Importance of Health Literacy in a Diverse Healthcare Environment - Literature review Example

Crucial Importance and Relationship of Health Literacy to Effective Communication in a Culturally Diverse Healthcare Environment Name Date Crucial Importance and Relationship of Health Literacy to Effective Communication in a Culturally Diverse Healthcare Environment In the contemporary world, nurses are providing health education, care, and case management in an ever-increasing diverse population. Healthcare delivery is becoming increasingly challenging due to triad of health literacy, linguistic, and cultural barriers. Nevertheless, healthcare providers have the responsibility to ensure best patient outcomes. Effective communication plays a fundamental role in patient care delivery. For there to be a seamless care provision, and in order for caregivers to meet all the patient needs, there must be high quality communication between caregivers as well as between healthcare professionals and patients (including family members and friends). In addition, health communication is pivotal in promoting health of populations/ communities and individual members. There is a close relationship between health literacy and healthcare communication. According to Andrulis and Brach, health literacy is integral to health communication (2007). This implies that in order for nurses to communicate effectively with patient populations, health literacy must be in existence. This paper explores the relationship between health literacy and effective communication. It then investigates the role of the relationship in promoting patient and health outcomes. The paper begins with a brief description of health literacy and healthcare communication before delving into the relationship between the two concepts. Importance of Health Literacy in a Diverse Healthcare Environment Health literacy is a critical factor in healthcare safety and quality and consequently a key determinant of health. The Calgary Charter on Health Literacy agreed that improvement in health literacy is associated with the ability to make more informed choices, which in turn leads to improved healthcare outcomes (Baker, 2006). Other direct results of increase health literacy include improved patient safety, reduction in health risks, and improvement in disease prevention (Bann et al., 2012). Others include increased wellness, reduction in healthcare inequalities, improvement in patient care, ability to navigate through the health system, and improved quality of life (Coleman et al., 2011). Owing to awareness of its importance in healthcare delivery, health literacy has received wide research attention, which has resulted to lack of consensus regarding its definition. Consequently, as Frisch, Diviani, and Schulz (2011) note, there lacks a clear guideline on the measurement of this fundamental factor in healthcare outcomes. Definitions range from viewing health literacy as a set of skills (Berkman, Davis & McCormack, 2011), to its consideration as a behaviour change (Pleasant & McKinney, 2011) while some authors consider it as a social practice (Rubin et al., 2011). This paper considers health literacy as a set of social and cognitive skills. It adopts the definition given by World Health Organisation (WHO, 2016) defining health literacy as a set of social and cognitive skills that determine the ability and motivation of a person or population to access, understand, and use health information in such a manner to maintain and promote good health. Health literacy goes simply being able to access, for example, health-related pamphlets, but also involves the ability to interpreted information contained within and use it appropriately such as change their behaviour to healthy lifestyles. Health literacy does not simply concern healthcare consumers. Healthcare providers and systems are also supposed to have high levels of health literacy in order to deliver required care effectively. According to the Calgary Charter (as cited in Coleman et al., 2011), health literacy in healthcare professionals is required so that they can present health information in ways and manner that people can easily understand and act on it accordingly. System’s health literacy is evidenced by the manner in which it provides health care and information, in a shame-free, easy, and equal way (Coleman et al., 2011). In short, health literacy is necessary for effective healthcare communication and therefore healthcare promotion. Importance of Effective Health Communication in a Diverse Healthcare Environment Effective communication is one of the key requirements in health promotion. According to the United States of America (USA)’s Health People 2020, health communication critically affects virtually every aspect of people’s health and well-being including health promotion, disease prevention, and quality of life (Rimal & Lapinski, 2009). Healthy People 2020 goal on health communication and health information technology is on “improving population health outcomes and health care quality, and to achieve health equity” through use of health communication strategies (Office of Disease Prevention and Health Promotion, 2016). This implies then that effective health communication is vital in promoting health outcomes whose direct results include health equity and improved care quality. In its most succinct form, communication is about exchange of information. According to the Harvard School of Public Health, health communication involves generation and dissemination of information (2016). It also includes how shared information affects people, population, and public policy (Harvard School of Public Health, 2016). Effective health information does not simply involve sharing of health-related information. It also involves selecting the best communication channel, contexts, messages and reasons that will