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Maximiano-Barreto MA, Monteiro DQ, Alves LCDS, Raminelli AO, Coelho HER, Inouye K, Bas-Sarmiento P, Luchesi BM. Sociodemographic and health-related factors associated with low health literacy among Indigenous populations: a systematic review. Health Promot Int 2025; 40:daaf018. [PMID: 40159950 DOI: 10.1093/heapro/daaf018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Indigenous people represent 6% of the world's population and, over time, this population has faced different negative consequences, including those related to health. Health literacy is a variable that can help reduce the health-related harm faced by Indigenous people, since low health literacy has been considered a public health problem. The aim was to review the literature on sociodemographic and health-related factors associated with low health literacy among Indigenous people. To do this, we conducted a systematic review following the recommendations of the PRISMA Statement and approved by PROSPERO (CRD42024591888). A total of seven articles make up the results of this review. The findings show that the low health literacy of Indigenous people is associated with sociodemographic characteristics (e.g. older age, male gender, lower income and educational level) and health-related aspects such as having more than one chronic condition, low perception of COVID-19 risk, low chance of cancer screening, poorer glycemic control, eating behavior, self-monitoring of blood glucose and knowledge about diabetes and difficulty in understanding health information (e.g. medication labels). Although the number of articles selected for this review was small, it should be noted that they all presented a low risk of bias. Sociodemographic and health factors are associated with low health literacy among the Indigenous population. The findings demonstrate the importance of planning public policies to promote health and especially health literacy among this neglected population.
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Affiliation(s)
| | - Diana Quirino Monteiro
- Postgraduate Programme in Gerontology, Catholic University of Brasilia, Brasília-DF, Brazil
| | | | | | | | - Keika Inouye
- Três Lagoas Campus, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Bruna Moretti Luchesi
- Postgraduate Programme in Nursing, Federal University of São Carlos, São Carlos, SP, Brazil
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Warner ZC, Gilbert-Gard K, Reid B, Joseph W, Kepka D, Auguste P, Warner EL. Knowledge and awareness of colorectal cancer among a predominantly Indigenous Caribbean community. BMC Public Health 2023; 23:243. [PMID: 36737701 PMCID: PMC9898893 DOI: 10.1186/s12889-022-14810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/05/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess awareness levels and knowledge of colorectal cancer (CRC) and CRC screening among an Indigenous Caribbean community. METHODS A community-based participatory research project was developed to perform a needs assessment of cancer prevention and education in an Indigenous non-metropolitan community in Dominica. Purposive sampling occurred at a local health clinic. Data was collected from 58 eligible patients via a 57-item structured interview. Descriptive statistics were calculated, and demographic correlates of CRC knowledge and awareness were assessed using chi-square and Fisher Exact tests. RESULTS Of 58 participants, 72.4% identified as Indigenous, and 36.5% had heard of CRC. Most respondents (96.1%) believed CRC screening to be "important," yet only 3.0% of those who were age eligible had received screening in the prior 10 years, and 12.5% knew how to get screened. More respondents with incomes over $5,000 ECD had heard of CRC (72.2%) compared to those who had not (21.7%), and those who were unsure (16.7%, p < 0.01). Among those with a family cancer history, 14.3% knew how to get tested for CRC, 60.0% did not, and 25.0% were unsure (p < 0.03). CONCLUSION Despite limited familiarity with CRC screening, participants broadly believed CRC screening to be important. Health education research is needed to develop patient-centered, culturally appropriate materials about CRC screening and prevention. Future work facilitating productive community partnerships and incorporating prevailing community traditions may align cancer prevention and education initiatives with community priorities.
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Affiliation(s)
- Zachary C. Warner
- grid.134563.60000 0001 2168 186XDepartment of Internal Medicine, University of Arizona, Tucson, USA
| | - Kacy Gilbert-Gard
- grid.134563.60000 0001 2168 186XSchool of Medicine, University of Arizona, Tucson, USA
| | - Brandon Reid
- grid.266515.30000 0001 2106 0692 Department of Family Medicine, University of Kansas Wichita, Lawrence, USA
| | | | - Deanna Kepka
- grid.223827.e0000 0001 2193 0096College of Nursing, University of Utah, Salt Lake, USA ,grid.479969.c0000 0004 0422 3447Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake, USA
| | - Priscilla Auguste
- grid.411017.20000 0001 2151 0999Department of Family Medicine, University of Arkansas for Health Sciences, Fayetteville, USA
| | - Echo L. Warner
- grid.223827.e0000 0001 2193 0096College of Nursing, University of Utah, Salt Lake, USA ,grid.479969.c0000 0004 0422 3447Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake, USA
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Sanjida S, Garvey G, Ward J, Bainbridge R, Shakeshaft A, Hadikusumo S, Nelson C, Thilakaratne P, Hou XY. Indigenous Australians' Experiences of Cancer Care: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416947. [PMID: 36554828 PMCID: PMC9779788 DOI: 10.3390/ijerph192416947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 05/31/2023]
Abstract
To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples' cancer care experiences in the Australian healthcare system from the patient's point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.
