Health Literacy and Cultural Competency: Why is this an important issue in health care and what strategies should pharmacists incorporateinto their practices to address this issue.




Health Literacy and Cultural Competency:  Why is this an important issue in health care and what strategies should pharmacists incorporate

into their practices to address this issue.




Health Literacy and Cultural Competency:  Why is this an important issue in health care and what strategies should pharmacists incorporate

into their practices to address this issue.

A.    Summary of the literature “ Include how the literature reviewed supports your answers to the topic question.
(To writer: Please write the summary about the ONLYCultural Competency)

B.    describing how this topic will affect how you approach pharmacy and your professional future.  In particular how you individually

assess the question asked above as the focus point of the paper. This is a reflective piece where your personal statements and thoughts on

this issue should be expressed.

The Role of Culture in Health Literacy and Chronic Disease
Screening and Management

Health Literacy and Racial and Ethnic Health
Minority ethnic groups are at higher risk for several diseases and suffer from more severe illnesses than their majority-culture counterparts

[16, 17]. It is important to bear in mind that research on culture and health must take care to specify salient differences among

populations, while avoiding the construction of ethnic groups as˜˜monolithic entities™™ [69, p. 145]. Cross-cultural research can be

inappropriately reductive, identifying ˜˜traditions, beliefs and behaviors that are supported by one population yet criticized by another™™

[70]. This problem is particularly apparent in generalizations about ˜˜Latinos,™™ who may
come from many different countries, and/or several different cultural/ethnic traditions within a single country. lndeed, the demographic

category ˜˜Hispanic™™ may conceal widely varying disease prevalence rates according to country of origin [71] or other differences [56].

Further, reductionistic biological understandings of race areincreasingly criticized for neglecting the complex socialhistory of racial

categories [72]. Research on health disparitiesmust balance a genetic understanding of diseaserisk with a critical examination of the social

and economicfactors that combine to create racial and ethnic health
disparities [73].

Health Literacy and Patient Adherence
With several notable exceptions (e.g., [30, 46, 68, 74]), most literature on health literacy and patient adherencedoes not seek to

investigate culture or ethnicity as variablesrelated to health literacy, though it is commonly observedthat low health literacy is more

prevalent in ethnicminority, low-income and elderly populations. In general,low health literacy is associated with worse health status [74]

and poor chronic disease management. In a sample of408 English- and Spanish-speaking patients with diabetes,Schillinger et al. [75] found

that patients with inadequatehealth literacy were less likely than patients with adequate
health literacy to achieve tight glycemic control and were more likely to have poor glycemic control. Inadequatehealth literacy was

independently associated with worseglycemic control and higher rates of retinopathy. Similarly,poor medication knowledge was positively

associated withlower adherence and lower literacy among 128 HIV-seropositivepatients [76]. Lack of adherence with chronic disease management

plans, especially among low-income,urban and minority patients, is widespread, leading tocostly ED visits for patients with asthma and other

chronicdiseases.The successful management of chronic disease is oftenachieved by combining lifestyle modifications such as dietand exercise

with a physician-supervised medication regimen.The doctor-patient relationship and patients™ capacityfor self-management are both critical to

this process. Intheir study with three California ethnic groups, Beckeret al. [67, p. 176] report that Latinos had the highest burdenof

chronic illness yet the least knowledge of the U.S.biomedical system. This lack of familiarity contributed to™ ˜vague [ness] about illness

management¦ and they did not
understand that they had a role in managing their illness beyond taking medication.™™ In addition to lack of exposureto biomedical care,

culturally varying health beliefs mayalso influence patients™ health-seeking behaviors andwillingness to comply with treatment regimens [22,

77].For example, in a study of prophylactic TB treatmentamong Vietnamese immigrants, researchers found recentimmigrants were more reluctant

to complete the medicationregimen because its side effects were deemed too˜˜hot™™, ˜˜while Asian herbal medicines were [seen as] morebenign

and cooling™™ [57, p. 352]. Situations like this call
for, first, the recognition of different explanatory models, and second, a cultural broker who understands both the EMand the biomedical aims

of the recommended treatment todevelop an explanation that is both comprehensible andacceptable to recent arrivals.Diet and nutrition are

commonly recognized as culturally-influenced domains of behavior [37] that areparticularly relevant to diabetes management and education[78].

