Literacy and culture as determinants of health: designing education for improved outcomes

Date of Award


Document Type



Caspersen School of Graduate Studies

Degree Name

Doctor of Medical Humanities


The poor state of health literacy in the United States has been a growing concern over the past several decades. Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. It is estimated that more than 90 million Americans cannot understand basic health information, often leading to inadequate care for these families. Many of those with low health literacy are members of socio-economically disadvantaged minority populations. In addition to health disparities suffered by these groups, often due to preventable illness, inadequate health literacy contributes significantly to rising healthcare costs by way of increased use of emergency and illness services. Government agencies, private foundations, and healthcare systems have identified low health literacy as one of the central challenges that faces the American healthcare system. The Institute of Medicine (IOM), in its 2004 report Health Literacy: A Prescription to End Confusion noted that health literacy provides an effective area to focus the fight to eliminate health disparities because adult literacy can be potentially improved across a person's lifespan. The report recommends that healthcare systems develop and support programs to reduce the negative effects of limited health literacy, and that such health education programs must be sensitive to cultural and language preferences. The purpose of this study is to examine the effectiveness of a health literacy teaching program I designed for economically and educationally disadvantaged Hispanic women who attend the Oasis Program in Paterson, NJ. The program consists of four weekly sessions of sixty to ninety minutes and covers the topics of child care, nutrition, and physical activity. Through culturally competent teaching methods, based on health literacy research and behavioral theory, I hope to observe healthful lifestyle changes by the program participants and their families as a result of their newly gained knowledge. Further, I expect that the anticipated success of the program will make possible its replication in other comparable settings.