Module 5: Cultural and Linguistic Literacy
Cultural literacy is the ability to understand the traditions, norms, activities and historical background of a given culture. Cultural literacy also involves the ability to participate fluently in formal and informal traditions, norms and activities. Cross-cultural communication problems and gaps in cultural literacy may cause or exacerbate health inequity.
We can define linguistic literacy as “a constituent of language knowledge characterized by the availability of multiple linguistic resources and by the ability to consciously access one’s own linguistic knowledge and to view language from various perspectives.”
Culture is the integrated pattern of human behavior that includes the thoughts, communication, actions, customs, beliefs, values and institutions of a racial, ethnic, religious, social or other group. Culture is typically described as the totality of learned behaviors of a group of people that emerges from their interpersonal interactions. Culture provides people with a framework (such as Hofstede’s framework) to understand identity, beliefs, values and behavior related to health.
It is also important to know what culture is not. Culture is not an individual’s personality, it is not static, it is not the language a person speaks, it is not an ethnic or racial group, it is not solely related to geography.
Culture is personal and deeply rooted. It includes our environment, thoughts, values, beliefs, feelings and sensations. Culture is dynamic – changing and adaptive. The purpose of understanding culture is to understand the cultural strengths of other people, especially when differing from one’s own worldview.
Cultural interactions have often been described as encountering the tip of an iceberg because initial interactions involve those aspects of culture (approximately 10%) that are readily apparent, with the remainder of cultural aspects not being as immediately observable. The majority of cultural beliefs and attitudes are implicit, deeply embedded and sometimes not readily apparent. It is often said that cultural competence is an inside job, or an internal process that involves exploring and reflecting on internalized beliefs to expand awareness of one’s own culture and to grow one’s knowledge and understanding of other cultures.
When reflecting on health literacy discussed in Module 4, it is important to consider how an individual’s ability to find, understand and use information and services to inform their health-related decisions and actions for themselves and others, is directly related to their culture(s), which includes their language practices and norms. For health care workers and organizations hoping to practice organizational health literacy, cultural and linguistic dimensions of health information and services must also be explored, understood and addressed, especially across populations and cultures.
- The reader will be able to define cultural literacy.
- The reader will acquire additional resources for their toolbox about cultural literacy.
- The reader will be able to apply the skills and tools acquired in this module to a case vignette.
Step 1: Let’s Get Started
This step briefly introduces cultural and linguistic literacy and provides specific objectives that will move you closer to your goals.
Step 2: Time to Engage
The information in this step is accessible and provides a general introduction to cultural and linguistic literacy. You can listen to a podcast on your morning walk, download a resource to help your client or get a short audio summary of an article that caught your eye before fully engaging with the reading.
Videos and Webinars
- Matthew A. Cherry is recognized for his Oscar-winning animated short film, Hair Love, (7 minutes) a story about an African American father learning to do his daughter’s hair with the support of the tutorials that she and her mother made together.
Additionally, a viewing guide written and designed by Patricia Juri, Paola Rojas and Maddy Leonard is also available. In the Hair Love Viewing Guide, you will find.
- About the film and subject areas.
- Discussion questions.
- Writing exercises.
- Supplementary resources.
- Miguel Gallardo, Psy.D., of the National Institute for the Clinical Application of Behavioral Medicine discusses a case in which a client made a racist comment during a therapy session.
Dr. Gallardo shares his reaction with his client to help him understand intent versus impact. In his talk, Dr. Gallardo explains When Staying Neutral Isn’t the Best Approach (6 minutes).
- Reginald Chen Stewart, PhD, chief diversity officer of the University of Nevada serves as the executive level diversity and inclusion strategist.
In his TED Talk on Cultural (il)literacy: What Modern America Needs to Know, he brings light to the topic of cultural illiteracy as a lack of understanding and knowledge of the history, politics, social norms, value systems and belief systems of cultures other than our own.
- The American Psychiatric Association provides multiple videos that will help guide assessment and treatment of patients from diverse populations in its Best Practice Highlights for Treating Diverse Patient Populations.
