Abstract
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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Baker DW, Wolf MS, Feinglass J, et al. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503–9.
Weiss BD, Hart G, McGee DL, et al. Health status of illiterate adults: relationship between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1994;5(3):257–64.
Nelson Jr MD. Socioeconomic status and childhood mortality in North Carolina. Am J Public Health. 1992;82:1131–3.
Gregg EW, Geiss LS, Saaddine J, Fagot-Campagna A, et al. Use of diabetes preventive care and complications risk in two African-American communities. Am J Prev Med. 2001;21(3):197–202.
Davis TC, Michielutte R, Askov EN, Williams MV, Weiss BD. Practical assessment of adult literacy in health care. Health Educ Behav. 1998;25(5):613–24.
Wilson FL. Are patient information materials too difficult to read? Home Healthc Nurse. 2000;18(2):107–15.
Gausman Benson J, Forman WB. Comprehension of written health care information in an affluent geriatric retirement community: use of the Test of Functional Health Literacy. Gerontology. 2002;48(2):93–7.
Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients with low health literacy. J Gen Intern Med. 1999;14(5):315–7.
Jecker N, Carrese J, Pearlman R. Caring for patients in cross-cultural settings. Hastings Cent Rep. 1995;25:6–14.
Uppaluri CR, Schumm LP, Lauderdale DS. Self-reports of stress in Asian immigrants: effects of ethnicity and acculturation. Ethn Dis. 2001;11(1):107–14.
Schoenberg NE, Drew EM. Articulating silences: experiential and biomedical constructions of hypertension symptomatology. Med Anthropol Q. 2002;16(4):458–75.
Davidhizar R, Havens R, Bechtel GA. Assessing culturally diverse pediatric clients. Pediatr Nurs. 1999;25(4):371–6.
Penchaszadeh VB. Genetic counseling issues in Latinos. Genet Test. 2001;5(3):193–200.
Hawthorne K. Effect of culturally appropriate health education on glycaemic control and knowledge of diabetes in British Pakistani women with type 2 diabetes mellitus. Health Educ Res. 2001;16(3):373–81.
Watson MR, Horowitz AM, Garcia I, Canto MT. A community participatory oral health promotion program in an inner-city Latino community. J Public Health Dent. 2001;61(1):34–41.
Alcalay R, Alvarado M, Balcazar H, Newman E, Huerta E. Salud para su Corazon: a community-based Latino cardiovascular disease prevention and outreach model. J Community Health. 1999;24(5):359–79.
Ortega AN, Calderon JG. Pediatric asthma among minority populations. Curr Opin Pediatr. 2000;12(6):579–83.
Fortier JP, Bishop D. Setting the agenda for research on cultural competence in health care: final report. Brach C, editor. Rockville, MD: U.S. Department of Health and Human Services, Office of Minority Health and Agency for Healthcare Research and Quality; 2004.
Anderson LM, Scrimbshaw S, Fullilove M, Fielding JE, Normand J, the Task Force on Community Preventive Services. Culturally competent healthcare systems: a systematic review. Am J Prev Med. 2003;24(3S):68–79.
Shaffer CF. Factors influencing the access to prenatal care by Hispanic pregnant women. J Am Acad Nurse Pract. 2002;14(2):93–6.
Davidson B. Questions in cross-linguistic medical encounters: the role of the hospital interpreter. Anthropol Q. 2001;10(2):170–8.
Brach C, Fraserirector I. Can cultural competence reduce racial and ethnic health disparities? Med Care Res Rev. 2000;57(suppl1):1181–217.
Baker DW, Parker RM, Williams MV, et al. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–8.
Elderkin-Thompson V, Silver RC, Waitzkin H. When nurses double as interpreters: A study of Spanish-speaking patients in a U.S. primary care setting. Soc Sci Med. 2001;52(9):1343–58.
Bonacruz Kazzi G, Cooper C. Barriers to the use of interpreters in emergency room pediatric consultations. J Paediatr Child Health. 2003;39(4):259–63.
Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14(2):82–7.
Shaw S. The politics of recognition in culturally appropriate care. Med Anthropol Q. 2005;19(3):290–309.
Tucker CM, Herman KC, Pedersen TR, Higley B, Montrichard M, Ivery P. Cultural sensitivity in physician-patient relationships: Perspectives of an ethnically diverse sample of low-income patients. Med Care. 2003;41(7):859–70.
Grossman SA, Piantadosi S, Covahey C. Are informed consent forms that describe clinical oncology research protocols readable by most patients and their families? J Clin Oncol. 1994;12(10):2211–5.
Barrett B, Shadick K, Schilling R, Spencer L, et al. Hmong/medicine interactions: Improving cross-cultural health care. Fam Med. 1998;30(3):179–84.
Schillinger D, Bindman A, Wang F, et al. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns. 2004;52(3):315–23.
Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83–90.
Roter DL, Rudd RE, Comings J. Patient literacy: a barrier to quality of care. J Gen Intern Med. 1998;13:850–1.
Benjamin-Garner R, Oakes JM, Meischke H, Meshack A, et al. Sociodemographic differences in exposure to health information. Ethn Dis. 2002;12(1):124–34.
Watson J, Obersteller EA, Rennie L, Whitbread C. Diabetic foot care: developing culturally appropriate educational tools for Aboriginal and Torres Strait Islander peoples in the Northern Territory, Australia. Aust J Rural Health. 2001;9(3):121–6.
Griffin JA, Gilliland SS, Perez G, Helitzer D, Carter JS. Participant satisfaction with a culturally appropriate diabetes education program: The Native American Diabetes Project. Diabetes Educ. 1999;25(3):351–63.
Ikeda JP, Pham L, Nguyen KP, Mitchell RA. Culturally relevant nutrition education improves dietary quality among WIC-eligible Vietnamese immigrants. J Nutr Educ Behav. 2002;34(3):151–8.
Hoang G, Erickson R. Cultural barriers to effective medical care among Indochinese patients. Ann Rev Med. 1985;36:229–39.
Lannin DR et al. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998;279(2):1801–7.
McDonald JT, Kennedy S. Cervical cancer screening by immigrant and minority women in Canada. J Immigr Minor Health. 2007;9:323–34.
Pobutsky AM, Pordell P, Yamashita B, et al. Community based participatory approaches to address health disparities in Hawai’i: Recent applications in cancer prevention, detection and treatment programs. Pac Health Dialog. 2004;11(2):183–90.
Davis T, Arnold C, Berkel H, et al. Knowledge and attitude on screening mammography among low-literate, low-income women. Cancer. 1996;78:1912–20.
Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347(20):1585–92.
Meiser B, Eisenbruch M, Barlow-Stewart K, et al. Cultural aspects of cancer genetics: setting a research agenda. J Med Genet. 2001;38(7):425–9.
Boyer LE, Williams M, Callister LC, Marshall ES. Hispanic women’s perceptions regarding cervical cancer screening. J Obstet Gynecol Neonatal Nurs. 2001;30(2):240–5.
Davis TC, Dolan NC, Ferreira MR, et al. The role of inadequate health literacy skills in colorectal cancer screening. Cancer Invest. 2001;19(2):193–200.
Chavez LR, et al. Structure and meaning in models of breast and cervical cancer risk factors: a comparison of perceptions among Latinas, Anglo women, and physicians. Med Anthropol Q. 1995;9(1):40–74.
Chavez LR, McMullin JM, Mishra SI, Hubbell FA. Beliefs matter: cultural beliefs and the use of cervical cancer-screening tests. Am Anthropol. 2001;103(4):1114–29.
Paisley JA, et al. An examination of cancer risk beliefs among adults from Toronto’s Somali, Chinese, Russian and Spanish-speaking communities. Rev Can Sante Publique. 2002;93(2):138–41.
Juon HS, Choi Y, Kim MT. Cancer screening behaviors among Korean-American women. Cancer Detect Prev. 2000;24(6):589–601.
Collins KF. International students’ perceptions of health care. J Sch Nurs. 2001;17(3):140–7.
Fadiman A. The spirit catches you and you fall down: a Hmong girl, her American doctors and the collision of two cultures. New York: Farrar Straus and Giroux; 1997.
Gomez-Beloz A, Chavez N. The botanica as a culturally appropriate health care option for Latinos. J Altern Complement Med. 2001;7(5):537–46.
Ries A, Picchi M, Nguyen L, et al. Asthma in a Vietnamese refugee population. Am J Respir Crit Care Med. 1997;155:1895–901.
Pachter L, Cloutier M, Berstein B. Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Arch Pediatr Adolesc Med. 1995;149:982–8.
Guarnaccia P, Pelto P, Schensul S. Family health culture, ethnicity, and asthma: coping with illness. Med Anthropol. 1985;9(3):203–24.
Ito K. Health culture and the clinical encounter: Vietnamese refugees’ responses to preventive drug treatment of inactive tuberculosis. Med Anthropol Q. 1999;13(3):338–64.
Tedeschi A, Barcella M, Bo GA, Miadonna A. Onset of allergy and asthma symptoms in extra-European immigrants to Milan, Italy: possible role of environmental factors. Clin Exp Allergy. 2003;33(4):449–54.
Arcia E, Skinner M, Bailey D, Correa V. Models of acculturation and health behaviors among Latino immigrants in the U.S. Soc Sci Med. 2001;53(1):41–53.
Coonrod DV, Bay RC, Balcazar H. Ethnicity, acculturation and obstetric outcomes: Different risk factor profiles in low- and high-acculturation Hispanics and in white non-Hispanics. J Reprod Med. 2004;49(1):17–22.
