DNP 825 Topic 3 Discussion Question Two
DNP 825 Topic 3 Discussion Question Two
Describe an example where a patient’s culture could impact health literacy. What measures would you employ to address the health literacy barrier? How effective is the current protocol for implementing practice changes in your institution? Examine any barriers and the facilitators for implementing an evidence-based change in your specific setting?
Culture is the shared ideas, meanings, and values acquired by individuals as members of society. It is socially learned, not genetically transmitted, and often influences us unconsciously. Human beings learn through social means—through interactions with others as well as through the products of culture such as books and television (IOM, 2002). Reliance on tools and symbolic resources, notably language, is a hallmark of culture. Language is central to social life and mediates the acquisition of much cultural knowledge.
Language “provides the most complex system of the classification of experience” and is “the most flexible and most powerful tool developed by humans” (Duranti, 1997: 49 and 47). Differences in languages and underlying concepts may lead to problems with health-related communication. For example, translating the word “chemotherapy” into the Navajo language might require pages of text. Since the Navajo language has no word or concept for chemotherapy, the translation must start with the idea of cancer, and include what the person might experience as a result of chemotherapy. This is further complicated by the fact that many Navajos believe that if you say something will happen, it will1 (Billie, 2003).
Beyond the differences of language, culture gives significance to health information and messages. Perceptions and definitions of health and illness, preferences, language and cultural barriers, care process barriers, and stereotypes are all strongly influenced by culture and can have a great impact on health literacy and health outcomes. Differing cultural and educational backgrounds among patients and providers, as well as among those who create health information and those who use it, contribute to problems with health literacy. The relationship between culture, patient–provider interaction, and quality of care has been reviewed by Cooper and Roter (2003). Early work showed that European-American cultural groups used language differently in discussing symptoms such as pain (Zborowski, 1952; Zola, 1966). These linguistic differences were associated with differences in diagnoses, irrespective of symptomology. African-American patients frequently experience shorter physician–patient interactions and less patient-centered visits than Caucasian patients (Cooper and Roter, 2003; Cooper-Patrick et al., 1999).
It is crucial to note that culture is not static for individuals or for societies. 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. Their behavior may reflect an amalgam of this “experiential identity” (IOM, 2002). For example, the experiential identity of immigrants includes their experience with the health systems from their country of origin as well as their immigrant experience. This experiential identity will incorporate new experiences with the American health system. Development of adequate health literacy may be hindered by limited English skills or outcomes of poorly understood health experiences.
Today’s families and communities consist of people with multiple cultural backgrounds and experiences, who cannot be put into rigid “boxes” by using racial and ethnic labels that are often resented and are misleading. Individuals, families, and communities have belief systems, religious and cultural values, and group identity that serve as powerful filters through which information is received and processed. These concepts of cultural processes and lived identities replace more traditional concepts such as “acculturation” and present measurement challenges to researchers and health service providers.
Culture, cultural processes, and cross-cultural interventions have been discussed in-depth in several Institute of Medicine (IOM) reports (IOM, 2002, 2003a) which suggest that ways of learning, beliefs about health and illness, and patterns of communications contribute to health literacy through their effect on communication, comprehension, understanding, and decision-making. Socioeconomic status was found to affect health in the IOM report Promoting Health: Intervention Strategies from Social and Behavioral Research (IOM, 2000). Behavioral and social factors influence a person’s susceptibility to disease, especially among individuals of lower socioeconomic status. The 2000 IOM report identified increased prevalence of disease among socio-economically underserved groups and outlined “the need to balance clinical approach to disease with recognized social and class determinants” (IOM, 2000). Social and behavioral interventions were further investigated in Speaking of Health (IOM, 2002), which recognized the link between behavior and disease.
In the following section, we examine the relationships between cultural processes and health literacy for indications of how to make Americans more literate about health and illness through health systems that are more responsive to patient needs, preferences, and perspectives.