Here are the videos available:
- Working with African American Patients (3:40 min)
- Working with Appalachian Patients (3:50 min)
- Working with Asian Patients (3:20 min)
- Working with Latino/a and Hispanic Patients (5:29 min)
- Working with LGBTQ Patients (6:35 min)
- Working with Muslim Patients (3:49 min)
- Working with Indigenous/Native American Patients (8:22 min)
- Working with Refugee and Forced Displacement Patients (3:13 min)
- Working with Women Patients (5:02 min)
- The Health Resources and Services Administration (HRSA) discuss the importance of addressing culture, language and health literacy to meet the diverse needs of clients and communities.
In its video, Effective Communication Tools (6 minutes), experts discuss cultural and linguistic literacy more in-depth.
- Thema Bryant-Davis, Ph.D., of the National Institute for the Clinical Application of Behavioral Medicine discusses Moving from Cultural Competence to Antiracism (6 minutes).
Dr. Bryant-Davis describes an antiracist’s stance as more active and intentional. Dr. Bryant-Davis provides some evaluative questions to guide clients when they are seeking a therapist to explore their thoughts of the impact of white supremacy on mental health. If you enjoyed the discussion, Moving from Cultural Competence to Antiracism, then we recommend you check out this short video, Working with the Trauma of Racism (6:37 minutes) also by Dr. Bryant-Davis.
- Think Cultural Health provides a collection of recorded presentations on various topics related to culturally and linguistically appropriate services (CLAS) and the National CLAS Standards.
Here are the presentations available for readers to watch at their own pace:
- Why Culturally and Linguistically Appropriate Services? (19:34 min)
- Exploring Culture in CLAS: Sexual Orientation and Gender Identity (25:09 min)
- Exploring Culture in CLAS: Religion and Spirituality (24:33 min)
- A Primer on Communication and Language Assistance (22:33 min)
- The National CLAS Standards, Health Literacy and Communication (34:44 min)
- The National CLAS Standards: Advancing Health Equity at the Community and Systems Level (76 min)
- The Context of CLAS in Mental Health (25:08 min)
- Leveraging CLAS: A Webinar for the Heartland Regional Health Equity Council (47:45 min)
- National CLAS Standards for Grant Reviewers (41:43 min)
- Promotores de Salud E-Learning Program: Stakeholder Call (60 min)
- Cultural Awareness Training for United States Public Health Service Commissioned Corps (23:44 min)
- The Black Women’s Health Imperative is the first nonprofit organization created by Black women to help protect and advance the health and wellness of Black women and girls.
Some of the tools that you will find on its website include:
- Parenting During a Pandemic
- Black & Well TV
- Episode 1: Remaining Black & Well During The COVID-19 Pandemic (41 min)
- Episode 2: High Risk Conditions & COVID-19 (45 min)
- Episode 3: The Front Lines of Reproductive Health for Sisters in Need
- Episode 4 : Navigating Relationships During Quarantine & Beyond (48 min)
- Episode 5: Managing the Mental & Emotional Impact of the Pandemic (50 min)
- Episode 6: The Importance of Clinical Research in Communities of Color
- Episode 7 : Black Women, COVID-19 and HIV, Where Do We Go From Here (50 min)
- Episode 8: Supporting Our Village During Trying Times (51 min)
- Episode 9: The Black Reproductive Justice Response to COVID-19 & Community Unrest (49 min)
- The podcast, Latinx Therapy discusses mental health topics related to Latinx individuals.
