Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations

Abstract

Objective-To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection.Methods-Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed.Results-Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups' needs. A vision for integrated care is presented.Conclusion-Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. Keywords communication; cultural competence; health literacy; language barriers; literacy; linguistic competence; minority health; quality improvement Many patients face great difficulties in understanding health information and navigating the health care system. Nearly 2 decades of research have linked limited literacy with challenges in health care, including lower health knowledge, misinterpretation of prescriptions, and lower receipt of preventive services. [1][2][3] Only in the last 5 years has health literacy-defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," 4 -received national attention.

Conceptualizing the Pathways and Processes Between Language Barriers and Health Disparities: Review, Synthesis, and Extension

“…Although showing their efforts in creating patient-centered care may bring positive influence as discussed above, it is important to be aware that clinicians' second language skills are not always sufficient and can lead to clinical consequences [52]. Moreover, it is important to note that language-concordance does not always mean that the people share cultural understandings about medical treatment [53]. Clinicians' insufficient proficiency in their patients' language prevents them from engaging in effective communication to assist in shared decision-making [52], contributing to patients dissatisfaction [42,52].…”

What do Korean American immigrants know about Alzheimer's disease (AD)? The impact of acculturation and exposure to the disease on AD knowledge

“…Moreover, the impact of acculturation on AD knowledge among immigrants has not been widely examined. Culture influences how people define, perceive, and respond to illness and explains variations in illnessrelated behaviors (Andrulis and Brach, 2007;Chrisman and Kleinman, 1983). For immigrants living in both their native and American cultures, level of acculturation can play a role in understanding a disease and explaining health behaviors.…”

Community Engagement as a Process and an Outcome of Developing Culturally Grounded Health Communication Interventions: An Example from the DECIDE Project

“…CE has been especially useful when considering the cultural influence on health. To implement behavior change, meanings must be understood and shared when talking about issues that influence health (Andrulis and Brach 2007;CTSAC 2011). For the DECIDE project, the first four stages were central to the success of the project, and we have potential to reach the fifth stage, shared leadership, after piloting the intervention and assessing its feasibility and effectiveness.…”