An Intercultural Study in Health Literacy and Adherence among Patients with Diabetes

Abstract

Health Literacy is believed to play an essential role in the ability of individuals to effectively manage their own health care. A report by the Institute of Medicine acknowledges that 90 million Americans with low literacy probably also have low health literacy, and that even individuals with adequate health literacy face challenges in the complex demands of health care contexts. This poster presents results of a 3-year study of an interdisciplinary project on health literacy and adherence at the Indiana Center for Intercultural Communication (ICIC) funded by the Eli Lilly & Co. Foundation. The purpose was to examine multiple dimensions of health literacy, based on patients’ perspectives (van Dulmen et al., 2008), with the goal of creating a new conceptualization and way of assessing health literacy in its broader sense that includes processing and acting on information in order to integrate those findings into interventions to improve health regimen adherence. Taking critical studies into account, we developed a model to identify the most important variables of adherence (Nutbeam, D., 2000; Levin-Zamir, D. and Peterburg, Y., 2001; Von Wagner, C., Steptoe, A., Wolf, M., and Wardle, J., 2008). The data consisted of video-taped interviews with 43 English-speakers and 21 Spanish-speakers, all of whom have diabetes. The interviews involved open-ended questions that elicited information about living with diabetes as well as questions on health beliefs, medication adherence, information sources and uses, literacy level and basic demographic information. These narratives were analyzed using grounded theory methodology of the patients’ own words. The quantitative data were analyzed using a multivariate analysis as well as an ordered probit analysis (Connor, U., et al., 2008, 2009, 2010; Lauten, K., et al., 2009, 2010; Lopez-Yunez, A., et al., 2009; Matthias, M.S. & Goering, E., 2008; Rozycki, W. & Connor, U., 2008; Wolf, M.S., et al, 2007). The model that ICIC has built provides practical interventions for patient-centered care. This poster presents examples of linguistic cues and phrases from the interviews, the results of the intercultural comparisons between which information sources were used in the English-speaking and Spanish-speaking subgroups, and the resultant model. Implications are discussed in terms of enhancing the patient-centered tailoring of health information and communication.