National Information Center on Health Services Research and Health Care Technology (NICHSR)
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Health Literacy and Cultural Competence
Health Literacy is defined in the National Library of Medicine's Current Bibliographies in Medicine: Health Literacy as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Selden, Zorn, Ratzan, Parker, 2000)
Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.” (at Center for Linguistic and Cultural Competence in Health Care, cited 11/13/2013)
A specialized search for published research in PubMed has been developed to help inform investigations of health literacy. An extensive list of health literacy resources is also featured on this website.
- The "SMOG" Readability Test - (University of South Carolina. Arnold School of Public Health USA) - This tool assists in the assessment of readability in written documents.
- CMS Health Literacy Toolkit - (Centers for Medicare & Medicaid Services (CMS)) - Provides a detailed and comprehensive set of tools to help make written material in printed formats easier for people to read, understand, and use.
- Cultural and Linguistic Competence: Additional AHRQ and HHS Resources - (Agency for Healthcare Research and Quality (AHRQ)) - This series of resources is geared for policymakers.
- Cultural Competency - (Office of Minority Health (OMH)) - Resources on cultural comptency and removing language and cultural barriers to health care for limited English-speaking populations.
- Culture, Language and Health Literacy - (Health Resources and Services Administration (HRSA)) - This collection of resources, including toolkits, videos, and workbooks, is aimed at healthcare providers, to enable them to better address the cultural, language and health literacy needs of their consumers.
- Fry's Readability Graph - (Iowa Department of Public Health) - This tool assists in assessing document readability.
- Gunning-FOG Formula - (Iowa Department of Public Health) - This tool provides a calculation for assessing document readability.
- Health Communication, Health Literacy, and e-Health - (Office of Disease Prevention and Health Promotion, HHS (ODPHP)) - The Office of Disease Prevention and Health Promotion (ODPHP) has pulled together key tools, research and reports, and resources for public health and health communication professionals.
- Health Literacy Activities by State - (Centers for Disease Control and Prevention (CDC)) - This set of links provides information on local organizations and local government activities in the area of health literacy.
- The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy - (National Center for Educational Statistics (NCES) USA) - The report uses four performance levels to report health literacy: Below Basic, Basic, Intermediate, and Proficient.
- Health Literacy Online - (Office of Disease Prevention and Health Promotion, HHS (ODPHP)) - Guide for writing and designing easy-to-use health websites.
- Health Literacy Universal Precautions Toolkit - (Agency for Healthcare Research and Quality (AHRQ)) - This toolkit is designed to assist primary care practices by providing a method to assess their services for health literacy considerations, raise awareness of the entire staff, and work on specific problem areas.
- Health Literacy: Accurate, Accessible and Actionable Health Information for All - (Centers for Disease Control and Prevention (CDC)) - Information and tools to improve health literacy and public health.
- MEDLINE/PubMed Search and Health Literacy Information Resources - (National Library of Medicine (NLM) U.S.) - This structured search will assist the user in formulating a detailed search within the MEDLINE/Pubmed database. The website also contains a list of important resources concerning health literacy.
- National Action Plan to Improve Health Literacy - (Department of Health and Human Services (HHS) U.S.) - The National Action Plan to Improve Health Literacy seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked, multisector effort to improve health literacy.
- The Newest Vital Sign: A New Health Literacy - Assessment Tool for Health Care Providers - Available in English and Spanish, this health literacy tool was developed by researchers at University of Arizona College of Medicine and the University of North Carolina.
- Pubmed Health: Health Literacy - (National Library of Medicine (NLM) U.S.) - PubMed Health provides access to reviews of clinical effectiveness research, in this case relevant to health information literacy.
- Quick Guide to Health Literacy - (Office of Disease Prevention and Health Promotion, HHS (ODPHP)) - Provides an overview of health literacy concepts and techniques for improving health literacy. Designed for government employees, grantees and contractors, and community partners working in healthcare and public health fields. The tools can be applied to healthcare delivery, policy, administration, communication, and education activities aimed at the public.
- Rapid Estimate of Adult Literacy in Medicine revised, shorter version (REALM-R) - (Agency for Healthcare Research and Quality (AHRQ)) - This test is a brief screening instrument used to assess an adult patient's ability to read common medical words.
- Simply Put: A guide for creating easy-to-understand materials - (Centers for Disease Control and Prevention (CDC)) - This toolkit assists in transforming complicated scientific and technical information into materials more easily understood by a variety of health audiences.