Some of the episodes are available in Spanish. Here are some of the most recent episodes:
- Parents’ Mental Health (19:31 min)
- Sexual Abuse in Teens (26:57 min)
- Substance Abuse in the Latinx Community (42:53 min)
- Season 3: Children’s Mental Health (10:58 min)
- When God and Therapy Are Both Okay (40:03 min)
- Nalgona Positivity Pride Talks Body Positivity & Disordered Eating (27:22 min)
- An AfroLatinx Experience (34:38 min)
- Break the Stigma: Vivian Nuñez – Too Damn Young (26:01 min)
- Coming Out of the Closet in a Machismo Dominated Culture (26:10 min)
- When You’re the English Translator for Your Family (34:22 min)
- Sneak Peek into a Forbidden Topic: Sex (34:31 min)
- Self-forgiveness Conquers All (42:25 min)
- Anxiety 101 (32:37 min)
- Healthy Children discusses strategies for selecting diverse and inclusive books in its blog, Using Books to Talk with Kids About Race and Racism.
Books are a great way to transmit cultural literacy and Healthy Children also provide book suggestions that are developmentally appropriate from infants to teens.
- The Centers for Medicare and Medicaid Services (CMS) have developed a Toolkit for Making Written Material Clear and Effective.
You are 11 parts in the toolkit:
- About This Toolkit and How It Can Help You
- Using a Reader-centered Approach to Develop and Test Written Material
- Summary List of the “Toolkit Guidelines for Writing and Design”
- Understanding and Using the “Toolkit Guidelines for Writing”
- Understanding and Using the “Toolkit Guidelines for Graphic Design”
- How to Collect and Use Feedback from Readers
- Using Readability Formulas: A Cautionary Note
- Will Your Written Material be on a Website?
- Things to Know if Your Written Material is for Older Adults
- “Before and After” Example: Using this Toolkit’s Guidelines to Revise a Brochure
- Understanding and Using the “Toolkit Guidelines for Culturally Appropriate Translation”
- The Cultural and Linguistic Competence Policy Assessment (CLCPA): A Guide for Using the CLCPA Instrument was developed by the National Center for Cultural Competence to assist community health centers to advance and sustain cultural and linguistic competence.
The CLCPA supports health care organizations to:
- Improve health care access and utilization.
- Enhance the quality of services within culturally diverse and underserved communities.
- Promote cultural and linguistic competence as essential approaches in the elimination of health disparities.
- Through the organization, Informed Immigrant, Germán A. Cadenas, Liliana Campos, Laura P. Minero and Cheryl Aguilar designed A Guide to Providing Mental Health Services to Immigrants Impacted by Changes to Deferred Action for Childhood Arrivals (DACA) and the COVID-19 Pandemic.
The goal of this guide it to support individuals who are providing services to individuals who benefit from DACA. This guide includes 10 steps:
- Listen to the stories of DACA recipients.
- Explore the impact of the COVID-19 pandemic.
- Learn the basics of immigration policy and stay attuned to changes.
- Identify and challenge your own biases and misconceptions about immigrants.
- Review existing models and recommendations for clinical work with immigrants.
- Integrate trauma-informed care and multicultural competence in your clinical style.
- Strengthen psychological and behavioral coping strategies.
- Foster immigrants’ wisdom and resilience.
- Connect with community resources: Legal support, educational programs, financial help, health services, advocacy and activist groups.
- Engage in continuing education, supervision, consultation and professional support.
Step 3: Creating a Stronger Foundation
This list of materials and resources provides a more detailed description of how to apply the tools introduced in Step 2. This step requires you to engage in deeper analysis of the topic through documentaries, research articles, trainings and books. Some of the tools, like research articles and books, may have a cost attached and we recommend that your organization provide them and that you share them with other team members. Tools like trainings may require you to engage for longer periods of time than the initial resources.
For additional tools on cultural literacy check-out some of the following articles:
- Addressing Cultural Determinants of Health for Latino and Hmong Patients with Limited English Proficiency: Practical Strategies to Reduce Health Disparities
- Park, L., Schwei, R. J., Xiong, P. & Jacobs, E. A. (2018). Addressing cultural determinants of health for Latino and Hmong patients with limited English proficiency: Practical strategies to reduce health disparities. Journal of Racial and Ethnic Health Disparities, 5(3), 536–544.