achieve best results, which is motivating people to seek, understand, and use health information as required. It is evident, therefore, that there is a close relationship between health literacy and effective communication. The two are geared towards ensuring that individuals and populations act accordingly by getting access to and using health-related information appropriately for own health needs. Relationship between Health Literacy and Effective Communication As earlier mentioned, health literacy is integral to health communication. This implies that in order for effective health communication to occur, healthcare providers and recipients must have high levels of health literacy. Schmitt, Chin, and Connors (2014) present a framework linking these two important concepts (shown in appendix 1). In the model, health literacy influences health communication and vice versa. High levels of health literacy lead to highly effective health communication. Effective communication facilitates and enhances health literacy (Schmitt, Chin & Connors, 2014). According to this model, health literacy is required for effective health communication just as the latter is a necessary element of health literacy. Further, according to the model, health literacy is an attribute, which involves skills and knowledge of healthcare givers, consumers, educators, and other elements of the systems (organisations, interpreters, and media/channels). On the other hand, health communication is considered a process that exists between the various elements of the health system (caregivers, consumers, educators, organisations, educators, media, and interpreters). The model suggests that when skills and knowledge of the healthcare system is good, the process between the various elements of the healthcare system is smooth. On the same, effective communication facilitates health literacy. For example, when the interaction between healthcare educators and consumers is healthy, which is characterised by each party understanding the other clearly, the former will have easy understood health information, which will in turn lead to improved health outcomes. For instance, when linguistic barriers between healthcare providers and patient populations are addressed, the two parties will communicate effectively. The latter will easily understand information that the former gives and will therefore be motivated to act accordingly such as implement required lifestyle changes to lower risk of disease development. Cultural diversity and language barriers present a major challenge to effective health communication leading to low health literacy especially on the side of healthcare consumers. According to Nielsen-Bohlman and Panzer (2005), culture and language act as crucial mediators of a person’s health literacy. Since it has already been shown that health literacy is necessary for effective health education, it then shows that culture and language highly determine the effectiveness of health communication especially between caregivers and consumers. Healthcare systems today are faced with the challenge of cultural diversity, which makes it extremely difficult to communicate with patients and patient populations as well as other caregivers. According to Coleman are colleagues (2011), linguistic barrier posses the main challenge. However, even among educated people, cultural diversity may prevent effective communication mainly because of different interpretation of unspoken words. For example, one culture may interpret high voice as a way of clarifying a point while in another culture, this may be take for being harsh or rude to the other person. Such misunderstandings prevent effective health communication leading to low levels of health literacy, according to Schmitt, Chin, and Connors’ (2014) model. Since low health literacy leads to poor patient/health outcomes, health and wellbeing of an individual or population deteriorates. Nurses today are faced with these challenges in their day-to-day work due to cultural diversity in the patient population they serve. Diversity is increasing mainly due to globalisation. For instance, the number of foreigners in Australia, as workers, business people, tourists, and students, is on the rise, which only intensifies cultural diversity (Koleth, 2010). Therefore, high levels of health literacy on the part of caregivers and the health system are required to ensure that they communicate in the most effective manner to each population or individual to promote health and wellbeing. Health equity is a major issue all over the world. According to WHO (2016a), health inequality is defined as “differences in health status or in the distribution of health determinants between different population groups” (para. 2). In the USA, one of the key goals in the healthcare system is to reduce existing health disparities in the effort to achieve equitable healthcare (Agency for Healthcare Research and Quality [AHRQ], 2014). The U.S. government endeavours to achieve this goal through the provision of culturally sensitive healthcare (AHRQ, 2014). In Australia, health inequality is a serious health issue evidenced by significant differences in death rates, maternity deaths, under five deaths, prevalence rates for different diseases, health behaviours, disease risks, life expectancy, health service utilisation, and health risk factors (Chand, 2012; Friel, 2009). There are a number of factors affecting health inequality. Culture is one of the notable factors of health inequality of equity. The inability to provide culturally appropriate care and education, which mainly stems from lack of cultural competence, is the key reason why some cultures have better health outcomes than others (Markova & Broome, 2007). Inability for healthcare professionals to communicate effectively with members of certain cultures leads to low levels