Predictors of English Health Literacy among U.S. Hispanic Immigrants: The importance of language, bilingualism and sociolinguistic environment

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Holly E. Jacobson
Lauren Hund
Francisco Soto Mas


In the United States, data confirm that Spanish-speaking immigrants are particularly affected by the negative health outcomes associated with low health literacy. Although the literature points to variables such as age, educational background and language, only a few studies have investigated the factors that may influence health literacy in this group. Similarly, the role that bilingualism and/or multilingualism play in health literacy assessment continues to be an issue in need of further research. The purpose of this study was to examine the predictors of English health literacy among adult Hispanic immigrants whose self-reported primary language is Spanish, but who live and function in a bilingual community. It also explored issues related to the language of the instrument. An analysis of data collected through a randomized controlled study was conducted. Results identified English proficiency as the strongest predictor of health literacy (p < 0.001). The results further point to the importance of primary and secondary language in the assessment of heath literacy level. This study raises many questions in need of further investigation to clarify how language proficiency and sociolinguistic environment affect health literacy in language minority adults; proposes language approaches that may be more appropriate for measuring health literacy in these populations; and recommends further place-based research to determine whether the connection between language proficiency and health is generalizable to border communities.

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Author Biographies

Holly E. Jacobson, University of New Mexico

Holly E. Jacobson is an Associate Professor of Linguistics. Her areas of research and teaching include health discourse, intercultural communication in healthcare settings and health literacy, within the frameworks of interactional sociolinguistics, conversation analysis and translation and interpreting theory.

Lauren Hund, University of New Mexico

Lauren Hund is an Assistant Professor of Statistics in the Department of Family & Community Medicine, University of New Mexico School of Medicine in Albuquerque

Francisco Soto Mas, University of New Mexico

Francisco Soto Mas is an Associate Professor of Public Health and conducts cross-disciplinary research on health equity and Latino health.