Better Communications With Special Groups

According to the American Medical Association, poor health literacy is "a stronger predictor of a person's health than age, income, employment status, education level, and race." In Health Literacy: A Prescription to End Confusion, the Institute of Medicine reports that 90 million people in the United States (nearly half the population) have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and do not understand instructions like "take on an empty stomach."

Vulnerable populations include:

  • Elderly (age 65+) - Two thirds of U.S. adults age 60 and over have inadequate or marginal literacy skills, and 81% of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels (Williams, MV. JAMA, December 6, 1995).
  • Minority populations.
  • Immigrant populations.
  • People with chronic mental and/or physical health conditions.

Reasons for limited literacy skills include:

  • Lack of educational opportunity - people with a high school education or lower.
  • Learning disabilities.
  • Cognitive declines in older adults. (Use it or lose it)
  • Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma typically read at a seventh or eighth grade reading level.

That is why it is so important to be able to communicate effectively with patients who have low literacy or limited English proficiency (LEP).  The resources below can help you understand the cultures of the various populations you treat in your practice. Some of these resources also provide health information in other languages.

African American
American Indian/Alaskan Native
Arab American
Asian American/Pacific Islander American
Hispanic/Latino American
Other Ethnic Groups
Older Adults
Low Literacy/Low English Proficiency

African American

National Association of Black Cardiologists

National Black Nurses Association

Provider's Guide to Quality and Culture  -- African Americans

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American Indian/Alaskan Native

Association of American Indian Physicians

National Indian Council on Aging

National Indian Health Board

Native American Cancer Research

Provider's Guide to Quality and Culture  -- Native Americans

Culture Clues – University of Washington Medical Center

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Arab American

Provider's Guide to Quality and Culture  -- Arab Americans


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Asian American/ Pacific Islander American

Asian & Pacific Islander American Health Forum

Chinese American Medical Society

National Asian Pacific Center on Aging

National Asian Women's Health Organization

National Resource Center on Native American Aging (Native Hawaiian)

Provider's Guide to Quality and Culture

Asian Americans

Central Asians:

South Asians:

Pacific Islanders:

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Hispanic/Latino American

National Alliance for Hispanic Health

National Council of La Raza

National Hispanic Medical Association

Provider's Guide to Quality and Culture  -- Hispanics/Latinos

Culture Clues – University of Washington Medical Center

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Other Ethnic Groups

Culture Clues -- University of Washington Medical Center
Tip sheets for clinicians, designed to increase awareness about concepts and preferences of patients from diverse cultures.

Provider's Guide to Quality and Culture  -- Cultural Groups

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Older Adults

Center on an Aging Society

Medical News Today
Article: Health Care Literacy Might Affect Mortality Rates of Elderly U.S. Residents,

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Low Literacy and Limited English Proficiency

Speaking of Health: Assessing Health Communication Strategies for Diverse Populations
A report that examines the challenges of effective communication.

Health Literacy: A Prescription for Confusion
An Institute of Medicine (IOM) report summarizing the financial and health care impact of health literacy on the health care system. 

Health Literacy Fact Sheets
A series of nine fact sheets defining health literacy and its impact on creating and evaluating patient education materials for consumers with low health literacy skills.

Practical Solutions to the Problems of Low Health Literacy
An executive summary for the fourth annual national health communication conference to address solutions and highlight programs that address low health literacy

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