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Health literacy and cultural awareness

Health literacy and cultural awareness
1. Introduction
The term health literacy is commonly used in the healthcare setting. The first implication that comes to the minds of many professionals is the ability of the patient to read and understand medical information. However, health literacy involves more than just the ability to read. It involves the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. This involves a complex group of physical, cognitive, and social skills which are needed to function in the healthcare environment. In order for a patient to make the correct health decision, it is important for the healthcare provider to be able to convey information in a way that it can be easily understood by the patient. This has led to the development of a number of proposals for improving health literacy. The second and equally important factor for the delivery of healthcare services is cultural awareness. In a multicultural society like the one in the United States, it is important for the healthcare provider to have the knowledge of, and the ability to deliver services to, different cultural communities or populations. This is in addition to understanding the beliefs, customs and values of the individuals and families that they serve. In general, the golden rule in the healthcare profession is to allow and respect each culture to have its own identity. However, this may be a novice and an uphill task in the application if a healthcare provider does not have a clear understanding of cultural competence. He or she must first have the capability to engage self-reflection and understand the patient’s view of health and well-being. Only then may the provider make a conscious effort to view the patient’s beliefs in a positive light. The main object of this paper is to discuss the connection between health literacy and cultural awareness. Both of them contribute significantly to the disparities in healthcare access and the delivery of healthcare services. The paper will first define health literacy and then shed some light on how its importance in knowledge-based economy is transforming healthcare delivery.
1.1 Importance of health literacy
Health literacy, as defined in the article, is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It is important for individuals to be health literate and be able to make informed decisions about their health. Moreover, the results of health illiteracy can be severe for public health and healthcare delivery. It introduces a new term, “informed consent,” which literally means that the patient must give consent to a treatment or a part of the treatment on his own will, and this can only be achieved by getting adequate health information and understanding the details of the information. However, as discussed in the article, if a patient cannot understand the information presented, how will this informed consent be achieved? Low health literacy is associated with the lack of adherence to medical regimes, higher rates of hospital admissions, and longer hospital stays. It increases morbidity and mortality and decreases the efficiency of the healthcare system. Also, it results in increased healthcare costs, estimated from $106 billion to $238 billion every year in the United States as it states in the article. The impacts of health illiteracy are profound globally. However, some studies in the article have shown that the impact can be reduced by improving the knowledge and skill of the patient such that positive health behaviors can be facilitated by advancement in health literacy skill. For example, the use of clear evidence or updated statistics on the effectiveness of treatments and the impact of symptoms as a method of empowering patients. From the healthcare provider perspective, the article emphasizes the “Universal Precautions” approach, which assumes that patients may have difficulty understanding health information, irrespective of their educational or cultural background. This approach emphasizes the simplification of the healthcare language and environment, such as providing overly complex material in a more understandable format, providing visual aids to support verbal information, creating a health literate environment, and so on. Moreover, the cultural diversity lingers on in “2.1 Definitions,” addressing the potential of culture to obstruct how it is measured and assessed in the article. Last but not least, the article stresses the significant impacts of having low health literacy, “both for the patient and for the performance of the healthcare system as a whole,” it states.
1.2 Role of cultural awareness in healthcare
In contrast to health literacy, which is considered an individual characteristic, cultural awareness focuses on the social group. Cultural awareness is the foundation of communication and it involves the ability to stand back from ourselves and become aware of our cultural values, beliefs, and perceptions. The United States is a very diverse nation and is increasingly becoming more and more diverse. It is important that individuals in the healthcare field have knowledge and understanding of different cultural values and practices. Each individual has his or her own unique reality, and everyone interprets this reality in terms of their own cultural background. Nonetheless, the important initiatives of the Surgeon General’s “Cultural and Linguistic Competence Policy” and the “National Standards for Culturally and Linguistically Appropriate Services in Health Care” are significant. The federal government has recognized the need for both cultural and linguistic competencies in the healthcare field. By
2. Understanding Health Literacy
I believe that by understanding what influences health literacy and identifying who is more at risk of low health literacy, it will help to drive more effective strategies to support people with differing health literacy needs. However, to create a health literate society, everyone needs to get involved to focus efforts and strategies across the spectrum of life. For instance, getting health advice or information from digital technology, having more options will suit different literacy and language preferences, and more and more people now using Health365, ConnectMed. I understand that ConnectMed in particular has launched the ‘doctors video consultation program’ which will provide more options for people to receive health advice, and this will also be a further step to provide options to suit different literacy and language preferences.
