This paper provides strategies to improve communication between clinicians and patients, particularly patients who are among the 44 million adult Americans with low literacy skills. Included are insights into the nature of the literacy problem and how it affects patient comprehension of information across the continuum of cancer care. Practical strategies address how to help patients understand medical advice, reduce literacy levels of cancer information, and help patients remember the advice given. A summary of the strategies is included in the Appendix for convenient reference.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.48.3.151

Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians

Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population.

Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study.

The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, this article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.

Similarities and Differences across Cultures: Questions to Inform a Third Generation for Health Promotion Research

Objectives. We examined the efficacy of a cancer prevention intervention designed to improve health behaviors among working-class, multiethnic populations employed in small manufacturing businesses.Methods. Worksites were randomly assigned to an intervention or minimal-intervention control condition. The intervention targeted fruit and vegetable consumption, red meat consumption, multivitamin use, and physical activity.Results. Employees in the intervention group showed greater improvements for every outcome compared with employees in the control group. Differences in improvement were statistically significant for multivitamin use and physical activity. Intervention effects were larger among workers than among managers for fruit and vegetable consumption and for physical activity.Conclusions. The social-context model holds promise for reducing disparities in health behaviors. Further research is needed to improve the effectiveness of the intervention.

Promoting Behavior Change Among Working-Class, Multiethnic Workers: Results of the Healthy Directions—Small Business Study

Pathways to Early Cancer Detection in Four Ethnic Groups is a program project funded by the National Cancer Institute aimed at increasing the use of breast and cervical cancer screening among underserved African American, Chinese, Hispanic, and Vietnamese women. The program project core is dedicated to cross-cultural studies including development of survey questions that are comparable in four languages. This article describes the Pathways surveys, summarizes the challenges encountered in question translation, and presents an adapted approach to translation. Concurrent, multilingual, decentered translation was the process through which an English version of each question was selected only when it could be directly and meaningfully translated into Mandarin, Cantonese, Spanish, and Vietnamese. Examples of challenges and how these were addressed in the Pathways surveys are presented, along with lessons learned throughout this process.

Robert A. Hiatt

Papers

Problems and Progress in Translation of Health Survey Questions: The Pathways Experience