Personal health literacy is defined by Healthy People 2030 as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” 

Health literacy is relevant to the state of Hawai‘i in many ways. Dr. Tetine Sentell has researched health disparities and health literacy for over twenty-five years, considering these issues across multiple health outcomes. Research teams have included many valued colleagues and talented students. Current students engaged in health literacy research include Uday Patil, PhD student in Public Health, Uliana Kostareva, PhD student in Nursing, and Anam Maniar, an undergraduate Public Health student. Valued students and partners across academic and community settings make this work possible.

Taken together, this research has provided a detailed consideration of the distinct role of low health literacy in health disparities, especially within linguistically vulnerable communities, including Asian American and Pacific Islanders. This research has also considered solutions to these inequities, including digital health communication strategies. It has highlighted the importance of looking at health literacy beyond the individual-level to include families, social networks, and communities. This focus is relevant to a strength-based approach to achieven health equity in Pacific Islander, Asian, and many other communities. 

The health organization perspective is also critical. Organizational health literacy is defined by Healthy People 2030 as “the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” In this perspective, it is the responsibility of the organization to make it possible for individuals and populations to achieve health literacy.

This web page consolidates studies across various efforts that have relevance to building health literacy, particularly highlighting studies on this topic of relevance to Hawai‘i. This resource is designed to provide background information and ideas for future research on health literacy related topics in the Pacific context. If you want to join us in this work or have resources to share, please write to us at healthliteracy@gmail.com or follow us on Twitter at @hlithawaii.

Health Literacy in a Social Context 

• Hawai‘i
  • Sentell T, Zhang W, Davis J, Baker K, Braun KL. (2014). The influence of community and individual health literacy on self-reported health status. Journal of General Internal Medicine 29(2):298-304.
  • Sentell TL, Agner J, Pitt R, Davis J, Guo M, McFarlane M Considering Health Literacy, Health Decision Making, and Health Communication in the Social Networks of Vulnerable New Mothers in Hawai'i: A Pilot Feasibility Study. 2020 Mar 31;17(7):2356. doi: 10.3390/ijerph17072356. 
  • Sentell T, Kennedy F, Seto T, Vawer M, Chiriboga G, Valdez C, Garrett LM, Paloma D, Taira D.  Sharing the Patient Experience: A “Talk Story” Intervention for Heart Failure Management in Native Hawaiians. 2020. Journal of Patient Experience. 1-9. 
  • Sentell T, Agner J, Davis J, Mannem S, Seto TB, Valente TW, Vawer M, Taira DA. Social Networks in Patients Hospitalized with Preventable Conditions for Heart Disease and Diabetes in Hawai‘i by Health Literacy (in press) Chronic Illness. 
• General 
  • Sentell T, Pitt R, Buchthal OV. Health Literacy in a Social Context: Review of Quantitative Evidence. HLRP: Health Literacy Research and Practice. April 2017 - Volume 1 · Issue 2: e41-e70. https://pubmed.ncbi.nlm.nih.gov/31294251/
  • Pitt R, Davis T, Manganello J, Massey P, Okan O, McFarlane E, Buchthal OV, Davis J, Arnold C, Sentell T. (2019). Health literacy in a social context: A meta-narrative review. In Handbook of Health Literacy. Orkan Okan, Ulli Bauer, Paulo Pinheiro, Diane Levin-Zamir and Kristine Sorensen (Eds.) Policy Press Bristol (UK)
  • Sentell TL, Shen C, Landsittel D, Mays MH, Southerland J, Henriques-King M, Taira DA Racial/ethnic differences in those accompanying Medicare patients to the doctor: Insights from the 2013 Medicare Current Beneficiary's Survey. Journal of Immigrant and Minority Health. 2017 Apr 12. doi: 10.1007/s10903-017-0582-8.  

