Sola, a 20 year old Cambodian woman who had just come to the US, and her husband Deng, a 40 year old Cambodian refugee who had been living in the US for 15 years and was semi-fluent in English, were expecting their first child. The couple went to several specialists who ultimately told them that the baby had an abnormally large valve in his heart. A cardiology nurse drew a picture of the heart with its chambers and valves to show the couple.
Fortunately the problem corrected itself later in the pregnancy, so she did not need to make a decision while concerned about what a beta-blocker might do to her and her baby. Sola and Deng, who were semiliterate in their primary language and who had been raised in a familistic, high context, deterministic culture, had not learned about human anatomy in Cambodia. They struggled to understand the potentially serious heart problem that their unborn child faced. Their exposure to doctors in their native country had been limited.
They did not know that Sola had a right to an interpreter and the responsibility to ask questions of her care providers. They felt lost without extended family around to help with making these important decisions. While they may know how to seek and participate in healthcare in their native culture, many of these people do not have an understanding of what the U.
Nor are these patients necessarily aware of what they can expect from care providers, such as the right to an interpreter or the right to a second opinion. Depending on their culture of origin, LEP patients with low health literacy may avoid printed health materials, not only because they are printed in English, but also because they are presented in a printed rather than an oral manner.
Debra was a 38 year old African American woman with a tenth grade education living in Houston. Later, in a temporary shelter, a nurse who was part of the medical response team partnered with Debra to ensure her medication needs were met and to transition her into primary and specialty care. Preparedness for a public health emergency, especially for patients like Debra with existing medical conditions, calls for the implementation of future-oriented health literacy tasks. Preparedness tasks include generating plans, procuring medical supplies and extra medications, and constructing personal health records.
In the face of an impending public health threat, people must think critically and make decisions as they work to decode low-context information and weigh the risks and benefits of acting on health directives. Communicating risk is challenging for health professionals and accurately interpreting risk is challenging for these patients.
From a cultural standpoint, the investigators found that African Americans who did not evacuate tended to be optimistic that they would be okay because of religious faith, did not trust law enforcement to protect their property, and often decided to remain with extended family members who were unable to leave.
Far too often providers rely on uninformed approaches to assess the health literacy of their patients. We offer the following recommendations to help nurses and all healthcare providers enhance the health literacy of our patients whose backgrounds reflect diverse cultures and languages. We would add the ability to recognize health literacy assumptions and biases as part of cultural awareness.
To-date, provider self-assessment in the area of health literacy has not been a routine part of nursing practice; there is a need for cultural competence self-assessment tools that incorporate health literacy. Schlichting et al. Gut feelings can be imprecise and influenced by unconscious biases.
Nurses can work with other healthcare providers to develop patient assessment tools, as well as strategies that use these tools, to strengthen the healthcare provided. Broad-based patient assessments will enable nurses to explicitly incorporate health literacy into transcultural nursing practice.
This training could involve partnering with a local, adult education center. Adult learners in these centers are eager to practice health literacy skills, such as preparing and asking health-related questions and receiving appropriate health guidance, with nurses in a supported setting.
The learners, in turn, can share their cultures and their experiences of accessing health care with nurses. Nurses can also facilitate partnerships with colleagues in medicine, social work, and public health. All health-related disciplines are struggling to communicate health messages to client populations for whom language, culture, and literacy can be barriers. One approach could involve forming an interdisciplinary learning collaborative on health literacy, culture, and language, in which to share approaches to improving patient care.
Health literacy advocates are needed to motivate healthcare organizations to address patient- communication barriers. Nurses are in an excellent position to serve as such advocates by describing how impaired communication negatively affects patient safety and outcomes, noting how the Joint Commission and federal standards support improvements, and illustrating how decreasing health literacy barriers can bring down legal costs related to communication breakdowns and medical errors Joint Commission, , ; Office of Minority Health, ; Minnesota Health Literacy Partnership, Nurses are also well qualified to develop patient forms and educational materials that are appropriate from cultural, linguistic, and literacy standpoints.
