A qualitative study of health literacy and cultural influence on nursing practice in mental health

Abstract

OBJECTIVE: Despite the critical role that health literacy plays in the provision of health services, a significant proportion of nurses have limited knowledge and experience on how to assist their patients with lower levels of health literacy. This lack of adequate understanding is due to numerous contextual factors. To investigate these factors, this study begins by exploring the perceptions and understanding that mental health nurses (MHNs) have about their patients' health literacy. It then examines how local factors, such as culture and language, shape knowledge and the adoption of strategies to deal with issues affected by health literacy in clinical practice in the Greater Accra Region in Ghana. METHOD: This study has employed a qualitative descriptive design with the use of purposive sampling techniques to recruit 43 mental health nurses from two psychiatric hospitals in order to conduct semi-structured interviews. Six focus group discussions and three in-depth interviews were conducted amongst these nurses from October to December 2017. The data were analysed using a content analysis approach. FINDINGS: Major findings of the study were: the experience and practice of MHNs is shaped by local cultural beliefs; MHNs interpretation of health literacy has an impact on mental health nursing practice; the practice of health literacy has to be negotiated within a cultural context. Nurses' understanding of their patients' health literacy was generally poor and this was reflected in an inadequate application of health literacy strategies in nursing practice. Nurses attributed low health literacy among patients to firstly, the cultural beliefs of their patients (which included spirituality as a cause of and a solution to mental health problems); and, secondly, the level MHNs' skills such as their communication skills and their knowledge about mental disorders. However, most of the informants reported that they believed that spirituality was a major cause of mental illness in Ghana. Some of them admitted that they avoided giving care to patients with low levels of education, strong spiritual beliefs and low socioeconomic status. These observations were exacerbated by several factors, viz, language differences between nurses and patients; limited trust in biomedical treatments, lack of materials needed for educating patients regarding relevant health care services as well as impediments related to the Ghanaian health system itself. All these factors militated against nurses' attempts to address health literacy deficits among their patients. The implication for practice: Findings from this current study suggest that health literacy, language and cultural issues interact with each other and they affect nursing practice. CONCLUSION: Understanding health literacy issues from a cultural perspective can assist nursing practice and health services to address the challenges that hamper care delivery by enabling them to rectify misconceptions about mental health. The findings and the framework proposed in this study can be adopted to develop interventions to improve MHNs' understanding of health literacy and that of their patients. In addition, these initial findings can be used to inform further investigation in order to examine how health literacy and cultural competence can be harmonised more extensively in nursing practices.