I have learned that, in New Zealand’s societies, Maori uses the health concepts which are quite different from the western concepts, and Maori tend to focus on the balance of the body, mind, and spirit as well as integrating the collective, interconnection with the environment. However, there is no one way that can help to improve health literacy. It requires a combination of individual skill development and systemic support, and a whole system approach is needed to create a health literate society. This includes people having access to relevant and easy-to-understand information in the right place and at the right time to make informed choices and decisions about their health. It is also about a greater awareness and adoption of practices that promote health and wellbeing by health professionals and policymakers. Health services also need to ensure that the care they provide is aligned with helping to enable health and wellbeing through services that reflect what is known to work best.
Over the years, health professionals have recognized that the health literacy level of an individual could have a profound impact on their ability to manage their own health. The emergence of the internet has also shifted the way in which people now seek health information, which can also be problematic because there is a lot of bad information. New Zealand researchers identify that one’s understanding of health, illness, and wellbeing can be influenced by many factors. For example, the researchers have found that they may be influenced by cultural cycles, one’s connection to the environment, and even their perspective on time.
Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It is a multi-dimensional issue and is influenced by individual and systemic factors. The definition implies that health literacy extends beyond the individual and is also about the capacity of the health system and the broader society to support people in their health literacy journey. This is why I think health literacy in New Zealand should be seen as both an individual and a societal issue, and there has to be a dual focus on building individuals’ capacity and the responsiveness of health services.
2.1 Definition and components of health literacy
To comprise individuals, it is thereby of pertinent finding that health literature be construed through the respective definitions. In the varied domain, education can be termed as the process that inculcates attitudes, values, acquisition of skills or imparting information aimed at building knowledge on particular areas. In attempt to define the health literature, I have come up with the definition to refer to the public’s and the individuals capacity to gain access to, process and comprehend the health information that has been availed to them and a stag like decisions appropriately. This is a definition that is so stalwart and very key while at the same time it accords those with the low level of health literature with avenue to try and raise their levels. According to the United States Department of Health and Human Services, they concretely defines health literature in similar manner to the definition that I have fronted. They define it as the skills of persons have to extract information from varied sources to include the internet and the ability of such persons to apply their knowledge in day to day decisions with the ultimate aim of improving their health. On the converse, if you could have to ask me to define cultural literature, I will tell that cultural competence is the ability of the systems to understand and integrate the cultural distinctions or rather simply understand the difference that exists especially when it comes to cultural practices and also comprehend about how such differences might manifest themselves on the health settings. In broader way, I can stipulate that the cultural literature can be taken to imply the capability of the systems to provide health care to the patients using the shared and integrated type of treatment.
2.2 Impact of low health literacy on individuals and healthcare systems
Low health literacy is a major social problem and effectively taking steps to tackle it has a great potential to improve many people’s lives. Studies have suggested that there is a relationship between the level of health literacy of a person and their health status. Those with lower health literacy are more likely to have poorer health and experience more hospitalizations and emergency care, compared to those with higher health literacy. Poor health literacy not only has a negative impact on individual patients but also on the healthcare system. For instance, low health literacy means that people are less likely to use preventive health services and are more likely to use health services unsuitably such as emergency care. This leads to what is often referred to as high “healthcare utilization”, which increases the cost of healthcare at all levels. In the US, the cost associated with low health literacy is estimated to be between $106 billion to $238 billion a year. High levels of such healthcare utilization makes the healthcare system less efficient and more costly for everyone. Low health literacy results in a higher rate of hospital admittances and recidivism. Given that discharge from hospital can be a critical time for a patient, this could have implications for the quality of care received. Also, in an acute setting, where a rapid exchange of accurate information is essential, the healthcare professionals may fail to appreciatively understand and act on.
2.3 Strategies to improve health literacy
However, in the meantime there is a growing body of evidence for various health literacy interventions that can be delivered to identified groups such as older people, ethnic groups, and specific long-term conditions, which can be facilitated more easily through modern and inclusive healthcare systems, innovative interventions and the right personality and conditions.
The briefing called for ‘key actions’ from national and European policy makers to take steps to promote health literacy, such as introducing health literacy standards for health professionals and the establishment of a European Health Literacy Forum, to facilitate cooperation and the sharing of best practices in health literacy. This example from the briefing demonstrates a top-down approach to health literacy improvement – that is, by creating institutional and structural change. It is suggested that the establishment of health literacy guidelines for health professionals and cooperation across countries would help the diffusion of health literacy practices and encourage its uptake in an increasingly globalised world.