Mendoza FS. Health risk profiles and race, culture, and socioeconomic status. In: Pachter LM, editor. Child health in the multicultural environment. Columbus, OH: Ross Products Division, Abbott Laboratories; 2000. p. 5–18.
Zambrana RE, Scrimshaw S, Collins N. Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation. Am J Public Health. 1997;87:1022–6.
Kleinman A. Concepts and a model for the comparison of medical systems as cultural systems. Soc Sci Med. 1978;12:85–93.
Kendall C, Foote D, Martorell R. Ethnomedicine and oral rehydration therapy: a case study of ethnomedical investigation and program planning. In: Brown P, editor. Understanding and applying medical anthropology. Mountain View, CA: Mayfield Publishing Co.; 1998. p. 415–22.
Pearce TO. Lay medical knowledge in an African context. In: Lindenbaum S, Lock M, editors. Knowledge, power and practice: the anthropology of medicine and everyday life. Berkeley: University of California Press; 1993. p. 150–65.
Pachter LM, Weller SC, Baer RD, et al. Variation in asthma beliefs and practices among mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans. J Asthma. 2002;39(2):119–34.
Becker G, Beyene Y, Newsom E, Rodgers D. Knowledge and care of chronic illness in three ethnic minority groups. Fam Med. 1998;30(3):173–8.
Heurtin-Roberts S, Becker G. Anthropological perspectives on chronic illness: Introduction. Soc Sci Med. 1993;37:281–3.
Lambert H, Sevak L. Is ‘cultural difference’ a useful concept? In: Kelleher D, Hiller S, editors. Researching cultural differences in health. London: Routledge; 1996. p. 124–59.
Michaud P, Blum R, Slap G. Cross-cultural surveys of adolescent health and behavior: progress and problems. Soc Sci Med. 2001;53(9):1237–46.
Weinick RM, Jacobs EA, Stone LC, et al. Hispanic healthcare disparities: Challenging the myth of a monolithic Hispanic population. Med Care. 2004;42(4):313–20.
Goodman A. Bred in the bone? Sciences. 1998;37:20–25.
Krieger N. Does racism harm health? Did child abuse exist before 1982? On explicit questions, critical science and current controversies: an ecosocial perspective. Am J Public Health. 2003;93(2):194–99.
Schillinger D, Chen AH. Literacy and language: disentangling measures of access, utilization and quality. J Gen Intern Med. 2004;19:288–300.
Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475–82.
Miller LG, Liu H, Hays RD, Golin CE, Ye Z, Beck CK, et al. Knowledge of antiretroviral regimen dosing and adherence: a longitudinal study. Clin Infect Dis. 2003;36(4):513–8.
Heurtin-Roberts S, Reisin E. The relation of culturally influenced lay models of hypertension to compliance with treatment. Am J Hypertens. 1992;5(11):787–92.
Roubideaux YD, Moore K, Avery C, et al. Diabetes education materials: recommendations of tribal leaders, Indian health professionals, and American Indian community members. Diabetes Educ. 2000;26(2):290–4.
Mull DS, Nguyen N, Mull JD. Vietnamese diabetic patients and their physicians: What ethnography can teach us. West J Med. 2001;175(5):307–11.
Rosal MC, Goins KV, Carbone ET, Cortes DE. Views and preferences of low-literate Hispanics regarding diabetes education: results of formative research. Health Educ Behav. 2004;31(3):388–405.
Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51(3):267–75.
Lutfey KE, Wishner WJ. Beyond ‘compliance’ is ‘adherence’: improving the prospect of diabetes care. Diabetes Care. 1999;22(4):635–9.
Samuel-Hodge CD, Headen SW, Skelly AH, et al. Influences on day-to-day self-management of type 2 diabetes among African-American women: Spirituality, the multi-caregiver role, and other social context factors. Diabetes Care. 2000;23(7):928–33.
von Goeler DS, Rosal MC, Ockene JK, et al. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educ. 2003;29(4):663–72.
Becker G. Effects of being uninsured on ethnic minorities’ management of chronic illness. West J Med. 2001;185:19–23.
Plescia M, Groblewski M. A community-oriented primary care demonstration project: refining interventions for cardiovascular disease and diabetes. Ann Fam Med. 2004;2(2):103–9.
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This research was supported in part by grant number 1 R03 HS014086 from the Agency for Healthcare Research and Quality and by grant number R01 CA128455-01 from the National Cancer Institute.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s10903-008-9149-z
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Shaw, S.J., Huebner, C., Armin, J. et al. The Role of Culture in Health Literacy and Chronic Disease Screening and Management. J Immigrant Minority Health 11, 460–467 (2009). https://doi.org/10.1007/s10903-008-9135-5
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DOI: https://doi.org/10.1007/s10903-008-9135-5