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cultural backgrounds, health literacy is affected by belief systems, communication styles,
and understanding and response to health information. Even though culture is only one part
of health literacy, it is a very important piece of the complicated topic of health literacy. The
United States Department of Health and
Human Services (HHS) recognizes that
“culture affects how people communicate,
understand and respond to health
information.”
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The National Assessment of Adult Literacy
(NAAL) measures the health literacy
of adults living in the United States.
Health literacy was reported using four
performance levels: Below Basic, Basic,
Intermediate, and Proficient. According to
the NAAL, there is a relationship between
health literacy and race or ethnicity. White
respondents scored better on the survey
than other ethnic or racial groups. Only
9% of White respondents scored at the
lowest (Below Basic) level. However,
24% of Blacks, 41% of Hispanics, 13% of
Asians, and 25% of American Indian and
Native Alaskan respondents scored at the
“Below Basic” level.
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Adults living below
the poverty level have lower average
health literacy than adults living above the poverty threshold. In adults who receive Medicaid,
30% have “Below Basic” health literacy.
Schillinger and associates found that among primary care patients with Type 2 diabetes,
inadequate health literacy is independently associated with worse glycemic control and higher
rates of retinopathy and that inadequate health literacy may contribute to the disproportionate
burden of diabetes-related problems among disadvantaged populations.
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Motivation to Change Behaviors
Weight Control
We still know very little about how to control weight over the long term, and we know
even less about how to control weight among African Americans and other ethnic minority
populations. Studies to identify effective strategies for obesity prevention and treatment in
Black and other minority communities are just emerging. Dr. Shiriki Kumanyika, a Black
Professor of Epidemiology at the University of Pennsylvania School of Medicine, notes
that “studies from which a direct comparison can be made between weight loss results
for Black and White participants suggest that the best treatments do not work as well
in Blacks as in Whites.
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One metanalysis of 25 published studies of Black women and
weight loss shows that Black women lose less weight than other subgroups in behavioral
weight loss interventions.
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Likewise, researchers have noted that traditional weight-loss
H
ealth literacy is the ability to
grasp and apply instructions
given by the provider. For Blacks,
Native Americans and Alaskans, about
25% score “below basic” in health
literacy; 41% of Hispanics also score
“below basic.” A lack of health literacy
has been independently associated
with an increase in diabetes related
pathology. Relevant, effective
instructional tools and support
become critical for patient compliance.