They are encouraged to develop these materials for the most common patient populations they encounter. Nurses should make appropriate use of trained medical interpreters and cultural brokers. Andrulis and Brach , and Jackson-Carroll, Graham, and Jackson, have stressed that interpreters should be cross-trained in cultural competence and health literacy in addition to medical interpretation training. Purnell and Paulanka have offered additional tips for effective use of interpreters. The challenges related to this integrative process are daunting considering all the other challenges nurses face in providing daily care to their patients.
Likewise, the menu of opportunities for improvement can seem long and under resourced.
It is important to recognize, though, that over the coming years, quality care will not be the mere inclusion of health literacy alongside cultural and linguistic competence. Rather it will be an expanded paradigm that involves the substantive integration of all three in ways that are practical for nurses to implement and that make a difference in the patient experience. Letter to the Editor by Epstein. In both of these positions she helps patients from diverse populations who face a variety of health literacy challenges. Kate previously worked in the adult literacy field as an English as a Second Language ESL instructor, curriculum developer, and teacher trainer.
It was while working in ESL that Kate became aware of the health literacy needs of adults with limited English proficiency, as her students shared stories of their attempts to access care and communicate their needs in the United States U. Kate created Pictures Stories for Adult ESL Health Literacy , one of the most popular items on the Center for Applied Linguistics website, to give LEP and low literacy students and teachers a starting point for talking about complex healthcare problems and solutions.
The Picture Stories are used widely across the US and abroad to instruct incoming refugees about the U.
Linguistic and Cultural Online Communication Issues in the Global Age [Kirk St. Amant] on eqwimvoi.ga *FREE* shipping on qualifying offers. International. Linguistic and Cultural Online Communication Issues in the Global Age: Media & Communications Books.
Kate also created the Virginia Adult Education Health Literacy Toolkit , to provide adult educators with information and tools for addressing health literacy education. Kate continues to consult, present, and publish literature regarding the health literacy needs of limited-English speakers, bridging the fields of adult education, social work, and healthcare.
Elizabeth M. As Senior Program Officer, she manages CT Health's ten year strategic objective to reduce racial and ethnic disparities by improving the patient-provider interaction. Her responsibilties include developing programmatic initiatives, reviewing proposals, monitoring a multi-million dollar grant portfolio, and providing technical assistance to grantees.
Her tenure with CDC included assignments with the National Center for Injury Prevention and Control and the CDC Foundation where she worked on traumatic brain injury, program evaluation, emergency preparedness, and mobile mammography. While at Harvard she studied health literacy with Rima Rudd, her graduate advisor, and went on to initiate successful health literacy programs at the Colorado Department of Public Health and the Connecticut Health Foundation. Agency for Health Care Research and Quality.
National health care disparities report Retrieved on May 4, , from www. Andrews , M.
Andrulis , D. Integrating literacy, culture, and language to improve health care quality for diverse populations, American Journal of Health Behavior. Retrieved on May 4, from www. Berkman , N. Literacy and health outcomes. January Burt , M. Campinha-Bacote , J. Many faces: Addressing diversity in health care.
Online Journal of Issues in Nursing, 8 1. Patient education: Addressing cultural diversity and health literacy issues. Urologic Nursing, 27 5 , Coyne , C. Social and cultural factors influencing health in southern West Virginia: A qualitative study. Preventing Chronic Disease, 3 4. Eiser , A.
Viewpoint: Cultural competence and the African American experience with health care: The case for specific content in cross-cultural education. Academic Medicine, 82 2 , Elder , K. Flores , M. Ambulatory Pediatrics 5 6 , Gamm , L. Rural healthy people A companion document to healthy people Galanti , G. Caring for patients from other cultures. Philadelphia: University of Pennsylvania Press.
Giger , J. Transcultural nursing: Assessment and intervention. Harthorn , B. Risk, culture, and health inequality: Shifting perceptions of danger and blame. Westport, CT: Praeger. Hunter , J. Retrieved on May 4 , from www. Institute of Medicine. Health literacy: A prescription to end confusion.