The Role of Culture in Health Literacy and Chronic Disease Screening and Management

Department of Anthropology, University of Arizona, Tucson, AZ 85721-0030, USA.
Journal of Immigrant and Minority Health (Impact Factor: 1.16). 05/2008; 11(6):460-7. DOI: 10.1007/s10903-008-9135-5
Source: PubMed


Cultural and language differences and socioeconomic status interact with and contribute to low health literacy, defined as the inability to understand or act on medical/therapeutic instructions. Health literacy is increasingly recognized as an important factor in patient compliance, cancer screening utilization, and chronic disease outcomes. Commendable efforts have been initiated by the American Medical Association and other organizations to address low health literacy among patients. Less work has been done, however, to place health literacy in the broader context of socioeconomic and cultural differences among patients and providers that hinder communication and compliance. This review examines cultural influences on health literacy, cancer screening and chronic disease outcomes. We argue that cultural beliefs around health and illness contribute to an individual's ability to understand and act on a health care provider's instructions. This paper proposes key aspects of the intersection between health literacy and culturally varying beliefs about health which merit further exploration.

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    • "Education is often thought of as a marker for HL. However, although HL and education are related to each other [20], they need to be understood as distinct concepts [21] [22]. Despite the increased recognition of the importance of both information provision and HL in cancer care, research on the role of HL in information provision to cancer patients is limited. "
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    ABSTRACT: Objective To assess the association of subjective health literacy (HL) and education with perceived information provision and satisfaction. Methods Women (N = 548) diagnosed with an ovarian or borderline ovarian tumor between 2000 and 2010, registered in the Eindhoven Cancer Registry, received a questionnaire including subjective HL, educational level, perceived information provision, and satisfaction with the information received. Multiple linear and logistic regression analyses were performed, controlled for potential confounders. Results Fifty percent of the women responded (N = 275). Thirteen percent had low and 41% had medium subjective HL. Women with low HL reported less perceived information provision about medical tests, and were less satisfied with the information received compared to women with high HL. Low educated women reported that they received more information about their disease compared to highly educated women. Conclusion Low subjective HL among women with ovarian tumors is associated with less perceived information provision about medical tests and lower information satisfaction, whereas low education is associated with more perceived information provision about the disease. Practice implications HL should not be overlooked as a contributing factor to patients’ perceived information provision and satisfaction. Health care providers may need training about recognizing low HL.
    Patient Education and Counseling 06/2014; 95(3). DOI:10.1016/j.pec.2014.03.008 · 2.20 Impact Factor
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    • "Other studies have found that women with low health literacy are less likely to breastfeed [12], plan their pregnancy [13], and to be insured [14]. These associations are not consistent across all studies, suggesting that other factors, such as attitudes and cultural beliefs about medicine, may mediate the effect of health literacy on health behaviors [15]. More information is needed about how the prevalence of these behaviors varies with health literacy and how to best support behavior change in these populations. "
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    ABSTRACT: Background Text4baby provides educational text messages to pregnant and postpartum women and targets underserved women. The primary purpose of this study is to examine the health behaviors and cell phone usage patterns of a text4baby target population and the associations with health literacy. Methods Pregnant and postpartum women were recruited from two Women, Infant and Children clinics in Atlanta. Women were asked about their demographics, selected pregnancy or postpartum health behaviors, and cell phone usage patterns. Health literacy skills were measured with the English version of the Newest Vital Sign. Multivariable logistic regression was used to examine health behaviors and cell usage patterns by health literacy classification, controlling for commonly accepted confounders. Results Four hundred sixty-eight women were recruited, and 445 completed the Newest Vital Sign. Of these, 22% had inadequate health literacy, 50% had intermediate health literacy, and 28% had adequate health literacy skills. Compared to adequate health literacy, limited literacy was independently associated with not taking a daily vitamin during pregnancy (OR 3.6, 95% CI: 1.6, 8.5) and never breastfeeding their infant (OR 1.4, 95% CI: 1.1, 1.8). The majority (69.4%) of respondents received nine or more text messages a day prior to enrollment, one in four participants (24.6%) had changed their number within the last six months, and 7.0% of study participants shared a cell phone. Controlling for potentially confounding factors, those with limited health literacy were more likely to share a cell phone than those with adequate health literacy (OR 2.57, 95% CI: 1.79, 3.69). Conclusions Text4baby messages should be appropriate for low health literacy levels, especially as this population may have higher prevalence of targeted unhealthy behaviors. Text4baby and other mhealth programs targetting low health literacy populations should also be aware of the different ways that these populations use their cell phones, including: sharing cell phones, which may mean participants will not receive messages or have special privacy concerns; frequently changing cell phone numbers which could lead to higher drop-off rates; and the penetrance of text messages in a population that receives many messages daily.
    05/2014; 72(1):13. DOI:10.1186/2049-3258-72-13
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    • "Some researchers have therefore urged providers to be aware that every patient is an unique individual [6,7,9,13,44,45]. Meanwhile others warned about intergenerational and inter-ethnic variations within migrant groups [10,13,15]. The question is whether and how care providers can pay attention to the total context of the patient’s situation including their immigration status, literacy level, gender, family dynamics, religious beliefs and stress factors while providing care or they just apply ‘one-size-fits all approach’ while providing care. "
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    ABSTRACT: Background Experiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice. Methods We used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis. Results We found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas with varied social, cultural and religious affiliations, migration histories and statuses, all of which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system. Conclusions The study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers’ contextual understanding of migrant groups and their needs, (d) and improve migrants’ health literacy through strategies such as community based educational outreach.
    BMC Health Services Research 11/2012; 12(1):433. DOI:10.1186/1472-6963-12-433 · 1.71 Impact Factor
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