# Bridging the Gap: Health Education Needs Among Rural Populations with Chronic Illness and Low Health Literacy in Unincorporated Communities in Southern California

## TL;DR

This study shows that rural, unincorporated communities in Southern California face significant health literacy and access issues, worsening chronic disease outcomes due to structural and educational barriers.

## Contribution

The study provides one of the first quantitative assessments of health literacy in chronically ill individuals in rural Southern California unincorporated communities.

## Key findings

- Over 82.7% of respondents demonstrated limited or possibly limited health literacy.
- Barriers to healthcare access were primarily due to distance and appointment availability.
- Trust in doctors was highest, while trust in government and religious organizations was lowest.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study examines health literacy and health information access among chronically ill adults living in rural, unincorporated communities, populations that face long standing structural, linguistic and socioeconomic health inequities.Findings highlight how inadequate health literacy abilities and systemic barriers to information access compound chronic disease burden in communities with limited healthcare infrastructure and minimal local governance.

This study examines health literacy and health information access among chronically ill adults living in rural, unincorporated communities, populations that face long standing structural, linguistic and socioeconomic health inequities.

Findings highlight how inadequate health literacy abilities and systemic barriers to information access compound chronic disease burden in communities with limited healthcare infrastructure and minimal local governance.

Public health significance—Why is this work of significance to public health?
The study provides one of the first quantitative assessments of health literacy in chronically ill individuals living in rural Southern California unincorporated communities, revealing pervasive low health literacy across demographic groups.Results of this study underscore that limited health literacy in these settings is likely shaped less by individual deficits and more by structural disadvantages, including low educational attainment, language barriers, poverty, and geographic isolation.

The study provides one of the first quantitative assessments of health literacy in chronically ill individuals living in rural Southern California unincorporated communities, revealing pervasive low health literacy across demographic groups.

Results of this study underscore that limited health literacy in these settings is likely shaped less by individual deficits and more by structural disadvantages, including low educational attainment, language barriers, poverty, and geographic isolation.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Public health interventions must go beyond simple translation of materials and prioritize culturally tailored, linguistically accessible, and community-driven approaches that address underlying educational and structural inequities.Policies and programs should invest in system-level solutions, such as improved digital infrastructure, mobile health services, community health worker integration, and trust-building strategies, to enhance health literacy, chronic disease self-management, and healthcare access in rural, unincorporated communities.

Public health interventions must go beyond simple translation of materials and prioritize culturally tailored, linguistically accessible, and community-driven approaches that address underlying educational and structural inequities.

Policies and programs should invest in system-level solutions, such as improved digital infrastructure, mobile health services, community health worker integration, and trust-building strategies, to enhance health literacy, chronic disease self-management, and healthcare access in rural, unincorporated communities.

Rural and unincorporated communities (UCs) experience persistent health disparities driven by limited healthcare infrastructure, geographic isolation, and socioeconomic inequities. Health literacy (HL), the ability to obtain, understand, and use health information, is a critical yet underexplored determinant of health outcomes in these settings. This study examined HL and barriers to healthcare and health information access among low-income adults living with chronic conditions in nine rural UCs in Southern California. A descriptive cross-sectional survey was administered in English or Spanish to 222 respondents during community food distribution events. The questionnaire included demographics, self-reported health status, chronic disease history, perceived access to care and health information, trust in information sources and HL assessment using the Newest Vital Sign (NVS). Over four-fifths (82.7%) of respondents demonstrated limited or possibly limited HL. Although Spanish-speaking respondents scored significantly lower than English speakers on the NVS, language was not a significant predictor of HL after adjusting for age, gender, education and Hispanic origin. Lower education and older age were associated with reduced HL. One in four respondents reported barriers to healthcare access, primarily due to distance and appointment availability. Over half of the respondents reported difficulty accessing or understanding health information, regardless of HL or demographic characteristics. Doctors were the most trusted source of health information, while trust in government and religious organizations was lowest. Findings reveal pervasive low HL and broad challenges accessing care and health information across rural UCs, highlighting the structural and educational inequities underlying these disparities. Addressing these gaps requires community-driven, bilingual, and culturally resonant strategies that build trust, enhance communication, and strengthen health system accessibility for residents of unincorporated rural regions.