Evaluate the implications of individual culture on health literacy and the role of the DNP in providing opportunities to improve levels of knowledge.
DNP 825 Topic 8 Discussion Question Two

Evaluate the implications of individual culture on health literacy and the role of the DNP in providing opportunities to improve levels of knowledge. Why is this relevant to the DNP and population health?

Impact of culture on health
Health is a cultural concept because culture frames and shapes how we perceive the world and our experiences. Along with other determinants of health and disease, culture helps to define:

How patients and health care providers view health and illness.
What patients and health care providers believe about the causes of disease. For example, some patients are unaware of germ theory and may instead believe in fatalism, a djinn (in rural Afghanistan, an evil spirit that seizes infants and is responsible for tetanus-like illness), the ‘evil eye’, or a demon. They may not accept a diagnosis and may even believe they cannot change the course of events. Instead, they can only accept circumstances as they unfold.DNP 825 Topic 8 Discussion Question Two
DNP 825 Topic 8 Discussion Question Two

Which diseases or conditions are stigmatized and why. In many cultures, depression is a common stigma and seeing a psychiatrist means a person is “crazy”.
What types of health promotion activities are practiced, recommended or insured. In some cultures being “strong” (or what Canadians would consider “overweight”) means having a store of energy against famine, and “strong” women are desirable and healthy.
How illness and pain are experienced and expressed. In some cultures, stoicism is the norm, even in the face of severe pain. In other cultures, people openly express moderately painful feelings. The degree to which pain should be investigated or treated may differ.
Where patients seek help, how they ask for help and, perhaps, when they make their first approach. Some cultures tend to consult allied health care providers first, saving a visit to the doctor for when a problem becomes severe.
Patient interaction with health care providers. For example, not making direct eye contact is a sign of respect in many cultures, but a care provider may wonder if the same behaviour means her patient is depressed.
The degree of understanding and compliance with treatment options recommended by health care providers who do not share their cultural beliefs. Some patients believe that a physician who doesn’t give an injection may not be taking their symptoms seriously.
How patients and providers perceive chronic disease and various treatment options.
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Culture also affects health in other ways, such as:

Acceptance of a diagnosis, including who should be told, when and how.
Acceptance of preventive or health promotion measures (e.g., vaccines, prenatal care, birth control, screening tests, etc.).
Perception of the amount of control individuals have in preventing and controlling disease.
Perceptions of death, dying and who should be involved.
Use of direct versus indirect communication. Making or avoiding eye contact can be viewed as rude or polite, depending on culture.
Willingness to discuss symptoms with a health care provider, or with an interpreter being present.
Influence of family dynamics, including traditional gender roles, filial responsibilities, and patterns of support among family members.
Perceptions of youth and aging.
How accessible the health system is, as well as how well it functions.
What health professionals can do
Health care providers are more likely to have positive interactions with patients and provide better care if they understand what distinguishes their patients’ cultural values, beliefs and practices from their own.

The following suggestions may help you care for and communicate with patients who are new to Canada:3,4

Consider how your own cultural beliefs, values and behaviours may affect interactions with patients. If you suspect an interaction has been adversely affected by cultural bias – your own or your patient’s – consider seeking help.
Respect, understand and work with differing cultural perceptions of effective or appropriate treatment. Ask about and record how your patients like to receive health care and treatment information.
Where needed, arrange for an appropriate interpreter.
Listen carefully to your patients and confirm that you have understood their messages.
Make sure you understand how the patient understands his or her own health or illness.
Recognize that families may use complementary and alternative therapies. For appropriate, specific conditions, remind them that complementary and alternative medicine use can delay biomedical testing or treatment and potentially cause harm.
Try to ‘locate’ the patient in the process of adapting to Canadian culture. Assess their support system. What are their language skills?
Negotiate a treatment plan based on shared understanding and agreement.
In Canada, health information is typically print-based. Find out whether a patient or family would benefit from spoken or visual messaging for reasons of culture or limited literacy.
Read more about cultural competence, including specific strategies for delivering culturally competent care. Helpful tools and resources are available from other sources. SickKids Hospital in Toronto has created a series of e-learning modules. You may wish to complete two modules in particular: Cross-Cultural Communication and Parenting Across Cultures.

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