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.

Module Objectives

  • 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.
    • Activities
    • 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.
  • 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.

Podcasts

Resources

  • 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 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:

    1. Listen to the stories of DACA recipients.
    2. Explore the impact of the COVID-19 pandemic.
    3. Learn the basics of immigration policy and stay attuned to changes.
    4. Identify and challenge your own biases and misconceptions about immigrants.
    5. Review existing models and recommendations for clinical work with immigrants.
    6. Integrate trauma-informed care and multicultural competence in your clinical style.
    7. Strengthen psychological and behavioral coping strategies.
    8. Foster immigrants’ wisdom and resilience.
    9. Connect with community resources: Legal support, educational programs, financial help, health services, advocacy and activist groups.
    10. 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.

Research Articles

For additional tools on cultural literacy check-out some of the following articles:

Trainings

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.

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.

Case Vignette

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.

Reflection questions

  • 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)

Related Resources

All Resources