Documenting Health Literacy Disparities

• Hawai‘i
  • Sentell T, Baker K, Onaka A & Braun, K. (2011). Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai`i. Journal of Health Communication. Sep 30;16 Suppl 3:279-94
  • Sentell T, Dela Cruz MR, Heo HH, Braun K. (2013). Health literacy, health communication challenges, and cancer screening among rural Native Hawaiian and Filipino women. Journal of Cancer Education. 28(2):325-34.
  • Sentell T & Zhang W. Insights in Public Health: The Importance of Considering Educational Inequity and Health Literacy to Understand Racial/Ethnic Health Disparities. Hawai`i Journal Medicine and Public Health.71(8):232-7. 
  • Guo M, Quensell M, Chang A, Miyamura J, Sentell T. (2018). Understanding of Key Obstetric Quality Terminology by Asian and Pacific Islander Subgroups: Implications for Patient Engagement and Health Equity. Maternal and Child Health Journal.
• General 
  • Sentell T & Halpin H.  (2006). The importance of adult literacy in understanding health disparities. Journal of General Internal Medicine, 21 (8): 852-856. PMID: 16881948
  • Howard D, Sentell T, & Gazmararian J. (2006). The impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of General Internal Medicine, 857-861. 
• Health Insurance
  • Sentell T. (2012).  Implications for Reform: Survey Of California adults suggests low health literacy predicts likelihood of being uninsured. Health Affairs;31(5):1039-48. E
• Mental Health
  • Sentell T & Shumway M. (2003). Low literacy and mental illness in a nationally representative sample. Journal of Nervous and Mental Disease, 191(8): 549-52. PMID: 12972860
  • Sentell T & Ratcliff-Baird R. Literacy and comprehension of Beck Depression Inventory Response alternatives. (2003).  Community Mental Health Journal, 39(4): 323-31. PMID: 12908646G
  • Mayeaux, EJ Jr, Davis TC, Jackson RH, Henry D, Patton P, Slay L, & Sentell T.  (1995).  Literacy and self-reported educational levels in relation to Mini-Mental State Examination Scores. Family Medicine. 7(10):658-62.
• Cancer 
  • Sentell T, Braun KL, Davis J, Davis T. Health Literacy and Meeting Breast and Cervical Cancer Screening Guidelines among Asians and Whites in California. Springer Plus. 2015 Aug 19;4:432. doi: 10.1186/s40064-015-1225-y.

Health Literacy, Language, and Immigration 

• Hawai‘i
  • Tong M & Sentell T. Insights in Public Health: Challenges Investigating Health Outcomes in Chinese Americans Using Population-Based Survey Data. Hawai`i Journal Medicine and Public Health. 76 (1): 27-32.
  • Sentell T, Chang A, Ahn H-J, Miyamura J. Maternal Language and Adverse Birth Outcomes in a Statewide Analysis. Women and Health. 2016;56(3):257-80. Epub 2015 Sep 
• General 
  • Sentell T & Braun K.  (2012). Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of Health Communication 17 Suppl 3:82-99. 
  • Kostareva U, Albright CL, Berens E-M, Levin-Zamir D, Aringazina A, Lopatina M, Ivanov LL, Sentell TL. International perspective on health literacy and health equity: factors that influence the former Soviet Union immigrants. Int. J. Environ. Res. Public Health. 
  • Kostareva U, Albright CL, Berens E-M, Polansky P, Kadish D, Ivanov LL, Sentell TL. A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants. Int. J. Environ. Res. Public Health. 2021, 18(2), 657; https://doi.org/10.3390/ijerph18020657 
  • Tsoh JY, Sentell T, Gildengorin G, Le GM, Chan E, Fung LC, Pasick RJ, Stewart S, Wong C, Woo K, Burke A, Wang J, McPhee SJ, Nguyen TT. Healthcare communication barriers and self-rated health in older Chinese American immigrants. J Community Health. 2016 Aug;41(4):741-52. doi: 10.1007/s10900-015-0148-4.
  • Sentell TL, Tsoh JY, Davis T, Davis J, Braun KL. (2015) Low Health Literacy and Cancer Screening among Chinese Americans in California: A Cross-Sectional Analysis. BMJ Open. 2015 Jan 5;5(1):e006104.
  • Sentell TL, Braun K, Davis J, Davis T. (2013). Colorectal cancer screening: Low health literacy and limited English proficiency among Asians and Whites in California. Journal of Health Communication 18 Suppl 1:242-55.
  • França AS, Pirkle CM, Sentell T, Velez MP, Domingues MR, Bassani DG, Câmara SM. Evaluating Health Literacy Among Adolescent and Young Adults Pregnant Women From a Low-income Area of Northeast Brazil. International Journal of Environmental Research and Public Health (in press)
  • Massey P, Mangenello J, Sentell T, Langellier B. Nativity and language preference as drivers of health information seeking: examining differences and trends from a U.S. population-based survey. Ethnicity and Health. 2017 Dec;22(6):596-609. doi: 10.1080/13557858.2016.1244745. Epub 2016 Oct 21.

