Andrulis PhD., D., Brach, C. (2007).  Integrating literacy, culture, and language to improve health care quality for diversive populations [Electronic version].  American Journal of Health Behavior, 31, 122-133.       Retrieved November 11, 2008, from Academic Search Premier.

Britten, N. & Smith, R. (2007). The beliefs of Jehovah’s witnesses. Telegraph.co.uk. http://telegraph.co.uk/news/uknews/1568448/The-beliefs-of-Jehovah’s-Witnesses.html.

King, D.E., (2006).  Spirituality, health, and medical care of adults [Electronic version].  Southern Medical Journal, 99, 1166-1167.  Retrieved November 7, 2008, from Academic Search Premier.

Nielsen-Bohlman, L., Panzer, A., & Kindig, D. (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academy of Sciences. Retrieved November 4, 2008, from National Academies      Press. http://books.nap.edu/openbook.php?record_id=10883&page=R2.

Paasche-Orlow, M.K., Schillinger, D., Greene, S. & Wagner E. (2006).  How health care systems can begin to address the challenge of limited literacy [Electronic version].  Journal of General Internal Medicine,      21, 884-887.  Retrieved November 11, 2008 from Academic Search Premier.

Reisfield, G.M., & Wilson, G. (2008).  Health literacy in palliative medicine.  Journal of Palliative Medicine, 11, 105-106.  Retrieved November 8, 2008 from Academic Search Premier.

Schyve M.D., P.  (2007).  Language differences as a barrier to quality and safety in health care: The joint common perspective[Electronic version].  Journal of General Internal Medicine, 22, 360-361.  Retrieved      November 10, 2008 from Academic Search Premier.

www. health.gov/communication/literacy/quickguide/Quickquide.pdf

     Before I began researching my topic, I only knew a broad definition regarding literacy.  I thought that literacy simply meant that an individual is capable of reading, writing and comprehending what he or she read.  I later grasped that one could be literate in several areas. This lead me to ponder the area of health literacy.  The United States is known as a “melting pot,” a country where millions of people who come from different cultural, racial, ethnic, religious, and linguistic backgrounds reside.  All these dissimilarities can play a role in providing and receiving quality health care. I found that there tends be be a major communication breakdown between health care professionals and these patients. I finally formed a statement after researching this topic: Five things health care professionals need to know when communicating with patients from various cultural communities. 

Foundation Questions/Areas:

1.  Cultural Competence

2.  Linguistic Competence

3.  Word Meanings

4.  Levels of Literacy

5.  Views Regarding Health  

Searching

      First, what is health literacy?  Health literacy as defined by www.health.gov is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decesions.”  Because of the many cultural differences, there may be obstacles between the patient and the health care professional when communicating.  For example, communication styles vary and topics that may be discussed may be off limits depending on the culture.  Communication between the patient and the health care provider is vital to quality health care, and because of the many differences that exist, this does not occur in every situation.  This example may be related to a health care professional’s lack of cultural competence or differences in general. Other obstacles may include low linguistic competence, differences in views regarding health, word meanings, and different levels of literacy.

      The first matter is cultural competence.  This is composed of several ideas: cultural awareness, cultural knowledge, cultural skill, and cultural encounter (Nielsen-Bohlman, 112).  Cultural awareness requires a health care professional to understand and acknowledge a cultures’ values, beliefs, and practices.  The more culturally competent a health care provider is, the better the communication between professional and patient.  

    Effective communication is crucial to a patient’s health. Effective communication is communication that is comprehended by both participants. When effective communication is absent, the provision of health care ends—or proceeds only with errors, poor quality, and risks to patient safety (Schyve, 360).  Several patients have limited English proficiency (LEP).  According to Nielsen-Bohlman, the 2000 census indicates that eleven million people state that they do not speak English well or not at all (113).  LEP individuals may be health literate in their primary language.  When this occurs, translated materials may be provided, translators may be provided. 