However, patients with diabetes may be especiallyreluctant to modify their eating habits when they feel thatthe recommended changes ask them

to give up culturallymeaningful habits and practices. Research suggests culturaldifferences coupled with low health literacy may be afactor

in patient noncompliance with dietary, medicationand screening regimens. Mull et al. [79] report that lowpatient adherence with diabetes

medications was commonin a convenience sample of 38 Vietnamese diabetics in
California. Two-thirds of participants reported using traditionalremedies for their diabetes and some discontinuedtheir oral medications

while doing so. According to Rosalet al. [80], diabetes prevalence among Hispanics is inverselyrelated to educational status. As we might

expect, lowhealth literacy is related to knowledge about disease.Gazmararian and colleagues [81] report that of 653Medicare recipients, 266

of whom had diabetes, 36% hadmarginal or inadequate health literacy. Health literacy in
this population was independently related to knowledge about diabetes. Lutfey and Wishner [82] give a thoroughreview of the many individual,

psychological, social andsocioeconomic studies that have been done on noncomplianceamong diabetics and others with chronic diseases,reporting

that a range of factors from the psychological tothe cultural account for lack of adherence to treatmentregimens.
Other factors also influence patients™ ability to maintain adherence with dietary, physical activity and medicationregimens. Samuel-Hodge and

colleagues [83] conductedfocus group interviews with African-American women with type 2 diabetes, and learned that their multiple

caregivingresponsibilities often interfered with managing theirown illnesses. Participants in this qualitative study reportedthat faith and

spirituality were important and under-recognizedcoping mechanisms for people living with chronic disease. In exploratory research with 30

Puerto Ricanadults with type 2 diabetes, von Goeler et al. [84 ] foundthat most participants regularly self-monitored their bloodglucose but

did not use the results to improve their diabetescontrol. Many frequently missed doses of their medications.Barriers to adequate self-

management includedfinancial and social obstacles, and competing health andfamily concerns. In a community study of 625 African-American

adults with diabetes, lack of health insurancewas the most consistent correlate of inadequate preventivecare for their diabetes [4 ].

Similarly, a qualitative study
with members of three ethnic groups in California found that ˜˜uninsured respondents were much less effective atmanaging their [chronic]

illnesses™™ compared with insuredrespondents. ˜˜The uninsured had poorly controlled illnesses,frequent health crises, difficulty

procuringmedication¦and displayed little knowledge of self-caremeasures or risk awareness™™ [85 , p. 19]. In another multimethodstudy,

African-American participants describedbarriers to healthy eating and physical activity that included lack of places to exercise and lack of

grocery stores[86 ].

Works Cite:
Shaw, S; et al.The role of culture in health literacy and chronic disease screening and management. Journal of Immigrant & Minority Health.,

<Blank>, 11, 6, 460-467 8p, Dec. 2009. ISSN: 1557-1912

Using Campinha-Bacote™s process of cultural competence model
to examine the relationship between health literacy and cultural

Health literacy
One of five adult Americans reads at or below the fifth grade level (Doak et al. 1996). To function adequately in the
twenty-first century, one must be able to read above the fifth grade level, indeed at or above the 8th to 9th grade level.
Patients with low literacy face numerous challenges in manoeuvring in the healthcare system. They often face difficulties in completing

healthcare forms, understanding their healthcare instructions, keeping appointments for follow-up care, and self-administering their

medications. Patients with low health literacy are prone to make potentially fatal mistakes in regard to their health care because of their

inability to obtain, process and analyse basic health information (Chang & Kelly 2007). Ethnic minorities have lower literacy levels than

their nonminority counterparts (Doak et al. 1996). In the US, some ethnic minorities have marginal literacy levels, while others have low

literacy levels. Persons who are considered marginally literate typically manoeuvre through life only slightly above the low literate level.

