What Do Health Literacy and Cultural Competence Have in Common? Calling for a Collaborative Health Professional Pedagogy

Abstract

Limited health literacy is recognized as contributing to racial/ethnic and other health disparities through mechanisms of poor understanding and adherence, as well as to limited access to health care. Recent studies have focused on interventions to address literacy gaps between patients and health care providers, focusing on communication techniques and redefining the responsibility for closing gaps. Cultural differences between patient and provider, if left unaddressed, have been shown to contribute to poor health outcomes through misunderstanding, value conflicts, and disparate concepts of health and illness. The dual challenges of limited health literacy and cultural differences are likely to increase with an expanding, increasingly diverse, and older population. There is evidence that training providers to attend to both issues can reduce medical errors, improve adherence, patient-provider-family communication, and outcomes of care at both individual and population levels. The two fields continue to have separate trajectories, vocabularies, and research agendas, competing for limited curricular resources. This article presents a conceptual framework for health professions education that attends simultaneously to limited health literacy and cultural differences as a coherent way forward in training culturally competent providers with a common skill-set to deliver patient-centered care that focuses on health disparities reduction.

Acknowledgments

The authors wish to acknowledge conference funding support by 2R13MD006056-02 (O. Carter-Pokras) from the National Institute on Minority Health and Health Disparities; comments by participants of the Third Annual Health Literacy Research Conference session, “Let's Talk: Health Literacy and Cultural Competency Researchers Working Together”; and “Cultural Competency and Health Literacy Primer: A Guide for Teaching Health Professionals and Students,” held on October 17 and 18, 2011, in Chicago, Illinois. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. We are especially grateful to Drs. Dorothy Castille and Michael Paasche-Orlow for their encouragement and support for bringing together experts in both fields for a productive and inspiring dialogue.