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Promoting Health Literacy with Beginnings Guides Part 14 Cultural Appropriateness

This is the last in our series using the SAM Suitability Assessment
of Materials to assess the suitability of Beginnings Guides to
pregnancy and parenting for low skilled readers who may be new
to the healthcare system.

For a good cultural fit match readers’  LLE
Leonard and Cici Doak, authors of the SAM,
concluded that most communication errors
in healthcare are caused by cultural gaps
between patients and providers,particularly
gaps in Logic, Language & Experience - LLE. 
For anyone in health communications
-that’s everyone in healthcare, it’s an acronym
worth remembering. 

Logic refers to a way of thinking about health, illness, treatment. 
Because of their specialized training, healthcare professionals have
a special way of thinking. For example, to a clinician who sees 30
sick people per day, illness is normal, another day at work, the usual
routine.  But to those 30 sick people, their illness  is exceptional, a
major source of physical, emotional, spiritual and financial stress for
a whole family, a reason to miss work and suspend the usual routine.
The clinician’s routine challenge may be the patient’s life changing
event. Consider, too differences between Western and Eastern medicine,
between medical specialties,  between medicine and public health,
between medicine and health promotion. A challenge for all health
communicators is to understand and match the learner’s logic about
your topic.

Language refers to a way of talking
about health, illness, treatment
Of course, logic and language overlap.
To a professional the problem
may be hypertension exacerbated by
obesity; to the patient the problem is
bad blood making it hard to walk up the
stairs. In the West, we describe epilepsy
as a disease - abnormalities in brain cells that cause seizures. Elsewhere,
epilepsy is described as  blessing - a sign that the person may be a shaman;
“the spirit catches you and you fall down”. Other language issues are less
English is the language of the healthcare system.
If you are not proficient in English, you will struggle
at every level. And even if you are, you may still
struggle when simple English terms like stool and screen,
minor and routine take on a whole new medical meaning.
Or when simple concepts like walking  and pus or go home
take on a whole new vocabulary like ambulation and
Latin and Greek are the language of medicine.
Terms are long and technical, so a natural short hand
emerges. As public relations director for a hospital that
specializes in heart surgery, I encountered more than
one family who objected to hearing staff refer their loved one as “the cabbage
in 206”. They were using shorthand for coronary artery bypass, thinking and
talking about the patient as his procedure and location.
Experience refers to participation in events as a basis of knowledge
A clinician lives in the hospital or clinic. S/he is intimately familiar with
the technology. S/he is in charge and in control. Everything is organized
for his or her convenience and efficiency. His or her status comes from
specialized knowledge.  In many cases, the patient has no experience
and very limited knowledge. That means no basis on which to judge
quality, weigh options, or interpret instructions. At that same hospital,
two patients who had open heart surgery by the same surgeon on the
same day were re-admitted two weeks later. Their doctor had told 
them to “take it easy.”  Both complied. One ran 3 miles instead of
his usual 5. The other never got off the couch.

Who is responsible for bridging the gap?
Federal, state and local laws, Medicare and Medicaid regulations,
and accrediting bodies clearly state it is the healthcare providers’
duty to communicate in a way the patient and family can understand.
SAM says Superior health education materials match the readers LLE
and present images and examples that are realistic and and positive.

Beginnings Guides are intended for a broad
national audience. It’s intent is to be as
culture-neutral as possible. We chose cover
art by Laurel Burch in which our testers saw
whatever was important to them. 

Last words on SAM: Only readers know for sure
SAM is an at-your-desk review. It cannot tell you that your information
is easy to understand and use.  Only the intended learners can tell you
that they learn easily from your document. SAM helps you get your
materials to the point where they are ready for Reader Verification
Interviews. More on that next time.
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