Chronic disease self-management and health literacy in four ethnic groups

Susan J. Shaw, Julie Armin, Cristina Huebner Torres, Kathryn M. Orzech, James Vivian

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Research from several fields has explored health literacy as a multidimensional construct. The authors' multimethod study, The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes, assessed health literacy and chronic disease self-management among 296 patients from four ethnic groups (Vietnamese, African American, White, Latino) at a Massachusetts community health center between 2006 and 2010. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA) measures. Qualitative research methods, including in-depth interviews (n=34), home visits (n=12), chronic disease diaries (n=15), and focus groups (n=47), were completed with a subset of participants. Qualitative interviews indicated a wide range of interpretations of S-TOFHLA questions in which participants substituted their own illness or health care experiences for the abstract examples offered in the instrument, at times leading to incorrect responses. Situating these responses in a broader social and cultural context, this article describes examples of the wide range of chronic disease self-management abilities among participants with limited education and/or low health literacy. It also discusses the culturally variable health beliefs identified among participants interviewed that may play important roles in their chronic disease self-management practices.

Original languageEnglish (US)
Pages (from-to)67-81
Number of pages15
JournalJournal of Health Communication
Issue numberSUPPL. 3
StatePublished - Jan 1 2012

ASJC Scopus subject areas

  • Health(social science)
  • Communication
  • Public Health, Environmental and Occupational Health
  • Library and Information Sciences


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