Language, Literacy, Culture: Communication of Health

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Spoken communication of key health concepts for many diseases is critical to prevention, screening and clinical management. This communication is made more difficult when words get in the way. Health literacy is affected by general literacy, language and cultural interpretation. Very little is known about maximizing spoken communication of health concepts across these potential barriers. Because of the lack of knowledge, there is a need for first stage studies that lay the basis for future research. We propose a study that will develop methodological approaches to the study of effective spoken communication of three key health concepts: headache, wheezing, and depression. 1) Our primary hypothesis is that different language groups and groups with different levels of general literacy will have different levels of health literacy which will, in turn, be reflected in their understanding of spoken key health concepts. 2) Further, we hypothesize that we will be able to develop from focus group data a conceptual framework that can be applied to future intervention studies designed to overcome spoken health communication barriers. The first phase of the study will consist of key informant interviews with medical experts, some of whom are bilingual in Spanish or Cantonese. In the second phase, we will hold 12 focus groups of 8-10 persons in English, Spanish and Cantonese, each at low and high general literacy. We will use highly skilled focus group moderators from Erlich Transcultural Consultants who have many years of experience leading focus groups in each language. The focus groups will be held in a new state-of-the-art focus group facility with extensive technical capability, including an observation room in which the project leaders will observe the focus groups in the presence of a simultaneous translator. Focus groups will be video recorded and the resulting record transcribed and translated. We will use data immersion to analyze the focus groups. This will include a systematic content analysis, a thematic analysis and a logical analysis. Our goal is to develop sufficient understanding of how persons with different language, culture and general literacy understand key health concepts so that an intervention study (R01) aimed at improving spoken health communication can be developed.