health literacy such that members of such populations are unable or not motivated to make healthy decisions. In addition, when healthcare professionals and the system have low levels of health literacy, they fail to select the best communication channel, style, context, method, and strategy for the respective culture to enable members of the population to access, understand it easily, and consequently make appropriate healthy decisions (Markova & Broome, 2007). The resultant is a population with low levels of health literacy, one that is not motivated to make right decisions, and one that suffers low health outcomes. Consequently, health equity simply becomes a dream never to be achieved. In this case, low levels of health literacy among healthcare professionals and in the healthcare system are translated to reduced health literacy in the patient population. The result is poor health and wellbeing. For example, some cultures will remain at high risks of cardiovascular diseases because they do not have easy access to health information, one that they can easily understand. Therefore, health literacy and effective communication interact in a two-way manner to affect health equality. High levels of health literacy and effective communication are necessary to achieve health equality goals. Conclusion Health literacy and health communication have a strong interrelationship that in turn has a critical role in health outcomes. These two concepts determine how well patient populations are motivated to make health decisions through access to health information, understanding it, and being able to use it accordingly. In a culturally diverse healthcare environment, health literacy and effective communication are necessary to reduce health inequalities and deliver culturally appropriate health care. Healthcare professionals and healthcare system have the primary responsibility of improving levels of health literacy and promoting effective communication. The must begin by increasing their levels of health literacy so that they can use the best communication methods, strategies, and channels to improve consumers’ health literacy levels. References Agency for Healthcare Research and Quality. (2014). Improving cultural competence to reduce health disparities for priority populations. Retrieved from http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1934&pageaction=displayproduct Baker, D. W. (2006). The meaning and measure of health literacy. J Gen Intern Med, 21(8), 878-883 Bann, C. M., McCormack, L. A., Berkman, N. D., & Squiers, L. B. (2012). The health literacy skills instrument: A 10-item short form. Journal of Health Communication, 17(sup3), 191-202. Berkman, N. D., Davis, T. C., & McCormack, L. (2010). Health Literacy: What Is It? Journal of Health Communication: International Perspectives 15(S2), 9-19. Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., Viera, A., Crotty, K., …. Harden, E. (2011). Health literacy interventions and outcomes: An updated systematic review. Agency for Health Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK82434/ Chand, M. (2012). Health equity in Australia with a focus on culturally diverse populations - a summary article. Brisbane. World Wellness Group. Coleman, C., Kurtz-Rossi, S., McKinney, J., Pleasant, A., Rootman, I., & Shohet, L. (2011). The Calgary Charter on Health Literacy: Rationale and core principles for the development of health literacy curricula. . Retrieved from http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdf Friel, S. (2009). Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco. The Australian National Preventive Health Taskforce. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwi1rM30-oHMAhVEaRQKHSDXD_EQFgghMAE&url=http%3A%2F%2Fwww.health.gov.au%2Finternet%2Fpreventativehealth%2Fpublishing.nsf%2Fcontent%2F0fbe203c1c547a82ca257529000231bf%2F%24file%2Fcommpaper-hlth-equity-friel.pdf&usg=AFQjCNGe7-sgdhrB0wFMhbx9sCGVbce6eQ&sig2=9TqGWPuxP9WX06epSDdiDg&bvm=bv.119028448,d.d24 Frisch, A. C., Diviani, N., & Schulz, P. J. (2011). Defining and measuring health literacy: How can we profit from other literacy domains? Health Promotion International, 27(1). doi: doi:10.1093/heapro/dar043. Harvard School of Public Health. (2016). Health communication concentration. Retrieved from http://www.hsph.harvard.edu/health-communication/ Koleth, E. (2010). Multiculturalism: A review of Australian policy statements and recent debates in Australia and overseas. Parliament of Australia. Retrieved from http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1011/11rp06 Markova, T., & Broome, B. (2007). Effective communication and delivery of culturally competent health care. Urologic Nursing, 27(3), 239-42. Office of Disease Prevention and Health Promotion. (2016). Health communication and health information technology. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology Pleasant, A., & McKinney, J. (2011). Coming to consensus on health literacy measurement: an online discussion and consensus-gauging process. Nursing Outlook, 59(2), 95-106 Rimal, R. N., & Lapinski, M. K. (2009). Why health communication is important in public health. Bulletin of the World Health Organisation, 87(4), 245-324. Rubin, D. L., Parmer, J., Freimuth, V., Kaley, T., & Okundaye, M. (2011). Associations between Older Adults' Spoken Interactive Health Literacy and Selected Health Care and Health Communication Outcomes. Journal of Health Communication, 16(sup3), 191-204. World Health Organisation. (2016). Track 2: Health literacy and health behaviour. Retrieved from http://www.who.int/healthpromotion/conferences/7gchp/track2/en/ World Health Organisation. (2016a). Health impact assessment (HIA). Retrieved from http://www.who.int/hia/about/glos/en/index1.html Appendix Appendix 1: Schmitt, Chin, and Connors’ (2014) Health Literacy-Effective Communication Model Read More