A 2015 briefing published by the European Parliament has pointed out that many health systems across the world are struggling with the challenges of providing high-quality care in the face of increasing demand, rising costs, and limited capacity to deliver services. To mitigate these challenges, the briefing highlighted the potential of improving health literacy – not just for individual patients to make better decisions about their own care and treatment, but also for health systems globally to deal more effectively with changes and challenges, through achieving knowledge transfer and better use of resources.
Section 2.3 Strategies to improve health literacy
3. Cultural Awareness in Healthcare
Lastly, by training healthcare professionals to be culturally aware and literate, healthcare providers may be able to display their non-discriminating practices in a visible and professional context. This can help to increase the level of patient confidence and trust in the services delivered. On the other hand, it is believed that by exposing oneself to the process of learning and development of cultural awareness, individuals will start to recognize many of the negative criticisms that have been surreptitiously embedded within societal values and norms. For example, prejudices and stereotypes against different sexual orientations may be dissolved once some rationality is provided through the exposure of cultural diversities and the meaning behind such preferences (McGarry et al., 1999). As a result, the general awareness and acceptability of the individual towards non-conventional values and beliefs may be increased and accepted, thereby promoting positive recognition of the cultural awareness program.
It is argued that improvements in doctor-patient relationships, such as empowering patients to participate and playing an active role in their own healthcare, can be achieved through both training and application of cultural awareness in healthcare encounters. For many researchers, cultural awareness, coupled with other related education programs such as cross-cultural communication and developing cultural competence, is recommended to be proposed in a three-level successive manner; that is, to spread such knowledge in the medical curriculum, continuous medical education within the working medical professionals, and finally, reaching the patient as part of the social health program and bringing up health consciousness in the community (Hans, 2009).
Secondly, cultural awareness serves to reduce the chances of non-verbal types of misdiagnosis – that is, misinterpretation of the illness of the patient. Different cultures may elicit and interpret the same series of symptoms in a variety of ways. For example, death and illness may be viewed emotionally among some Middle Eastern cultures as opposed to those in Western culture, whereby death is commonly seen as numeral and the focus of grief may be kept short (Kleinman et al., 1978).
First of all, cultural awareness tries to provide a platform whereby different views and grounds for dispute can be mediated. By making a comparison between the patient’s health belief and the caregiver’s system, a compromise that is both beneficial and non-discriminatory to either party may be reached. Such a level of understanding can help to negate negative assumptions of the others during a consultation session.
Cultural awareness signifies an essential first step in developing cultural competence. It denotes the possession of knowledge whereby one is aware of his or her own culture, while being conscious of the existence of another culture, together with the feeling of the inter-ethnic dynamics that are occurring due to the mixing of different cultures (Patel & Kantack, 2007). In the context of healthcare delivery, cultural awareness is also found to be significant. Given the increasingly diverse multi-ethnic composition of the patient population in the United States, healthcare professionals and providers need to develop cultural awareness as a means to effective medical care (Carrillo et al., 1999).
3.1 Definition and significance of cultural awareness
Cultural awareness refers to the ability to recognize and respect the beliefs, values, attitudes, traditions, and customs of a particular culture. According to the National Cancer Institute (2004), cultural awareness in healthcare refers to an individual healthcare provider’s “understanding of his or her own culture and the cultures of others, and the ability to self-assess and to recognize the dynamics of difference inherent in interactions among people.” The definition emphasizes the importance of introspection and recognition of cultural differences. Significantly, cultural awareness takes into consideration the essential aspect of culture itself, and that is learned, shared, and dynamic. It is never about a single person’s representation but understanding a group of people’s identity representation and expression. In the increasingly diverse healthcare landscape, cultural awareness becomes critically important. As stated by the Health Resources and Services Administration, “cultural awareness is an important first step in the process of developing cultural competence.” Culturally competent healthcare providers are equipped with the means to deliver person-centered care that respects the cultural values, beliefs, and practices of diverse individuals. In other words, cultural awareness lays the groundwork for the development of essential skills and strategies required to effectively deliver healthcare that is sensitive and responsive to culturally diverse patients. By promoting an inclusive environment that embraces cultural diversity, healthcare providers will be able to reduce the experience of social, economic, and health inequalities among patients. This is particularly significant in the context of health outcomes. Numerous studies have consistently shown that cultural competence in healthcare is associated with positive health outcomes and the elimination of health disparities for diverse populations.
