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Health Literacy and Communication in a Culturally Diverse Environment

Health Literacy and Communication in a Culturally Diverse Environment

From its conceptualization, literacy has been seen as school achievement in relation to the ability to perform in a particular job. Literacy in the health context is evaluated in terms of understanding health related interventions and health outcomes. In this case, health literacy has to do with the ability of providers and consumers to use health related information. Basically, it is the capacity to access and use health information in order to make informed decisions about their health (Australian Bureau of Statistics (ABS), 2009). Health communication entails the interpersonal and mass interactions that take place in access and delivery of care. There is increasing recognition of the connection between health literacy, effective communication and cultural diversity in health care. Health literacy extends beyond the ability to read in the health context, it also entails having cultural and conceptual knowledge, language and assumptions. Effective communication in health care involves creation of shared meaning between the providers and the patients. Health professionals’ communication skills must also include language and culture. This paper will investigate the crucial importance and relationship of health literacy to effective communication in a culturally diverse environment.

There is no consensus in literature of a single definition of health literacy since there are many skills used to qualify one as a health literate individual. Zarcadoolas (2011) describes health literacy as multifaceted and complex. Although early definitions were limited to the ability of patients to obtain and understand printed definitions, definitions in health literacy goes beyond having literacy skills. Berkman et al. (2011) says that health literacy as it is now has “evolved from a history of defining, redefining, and quantifying the functional literacy needs of adult population” (p. 9). As an individual-level construct, health literacy is described as an ability or capacity (Berkman et al., 2010). Health literacy means having the ability to seek and assess health information that enables one to “understand and carry out instructions of self-care, including the administering of complex daily medical regimens, plan and achieve the lifestyle adjustments required to improved health, make informed positive health-related decisions, know how and when to access health care when necessary…” (Mitic & Rootman, 2012, p. 3). Nutbeam (2008) defines it as personal, social and cognitive skills that enable an individual to access, integrate and use health information for the promotion of good health.

According to Lowell et al (2014), health literacy, communication and cultural competence should be evaluated at all levels in order to ascertain that health care responds to different consumer needs. Health literacy involves all stakeholders in the health sector including consumers, health staff, organizations and the health system. Health literacy is affected by cultural and language differences. Additionally the social economic status and contribute to the level of health literacy (Shaw et al., 2008). It is also affected by the political environment. Lowell et al (2014) say that there is need to look at health literacy in the language and culture context especially in the culturally diverse Australia.

Health communication entails having interpersonal and mass communication ability that will promote improved health for individuals and populations (Lowell et al., 2014). Communication is important in delivery of care and in health promotion. Effective communication is important in providing quality and safe care. Additionally, it is central in achieving equity of access to health services. Cultural and linguistic differences between the healthcare providers and consumers are factors that affect effective communication in healthcare. This means that even in situations where the health care providers and patients are not of the same cultural background and conceptual knowledge, there is the risk of ineffective communication. The media has also been cited as an important factor in effective communication because of its focus of health horror stories. According to Lawrence et al (2009), ineffective communication between staff and within institutions compromise patient safety. Different communication protocols, use of metaphors lack of cultural specificity also impacts on effective communication.

To improve communication in a culturally diverse environment, Lowell (2013) proposes use of collaborative practice. Health care staff should engage in cultural reflexivity to come to terms with how culturally specific ones practice is. Booth and Nelson (2013) say that reflective practice is an important tool in ensuring safety and critical relationships first Australians. It is important for providers to recognize the needs of health consumers and accommodate them. Additionally, reflection helps in ensuring the shared understanding has been achieved. Furthermore, in instances where language creates ineffective communication health providers should ensure access to interpreters. This is because as Kosny et al (2014) say when providers and consumers do not speak the same language, the meanings communicated between the two could be lost. Again, in such cases misinterpretations are frequent.

Australia is a culturally diverse country. Again, the number of migrants coming to Australia has increased, which has further increased the cultural diversity in the populations that healthcare providers have to deal with. The diversity of languages in Australia is vast, thus, it is impossible for health professionals to communicate with their patients using the patients’ languages (Phillips, 2010). In 2006, 41% of adults in Australia were found to have adequate health literacy levels (ABS, 2009). As Grant and Luxford (2011) point out, in an increasingly globalized, the way health care providers perceive and understand of culture and multicultural issues will impact on how families experience healthcare services.

While health literacy denotes use of skills and abilities, health communication encompasses exchanging information in the health context. Health literacy is an important component of health communication (Berkman et al, 2010). In patient-provider relationships, communication is the connection between health literacy and health outcomes. Communication skills are used to speak, listen and negotiate – all of which are dimensions of health literacy. Lowell et al. (2014) however notes that despite the fact that health literacy and effective communication are interconnected, one could possess outstanding communication abilities but not be literate enough to communicate efficiently in health issues. Integrating health literacy and communication and cultural competence ensures that the kind of care provided is high quality, equitable and culturally responsive (Lowell et al (2014).