- Tool for Health Plans to Assess their Health Literacy Programs - (America's Health Insurance Plans (AHIP)) - Developed by Emory University researcher Dr. Julie Gazmararian, working with the AHIP Health Literacy Task Force, this tool allows health plans to assess their health literacy programs and to use the assessments in the development and advancement of their initiatives.
- Understanding and Promoting Health Literacy (R01) - (National Institutes of Health (NIH)) - The goal of this program announcement is to encourage methodological, intervention and dissemination research for understanding and promoting health literacy.
- Understanding and Promoting Health Literacy (R21) - (National Institutes of Health (NIH)) - The goal of this program announcement is to encourage methodological, intervention and dissemination research for understanding and promoting health literacy.
- AHRQ Pharmacy Health Literacy Assessment Tool User's Guide - (Agency for Healthcare Research and Quality (AHRQ)) - This site provides pharmacists with recently released health literacy tools and other resources from AHRQ.
- Becoming a Culturally Competent Health Care Organization - (Health Research and Educational Trust (HRET)) - This guide describes the benefits, steps and educational techniques of becoming culturally competent.
- Consumer Health Informatics Research Resources: Health Literacy - (National Library of Medicine (NLM) U.S.) - CHIRr provides a resource of outcome variables and suggested measures to guide a comprehensive consumer health informatics assessment.
- Designing Health Literate Mobile Apps - (Institute of Medicine (IOM)) - This discussion paper presents a case study to assist developers in creating health literate mobile apps.
- Enhanced National CLAS Standards and The Blueprint with guidance and implementation strategies. - (Office of Minority Health (OMH)) - CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.
- The Evidence Base for Cultural and Linguistic Competency in Health Care - (Commonwealth Fund) - This study, which includes an introductory video, examines the literature for the evidence of cultural and linguistic competence affecting health and mental health outcomes.
- Health Literacy Fact Sheets - (Center for Health Care Strategies (CHCS) USA) - This series of fact sheets was developed to assist clinicians, patient advocates, and other stakeholders in improving care for individuals with low health literacy.
- Health Literacy Implications of the Affordable Care Act - (Center for Health Care Strategies (CHCS) USA) - This paper looks at health literacy as a major component in the implementation of the Affordable Care Act.
- Health Literacy Interventions and Outcomes: An Updated Systematic Review - (Agency for Healthcare Research and Quality (AHRQ)) - Released in March of 2011, this update of the 2004 systematic review looks at health care service use and health outcomes related to differences in health literacy level.
- Health Literacy: A Prescription to End Confusion - (Institute of Medicine (IOM)) - This book, from 2004, presents a series of recommendations to promote health literacy.
- Leveraging Culture to Address Health Inequalities: Examples from Native Communities - Workshop Summary - (Institute of Medicine (IOM)) - Held November 14, 2012, this workshop examined the health inequalities affecting Native American, Alaska Native, First Nation, Native Hawaiians, and Pacific Islander populations, and the ways in which culture could help reduce those disparities.
- Literacy and Health in America - (Educational Testing Service (ETS) USA) - This policy information report from 2004 builds on two prior reports to demonstrate the effects of literacy on health status.
- Research-based Health Literacy Materials and Instruction Guide - (National Institute for Literacy US) - These health literacy materials meet both the need of adults to enhance their literacy skills as well as their need to navigate the health care system and begin to achieve better health care for themselves and their families.
- Responding to Culture: Beyond Cultural Competence Training - (Robert Wood Johnson Foundation (RWJF)) - This issue brief examines the importance of culture to health care and health disparities.
- Cultural Competence Education - (Association of American Medical Colleges (AAMC)) - These educational standards were developed to introduce cultural competence into the medical curriculum.
- Health Literacy for Public Health Professionals - (Centers for Disease Control and Prevention (CDC)) - Free web-based course to educate public health professionals on the importance of health literacy and their role in providing health information and services and promoting public health literacy.
- Health Literacy Out Loud Podcasts - (Agency for Healthcare Research and Quality (AHRQ)) - This series of podcasts looks at various aspects of health literacy. The podcasts can be listened to here, or downloaded via ITunes.
- Health Literacy Special Collection: Tools and Resources for Health Literacy Initiatives - This collection serves as a starting point for finding health literacy resources to improve health literacy, improve health outcomes, and reduce disparities in health.
- Transforming the Face of Health Professions through Cultural and Linguistic Competence Education: The Role of the HRSA Centers of Excellence - (Health Resources and Services Administration (HRSA)) - A curriculum guide, this publication was published in 2005.
