A systematic review of asthma and health literacy: a cultural-ethnic perspective in Canada.
BACKGROUND
Asthma is one of the most common inflammatory lung diseases and its prevalence and incidence have increased in many developed and developing countries. Asthma places a heavy burden on healthcare expenditures and productivity, which in turn diminishes the quality of life of the individuals involved as well as their families. The goal of improving a patient's knowledge about asthma management should include the enhancement of the individual's skills with the hopeful outcome of improving how the individual manages the condition. However, when health professionals prepare a training program, they are faced with the challenging cosmopolitan reality of individuals with different ethnic backgrounds.


METHODS
In order to find links between asthma and health literacy in a cultural/ethnicity perspective, we performed a systematic review of all publications on the topic of asthma, health, and literacy among cultural groups from 1980 to 2006 using the Internet and journals: Medline (Ovid), ERIC, EMBASE, PsycINFO, Google, Google Scholar, Sociological Abstracts, and Anthropology Plus. Key words included the following: "asthma," "culture," "ethnicity," "literacy," "health," "health literacy," "health beliefs," "adults," "disease management," "chronic condition," "ethnocultural groups," "minority groups," and "newcomers/immigrants."


RESULTS
More than 650 articles were initially identified in our review; 65 met our inclusion criteria. From these, we examined the factors related to asthma and literacy/health literacy with a cultural lens. All of these are categorized and summarized below. We chose what we considered to be the most relevant and important articles/documents in the research literature to date. Because many of the studies were qualitative, a formal meta-analytic review was not undertaken. We found that current asthma management techniques - including patient education - are not culturally sensitive, linguistically sensitive, or relevant, which creates further difficulties for ethnocultural communities and minority groups in many Western countries. In this systematic review, several themes were identified, including: approaches to language limitation and cultural barriers; the recognition of healthcare system bias (in terms of culturally competent care); and relationship-building to facilitate participatory decision-making by both provider and patient. This review provides further understanding and considerations regarding the beliefs and perspectives of care providers and populations in relation to health and illness, literacy and health literacy, and their association with asthma among ethnocultural communities.


CONCLUSIONS
There is an urgent need to better define the impact of cultural and ethnic issues in the management of asthma in Canada. Appropriately designed studies should better define the barriers in the optimal delivery of asthma care influenced by these parameters.
Poureslami
Iraj M
IM
Institute for Health Promotion, University of British Columbia, Vancouver.
Rootman
Irving
I
Balka
Ellen
E
Devarakonda
Rajashree
R
Hatch
James
J
Fitzgerald
J Mark
JM
D001249:Asthma / Q000208:ethnology* / Q000628:therapy*; D002170:Canada; D003466:Cultural Characteristics; D006801:Humans; D010353:Patient Education as Topic