Health Literacy in College Students and Adolescents 

• Hawai‘i
  • Tik Tok Challenge Across Linguistic Communities to Combat COVID 19 and Increase Digital Health Literacy
• General 
  • T Sentell, P Massey, J Manganello, K Dadaczynski, Patil U, Hadley M, Kostareva U. Panel: Digital Health Literacy and US College Students in the Time of COVID-19. HARC/Health Literacy in Action Conference. Oral Presentation. October 19, 2020.
  • T Sentell, M Kearney, A Hazen, MR Dela Cruz, J Yamauchi, L McHenry, B Rodericks, P Massey. Do you Vape With Aloha?: How culture and place are used to spread misinformation on Instagram. 16th World Congress on Public Health, Rome, Italy (virtual). Oral Presentation. October 12-16, 2020.
  • Manganello J, Sentell T, Davis T. (2013).  Health literacy, mental health, and adolescents. In Handbook of Adolescent Health Psychology.  O'Donohue, William T.; Benuto, Lorraine T.; Woodward Tolle, Lauren (Eds.) New York, NY: Springer. 
  • Sentell T.  (2012). Adolescent-rated health and intention to attend College: Variation by race/ethnicity and levels of health status. Race and Social Problems, 4 (2). 112-120. 

Ideas/Solutions to Address Health Literacy Inequities 

• Hawai‘i
  • Kim JK, Garrett L, Latimer R, Nishizaki LK, Kimura JA, Taira D, Sentell T. Ke Ku'una Na'au: A Native Hawaiian Behavioral Health Initiative at The Queen's Medical Center. Hawaii J Med Public Health. 2019 Jun;78(6 Suppl 1):83-89. 
  • Trinacty CM, LaWall, Ashton M, Taira D, Seto TB, Sentell T. Adding Social Determinants in the Electronic Health Record in Clinical Care in Hawai'i: Supporting Community-Clinical Linkages in Patient Care. Hawaii J Med Public Health. 2019 Jun;78(6 Suppl 1):46-51. 
  • Sentell TL, Young MM, Vawer MD, Quensell M, Seto TB, Braun K, Juarez DT. (2016) Pathways to Potentially Preventable Hospitalizations for Diabetes and Heart Failure: Patient Perspectives. BMC Health Services Research;16:300.
• General 
  • Sentell T, Foss-Durant A, Patil U, Taira D, Paashe-Orlow M, Trinacty CM.  Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19. Quality Management in Health Care. Qual Manag Health Care. 2021 Jan/Mar 01;30(1):49-60.
  • Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19 Int. J. Environ. Res. Public Health.
  • Vamos S, Orkan O, Sentell T, Rootman I. Making a Case for 'Education for Health Literacy': An International Perspective. Int. J. Environ. Res. Public Health. 2020 Feb 24;17(4):1436.doi: 10.3390/ijerph17041436
  • Mayeaux EJ Jr, Murphy, PW, Arnold C, Davis TC, Jackson RH, & Sentell T. (1996).  Improving patient education for patients with low literacy skills. American Family Physician, 53(1): 205-11.
  • Murphy PW, Davis TC, Mayeaux EJ, Sentell T, Arnold C, & Rebouche C. (1996). Teaching nutrition education in adult learning centers: Linking literacy, health care, and the community. Journal of Community Health Nursing, 13(3): 149-58.