ments via predominant use of nouns, adjectives, and pronouns is necessary when working with Aboriginal people during health and illness encounters.

In Native American cultures, dreams function as a cultural language to communicate realities in everyday life and deal with health and illness. The significance of this for health care is demonstrated by Lincoln (2003) with respect to the Navajo Indians in Arizona: “Diagnosticians are called upon to cure sickness caused by dreams or to prevent sickness predicted by dreams.” (Lincoln, 2003). For Native American peoples, therefore, dreams are part of the cultural lexicon that informs health literacy.

The Hmong language has no word for cancer, or even the concept of the disease. “We’re going to put a fire in you,” is how one inexperienced interpreter tried to explain radiation treatment to the patient, who as a result, refused treatment (Morse, 2003).

Language and Meaning in the Context of Health

Frequently, words or their underlying concepts have little or no meaning, or a different meaning, for a person from another culture. This is true both of specific terminology as well as the essential meaning of health and illness to different people. For example, instructing a patient to take a teaspoon of medicine assumes that the patient owns a teaspoon that holds 5 cc of liquid, and identifies it as such. Promoting health literacy requires an awareness and understanding of these differences in meaning and providing what is needed to increase the probability of treatment adherence (for example, a teaspoon with which to measure the medicine, or pre-measured quantities of medicine).

As noted, recent IOM reports (IOM, 2002, 2003a) urge a broad, more realistic perspective of culture as fluid processes and lived experiences, in which communications, relationships, and meaning are central themes relevant to health literacy. Conceptual definitions and proposed relationships between culture and health literacy as human experiences have yet to be developed. In-depth theoretical concepts to guide scientific inquiries could arise from conceptual frameworks on the interface between cultural processes, literacy, and health literacy. These frameworks must distinguish between linguistic and cultural processes, both of which are rooted in the concept of meaning. For example, research on epilepsy found that both neurologists and patients use the word “trauma,” but neurologists most often mean “a physical blow,” while patients and families most often understand the word to imply “psychological damage.” This confusion is



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