Assessing the Prevalence and Association of Acculturation and Health Literacy Levels in Spanish-Speaking Hispanic Patients at Midwestern Community Health Centers in the USA

  • Armando De AlbaEmail author
  • Denise H. Britigan
  • Elizabeth Lyden
  • Patrik Johansson



Predictions from the US census indicate that by 2060 one of every three individuals living in the nation will be of Hispanic origin. Hispanics experience health disparities manifested with higher rates of chronic conditions such as hypertension and diabetes in contrast with other US population groups. Health literacy and acculturation have been well identified as key contributors for this issue. However, very few studies have examined the association between health literacy and levels of acculturation in Spanish-speaking Hispanics living in rural and urban areas of the USA.


To assess the prevalence and association of acculturation with low levels of health literacy and demographic variables in Spanish-speaking Hispanics in the US Midwest.


We measured levels of acculturation in Spanish-speaking adult Hispanics (N = 401) accessing community health centers in rural and urban Nebraska. We used a survey that included the Bidimensional Acculturation Scale for Hispanics/Linguistic Proficiency Subscale (BAS/LP) and the Short Assessment of Health Literacy in Spanish (SAHL-S).


We observed similar acculturation levels with rural and urban status participants. A total of 85% of the total participants had low levels of acculturation to US culture. Of the 15% of the participants who showed themselves to be bicultural, 81% reported adequate levels of health literacy in Spanish.


Our findings are consistent with previous studies that report the associations between acculturation and health literacy levels are significant. This study underscores the importance of considering the cultural aspects of the Hispanic community for the development of health literacy interventions and education programs.


Acculturation Health literacy Spanish-speaking Hispanics Rural Urban US Midwest 



This project was supported in part by an appointment to the ORISE Research Participation Program at the Center for Drug Evaluation and Research administered by the Oak Ridge Institute for Science and Education through an agreement between the U.S. Department of Energy and CDER.

In addition, we want to express our gratitude to the OneWorld Community Health Centers, Inc. (Omaha, NE) and Good Neighbor Community Health Center (Columbus, NE) for allowing us to conduct this study in their facilities.

Compliance with Ethical Standards

We have no conflict of interest to declare. This research study received institutional review (IRB) approval from the University of Nebraska Medical Center. We warrant that informed consent was obtained from all individual participants included in the study. All co-authors have both contributed substantially to the paper and have approved the version being submitted.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Armando De Alba
    • 1
    Email author
  • Denise H. Britigan
    • 1
  • Elizabeth Lyden
    • 2
  • Patrik Johansson
    • 1
  1. 1.Department of Health Promotion, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of Biostatistics, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA

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