A person™s level of health literacy can be determined using a variety of measures, some of which
are available in both English and Spanish. The most common measures used are the Rapid Estimate of Adult Literacy in Medicine (REALM) and the

Short Test of Functional Health Literacy in Adults (STOFHLA) (Davis et al. 1991, 2006, Greenberg 2001, Bass et al. 2003, Golbeck et al. 2005,

Paasche-Orlow et al. 2005, Monachos 2007, Osborn et al.
2007). Additional methods that can be used to assess health literacy and enhance the comprehension of health-related
information include pictorials or the teach-back method (Osborne 2006). One of the newest measures of health
literacy is Weiss et al.™s (2005) the ˜Newest Vital Sign™. This measure uses the ˜cloze™ method to assess comprehension of healthcare

information, allowing a patient to fill in the blanks in healthcare related passages (Weiss et al. 2005).
The definition of health literacy has progressed from having the ability to read health-related information, to having the skills necessary

to problem solve, compute, articulate and make appropriate healthcare decisions (Cutilli 2005). These skills are often associated with

cultural and societal influences (Cutilli 2005). Incorporating health literacy as an assessment tool in clinical settings is thus imperative

to achieve successful patient outcomes (Andrulis& Brach 2007); not having the tools and training to assess health literacy in clinical

practice can create barriers to patients and thus limit positive patient outcomes.
Cultural competence
Culture affects how persons view the world, including how they seek and value healthcare (Chang & Kelly 2007). As
noted by Goody and Drago (2009), a group™s culture is based on an accumulation of learned behaviour that is shared over time. Culturally

related behaviours are the foundation of the group™s socialization practices, decision-making, and communication styles, and they are both

formally and informally transmitted (Goody &Drago 2009). A group™s culture
determines members™ perceptions of health and illness and the ways in which treatment is sought. These determinants
are based on the group™s attitudes, values and practices. In addition, there is a strong connection between patients™ culture and their

healthcare (Goody &Drago 2009). Thus, populations with cultural backgrounds that differ from the
culture of the majority group tend to encounter healthcare issues such as decreased access to care and low quality of
care, which lead to poorer health (AHRQ 2007). Assessing patients™ culture and understanding their value system can
help to alleviate these poor healthcare outcomes and enhance health and illness management (Goody &Drago 2009).
Assessment should include the ethnic group™s health literacy and their ability to obtain, process and understand healthcare information and

make appropriate healthcare decisions based on their cultural beliefs. Healthcare professionals who respect and use information about a

group™s culture and their health literacy are deemed culturally competent. Differences in cultures should be acknowledged and respected

during cross-cultural health encounters. However, healthcare professionals often focus on the management of a patient™s health, while the

patient tends to focus on the management of the illness, leading to cultural dissension or conflict (Goody &Drago 2009). Cultural conflict

between healthcare professionals and patients in regard to health and illness occurs when their value systems, attitudes, beliefs and

practices differ. Fadiman™s (1997) book The Spirit Catches You and You Fall Down, for example, illustrates the conflicts between the

worldviews of modern Western medicine and Hmong culture. The book depicts the controversy experienced by a Hmong family having a child with

epilepsy, receiving care from healthcare professionals who were unfamiliar with Hmong culture, causing a major conflict in the child™s care.

This conflict can be avoided if the patient™s cultural values are assessed and included in the plan of care by nurses and other healthcare

professional. However, this requires skill and experience on the part of healthcare
Works Cited
Ingram, Racquel Richardson. œUsing Campinha-Bacote™s Process Of Cultural Competence Model To Examine The Relationship Between Health Literacy

And Cultural Competence. Journal Of Advanced Nursing 68.3 (2012): 695-704 10p. CINAHL Plus with Full Text. Web. 13 Oct. 2015.

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