Health Literacy A Prescription to End Confusion (2004) / Chapter Skim
Currently Skimming:
4 Culture and Society
4 Culture and Society
Pages 108-141
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From page 108... ...
O ur understanding of health literacy gains greater depth and mean ing in the context of culture. This is especially important given the ethnic and linguistic diversity of the U.S.
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From page 109... ...
A definition of health literacy that does not recognize the potential effect of cultural differences on the communication and understanding of health information would miss much of the deeper meaning and purpose of literacy for people (Nutbeam, 2000)
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From page 110... ...
. Beyond the differences of language, culture gives significance to health information and messages.
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From page 111... ...
This dynamic principle of culture is referred to as "cultural processes" when groups are discussed, and "lived experiences" in the case of individuals. Individuals are shaped by their life experiences and are exposed to multiple cultures.
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From page 112... ...
2For example, the HHS CLAS standards define cultural competence as "the capacity to function effectively as an individual and as an organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities" and the National Medical Association defines cultural competence as "the application of cultural knowledge, behaviors, clinical and interpersonal skills that enhances a provider's effectiveness in patient care."
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From page 113... ...
. For individuals whose native language is not English, issues of health literacy are compounded by issues of language and the specialized vocabulary used, both in written and spoken form, to convey health information.
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From page 114... ...
The effect of primary language on health remains a central concern of the federal Office of Minority Health Center for Linguistic and Cultural Competence in Health Care, established in 1995 to address the health needs of populations who speak limited English Individuals with LEP have widely varying levels of literacy and health literacy in their primary language. When LEP individuals are health literate in their primary language, the key is providing language assistance either in the form of care in their primary language or interpreter services and translated materials.
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From page 115... ...
In-depth theoretical concepts to guide scientific inquiries could arise from conceptual frameworks on the interface between cultural processes, literacy, and health literacy. These frameworks must distinguish between linguistic and cultural processes, both of which are rooted in the concept of meaning.
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G presents to the emergency department one week later with dizziness.
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For a clinician, it means working with patients whose perspectives are shaped by diverse cultural contexts. Cultural processes and lived experiences contribute to widely different and unpredictable ways people understand concepts and spoken words.
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From page 118... ...
Health literacy must be understood and addressed in the context of culture and language. Measures Can Dissociate Culture, Meaning, and Health Literacy The interface among individuals, cultural processes, layers of cultural experience, families, communities, health systems, and health-care providers is extremely complex.
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From page 119... ...
, have created elaborate "user-friendly" information sources. These are often electronically accessible 24 hours a day to provide Americans with up-to-date health information on the care and prevention of disease.
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While data on health information alone is not available, responses of the National Adult Literacy Survey (NALS) participants indicated over half of individuals at each literacy skill level as measured by the NALS obtain information about current events, public affairs, and government from family and friends, newspapers and magazines, and radio and television (Kirsch et al., 1993)
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From page 121... ...
, one of the nation's first national surveys of health information sources.4 HINTS is designed to provide data regarding pattern of information use and opportunities to inform Americans about cancer; however, survey data is not yet available. In a Gallup Organization poll of 1,004 adults nationwide, several sources of information were cited as "a great deal" or "moderate" sources of health information (Gallup Organization, 2002)
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From page 122... ...
Complexity of Materials Many materials developed to provide health information fail to take into account the needs of the audiences for these materials. Rudd and colleagues (2000)
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From page 123... ...
Phil, regularly carry health information and advice. Health news, such as SARS, heart disease, obesity, antibiotic resistance, and smallpox vaccination has been a centerpiece in newspaper headlines dozens of times in 20022003 alone.
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From page 124... ...
They represent a small portion of the dollars aimed at providing health information to consumers and motivating specific health behaviors. The United States invested some $1,080,000,000 in its recent 6year National Youth Anti-Drug Media Campaign (Eddy, 2003)
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From page 125... ...
. Socioeconomic status and level of education are strongly associated with the likelihood that a consumer will obtain health information from the Internet.
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From page 126... ...
Finding 4-3 Competing sources of health information (including the national media, the Internet, product marketing, health education, and consumer protection) intensify the need for improved health literacy.
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Community Opportunities Community organizations provide an opportunity to address issues of health literacy directly. An example of this is a set of programs to address the needs of the Navajo community.
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128 HEALTH LITERACY TABLE 4-1 Examples of Published Studies of Community-Based Interventions Citation Setting Study Design Population Bill-Harvey Senior centers and Uncontrolled n = 76 (100 enrolled, et al., 1989 community centers trial 76 completed program) for the elderly, Hartford, CT Busselman WIC voucher Randomized n = 32 and Holcomb, distribution sites in trial Controls = 31 1994 7 urban and rural Participants were receiving WIC communities, vouchers Kansas Controls met all WIC criteria except for income Controls had significantly higher reading levels as measured by the WRAT-R than the WIC group (p < 0.001)
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From page 129... ...
introduction to dietary guildines, while the WIC group received a simplified seventh grade reading level version. Four one-act Spanish language plays Participants showed significantly greater intended to provide education about knowledge about information from the health and safety issues for plays (p < 0.01)
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Hartman Expanded Food and Randomized n = 134 participants et al., 1997 Nutrition controlled 70 controls Education Program trial, (EFNEP) , Twin randomized Cities Metropolitan by Area, MN instructor (not participant)
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Participants and controls received materials such as newletters and tipsheets. Nutrition education program.
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the health literacy skills of health consumers and care providers. The Gathering Place8 provides health and literacy programs for Navajo adults and children in their homes and community centers.
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From page 133... ...
These programs offer information on women's health needs such as breast cancer and pap smears, as well as information about health insurance for women and their children. The "Health is Strength" Project run by Asian Health Services provides Korean adults and children with health education materials (brochure, resource list, workshops)
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An evaluation of one of the books carried out by Molina Healthcare found that individuals and families who received the books visited the emergency department 6.7 percent less after receiving the books (Institute for Healthcare Advancement, 2003)
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As an example, the Alzheimer's Association of Los Angeles has developed a model to build the dementia care capability of existing community providers such as hospitals, public health clinics, adult day care centers, and community-based social service agencies. Using focus groups and community input, the Alzheimer's Association identified churches as a visible and trusted source of health information for the Los Angeles area
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From page 136... ...
While little evidence supports the use of any given approach, research into the value of existing and innovative approaches on health behaviors and the effect of participatory action and empowerment strategies can provide further direction for future approaches to address health literacy.
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Recommendation 4-2 AHRQ, the CDC, Indian Health Service, Health Resourc es and Services Administration, and Substance Abuse and Mental Health Servic es Administration should develop and test approaches to improve health commu nication that foster healing relationships across culturally diverse populations. This includes investigations that explore the effect of existing and innovative communi cation approaches on health behaviors, and studies that examine the impact of participatory action and empowerment research strategies for effective penetra tion of health information at the community level.
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2002. Empirical studies assessing the quality of health information for consumers on the world-wide web: A systematic review.
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2002. Users of Internet health information: Differences by health status.
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2001. Quality of health information on the Internet.
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2003. The impact of health information on the internet on the physician-patient relationship: Pa tient perceptions.
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