Health Literacy and Disparities in Pediatric Healthcare

In 1998, Milada Gorelik started her career as a researcher at Loyola University where she was involved in developing culture-specific research instruments for Eastern European participants. After 14 years of dedicated service as a therapist and teacher at multiple healthcare institutions, her career landed at Advocate Children's Hospital. Here, she facilitates inter-departmental collaboration to initiate culture-inclusive pediatric healthcare.

In recent years, the healthcare industry has undergone multifold transformations from automated operations to technology-driven patient-centrism. At the same time, access to these reforms is not easy due to cultural and linguistic diversity. Reasonably motivated, Milada Gorelik navigates cultural competency and implicit bias training to improve healthcare for underserved populations.   

Data-driven mitigation of culture-bias in pediatric care

Demographic changes in the United States have brought diverse cultures, languages, and challenges to healthcare delivery, especially for children. Providing a high-quality, patient-centered approach and equitable care focused on overcoming language barriers, implicit bias, and cultural disparities requires healthcare providers and interested community members to concurrently address both healthcare disparities and health literacy.

This framework is consistent with the objectives of  Medicaid and CHIP Innovation Center, A Strategic Vision for medicaid And The children's Health insurance program (CHIP) | health affairs. As the healthcare systems focus their ongoing attention on addressing health outcomes, consistent attention must be dedicated to the “underserved” communities.

They comprise high-risk pediatric populations like children who are economically disadvantaged, technology-dependent, uninsured, and recent immigrants who face barriers to accessing quality healthcare providers across the continuum. Improving their healthcare access entails enhancing consistent and reliable access to care management and care coordination in all areas of Social Determinants of Health (SDoH).

In-depth research, analysis and implementation

Few notable changes were made possible by the expanded access to healthcare via the Affordable Care Act (ACA) About the ACA | HHS.gov. It expanded access to healthcare for millions of Americans, including minorities and disadvantaged groups. With increased access, there has been an effort to systematically focus on collecting and analyzing data related to disparities by researchers, policymakers, and healthcare providers.

One of the critical outcomes of studies in identifying opportunities was the requirement to have education on Cultural Competency for medical schools and healthcare organizations.  Providers learn to understand diverse patient needs and tailor care accordingly. Further, the Implicit Bias Training requirement has allowed healthcare providers to take a moment and review, reflect, and recognize the ways that they have practiced that potentially have contributed to disparities. The required training for providers of healthcare shines light and mitigates long-held believes that have been perpetuated by cultural and historic practice standards.

Most recently SDOH assessments have become requirements in acute and clinical care setting on an annual basis. The following are some of the areas of attention to strategically mitigate concerns, as well as to provide focused opportunities in addressing the lifelong perspective of ensuring that children grow up healthy and become successful adults. (healthypeople 2030 | health.gov)

Health literacy and addressing disparities share a common focus on improving the quality of care. Understanding patients' health beliefs and overcoming language barriers are essential components. Community health centers and outreach programs have grown, providing services to underserved populations and are often gateways in supporting social determinants of health. Recognition of social determinants of health (e.g., housing, education, income) has increased since 2020 when it was particularly evident during the Covid-19 pandemic. Efforts to address these factors impact health outcomes and care management social work team has been at the forefront of shining the spotlight on ensuring adequate follow-up, continuity of care, and support for culturally and linguistically sensitive care.

For example, some best practice requirements have been widely adopted by Advocate Children’s Hospital as best practices that are also in compliance with Solutions for Patient Safety (SPS), chlidren's hospital work together to eliminate harm. We strive to ensure that every pediatric patient has a follow-up appointment scheduled before discharge. 

Our bedside nurses call patients’ families and ask if they have any clinical questions post-discharge, validate that a child has an appointment, home care, medical equipment, and medication as needed, and ensure that the child is doing well. It is a tall order to secure many hours focused on the coordination of care, but the outcomes are well worth the manpower and financial commitment by improving health, building lasting relationships, and decreasing avoidable readmissions.

Health literacy helps bridge gaps by ensuring clear explanations and understanding of treatment plans and diagnoses. Centers for Disease Control and Prevention (CDC) recommends and provides regulatory guidance on using “plain language” to ensure understanding and avoidance of medical jargon and abbreviations.Everyday words for Public health communication | the CDC clear communication index | centres for disease control and prevention. Additionally, providers should ensure that the after-visit hospital and clinic summary include actionable guidance on what to do if the child has ongoing medical needs and who to contact.

Patient-Provider Communication

Effective communication between patients and providers is crucial to compliance with the treatment regimen. One of the tools that providers can utilize is motivational interviewing. The gist of this communication approach is based on the social work principle of “starting where the patient is at”. The initial assessment allows to efficiently and cost-effectively address underlying barriers and risk factors early in admission. The integrated comprehensive multidisciplinary approach facilitates appropriate interventions at the right time, by the right team members, and leads to the right solutions.

It is always good to start with open-ended questions.

For example, “What difficulties are you facing in getting medications filled?” It is important not to project your own biases, solutions, or perspectives but rather allow the patient and family to offer their vision of the potential risk factors. As healthcare professionals, we sometimes are in a rush even if we follow the best practices of patient-centered care. Recently, we had a family that was struggling to pay rent, but by looking at the home zip code and availability of insurance, we did not immediately identify that there was an SDoH need. Only after the social worker built the rapport through frequent open-ended social check-in, was the parent feeling safe to disclose that she has not been able to return to work and now the family is living on one income only.

Thankfully, at Advocate Children’s Hospital, our team works diligently with donors who support the social well-being of families and children allowing us to provide a financial resource that enables parents to focus on the medical care of their children. Ultimately, uncovering and addressing fear, apprehension and guilt parents may feel about not being able to provide for their children’s basic needs can allow healthcare providers to mitigate SDoH factors that impact compliance and health outcomes.

Language Barriers

Children from marginalized communities face significant healthcare disparities due to language barriers, impacting access to care, triage, pain management, and diagnostics. The Healthy People Initiative emphasizes health equity, social determinants of health (SDoH), and health literacy to enhance population well-being. As patient diversity grows, healthcare providers must adapt by ensuring accessible, free language services. Hospitals are partnering with language services and offering interpreters via virtual, telephonic, and in-person means. Even bilingual parents may struggle with complex diagnoses like diabetes, necessitating clear, paced communication and support from providers. Addressing health literacy and disparities is crucial for equitable care.