Poureslami Iraj M, Rootman Irving, Balka Ellen, Devarakonda Rajashree, Hatch James, Fitzgerald J Mark
Institute for Health Promotion, University of British Columbia, Vancouver.
MedGenMed. 2007 Aug 21;9(3):40.
Asthma is one of the most common inflammatory lung diseases and its prevalence and incidence have increased in many developed and developing countries. Asthma places a heavy burden on healthcare expenditures and productivity, which in turn diminishes the quality of life of the individuals involved as well as their families. The goal of improving a patient's knowledge about asthma management should include the enhancement of the individual's skills with the hopeful outcome of improving how the individual manages the condition. However, when health professionals prepare a training program, they are faced with the challenging cosmopolitan reality of individuals with different ethnic backgrounds.
In order to find links between asthma and health literacy in a cultural/ethnicity perspective, we performed a systematic review of all publications on the topic of asthma, health, and literacy among cultural groups from 1980 to 2006 using the Internet and journals: Medline (Ovid), ERIC, EMBASE, PsycINFO, Google, Google Scholar, Sociological Abstracts, and Anthropology Plus. Key words included the following: "asthma," "culture," "ethnicity," "literacy," "health," "health literacy," "health beliefs," "adults," "disease management," "chronic condition," "ethnocultural groups," "minority groups," and "newcomers/immigrants."
More than 650 articles were initially identified in our review; 65 met our inclusion criteria. From these, we examined the factors related to asthma and literacy/health literacy with a cultural lens. All of these are categorized and summarized below. We chose what we considered to be the most relevant and important articles/documents in the research literature to date. Because many of the studies were qualitative, a formal meta-analytic review was not undertaken. We found that current asthma management techniques - including patient education - are not culturally sensitive, linguistically sensitive, or relevant, which creates further difficulties for ethnocultural communities and minority groups in many Western countries. In this systematic review, several themes were identified, including: approaches to language limitation and cultural barriers; the recognition of healthcare system bias (in terms of culturally competent care); and relationship-building to facilitate participatory decision-making by both provider and patient. This review provides further understanding and considerations regarding the beliefs and perspectives of care providers and populations in relation to health and illness, literacy and health literacy, and their association with asthma among ethnocultural communities.
There is an urgent need to better define the impact of cultural and ethnic issues in the management of asthma in Canada. Appropriately designed studies should better define the barriers in the optimal delivery of asthma care influenced by these parameters.
哮喘是最常见的炎症性肺部疾病之一，在许多发达国家和发展中国家，其患病率和发病率都有所上升。哮喘给医疗保健支出和生产力带来了沉重负担，进而降低了患者及其家庭的生活质量。提高患者对哮喘管理的认识的目标应包括提高个人技能，以期改善个人对病情的管理方式。然而，当卫生专业人员制定培训计划时，他们面临着不同种族背景的个体这一具有挑战性的国际化现实。
为了从文化/种族角度找出哮喘与健康素养之间的联系，我们使用互联网和期刊对1980年至2006年间文化群体中有关哮喘、健康和素养主题的所有出版物进行了系统综述，这些期刊包括：医学在线（Ovid）、教育资源信息中心（ERIC）、荷兰医学文摘数据库（EMBASE）、心理学文摘数据库（PsycINFO）、谷歌、谷歌学术、社会学文摘数据库和人类学加数据库。关键词包括：“哮喘”、“文化”、“种族”、“素养”、“健康”、“健康素养”、“健康观念”、“成年人”、“疾病管理”、“慢性病”、“种族文化群体”、“少数群体”以及“新移民”。
在我们的综述中，最初识别出650多篇文章；65篇符合我们的纳入标准。我们从文化角度研究了与哮喘和素养/健康素养相关的因素。所有这些因素分类总结如下。我们选择了我们认为是迄今为止研究文献中最相关和最重要的文章/文献。由于许多研究是定性研究，因此未进行正式的荟萃分析综述。我们发现，当前的哮喘管理技术——包括患者教育——在文化上不敏感、语言上不敏感且不相关，这给许多西方国家的种族文化社区和少数群体带来了更多困难。在这项系统综述中，确定了几个主题，包括：语言限制和文化障碍的应对方法；对医疗保健系统偏见的认识（在文化胜任力护理方面）；以及建立关系以促进提供者和患者的参与式决策。该综述进一步理解并考虑了护理提供者和人群在健康与疾病、素养与健康素养方面的信念和观点，以及它们在种族文化社区中与哮喘的关联。
迫切需要更好地界定文化和种族问题在加拿大哮喘管理中的影响。设计合理的研究应更好地界定受这些参数影响的哮喘最佳护理提供中的障碍。