3.2 Cultural competence in healthcare delivery
However, it also calls for healthcare administrators and policymakers to have a better understanding of both and create an environment that has been shown to reduce health disparities and increase the quality of care received by minority, underserved, and non-English speaking patients. Only through a joint effort can the vision of cultural competence be implemented in the healthcare system.
Cultural competence in healthcare is extremely important and it positively impacts not only the patients but also the healthcare providers. For example, research conducted by Davis and colleagues found that providing quality care to patients can result in reducing the rate of malpractice. It is very clear that healthcare providers need to recognize and understand that better practice leads to quality healthcare without a doubt.
According to a report by The Commonwealth Fund in October 2006, “Despite the growth in racial and ethnic diversity of our nation, too many patients are not getting the appropriate preventive and primary care they need.” Studies have shown that racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.
The Office of Minority Health developed 14 National Standards for Culturally and Linguistically Appropriate Services in Health Care to help organizations and healthcare providers align their practices with cultural competence. These standards also take into account the population’s diversity, incorporating cultural competency in all aspects of policymaking and healthcare delivery, and providing training on cultural awareness.
Cultural competence refers to the ability of healthcare providers to deliver healthcare services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. It is a continuous learning process that builds on the understanding, skills, and knowledge of healthcare providers to deliver holistic care that can meet patients’ needs.
3.3 Addressing cultural barriers and disparities
This powerful story communicates a truth that many healthcare providers intuitively understand: when the stress and complexities of linguistic and cultural differences are not respectfully and successfully navigated, both the health and the wellbeing of patients are at risk.
In her groundbreaking book, “The Spirit Catches You and You Fall Down,” Ann Fadiman relates the story of Lia Lee, a Hmong child in California with epilepsy whose parents struggle to understand and manage her condition within the American healthcare system. Fadiman’s narrative reveals the significant ways in which the Lees’ ability to understand and comply with treatment regimens were constrained by both language barriers and cultural differences. The harrowing story of Lia’s emergency room visit, during which a doctor dismissed the family’s concerns and subsequently refused to treat the child because her parents would not stop a ritual they feared would allow her soul to escape her body, is an extreme example of the life-altering consequences that can result from the communication and cultural chasms between patients and healthcare providers.
Systems of access to language services should be made more consistent, and patients should feel empowered to complain if language support is not offered to them. This will help to improve healthcare access specifically for those for whom language is a key barrier. Education in how to access and use these services, for both patients and professionals, is crucial, and campaigns to raise awareness of the importance of language support and addressing cultural disparities, such as the Department of Health’s ‘Helping the NHS to Help You’, can only support patient outcomes.
Particularly, for those from minority ethnic communities, language can be a major barrier to accessing these services and is therefore a significant factor in cultural disparities. The Interpreting and Translation Service (ITS) helps health professionals communicate with patients who need language support. Telephone and face-to-face support is available, catering to over 170 different languages. This helps ensure that, at every point of healthcare, language services are accessible. However, while signposting is available in some NHS settings, where professionals can follow a set of steps to access appropriate services, this is not consistent across the NHS, and difficulty still remains in knowing what to do to access these services.
Cultural disparities refer to different values, attitudes, and even treatment preferences that affect different cultural groups. It can exist on various levels, including personal (i.e. between individuals), systemic (i.e. within healthcare systems), and institutional (i.e. within professional institutions). These disparities can result in differential access to healthcare and patient treatment. For example, cultural disparities may result in different rates of certain procedures for patients from certain ethnicities, or lower use of preventative health practices among those from lower socioeconomic backgrounds.
3.4 Training healthcare professionals in cultural awareness
The general trend in the United Kingdom is towards an increasing awareness and recognition of the importance of cultural education in healthcare, as well as the development of predominantly online and mobile platforms for learning. It is hoped that such initiatives will continue to nurture a receptive and proactive mindset in practitioners, successfully culminating in more respectful and person-centered care for diverse patient populations.
Through initiatives such as the Cultural Awareness Programme (CAP), the NHS aims to ensure the provision of high-quality, safe and personalized care that takes into account service users’ cultural and linguistic needs. By providing an evolving mixture of digital, face-to-face, and work-based learning approaches, the program seeks to efficiently meet the requirements of a wide variety of healthcare professionals. Also, the CAP provides a flexible, just-in-time system for delivering continuous professional development opportunities, as its resources are available both online and offline.
