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Health Equity: Use of Linguistically and Culturally Appropriate Health Education Materials


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of four studies (search period 1965 - 2001).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to promoting health equity.

Summary of Results

Detailed results from the systematic review are available in the published evidence reviewpdf icon [PDF - 730 KB].

Four studies qualified for the review.

  • One study reported a change in health behavior and found African-American women exposed to a video specifically designed to emphasize culturally relevant values had an 18% increase in self-reported HIV testing during a two-week period following intervention.
  • The remaining studies reported significant, favorable differences in satisfaction with educational videos, credibility of content, and attractiveness of announcers.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.


Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How does changing the structure and process of healthcare delivery affect meaningful health outcomes? What works best, where, and for whom?
  • Do interventions improve satisfaction with care, reduce ethnic differentials in utilization and treatment, and improve health status?
  • What are intervention effects on knowledge, attitudes, use of services, receipt of treatments, and changes in health outcomes?
  • What are the unintended consequences of, and potential barriers to these interventions?
  • What are the additional effects of language on existing provider–client communication patterns?
  • Do ethnic-specific health messages generate negative stereotypes?
  • Do the client benefits of engaging in culturally competent healthcare systems carry over to other social institutions (e.g., education, employment)?

In 1964, the Civil Rights Act, Title VI, mandated provisions for the language needs of clients. Healthcare organizations cite cost as an important factor that limits their ability to provide trained interpreters. Very little research has been done on the effectiveness and cost-effectiveness of providing linguistically competent healthcare services in the United States or on ways to reduce the costs of providing such services.

  • Do trained interpreters compare favorably with family or ad hoc staff interpreters in improving outcomes of satisfaction, appropriate utilization, and health status?
  • What are the relative contributions of improvements in linguistic competence and cultural sensitivity skills to reducing miscommunication and the resulting medical errors?
  • Are linguistically and culturally appropriate health education materials more effective than standard materials in improving health outcomes?

Healthcare providers and provider organizations are concerned about the burden placed on resources by implementing interventions to improve the cultural competence of healthcare systems, particularly in the absence of proven effectiveness.

  • What role should communities play in collaborating with area healthcare organizations to communicate the needs of ethnically diverse populations? At what levels (e.g., management, provider, staff) in a healthcare organization does investment in linguistic and cultural competencies create the greatest improvement in health or other outcomes?
  • Which cultural competencies within a healthcare system increase client satisfaction and improve health outcomes?
  • Does cultural competency training of healthcare providers have a lasting effect or should it be repeated periodically?

Study Characteristics

  • Studies examined the effectiveness of culturally sensitive health education videos among African-American or mixed African-American and Latino populations.
  • Three studies examined HIV knowledge, attitudes, or behaviors—two among adults and one among adolescents. The remaining study examined tobacco use knowledge and behavior among adolescents.
  • The cultural communication techniques used in the videos included race or ethnic concordance between actors and the target audience, multicultural messages versus those targeted specifically to African Americans, and similarity in contemporary music and dress between actors and audience.