Learn why it’s important to understand a patient’s environment and cultural background.
In this latest post from our Social Determinants of Health series, Dr. A. Susana Ramírez discusses the challenges associated with communication inequalities in health care settings, as well as how these inequalities can act as deterrents to patients obtaining and processing health information. She also shares how health care professionals can address these inequalities by better understanding the environment in which patients live and their cultural background, especially for health information that relates to diabetes prevention and management.
Communication inequality is basically the argument that, like other social determinants of health, access to information and the ability to make sense of that information is socially patterned.
The information environment is just fundamentally structured differently for different groups of people. And it's these differences that can contribute to disparities in health outcomes.
Communication inequalities sometimes act as deterrents to obtaining and processing health information. They can make it hard for people to use the information to make prevention, treatment, and survivorship-related decisions, and also in establishing relationships with providers.
The movement to empower patients and to help train physicians to be more communicative with their patients is generally considered a good thing. But what it means is it really places a lot more burden on individuals’ ability to access health information and to make sense of that health information in a way that we really haven’t made a concerted effort to do with the citizens in this country.
We in public health have done a pretty good job at conveying the very basic principles of good health, and particularly in the context that I study, which is in diet. I've had women, Mexican American women for example, tell me that they try to eat less sugar to prevent diabetes.
The flip side is that public health folks are not the only ones who've done this good job of communicating about diet and diet-related disease.
The fact is that industry has much more money than public health does, and so the messages that various industries send get much more visibility than the public health messages.
The result then is another important barrier that people face as they seek information about how to prevent and manage diabetes, and that's what we call information overload.
The truth is that for most of us, there's just too much information and it's very confusing. And that has at least two negative consequences. Perceiving that the information environment is made up of a bunch of contradictory knowledge has been shown to engender mistrust in public information sources, and this mistrust can have really long-term consequences for interventionists who want to use those sources to disseminate really critical health information.
The second consequence is related to health outcomes and disparities. So the contradictions that are reported in news and other public sources sow confusion about what is the “right” healthy course of action, and this confusion could lead to inaction or a rejection of advice on the grounds that, well, it might just change in the future, just like prior messages have changed. So why act now?
Coming back to nutrition and diabetes, we see this sort of paradox in that, despite people reporting consistently that they are completely overwhelmed with—there's too much information, there's still important information gaps.
We need to be really careful before we say that health care professionals should encourage their patients to look for health information because we know there is a lot of junk available out there. And the concern that I have is that we have very low levels of health literacy and numeracy in this country.
Make sure, first of all, that patients have a high level of health literacy, particularly relating to the condition that they're worried about. So while they're getting treated for diabetes or they're coming up with a treatment plan for their diabetes, that they have a really clear understanding of what that means and why each of those components matter, and then to guide them specifically to the resources that might help fill in some of the gaps.
But I think a bigger question too is making sure that folks have the right level of media literacy. Things like understanding: who is the expert? Is it someone who has a medical degree? Is it a registered dietician who can give you reliable information versus an industry source or a company that has something to gain from your looking at this information and believing this information?
Especially for health information that relates to diabetes prevention and management, it's really important to understand your patient's cultural background. For example, in my own work to better understand how to communicate about diet among Latinas, I found that it's very critical to disaggregate the groups that are subsumed under this pan-ethnic label of Latino, because country and region-specific cuisines are really integral to cultural identity and expression, and so understanding the background of that particular patient is step one.
I would argue too that it's not just about culture and making messages meaningful to individual patients. We need to move beyond just thinking that educating people for behavior change is enough and really think about the context in which people are making decisions.
I argue that we're at a point basically, when we think about diet, that where we were with smoking decades ago. Most people know that having too much fast food is bad for you and that you should eat fruits and vegetables and drink water. But often people can't do what they know that they should do because of the environment that they live in.
And so we need to think about how can communication shape the environments in which people live, and for the providers, they need to think about what is the environment that their patients are living in, and how realistic are the prescriptions that they're giving?
It's really thinking about the structure that—what are the structures that need to be in place to support healthy lifestyles for everybody?