- Mental Health Literacy: A Cross-cultural Approach to Knowledge and Beliefs About Depression, Schizophrenia and Generalized Anxiety Disorder
- Altweck, L., Marshall, T. C., Ferenczi, N., & Lefringhausen, K. (2015). Mental health literacy: a cross-cultural approach to knowledge and beliefs about depression, schizophrenia and generalized anxiety disorder. Frontiers in psychology, 6, 1272. https://doi.org/10.3389/fpsyg.2015.01272
- Cultural Diversity and Mental Health: Considerations for Policy and Practice
- Gopalkrishnan, N. (2018). Cultural Diversity and Mental Health: Considerations for Policy and Practice. Frontiers in public health, 6, 179. https:/doi.org/10.3389/fpubh.2018.00179
- Developing Linguistic Literacy: A Comprehensive Model
- Ravid, D., & Tolchinsky, L. (2002). Developing linguistic literacy: a comprehensive model. Journal of child language, 29(2), 417–474.
- To Understand and be Understood: The Ethics of Language, Literacy and Hierarchy in Medicine
- Tauqeer, Z. (2017). To understand and be understood: The ethics of language, literacy, and hierarchy in medicine. Journal of Ethics, 19(3):234-237.
- The Impact of Language Development on the Psychosocial and Emotional Development of Young Children
- Cohen, N.J. (2010). The impact of language development on the psychosocial and emotional development of young children. Encyclopedia on Early Childhood Development.
- Overcoming Language Barriers in Health Care: A Protocol for Investigating Safe and Effective Communication when Patients or Clinicians Use a Second Language
- Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in health care: A protocol for investigating safe and effective communication when patients or clinicians use a second language.BMC health services research, 15, 371. https://doi.org/10.1186/s12913-015-1024-8
The Black Emotional and Mental Health Collective (BEAM) is a collective of advocates, yoga teachers, artists, therapists, lawyers, religious leaders, teachers, psychologists and activists committed to the emotional and mental health and healing of Black communities.
The BEAM provides a multitude of resources. Here are some of the topics you will find:
- Virtual Trainings
- Black Virtual Wellness Directory
- Toolkits & Worksheets
In its blog, We Are Teachers provides some age-appropriate recommendations of books that can be used to discuss mental health issues with students from as young as three-years-old.
Step 4: Your Turn
This step encourages you to apply what you have learned through a case vignette. We recommend that you explore the gaps present within the vignette and implement any new skills acquired through this module. Consult with others on your team to explore the multiple ways to address the issues, especially as you take your role within your organization and your experience, skills and worldview into account.
We provide reflection questions from the following perspectives: individual learning and beliefs, organizational learning and systemic. You can use the questions to have discussions with others and think through all the facets that are relevant to your work.
The brightly decorated room was empty. Margo was in the corner, visibly frustrated and upset. It had been her idea to host a health fair and decorate the cafeteria for the Day of the Dead within a predominantly Latino neighborhood. But few people showed up despite heavy promotion. Margo sulked, Day of the Dead was a big event in her Mexican American neighborhood during her youth and this was a missed chance to promote the clinic.
One of the social media interns, Mel, came into the cafeteria and grabbed a snack. Margo groaned and asked Mel what had happened. Mel told her that most of the neighborhood population was Puerto Rican, and they didn’t celebrate Day of the Dead the same way that people of Mexican origin did. Although everyone in the neighborhood was “Latino” and spoke the same languages (Spanish and English), they had different and distinct cultural traditions.
Mel offered to help Margo offer a Three Kings Day health fair in the new year and Margo gratefully accepted. She asked Mel to teach her more about Puerto Rican customs and food. Mel agreed and they chatted as a small group of people trickled in.
- Culture is dynamic and ever-changing. How can you stay aware of specific cultural beliefs and practices that relate to health? (individual learning and beliefs)
- How might your organization involve the community you serve or offer services to when planning health promotion events? (organizational learning and change)
- How is your organization perceived by different cultural groups? What are some ways to better understand this? (organizational learning and change)
- Cultural groups are often painted with a broad brush that can hide significantly different customs and traditions within the bigger group. What impact might stereotyping have on health? (systemic change)