University of Miami, Coral Gables, FL, 33146, USA.
Emerson College, Boston, MA, 02116, USA.
Soc Sci Med. 2024 Sep;356:117150. doi: 10.1016/j.socscimed.2024.117150. Epub 2024 Jul 16.
Extensive evidence of health disparities and systemic racism has prompted scholars to examine constructs that may account for differences in the burden of disease. One such construct is health literacy, which has been posited to have four components: print literacy, oral literacy, numeracy, and cultural and conceptual knowledge. Consistent with historical trends related to culturally based constructs, the latter component has garnered the least attention in the published literature, despite its pervasive influence on health care outcomes. We engage in a reformulation and conceptual analysis of cultural and conceptual knowledge, defined as the filter through which individuals obtain, process, and understand health information and options for diagnosis and treatment. We propose the construct of cultural schema, and operationalize the construct as having cognitive (knowledge, beliefs) and affective (attitudes, emotions) components. As we strive to achieve a more complex understanding of influences on behavioral outcomes, a greater focus on these culturally based factors is essential. In this article, we present a conceptual analysis that seeks to advance the field by: (a) providing distinct definitions for each component that can be applied across fields of study and theoretical frameworks, (b) offering measurement considerations consistent with their conceptualizations, and (c) making recommendations for future theory, research, and practice. We hope that with greater conceptual and measurement clarity of cultural schema, more consistent results will be obtained, constructs and processes that affect health outcomes will be identified, and more personalized intervention will be possible, optimizing the limited resources available for health promotion efforts.
大量的健康差异和系统性种族主义的证据促使学者们研究可能导致疾病负担差异的构建。其中一个构建是健康素养，它被认为有四个组成部分：印刷素养、口头素养、计算素养和文化与概念知识。与基于文化的构建相关的历史趋势一致，尽管它对医疗保健结果有普遍影响，但后者在已发表的文献中受到的关注最少。我们对文化和概念知识进行了重新表述和概念分析，将其定义为个体获取、处理和理解健康信息以及诊断和治疗选择的过滤器。我们提出了文化图式的概念，并将其操作化为认知（知识、信仰）和情感（态度、情感）两个组成部分。在我们努力更深入地了解对行为结果的影响时，更关注这些基于文化的因素至关重要。在本文中，我们进行了概念分析，旨在通过以下方式推动该领域的发展：（a）为每个组成部分提供可应用于各个研究领域和理论框架的明确定义；（b）根据其概念化提供测量考虑因素；（c）为未来的理论、研究和实践提供建议。我们希望通过更明确的文化图式的概念和测量清晰度，获得更一致的结果，确定影响健康结果的结构和过程，并实现更个性化的干预，从而优化用于促进健康的有限资源。