     Some cultures’ word lexicon or word meanings may greatly differ from the English meaning or a word may not exist at all.  For example,  The Navajo language has no word or concept for “chemotherapy.”  Therefore one could begin explaining the idea of cancer and state what the patient may experience as a result of chemotherapy.  It is further complicated by the fact that the Navajos believe that if you say something will happen, it will. (Nielsen-Bohlman, 110).  The medical field consists of an ample amount of jargon.  Not only does a professional need to know how to describe jargon in layman’s terms, he must know if certain words and concepts exist and if not, how he will effectively convey the message.  Health literacy must be understood and addressed in the context of culture and language (Nielsen-Bohlman, 118).

      One’s literacy level is probably linked to his or her health literacy.  Paasche-Orlow mentions that limited literacy has shown to be linked to poor health.  This is prevalent among the elderly, minorities, and those with lower levels of educational attainment and chronic diseases (884).  Health professionals should suspect literacy problems in patients who do not look at written materials or identify medications by color or shape rather by the label. Because many of these patients are excellent at masking their deficit, they should be screened by the professional.  Some screening questions will be discussed later.     

     Several individuals have different views about health.  Religion tends to play a crucial role in treatment choices, attutudues, coping, and future health (King, 1166).  It is important for the health professional to understand the patient’s spiritual and religious views.  For instance, some Jehovah’s Witnesses do not believe in accepting organ donations.  Other’s may accept, but the organ must be completely drained of blood (Britten).  Different religious beliefs may ultimately alter treatment and prognosis. 

Concluding/Answering 

     Millions of people are not receiving adequate health care because of low health literacy. If one suspects that a patient may be illiterate, screening may be effective.  The teach back method is also effective.  The health care provider explains instructions to the patient and have him or her teach them back.  This helps to ensure comprehension along with using jargon free language.  Health care providers should emphasize on improving the way they give instructions (Andrulis, 126).

      By making certain that their patients’ understand their health and treatment options, these professionals can help ensure that people from all cultural backgrounds receive quality health care.

Authorship

The authors were listed as Lynn Nielsen-Bohlman, Allison M. Panzer, David A. Kindig, Editors, Committee on Health Literacy.  The way in which they were listed was a little confusing to me.  I think they are also on the committee listed above.  I did not recognize the names, but they are the authors of the book Health Literacy: A Prescription to End Confusion.  On this site the book is available for purchase as a PDF file and the viewer can skim parts of each chapter. 

Publishing Body

The authoring organizations include Board on Neuroscience and Behavioral Health (NBH) and Institute of Medicine (IOM).  These are recognized names in my field of study.  Excerpts from every chapter and their page numbers along with the names of each chapter are readily available to readers.  This is an official website.  Copyright information of the website was as follows: Copyright 2008 National Academy of Sciences.  The book was published in 2004.

Point of View or Bias

I don’t believe the authors are biased but their point of view is of those that feel that more needs to be done for the millions of people who are health illiterate.  In the book, the authors make suggestions to help improve health literacy.  They also include factors that contribute to health illiteracy. 

Referral to and/or Knowledge of the Literature

This book contains staff and committee bibliographies in addition to other sources used (see each appendix).  The authors make it known that health literacy is important to ensure better healthcare.

Accuracy or Verifiablitity of Details

As mentioned before, this book includes a list of other sources used.  The authors researched,in depth, before writing the book.  Links to NBH and IOM are available for the reader to look at and read.  A foreword written by the president of IOM, Harvey V. Fineberg, M.D., Ph.D. is also included.

Currency

The publishing date of the book and copyright date of website are included.  Dates of studies and where are listed in appendix A. 

I found this on the second page of Google using the term “Improving health literacy in spanish speaking.”  The site also included the top 30 algorithims in which the site can be found.

Content Summary:

The focus of this memo is the unit Technology as a Clinical Tool.  We discussed social bookmarking but primarily focused on software evaluation.  I believe that this was an important assignment because we will have to conduct software evaluations in the future if we want to use them (software) with clients.  A good clinician does not just purchase software and implement it in therapy without reviewing or evaluating it.  There are some software tools that can benefit clients greatly; some are well developed, current and interesting.  Other software is outdated, boring, difficult to follow, and impractical.  The class realized this when we shared information about our software.  I learned about Turn Talking Software.  It seemed to be a good program to use with those who need practice with turn taking in discourse. Social bookmarking is an excellent way to share information with others and quickly collect information about specific topics.  We currently began using Diigo for social bookmarking. 

