Department of Family Medicine, Keck School of Medicine, University of Southern California, Alhambra, California 91803, USA.
J Health Commun. 2012;17 Suppl 3(0 3):13-22. doi: 10.1080/10810730.2012.712625.
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.
有限的健康素养被认为是导致种族/民族和其他健康差异的原因之一,其机制包括理解和遵守能力差,以及获得医疗保健的机会有限。最近的研究集中在解决患者和医疗保健提供者之间的读写能力差距的干预措施上,重点是沟通技巧和重新定义缩小差距的责任。如果不解决患者和提供者之间的文化差异,可能会导致误解、价值冲突以及对健康和疾病的不同概念,从而导致不良的健康结果。有限的健康素养和文化差异的双重挑战可能会随着人口的扩大、日益多样化和老龄化而增加。有证据表明,培训提供者关注这两个问题可以减少医疗错误,提高患者的依从性、医患家庭沟通以及个人和人群层面的护理效果。这两个领域继续沿着各自的轨迹发展,使用不同的词汇和研究议程,争夺有限的课程资源。本文提出了一个卫生专业教育的概念框架,同时关注有限的健康素养和文化差异,为培养具有共同技能的文化能力提供者提供了一个连贯的方法,以提供以关注健康差异减少为重点的以患者为中心的护理。