ownership and belonging, and this is the motivation for [the] implementation for the desired outcomes within the different communities. Yeah, thank you, Emma.
9:21 – ES: Thank you so much for sharing this, and as we conclude, what would you tell a programmer conducting health literacy activities at the community level, because of challenges they could be dealing with?
9:33 – HK: Oh, thank you. So from my experience, really, from the first time I interfaced with addressing gender issues, that’s around seven years back, applying the iDARE methodology would really be a good approach to address this because it helps identify the right problem using the data, it helps you design the right solution working within the community, but it also helps you follow through the cascade of applying, recording and expanding, and this helps you ground the interventions with evidence for implementation and the results that are attained.
HK: We’ve seen this happen in some of the communities where we really started with this work. So we started with this work in improving viral load suppression within the two districts. So, when we followed these, monitored these, working with the communities, the progress really led to the expansion. So we expanded to [five other] districts. So I’ve applied the iDARE methodology, and we’ve seen positive results. We’ve seen a positive trend toward the desired goal of addressing the gender, youth, and social inclusion issues. So I would recommend this methodology for programming. Partnership is another good way to go because you can’t do everything as one implementer, and then you can’t understand all communities as well as the local communities. So we need to partner with local communities as well as the implementing partners to have the desired goal and and create the synergy towards improvement. Thank you, Emma!
10:59 – ES: Thank you so much, Harriet, this is wonderful. I can’t agree more, because I know the results of the iDARE methodology. I appreciate you all who [are] listening to this chat, and please use the comment section to share how you have promoted health literacy in your own way. Also, you can share your thoughts about the chat. Thank you so much, goodbye!