Why is this an important issue in health care and what strategies should pharmacists incorporate into their practices to address this issue.

A. Summary of the literature – Include how the literature reviewed supports your answers to the topic question.
(To writer: Please write the summary about the ONLYCultural Competency)

B. describing how this topic will affect how you approach pharmacy and your professional future. In particular how you individually

assess the question asked above as the focus point of the paper. This is a reflective piece where your personal statements and thoughts on

this issue should be expressed.
The Role of Culture in Health Literacy and Chronic Disease
Screening and Management

Health Literacy and Racial and Ethnic Health
Disparities
Minority ethnic groups are at higher risk for several diseases and suffer from more severe illnesses than their majority-culture counterparts

[16, 17]. It is important to bear in mind that research on culture and health must take care to specify salient differences among

populations, while avoiding the construction of ethnic groups as‘‘monolithic entities’’ [69, p. 145]. Cross-cultural research can be

inappropriately reductive, identifying ‘‘traditions, beliefs and behaviors that are supported by one population yet criticized by another’’

[70]. This problem is particularly apparent in generalizations about ‘‘Latinos,’’ who may
come from many different countries, and/or several different cultural/ethnic traditions within a single country. lndeed, the demographic

category ‘‘Hispanic’’ may conceal widely varying disease prevalence rates according to country of origin [71] or other differences [56].

Further, reductionistic biological understandings of race areincreasingly criticized for neglecting the complex socialhistory of racial

categories [72]. Research on health disparitiesmust balance a genetic understanding of diseaserisk with a critical examination of the social

and economicfactors that combine to create racial and ethnic health
disparities [73].

Health Literacy and Patient Adherence
With several notable exceptions (e.g., [30, 46, 68, 74]), most literature on health literacy and patient adherencedoes not seek to

investigate culture or ethnicity as variablesrelated to health literacy, though it is commonly observedthat low health literacy is more

prevalent in ethnicminority, low-income and elderly populations. In general,low health literacy is associated with worse health status [74]

and poor chronic disease management. In a sample of408 English- and Spanish-speaking patients with diabetes,Schillinger et al. [75] found

that patients with inadequatehealth literacy were less likely than patients with adequate
health literacy to achieve tight glycemic control and were more likely to have poor glycemic control. Inadequatehealth literacy was

independently associated with worseglycemic control and higher rates of retinopathy. Similarly,poor medication knowledge was positively

associated withlower adherence and lower literacy among 128 HIV-seropositivepatients [76]. Lack of adherence with chronic disease management

plans, especially among low-income,urban and minority patients, is widespread, leading tocostly ED visits for patients with asthma and other

chronicdiseases.The successful management of chronic disease is oftenachieved by combining lifestyle modifications such as dietand exercise

with a physician-supervised medication regimen.The doctor-patient relationship and patients’ capacityfor self-management are both critical to

this process. Intheir study with three California ethnic groups, Beckeret al. [67, p. 176] report that Latinos had the highest burdenof

chronic illness yet the least knowledge of the U.S.biomedical system. This lack of familiarity contributed to’ ‘vague [ness] about illness

management… and they did not
understand that they had a role in managing their illness beyond taking medication.’’ In addition to lack of exposureto biomedical care,

culturally varying health beliefs mayalso influence patients’ health-seeking behaviors andwillingness to comply with treatment regimens [22,

77].For example, in a study of prophylactic TB treatmentamong Vietnamese immigrants, researchers found recentimmigrants were more reluctant

to complete the medicationregimen because its side effects were deemed too‘‘hot’’, ‘‘while Asian herbal medicines were [seen as] morebenign

and cooling’’ [57, p. 352]. Situations like this call
for, first, the recognition of different explanatory models, and second, a cultural broker who understands both the EMand the biomedical aims

of the recommended treatment todevelop an explanation that is both comprehensible andacceptable to recent arrivals.Diet and nutrition are

commonly recognized as culturally-influenced domains of behavior [37] that areparticularly relevant to diabetes management and education[78].

However, patients with diabetes may be especiallyreluctant to modify their eating habits when they feel thatthe recommended changes ask them

to give up culturallymeaningful habits and practices. Research suggests culturaldifferences coupled with low health literacy may be afactor

in patient noncompliance with dietary, medicationand screening regimens. Mull et al. [79] report that lowpatient adherence with diabetes

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