Pathy's Principles and Practice of Geriatric Medicine. Группа авторов
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CHAPTER 8 Health literacy and cultural sensitivity
Nina Tumosa
Health Resources and Services Administration, Rockville, MD, USA
Author’s disclaimer: The views expressed in this chapter are solely those of the author and do not represent the perspectives of the Health Resources and Services Administration or the US Department of Health and Human Services, or the United States Government.
Additional disclaimer: This publication lists non‐federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the US Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither the HHS nor the HRSA endorses the products or services of the listed resources.
Introduction
Cultural differences between patient and provider can lead to misunderstandings, value conflicts, and disparate understandings of health and illness. Low health literacy leads to poor understanding and adherence and often limits access to health care. Together, low levels of health literacy and a lack of cultural sensitivity can severely impact health outcomes.1 Dramatic shifts in population demographics may be due to migration or the natural demographic shifts of an ageing society. A dramatic example of the effects of migration on the ethnicity of a population occurred in the United Kingdom (UK). In the 1950s, Bethnal Green, an area in London, was a predominantly white, working‐class neighbourhood. In the 1990s, its name had changed to Tower Hamlet, and it had become the home of large numbers of Bangladeshi immigrants. In 2018, Tower Hamlets had the lowest life expectancy and the highest rate of heart disease in all the London boroughs.
Religion offers another measure of population diversity. Wolverhampton, in the West Midlands, UK, has significant multicultural diversity in religious preference. The population identifies as 55.5% Christian, 19.7% no religion, 9.1% Sikh, 3.7% Hindu, 3.6% Muslim, and 0.4% Buddhist. Language also plays a role in maintaining low health literacy: over 800 languages are spoken in New York City, and Mandarin is the language spoken by the largest number of people worldwide. London, Leicester, Luton, Slough, and Birmingham, UK currently have a greater than 50% ethnic minority population versus a white British majority.
Changes such as these require training programmes for health professionals in how beliefs of different cultures may impact the interactions between older people and their health care providers. These changes have resulted in the need for geriatrics health professionals to be aware of cultural differences between their patients and their varying levels of health literacy. They must also be aware of how these cultural differences and health literacy levels might impact the care that their patients receive and accept.2 For example, older migrants are often non‐adherent with medications, resulting from interactions between illness perceptions, low health literacy, language barriers, and disadvantaged socioeconomic circumstances, which can sometimes restrict the ability to purchase prescribed medications.3