Process Summary:

I feel as if I can now effectively evaluate particular software.  I can view pros and cons, effectiveness, and functional use.  I know that most advertisements of software are biased so it’s best to research on your own.  I am still learning how to bookmark, especially on Diigo.  Hopefully I will be able to do this effortlessly and soon.  I still check my email frequently.  Now, if I am using a new tool like Diigo, I try to play around and become familiar with it.  Before I just signed up and that was it, but now I know time investment early saves you time later.

Assessment:

It was valuable to me to participate in the discussion about various software evaluations because I became familiar with other software than the one I evaluated.  I became aware of some that were impractical and almost impossible to follow (ie Moriarty Mystery).  I think it helped that I critiqued my own adaptive technology powerpoint to an extent.  I still felt as if I may have overlooked some areas.  I still feel that it is better when others review your work.

Reflection:

This unit helped me to see examples of software that can, should and shouldn’t be used in therapy.  It is important to research various tools, compare them, research and then make a decision on whether or not it should be used in therapy.  In regards to social bookmarking, I could always see the use of social bookmarking but now that we’re using it, it’s even clearer to me.  This is something that we as future SLPs can use to share new and dynamic information with one another. 

URL:  http://www.betterdogfood.com/

Accuracy and Authority

In the site Better Dog Food, no particular author is named but the author lists the management team as Rebecca Hargrave and Carl Malamud.  Both names are unfamiliar to me. No particular sources that were used to develop the site were included.  The author, however, does list the website petchick@betterdogfood.com where more information can be found about Rebecca Hargrave, but I was unable to access this site.   The author also stated that Hargrave designed Today’s Breeder Magazine but this link was unaccesible as well.  Malamud was declared an international speaker in a place named Kazakhstan.  There is a link that displays the speech that was provided by Malamud.  The website also mentions that Malamud worked for The Telephone Company.  A link is included but no information was provided on this link concerning Malamud.  As mentioned before there is no background provided about the author.

Objectivity

The goal of this site is to sell dog food.  The company provides the consumer with a dog and the consumer purchases dog food from the company.  The website advertises dog food and other miscellaneous items, and it advertises animal exchange.  There is not enough information provided, especially about the author, for this site to be trustworthy.  In addition, Affina, Inc. discontinued selling  miscellaneous products online in August 2000.  This information was discovered by selecting the legal disclaimer via the storefront link.

Currency

The only date that was provided was the copyright year (2000) on the bottom of the “about” and “investor” pages.  One page, storefront, listed the copyright date as 1999-2000 by Affina, Inc.  No dates were provided as to when the page was written, updated and first posted on the internet.  The ads by Google direct one to the correct links in addition to The Telephone Company link.  Some pages are inaccessible.  For example, when the link Innotek Smart Dog Advanced Trainer is chosen, the page is discontinued.

Coverage

I felt that the website could have been more specific about the product and services.  From my understanding, the dog is given to the consumer, but I am unsure if the food MUST be purchased from the company.  Is there a contract?  There is also a blogging site called Real dogs listed but it has nothing to do with dogs or this website.  Overall, I feel as if more information about this website, the services, the author, the management team (almost aspect) should be provided.  It does not to appear to be a reliable website.

The scholarly journal article chosen focused on discourse skills of patients with aphasia. This was somewhat linked with this software.  In therapy, some patients with aphasia work on turn taking skills in conversation, since this is the primary focus of this software, it would be a good technique to attempt in therapy. 

In addition to the presentation, I continued using bullet points, but I made the points more in depth so that the observer may follow the presentation better.  I tried to remain as anti-bias as possible.  There was a limitied amount of information available regarding the software.  I could not find anyone who commented on the results of the use of this software therefore there was only one type of viewpoint. The main goal of the software is stated in the presentation, also.  It was difficult to get multiple viewpoints, include several details, etc. due to the limited amount of information about Turn Talking Software.