Health literacy can be defined using the cultural literacy perspective. According to Lowell et al (2014), it is the capability to know and use collective world view, customs, beliefs and social identity for interpreting and action on health information. Mitic and Rootman definition of health literacy entails having the ability to access health information in order to “share health promoting activities with others and address health issues in the community and others” (p. 3). In this regard, to be able to carry out health communications and address issues in the culturally diverse Australian communities, effective communication will depend of the kind of health literacy that one has. The level of health literacy impacts on the effectiveness of communication.

Culture and language are the major components of health literacy and communication in culturally diverse environments. In this light, health literacy is dynamic since the level of health literacy will differ depending on the cultural and linguistic contexts. Shaw et al. (2008) argue that the beliefs different cultural groups have on illness and health impact on their ability to act on the instructions given to them by healthcare providers. Addressing the issue of screening and management of chronic diseases, Shaw et al. (2009) argue that lack of healthcare providers’ ability to recognize how cultural differences affect care lead unsatisfactory health outcomes. They say that cultural differences create misunderstandings in chronic disease management, treatment regimens, disease severity and the health status. Understanding of health literacy that does not encompass the role cultural beliefs play in care is insufficient. Peoples’ cultural beliefs on illness and health determine their capacity to understand and follow doctors’ directions (Shaw et al. (2009). This includes the beliefs shared by minority groups and immigrants.

Vass et al. (2011) discuss how indigenous patients are not able to make genuinely informed choices because cultural difference that affects effective communication, mostly as a result of low levels of health literacy. Indigenous beliefs on causes of illnesses and their treatment have been found to differ from their biomedical explanations. Additionally, the indigenous people have varying worldviews which affect the way they access and use health information. Challenges of health literacy especially among refugee women and children have seen them suffer discriminatory health services (Grant & Luxford, 2011). Poor communication is the major contributing factor to the dissatisfaction in health services reported among this group. Evidence suggests that in to address the needs of such vulnerable groups, health providers must offer culturally appropriate services. Indigenous Australians in the Northern Territory experience three times of the disease burden compared to non-indigenous Australians (The Department of Health and Families, 2009). State and Federal governments in Australia have focused on closing the inequality gap between indigenous and non-indigenous populations. According to Vass et al. (2011) low health literacy levels have had detrimental effects on patient safety and health outcomes among the indigenous people. In another context, Latimer et al. (2012) found that Aboriginal children and youth experience higher rates of pain compared to children of non-Aboriginals. Youth from First Nations families have been hindered from participating in social activities like sports because of pain issues. Among the reasons cited for this phenomenon is the inability of the youths and the children to convey the quality and intensity of the pain they feel. Consequently, health professionals may not be able to adequately measure it and adequately treat it.

Although most health providers and organizations agree on the importance of health literacy to effective communication in a culturally diverse environment, Shaw et al. (2008) note that little effort has been put to place health literacy in the social economic and culturally diverse contexts. The lack thereof has hindered communication and compliance in providers and patients. Grant and Luxford (2011, p. 17) argue that as long as “health professionals remain securely within the borders of whiteness they inhabit, they will be restricted in their practice when working with those from cultures other than their own”. Health systems and organizations play an vital role in enhancing health literacy. In a culturally diverse environment like the one in Australia, it is important to consider the interconnections between health literacy, culture and language in training, practice and policies. The Australian Commission on Safety and Quality Health Care (2013) says that to enhance health literacy, efforts should be made to offer useable health information as well as effective interpersonal communication. Additionally, health literacy should be factored in in educating consumers and health care providers. Another strategy in addressing health literacy is to engage in active dialogue with those impacted by health literacy; government agencies, community based groups and individuals (Lowell et al., 2014). Furthermore, adopting a cultural safety approach to care in training health staff especially those dealing with Aboriginal patients would be an effective strategy in enhancing health literacy (Baker & Giles, 2012). Teaching of colonial history and power imbalances of the Aboriginals can help family medicine residents to come to terms with their biases during care, hence improving quality of care.

Health Professionals look at the issue of health literacy and communication because it determines the outcomes of the care they give. Their health literacy, cultural and communication competence will determine the level of responsiveness of the care to the communication and cultural needs of their patients. Apart from improving health outcomes, health care providers that are keen on the effects of health literacy on effective communication are able to improve the health literacy levels of consumers.

Health professionals have the onus to improve health literacy and in a bid to gain effective communication which is paramount to care delivery and health outcomes. This responsibility should taken at an individual level, organizational and system level. Reflective practice on the level of communication achieved in everyday practice, as well as collaboration between staff would improve the level of communication achieved in a culturally diverse environment. Additionally, training standards and policies should be set in place to ensure that providers working in culturally diverse environments are not only health literate, but they also engage in effective fruitful communication with consumers, while improving the consumers’ health literacy levels as well.


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