Some programs also involve direct interaction with members of local community groups, minority associations, and equal rights organizations, in order to encourage a broader, more inclusive approach to health provision. By facilitating links between healthcare professionals and diverse communities, such opportunities can help to promote respect and understanding – as well as providing insight into how cultural theory can be put into practical, positive action.
Many training programs also look at how best to acquire and use the verbal and non-verbal communication skills necessary to develop good relationships with patients from differing cultural backgrounds. Scenario-based learning is often utilized in cultural awareness training. This involves sharing hypothetical situations or real stories from clinical practice as a way of highlighting the impact of culture and diversity on patients’ experience of healthcare. By reflecting on these case studies, participants are encouraged to recognition and respect differing cultural and social norms, and to consider the impact these might have on patient-practitioner relationships.
Healthcare professionals are increasingly being provided with training in cultural awareness. This may be in the form of a short course designed to increase general understanding of cross-cultural issues, or a longer, more in-depth training programme that focuses on the knowledge, skills, and attitudes required to provide healthcare that is sensitive to the needs of diverse communities. The aim of such training is to enable healthcare professionals to examine the cultural and belief systems which shape their values and behavior, as well as to understand how these may differ from those of others. Healthcare workers need to be able to reflect on their own position, challenge their assumptions, and work towards eliminating cultural bias in order to understand their patients better and provide a more considerate, effective service.
4. Integration of Health Literacy and Cultural Awareness
The article concludes by underscoring the need to integrate healthcare delivery, public health, health policy, and education for the promotion of a health literate society. It explains that the alignment of research, policy, and practice in health literacy with strategic and interdisciplinary educational efforts will ultimately advance the integration of health literacy and cultural awareness in the provision of patient-focused care. As such, public health plays a leadership role in convening multi…
The article explains that the complexity and specificities of the U.S. healthcare system can deter collaboration on the part of healthcare providers. It also points out that the education and training for enhancing health literacy and cultural awareness are fragmented across various industries and academic disciplines.
Also, the article explores the link between patient-provider communication and health literacy. It defines health literacy as the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The article emphasizes the critical role of effective communication education for healthcare providers. In practicing communication-focused care, providers use communication as a skill, tool, and intervention for eliciting patients’ health beliefs towards the process of mutual understanding and shared decision-making.
In this context, the article defines patient-focused care as the ability to provide care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. It highlights the importance of tailoring healthcare delivery to suit individual patients’ health literacy, cultural background, and health beliefs by constructing an enabling healthcare environment through the inclusion of self-care infrastructure that promotes patient education and active participation in their healthcare journey.
The final section of the article looks at the integration of health literacy and cultural awareness. It highlights the synergies between the two concepts and emphasizes the role they play in enhancing patient-provider communication. Additionally, it discusses how the integration of health literacy and cultural awareness can promote equity in healthcare access and outcomes.
4.1 Synergies between health literacy and cultural awareness
When it comes to patient-provider communication, “Health literacy and cultural awareness” highlights the importance of these two concepts integrating in healthcare. Health literacy, as defined in the previous section, is about an individual’s ability to gather and process health information. Cultural awareness, on the other hand, is the recognition of different cultural beliefs and customs. Moreover, the cultivation of cultural awareness includes recognizing cultural differences and embracing them. The very good example to illustrate the synergies between health literacy and cultural awareness is languages. According to California HealthCare Foundation, 53% of Californians speak a language other than English at home but “only 14% rated their ability to speak English as less than ‘very well.'” This proves the fact that people need more support in health information as communication, such as the language used for health information, is one of the key components of health literacy. On top of that, Dr. Michael Paasche-Orlow and Dr. Michael Cating in the article “Health literacy and cultural competence in clinical care” also proposed that the combined use of interpreters and translations can break down language barriers and promoted a “health literacy suitable user environment”. In addition, the article “Health literacy and cultural competence in clinical care” also states that suitable multimedia and translators can be more successful to convey information across different cultural and language groups. This revealed that the correct implementation of cultural awareness, a strategy referring to the understanding of different ethnic and language groups and having the ability to help them in health literacy progress, is essential to utilize health literacy resources to the highest level of productivity. Instead of recognizing the differences in race or ethnic, cultural awareness focuses on differences in knowledge and attributes. In fact, as magnified by the Journal of Medical regulation, professionals with different levels of health literacy may have different health practices and desired level of health empowerment. However, cultural awareness emphasizes on recognizing and respecting the values, beliefs and customs of populations, not judging them. It sets the stage for better understanding each other’s health traditions with health literacy resources. By doing so, cultural awareness can help to determine how health information is communicated and utilized. Health information can be tailored to meet patients’ beliefs and needs, and help them to make healthy decisions. On the other hand, health literacy is important to individual and societal progression that bothers about empowerment, cost containment and resource allocation in health industry. However, the increasing attention “Health literacy and cultural awareness” receives in United States is not yet sufficient due to the lack of research and data support. But signs of changes are obvious with the most recent initiatives in the collective national public health created by The National Prevention and Health Promotion Strategy. The term “cultural and linguistic competency” is given a prominent position as one of the priority item of the health promotion or disease prevention strategy. Well, this is another persuasive proof for the benefits of integrating health literacy and cultural awareness.
