health literacy barriers, as well as ‘Plain Language’ resources, the tools and resources on ‘Visual Communication‘, and ‘Testing Messages and Materials’ to ensure that health information is accurate, accessible and actionable.
Cultural competence in health care
Cultural sensitivity is a powerful strategy that health care providers can use to help reduce the negative impact of cultural differences on health outcomes. The following is a partial list of web‐based resources that may be useful. A more complete list can be accessed through search engines using keywords such as cultural diversity, cultural competence, explanatory model, health promotion programs, and disease self‐management.
Diversity Rx (http://www.diversityrx.org/topic‐areas/cultural‐competence‐101): This portion of the www.diversityrx.org website promotes language and cultural competence to improve the quality of health care for minority, immigrant, and ethnically diverse communities. It describes how language and culture affect the delivery of quality services to ethnically diverse populations and provides resources to enable providers to learn about language and cultural competence in health care, design better programs and policies, and network with colleagues and experts. It also provides information on working with an interpreter and gives examples of model programs.
American Hospital Association (AHA) Institute for Diversity and Health Equity Disparities Toolkit (www.ifdhe.aha.org/hretdisparities.toolkit): A web‐based toolkit that provides guidance on collecting patient race, ethnicity, and primary language data. The free toolkit includes resources on collecting data from patients, training staff, and addressing legal and privacy concerns. The toolkit identifies the patient’s preferred method of communication, any potential language barriers, and the patient’s culture. With this information, the provider can enlist any outside assistance needed to ensure proper patient–provider communication. The toolkit is designed to educate and inform staff about the importance of data collection, how to implement a framework to collect race, ethnicity, and primary language data, and ultimately how to use these data to improve quality of care for all populations.
EthnoMed (http://ethnomed.org): Focuses on information about cultural beliefs, medical issues, and other related issues pertinent to the health care of recent immigrants to the United States, many of whom are refugees. Cultural profiles are provided for 16 different cultures. The website offers videos in many languages on taking basic medical histories with interpreters. Hyperlinks on this site may be useful when provider and patient languages differ. Disease‐specific patient education materials are provided in 25 different languages.
Health promotion programs
Caring for Caregivers (https://www.cdc.gov/aging/caregiving/index.htm): As the number of older adults increases, so will the number of caregivers needed to provide daily care or assistance to a person with a long‐term illness or disability. This is especially true for older adults who are experiencing cognitive decline. This website provides English and Spanish instructions for developing a daily care plan (https://www.cdc.gov/aging/caregiving/pdf/Complete‐Care‐Plan‐Form‐508.pdf) and lists important resources.
Family Caregiving Alliance National Center on Caregiving Learning Center (https://www.caregiver.org/caregiver‐resources): An online learning community offering information, training, classes, and more to busy caregivers on their own schedule. The website offers articles, fact sheets, videos, webinars, family‐friendly publications, and slide shows that are relevant to caregivers. Facts and tip sheets cover health topics, caregiving issues and strategies, and statistics and demographics. Selected tip sheets are provided in six languages: English, Spanish, Chinese, Korean, Vietnamese, and Tagalog.
MOVE! (http://www.move.va.gov): A national weight management program designed by the US Department of Veterans Affairs (VA). This program is designed to help veterans lose weight, keep it off, and improve their health. The entire program, from philosophy to handouts, from motivational messages to references, can be found on the Internet and is free. The website has sections for both patients and providers in English and Spanish. There is a patient recruitment message about why this program is important to health and well‐being, followed by questionnaires to help patients determine their degree of readiness to participate in the program. Multiple handouts address barriers that patients may face, such as depression, lack of time, and boredom. These handouts offer solutions to those barriers.
There are instructions for providers about administering the patient questionnaire and how to run successful group sessions. Reference tools are well labelled and accessible and include discipline‐specific information on such topics as nutrition, physical activity, medications, and surgery. Links to recommendations for preventive services, such as screening tests and immunisation, can also be accessed from this website.
Chronic Disease Self‐Management Education (https://www.ncoa.org/article/evidence‐based‐chronic‐disease‐self‐management‐education‐programs): In the United States, about 80% of older adults have at least one chronic conditions, and 68% have at least two chronic conditions. Stanford University developed a suite of chronic disease self‐management programs covering general health, diabetes, arthritis, and enhancing wellness to educate older adults on how to manage those conditions themselves. Trainings are delivered in a variety of settings such as senior centres, churches, libraries, and hospitals. People with different chronic health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are non‐health professionals who have a chronic disease. Subjects covered include (i) techniques to deal with problems such as frustration, fatigue, pain, and isolation; (ii) appropriate exercise for maintaining and improving strength, flexibility, and endurance; (iii) appropriate use of medications; (iv) communicating effectively with family, friends, and health professionals; (v) nutrition; and (vi) how to evaluate new treatments.
It is the process in which the programme is taught that makes it effective. Classes are highly participative, and mutual support and success build the participants’ confidence in managing their health and maintaining active and fulfilling lives. Courses are offered in multiple modes and in both English and Spanish.
Key points
Individuals with limited health literacy have less access to health knowledge, worse self‐management skills, less frequent use of preventive services, higher hospitalisation rates, and more premature mortality than individuals with adequate health literacy.
Medicine is a culture that is not easily understood by, and often intimidates, older adults.
Common areas of cultural conflict between provider and older adult that negatively impact health care delivery include misunderstandings about the role of the family in the patient’s care, lack of common verbal and non‐verbal communication styles, misconceptions about cultural norms, and ageism by both the older adult and the provider.
Health literacy in older adults can be improved by using written material that is in the primary