- Facilitating State Health Exchange Communication Through the Use of Health Literate Practices - Workshop Summary - (Institute of Medicine (IOM)) - Released February, 2012, from a workshop on July 19, 2011, this report examines the implications of health literacy on the Affordable Care Act. Without significant improvements in health literacy, nearly half of all Americans will find the selection of health insurance to be daunting.
- Health Literacy and Numeracy: Workshop Summary - (Institute of Medicine (IOM)) - The results of a workshop from July 18, 2013, this report looks at the issues surrounding numeracy in relation to health literacy.
- Health Literacy Out Loud - (Agency for Healthcare Research and Quality (AHRQ)) - Podcast Interviews with those in the know about health literacy.
- How Can Health Care Organizations Become More Health Literate?: Workshop Summary - (Institute of Medicine (IOM)) - This workshop, held in November of 2011, looks at the importance of the health care system in enhancing health literacy.
- Innovations in Health Literacy Research: Workshop Summary - (Institute of Medicine (IOM)) - This volume is the results of a workshop held May 27, 2010.
- Oral Health Literacy: Workshop Summary - (Institute of Medicine (IOM)) - The results of a workshop held March 29, 2012, this book examines the issues of oral health and health literacy.
- Proceedings of the Surgeon General's Workshop on Improving Health Literacy - (National Institutes of Health (NIH)) - Proceedings from workshop on health literacy held September 2006.
- Annual Health Literacy Conference - (Institute for Healthcare Advancement (IHA)) - The conference will be held on May 7-9, 2014, in Irvine, CA.
- Bringing Outcomes into Focus: Recognizing and Managing Low Health Literacy in Primary Care (Webinar) - (Med Learning Group USA)
- Health Literacy Leadership Institute - (Tufts University School of Medicine) - June 9 - 13, 2014, Tufts University School of Medicine, Boston, MA. This one-week institute is aimed at those working to improve patient-provider communication and healthcare quality, and those working directly with patients or adult learners in educational settings.
- Agency for Healthcare Research and Quality - AHRQ provides important resources aimed at improving health literacy as it pertains to prevention, healthy living, chronic disease management, patient-centered health care, cultural competence, and health disparities.
- Bridging the Health Literacy Gap - (Centers for Disease Control and Prevention (CDC)) - CDC's blog posts detailing important events on issues related to health literacy. Companion to the CDC's comprehensive Health Literacy site and resources
- Center for Linguistic and Cultural Competence - (Office of Minority Health (OMH)) - The mission of OMH is to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities and promote cultural competency, through the Center for Linguistic and Cultural Competence. OMH also supports the OMHRC Knowledge Center Library, an extensive searchable resource.
- Clear Communication: A NIH Health Literacy Initiative - (National Institutes of Health (NIH)) - The NIH Clear Communication Initiative focuses on tools and resources that address health literacy particularly as it relates to conveying scientific information and research: 1) Providing information in the form and with the content that is accessible to specific audiences based on cultural competence; and 2) Incorporating plain language approaches and new technologies.
- Eunice Kennedy Shriver National Institute of Child Health and Human Development - (National Institutes of Health (NIH)) - This agency explores health processes, and examines the impact of disabilities, diseases, and variations on the lives of individuals. As part of its mission, it supports and conducts research aimed at increasing health literacy and numeracy.
- Healthy People 2020: Health Communication and Health Information Technology - The Healthy People 2020 goals provide a science-based, 10-year national objectives for improving the health of all Americans. Among the goals are those aimed at 1)improving the health literacy of the population, and 2)increasing the proportion of persons who report that their health care providers have satisfactory communication skills.
- IoM Roundtable on Health Literacy - (Institute of Medicine (IOM)) - This Roundtable is comprised of representatives from academia, industry, government, foundations, and associations, as well as from patient and consumer interests.
- National Center for Cultural Competence - (National Center for Cultural Competence (NCCC)) - The National Center for Cultural Competence (NCCC) provides national leadership and contributes to the body of knowledge on cultural and linguistic competency within systems and organizations. Major emphasis is placed on translating evidence into policy and practice for programs and personnel concerned with health and mental health care delivery, administration, education and advocacy.
- Office of Behavioral and Social Science Research - (National Institutes of Health (NIH)) - The mission of this office is to stimulate behavioral and social sciences research throughout NIH and to integrate these areas of research more fully into others of the NIH health research enterprise, thereby improving our understanding, treatment, and prevention of disease.
- Office of Minority Health (OMH) - (Department of Health and Human Services (HHS) U.S.) - The mission of the Office of Minority Health (OMH) is to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities. Detailed information on cultural competency can be found on this site.