When Worlds Collide: The Intersection of Culture, Language and Health Literacy

January 16, 2020 HMS

Health plans are continually searching for ways to engage with members, in hopes of closing gaps in care, improving outcomes and reducing healthcare costs. Motivating members to take action can be challenging, however, if individuals have low levels of health literacy.

This challenge takes on greater importance when language and culture barriers are added into the mix. These issues are known contributors to lower levels of health literacy. The Joint Commission has suggested that low levels of health literacy in combination with language and cultural differences are the “triple threat” to effective health communication.

Understanding Language and Culture Barriers to Health Literacy

Both language and culture play a role in an individual’s health literacy. Culture, for example, influences who people communicate with, when and where information is communicated, and what to communicate about.

Many Latin American countries have high-context cultures. Members of the culture value groups, like the family, rather than individuality. As a result, outsiders often have to work to earn trust. In high context cultures, communication focuses on process and relationships, rather than formal and direct communication.

Cultural factors can also influence the way individuals listen and speak. If a member comes from a culture that favors conflict avoidance, they may say they agree with something even if they don’t. For example, a member may agree to make an appointment with their primary care physician, but then never follow through. It may not be culturally acceptable to ask questions, as it is perceived as impolite. As a result, questions about healthcare and insurance coverage may go unanswered.

Language itself can also hinder effective communication. If a member’s preferred language is Spanish, for instance, health plans should know this and strive to communicate based on member preferences. Even for native English speakers, language should not be overlooked. Like many industries, the healthcare sector has its own unique jargon. Using these terms with English-speaking members can also create confusion.

Tips for Bridging Cultural and Communication Gaps with Members

Health plans that recognize the importance of language and culture to communications are more likely to engage effectively with members. This is crucial for member onboarding and retention programs. Four best practices for bridging cultural and communication gaps include the following:

  1. Create messages that are easily understood by all members. This includes communications for native English speakers and members who prefer to communicate in another language. Messages should avoid jargon.
  1. Conduct a member assessment to collect information on linguistic ability and cultural beliefs. The Online Journal of Issues in Nursing recommends these types of assessments since cultural and linguistic factors have such a significant impact on health literacy.
  1. Target diseases where major health disparities have been identified in non-English speaking populations. Designing language and cultural adapted messages to help members address chronic conditions like diabetes and high cholesterol can lead to better health outcomes. The National Institute on Minority Health and Health Disparities’ Language Access Portal is a useful resource to identify opportunity areas.
  1. Avoid one-to-one translations. Not all ideas can be easily translated from English into other languages. HMS’ Eliza health engagement team includes a Hispanic communication group that culturally adapts outreach communications to maximize their impact across the targeted member population.


The worlds of culture and language can have a negative effect on members’ health literacy. This doesn’t have to be the case, however. Leading health plans acknowledge the importance of these factors and tailor their member communications accordingly. The result is higher member engagement and satisfaction, increased health literacy levels and better health outcomes.



Are you interested in learning more about how leading health plans are onboarding and retaining their members?  Download our white paper, “You Had Me at Hello: Best Practices in Member Onboarding and Retention.”

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