Poster Presentations (Group II)

BACKGROUND: Too often, people with the greatest health burdens have limited access to health information and limited ability to process that information. Immigrant and refugee groups as well as low income, ethnic minority populations are at greater risk for increased debilitation due to chronic illnesses such as diabetes and hypertension partly due to such limitations. SIGNIFICANCE: Health literacy is increasingly recognized as an important factor in chronic disease outcomes for ethnically and economically diverse patient groups. While much research has been done on patient literacy and readability of patient education materials, less work has placed health literacy in the broader context of socioeconomic and cultural differences between patients and providers that hinder communication and compliance. In an NCI-funded project, The Impact of Culture on Health Literacy and Chronic Illness Outcomes, we explore cultural factors that influence health literacy, chronic disease management, and outcomes. This study generates new approaches to health disparities that integrate health literacy and cultural differences to develop recommendations for health care providers serving ethnically diverse and low-income populations. SETTING: An inner-city community health center whose mission is to provide culturally competent health care to low income, minority and immigrant populations. More than half of patient visits involve a medical interpreter. METHODS: Qualitative and quantitative data were collected over two years as part of a four-year prospective study. Bilingual/bicultural interviewers conducted formative focus groups with 50 patients from the four predominant ethnic groups (White, African American, Latino/Puerto Rican, Vietnamese) among the patient population. Baseline survey data with 400 patients diagnosed with diabetes and/or hypertension includes health literacy scores, chronic disease status, treatment adherence, and satisfaction with care. FINDINGS: These data identify the cultural factors and associated health beliefs that shape health literacy, health seeking behaviors, and treatment compliance. Variation in health literacy across ethnic groups will be correlated with chronic disease outcomes to demonstrate the effect of culture on health literacy and chronic disease management. RECOMMENDATIONS: Based on these findings, recommendations for providers will focus on provider practices to increase patient-provider communication and maximize patient adherence by incorporating an understanding of the role of cultural health beliefs and health literacy in chronic disease management.