Associate Professor, College of Nursing and Health Sciences, University of Texas, USA
Received Date: January 23, 2014; Accepted Date: January 25, 2014; Published Date: January 27, 2014
Citation: Piven EF (2014) Culturally-Tailored Education Programs to Address Heath Literacy Deficits and Pervasive Health Disparities among Hispanics in Rural Shelbyville, Kentucky: From an Occupational Therapy Perspective. J Community Med Health Educ 4:e123. doi:10.4172/2161-0711.1000e123
Copyright: © 2014 Piven EF. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Cultural sensitivity; Occupational therapy
This is an editorial addressing the recently published article in the Journal of Community Medicine and Health Education: Culturally- Tailored Education Programs to Address Health Literacy Deficits and Pervasive Health Disparities among Hispanics in Rural Shelbyville, Kentucky .
The authors have identified health literacy as a pervasive issue across the U.S.A., affecting one third of the population who cannot read above the 7th-8th grade level. The impact of low health literacy among the Hispanic-American population, the largest group with health disparities that are underserved and disadvantaged, has led to severe health risks, less access to health care, and higher morbidity.
I found the findings of this article to be most useful for my profession of occupational therapy. Occupational therapists are rehabilitation professionals that enable “people across the lifespan to accomplish everything they want or need to do to function in all areas of daily life (self-care, work, leisure) by embedding common everyday activities (called occupations) into treatment” . The focus of our intervention is to assist people of all ages, racial, and ethnic backgrounds to learn to develop the new skills and behaviors that are needed to adapt and cope with interruptions in their functional capacities. I have focused my comments regarding diabetes in Mexican-Americans, as this is my research specialty that created my interest in the findings of this study.
Occupational therapists have been concerned about the best ways to approach health education of Hispanic-American clients with tertiary complications of diabetes, as most practitioners have seen the negative consequences of uncontrolled diabetes in clients, due to the current epidemic of diabetes in the U.S.A. Recently, some occupational therapists have initiated research in secondary prevention with Mexican-Americans using a group or population-based intervention, in order to prevent the tertiary complications of uncontrolled diabetes before they occur [3,4]. Other occupational therapists have provided a more individual approach to secondary prevention for people with diabetes [5,6].
This is a well-executed small pilot study of 43 temporarily unemployed Hispanic-American males. The authors surveyed stakeholders in health care in Shelbyville and gathered community concerns through health/social assessments. From this, five prioritized modules were developed to include: cardiovascular, nutrition, diabetes, metabolic syndrome, and sexually-transmitted diseases, capturing issues such as obesity, smoking, and high fat diets. Authors identified that the educational intervention was culturally-tailored because classes were delivered in Spanish, along with audio-visual materials, given in short sessions. Classes were held at the local community church, where participants were in comfortable surroundings, adding to the culturaltailoring of the intervention. Using a pretest-posttest design with a convenience sample, the authors described the setting, composition of the research group, general demographics and details about the delivery of their Environment and Your Health Program in two data points, thus allowing for assessment of post-test gains immediately following education and then determined retention of gains at nine months. The statistical results that compared short-term and long-term results of the intervention were presented clearly. The most important result was that the health education was retained long-term by 100% of the participants, which was highly significant at p<0.0001. Authors generously offered that readers could request and obtain the syllabi for each education module from the first author directly. Hopefully, this research will excite the authors to raise the level of their research by doing randomized control trials in the future. This publication may enable the authors to obtain more grants.
For replication and duplication of instructional methods, a reader would need more details about the execution of a train-the-trainer approach with subjects because the reference to the approach was open for interpretation. Questions generated were: Did the authors provide the health literacy education themselves or did they train others to do so? Did the modules include instructions for church leaders about how to deliver the education to their peers? Did promoteras are lay health care workers, who lived in the same community serve as trainers? The American Diabetes Association (ADA) has provided a good train-the-trainer example. The ADA has worked through community church leaders, providing detailed modules called Por tu Familia (For your Family) to reach individuals, in order to help module leaders to effectively deliver important health messages in their communities. They also provide community church leaders a module to plan community-wide events such as Feria de Salud (outdoor health fairs), to influence development of healthier lifestyles in entire families in the communities .
Development of personal cultural-sensitivity skills and the creativity with which provide health education for clients with low literacy, in a culturally meaningful way, is a daunting task. This has been a universal concern of most health professionals today. Those concerned may include: health educators, nurses, physicians, occupational therapists, speech and language pathologists, physical therapists, dieticians, nutritionists, and pharmacists, and others who participate on collaborative teams.
The article successfully targeted a vital concern and niche area for important research, useful to most health care professionals working with health disparity populations. Poor understanding, recall, and retention issues have been the central concerns of team members relating to client misunderstanding or non-adherence to medical instructions. Further, these issues have been compounded by Hispanic-American health-care beliefs of the individuals and families, socioeconomic challenges, and the many barriers to health care. There is high need for randomized control studies that will provide the best evidence-based research with Hispanic-Americans.