4.2 Enhancing patient-provider communication
The absence of viable patient-provider communication can prompt inappropriate diagnosis, unsuitable use of medications, and avoidable hospitalizations. Accordingly, improving patient-provider communication has been recognized as a key methodology to advance health literacy. There are various factors that can affect patient-provider communication. Patients who experience the ill effects of low health literacy typically face the challenge in understanding and acting on health information, which can lead to poor patient-provider communication. Correspondingly, healthcare professionals who need cultural awareness may be unequipped for guaranteeing patient-centered care when managing patients from various backgrounds. The ability to give quality care is fundamentally affected by the capacity of health professionals to perceive patients’ health literacy needs and involve patients in the decision-making process in a culturally sensitive way. To enhance patient-provider communication, both patients and health care professionals need to be engaged. Patients with low health literacy would benefit from communication strategies, for instance, repeat back strategy, whereby a patient repeating key information taught by the provider can help promote a more interactive and patient-centered communication. Furthermore, should encourage patients to bring their own note pads and pens with them to write down key information to help them remember the advice or treatment options discussed in the consultation. As for providers, in an situation where language barriers exist, the utilization of culture and language services is vital. All health care provider should receive proficient cultural competency training including training on understanding how health literacy and language needs affect the provision of quality care. By enhancing patient-provider communication through the utilization of techniques and workflows that streamline the communication process. For instance, an innovation system which allows patients to get to their electronic health record, for example, HealtheLife can be utilized. The innovative system permits patients to get to their health information from anyplace with an internet connection and also to schedule appointments and engage in virtual visits. Having the capacity to review and follow health progress and being proactively connected with their provider using the messaging feature may empower patients who experience low health literacy and support more fruitful patient-provider communication. Finally and above all, both patients and health care professionals should be open minded and respectful each other’s culture and beliefs. By establishing an environment where patients and providers are urged to be engaged in open communication and develop mutual respect for each other, we can have a significant improvement in patient-provider communication. Such a environment not only benefits patients with low health literacy, yet in addition promotes a culturally appropriate and patient-centered care delivery to all patients.
4.3 Promoting equity in healthcare access and outcomes
The integration of culturally responsive approaches is going to be influenced, in particular, by the capability and proficiency of the health workforce. Emerging evidence suggests that the development of a culturally competent workforce must involve the curriculum developers and accrediting bodies who set the standards of education, as well as policy makers and service planners who are involved in healthcare service and intervention designs. Such considerations signal the potential sustainable benefits of integration of health literacy and cultural awareness in the enhancement of quality care and health outcomes.
For example, in Australia, the National Health and Medical Research Council has developed the Cultural Respect Framework 2016-2026. This has been structured around the principles of culture, leadership, partnerships, workforce, quality and safety, responsiveness and equity and it aims to provide a strategic and coherent approach to supporting and strengthening cultural capability and responsiveness in health.
Processes that can contribute to the development and integration of these practices include cultural competency training for healthcare professionals, the involvement of members of the community in the planning and execution of health programs as well as adjustments to information and communication strategies to better reach and support people from a wide range of cultural and linguistic backgrounds.
Integrating cultural awareness and health literacy into healthcare service can be one strategy to addressing health disparities and promoting equity in healthcare access and outcomes. Such integration can assist healthcare organisations in tailoring their service to diverse population groups, reducing barriers to access and improving the responsiveness and quality of care. In addition, it can help to empower individuals to have more control over their own health and enable informed decision making.
Health literacy and cultural awareness are important contributors to promoting health equity in society. Not only do they affect the health outcomes and access to healthcare of individuals, but also the overall performance of the healthcare system. Disparities in health outcomes among vulnerable populations are often attributed to difficulties in accessing appropriate health services and complying with medical advice, which may be linked to low health literacy and cultural barriers.

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