Academic journal article Journal of Cultural Diversity

Overcoming Health Literacy Barriers: A Model for Action

Academic journal article Journal of Cultural Diversity

Overcoming Health Literacy Barriers: A Model for Action

Article excerpt

Abstract: A large influx of Indonesian immigrants seeking asylum from racial and religious persecution into our hospital service area alerted providers to the need for specific cultural knowledge about this ethnic group, and to develop new skill sets to effectively care for this population. Health education programs that provide knowledge and tools to overcome misunderstandings that arise from differences between provider and client expectations for behavior will be most effective in overcoming the health literacy barriers that so often contribute to health disparities. Aframework to understand factors that affect health literacy for local Indonesian asylum seekers guided community health education, while the written educational material for programs informed providers about health literacy barriers for this population. Community outreach engaged local pastors and interpreters as cultural brokers to collaborate with nurses to develop and implement culturally sensitive programs that are socially sensitive to the local Indonesian refugee population.

Key Words: Health Literacy, Barriers to Health Literacy, Model for Action

Building a health literacy program requires an understanding of the cultural and sociopolitical constructs impacting health behavior. A literature review provides answers to the following questions: What sources of support and guidance are used by refugees and asylum seekers? What is the impact of immigration status on access and utilization of nealth care? What evidence exists for successful health program development or service provision for non-citizen immigrant populations? A framework for an approach to health literacy education emerged from analysis and synthesis of the literature review.


Past Trauma and Present Perceptions

Refugees may question the motives of health professionals and commonly fear they are associated with law enforcement, immigration officials, or other government agencies. Nonverbal cues, provider age, gender, demeanor, reactions or responses to "tests" about motivation in working with refugees, projection of acceptance, caring and respect impact client willingness to disclose information. Engaging in dialogue, encouraging the client to share experiences, including the reason for seeking asylum and demonstrating sensitivity to and providing assistance with needs are provider behaviors that project a caring presence (Behnia, 2001 as cited in Behnia, 2004). The presence of culturally congruent artifacts in the health care setting can allay tension (Behnia, 2004).

Transnational communities establish a vehicle for continuance of cultural beliefs and traditional practices in a new country. These networks contain the same sense of familial obligation and helping tradition that exist in a collectivistic family living in a geographical area: linking individuals with jobs or human contacts in new areas; assisting in finding housing; providing financial assistance; and giving advice on suitable relocation sites. When a community provides a satisfactory quality of life, this information is shared through transnational networks. Families and friends migrate to the area. Large concentrations of immigrants from one country provide a sense of familiarity and reduce the stress of living in a new country. Local relationships between immigrants may also transcend ethnic background or country of origin as a sense of community develops between asylum seekers residing in a geographic location. These networks constitute "strong ties" (Williams, 2006).

Some asylum seekers do not identify with transnational communities due to differences of social class, or because they were marginalized in their own country due to political or social issues or because they wish to keep their location secret from home authorities. Yet, relationships develop with local residents, and local public officials are a source of information. …

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