2.2.1 Racial/ethnic and Cultural Disparities
Healthcare disparities based on race and ethnicity still exist in many developed countries. For example, African American men and Latinos frequently have serious comorbidities, such as cardiovascular disease, diabetes mellitus, and metabolic syndrome. The variability of race/ethnicity, socioeconomic status, language, healthcare-seeking behaviours, and cultural beliefs and practices influence the treatment resulting in unequal treatment or inferior quality of health care (Martinez et al., 2008). Immigrants disproportionately suffer from heart attacks, cancer, diabetes, strokes, HIV/AIDS, and many other serious diseases. These health risks demand effective health communication to help immigrants recognize, minimize, and respond effectively to potential health problems. Yet, immigrants often have significant language and health literacy difficulties, which are further exacerbated by cultural barriers and economic challenges to accessing and making sense of relevant health information (Kreps & Sparks, 2008). At these times, healthcare media plays an important role in bridging the gap between physicians and patients if it succeeds in providing the appropriate culturally-
sensitive practices to meet the needs of immigrant populations.
How can the cross-cultural communication between physicians and patients be improved? Campos (2006) conducted a comprehensive literature review to explore the ways to improve health outcomes for specific patients with diabetes mellitus (DM) from Hispanic/Latino populations. The findings showed that a better understanding of cultural differences and their impact on health care could influence how clinicians treat their minority patients with DM, leading to effective interventions that may help patients better manage their DM and narrow the cultural divide in DM care. Moreover, Jones-Caballero et
al. (2007) stress that social and cultural factors such as body image,
educational level, fears, general family integration and support, health literary, language, myths, and nutritional preferences, among others, might affect the success of the physician patient relationship and influence patients' adherence to treatment. Specific strategies to enable clinicians to communicate with culturally-diverse populations may include being aware of patients' educational level, asking questions about their personal goals, ascertaining what behaviour they have adopted from mainstream culture, and understanding the strength of family ties.
2.2.2 Language and Literacy Barriers
Language barriers may supersede the limited health literacy of a minority ethnic population in impeding their interactive communication with physicians.
For example, Sudore et al. (2009) attempted to explore whether the effect of health literacy (HL) on patient–physician communication varies with patient– physician language concordance and communication type. Three types of patient–physician communication, such as receptive communication (physician to patient); proactive communication (patient to physician); and interactive, bidirectional communication were rated by 771 participants. The result showed that poor patient–physician communication, due to HL and language barriers, contributed to poor healthcare quality and health disparities. Furthermore, Neuhauser & Kreps (2008) examined whether online cancer communication met the literacy, cultural, and linguistic needs of non- English-speaking populations. They conducted a comprehensive review of English-language online literature, selected books and policy documents related to literacy, cultural, and linguistic factors in health and cancer communication. The negative results showed that health providers should guide vulnerable patients to better websites, and supplement that information with oral and tailored communication.
To date, there are some websites which deliver medical and health information on a wide range of subjects with links especially aimed at low literacy audiences, such as “Medline Plus” which contains some materials for low-literate audiences, such as “Easy to read”, “Interactive Tutorials”, and “Low Vision”, but there is no online indication of the reading level. On the other hand, several websites are attempting to adapt current computer-based programmes tailored for low literacy ethnic minority populations. For example, “Ethnomed” provides health information in a variety of languages aimed at
specific ethnic groups, such as Spanish, Chinese, Russian, Japanese, and Cambodian, but text occupies almost the whole layout, which may increase users’ cognition load and mislead patients’ treatment decisions.
2.2.3 Reducing Healthcare Disparities
Rapidly shifting immigration trends pose a real challenge for healthcare. Numbers of new immigrants are forced to seek health information in a non- native language and navigate significant culture barriers. What are the healthcare disparities of race/ethnicity of minority ethnic populations? Institute of Medicine (2002) advocate these vulnerable populations are often confused and misinformed about health care services, early detection guidelines, disease prevention practices, treatment strategies and the correct use of prescription drugs. Bierman et al. (1998) mention three issues to be considered for reducing healthcare disparities of minority ethnic populations as follows: the problems to access health care system, the structural barriers within the system, and the ability of the provider to address patients’ needs. Smaje (1995) proposed three key issues related to the healthcare of minority ethnic populations required more sustained analytical attention: namely, a theoretically-informed empirical research to understand their difficulties and needs; a need to disentangle the various mechanisms underlying ethnic patterns in health experience; and a wider discussion about appropriate policies to improve their health and consider how such policies can be systematically implemented.
What are the effective ways to help these vulnerable populations to improve their health? Cooper et al. (2002) suggest that improving cross-cultural communication between primary care physicians and patients and providing patients with access to a diverse group of physicians may lead to more patient involvement in care, higher levels of patient satisfaction, and better health outcomes. Campos (2006) declares that many Hispanic/Latino individuals with diabetes mellitus lacked access to adequate health care because of their cultural divide. They recommend that providing interpreters, hiring bilingual staff members, and becoming more familiar with the cultural factors could reduce racial and ethnic disparities. Johnson et al. (2004) indicate that racial and ethnic minority respondents are more likely to perceive bias and lack of cultural competence when seeking treatment in the health care system than whites. Future studies should use validated measures of providers and health system cultural competences that incorporate patients' perspective. Coffman (2010) points out that improving the health literacy of immigrants, enhancing the cultural competence of clinicians, and increasing knowledge about minority health issues can help avoid ineffective non-traditional methods of treatment.
When taking a comprehensive view of the above scholars’ opinions, the healthcare disparities of immigrant population include low literacy and language barriers to communicate with clinicians, poor ability to access health care media, and poor skills to navigate the health care information. Low literacy is more than just the inability to read and write. Individuals’ health
literacy skills and capacities are mediated by their gender, age, education, income, residence, race, ethnicity, culture, religion, etc. (Andersen, 2008). The way to help immigrants with low literacy to improve their health might include enhancing the cultural competence of clinicians, improving the health literacy of immigrants, providing interpreters during face-to-face consultation and the most important way is improving the quality of healthcare media.