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Affiliation(s)
- Saira Sanjida
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Gail Garvey
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Anthony Shakeshaft
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Stephanie Hadikusumo
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
- Royal Brisbane and Women’s Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Carmel Nelson
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
| | - Prabasha Thilakaratne
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
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Warner ZC, Reid B, Auguste P, Joseph W, Kepka D, Warner EL. Awareness and Knowledge of HPV, HPV Vaccination, and Cervical Cancer among an Indigenous Caribbean Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5694. [PMID: 35565089 PMCID: PMC9105034 DOI: 10.3390/ijerph19095694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
Abstract
Caribbean women experience a cervical cancer incidence rate that is three times higher than that among their North American counterparts. In this study, we performed a needs assessment of the knowledge and awareness of HPV, HPV vaccination, and cervical cancer and receipt of cervical cancer screening among an indigenous Caribbean community. We purposively recruited individuals aged ≥18 from a community health care clinic (n = 58) to complete a 57-item structured interview including items on demographics, cancer history, knowledge and awareness of HPV, HPV vaccines, cervical cancer, and cervical cancer screening. Participants' mean age was 47.1 years (SD: 14.4). Most were female (74.1%), were married/partnered (51.7%), had primary education (63.8%), and identified as Kalinago (72.4%). Whereas 79.5% had heard of cervical cancer, few had heard of HPV (19.6%) or the HPV vaccine (21.8%). Among those who knew someone with cancer, 90.9% had heard of the HPV vaccine, compared with only 9.1% of those who did not know anyone with cancer (p = 0.02). Access to HPV vaccination is an immediate, cost-effective cancer prevention priority for reducing the disproportionate burden of HPV-related cancers, particularly cervical cancer, in the Caribbean. We recommend culturally targeted education interventions to improve knowledge about HPV vaccination and the link between HPV and cervical cancer.
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Affiliation(s)
- Zachary Claude Warner
- Department of Internal Medicine, University of Arizona, 1501 N Campbell Avenue, Tucson, AZ 85724, USA
| | - Brandon Reid
- Department of Family Medicine, University of Kansas, 138 N Santa Fe Ave, Salina, KS 67401, USA;
| | - Priscilla Auguste
- Department of Family Medicine, University of Arkansas for Health Sciences, Little Rock, AR 72205, USA;
| | - Winnie Joseph
- Salybia Health Clinic, Saint David Parish, Bataka 00109, Dominica;
| | - Deanna Kepka
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA; (D.K.); (E.L.W.)
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Echo Lyn Warner
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA; (D.K.); (E.L.W.)
- Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
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Nash S, Arora A. Interventions to improve health literacy among Aboriginal and Torres Strait Islander Peoples: a systematic review. BMC Public Health 2021; 21:248. [PMID: 33516186 PMCID: PMC7847024 DOI: 10.1186/s12889-021-10278-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples continue to experience poorer health outcomes than other population groups. While data specific to Indigenous Australians are scarce, a known social health literacy gradient exists linking low health literacy and poor health outcomes within many minority populations. Improving health literacy among Indigenous Australians is an important way to support self-determination and autonomy in both individuals and communities, by enhancing knowledge and improving health outcomes. This review aims to rigorously examine the effectiveness of health literacy interventions targeting Aboriginal and Torres Strait Islander peoples. METHODS A systematic review across six databases (The Cochrane Library, PubMed, Embase, SCOPUS, ProQuest Dissertation and Thesis and Web of Science) was performed for publications evaluating interventions to improve health literacy among Indigenous Australian adults using search terms identifying a range of related outcomes. RESULTS Of 824 articles retrieved, a total of five studies met the eligibility criteria and were included in this review. The included studies evaluated the implementation of workshops, structured exercise classes and the provision of discounted fruit and vegetables to improve nutrition, modify risk factors for chronic diseases, and improve oral health literacy. All interventions reported statistically significant improvement in at least one measured outcome. However, there was limited involvement of the Aboriginal and Torres Strait Islander community members in the research process and participant retention rates were sub-optimal. CONCLUSION There is limited evidence on interventions to improve health literacy in Indigenous Australian adults. Participation in interventions was often suboptimal and loss to follow-up was high. Future studies co-designed with Aboriginal and Torres Strait Islander community members are needed to improve health literacy in this population.
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Affiliation(s)
- Simone Nash
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, Westmead, NSW, 2145, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW, 2010, Australia.
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