gms | German Medical Science

Background: The constantly increasing opportunities of preventive and predictive medicine, combined with an immense growth in the field of technical innovation, challenge individuals, health systems and societies in manifold manners. The emphasis on risk (prevention) entails different perspectives:

1.

risk factors and behaviour from a disease-centred perspective;

2.

factors putting communication at risk in clinical interactions; and

3.

avoiding risk as a personal and a clinical responsibility.

These represent cultural phenomena of great interest for ethnological and socio-anthropological research.

Aims and research question: This contribution aims at

1.

offering insight into the field of HL through the lens of risk prediction, culture and communication, grounded in empirical findings;

2.

pursuing an ethnographic approach to health literacy as an (inter)cultural encounter;

3.

taking into consideration the perspectives of different actors in the sphere of health services.

The overarching research question is: Why and how can HL research and practice in the context of risk benefit from a culture-sensitive approach?

Methods: This study is based on a three-pillared qualitative research design which aims at combining the emic and etic views on health and risk, emphasising the shifts in meaning between uncertainty, health and disease, and offering insights into the collective and individual contexts of risk prediction and health communication. The data in this contribution is derived from two years of ethnographic research in health institutions, 30 narrative interviews with “persons at risk”, and secondary data analysis of seven interviews with “persons at risk” who consider themselves as having an intercultural background. The data was analysed using Reflexive Grounded Theory. The combination of research methods allows data triangulation, generating different types of narratives: verbal and non-verbal; individual and shared; reflecting real and hypothetical experience.

Findings: The data in this study portray the individual and collective perceptions of how HL and risk are negotiated within health encounters, the factors which have impact on the context of health risks and their communication, as well as the complex interplay of cultural meanings, risk and health in the individual lifeworlds. The findings are interpreted within a framework of three major themes:

1.

diversity;

2.

agency and vulnerability; and

3.

the intertwining of risk, health and culture.

Discussion and practical implications: The insights from this study illustrate the essential role of subjectivity in the way risk and health are explained, communicated and lived, embedded within the medical culture and the individual biographical background. Risk communication between professionals and patients can be thus defined as an intercultural encounter including different risk and health understandings, role expectations and strategies to handle the feeling of uncertainty and trust. The process of risk negotiation can be seen as a ritualised action, opening up a liminal space between the condition of being healthy and being ill. HL may be seen as a resource to deal with this ambiguity successfully both on a personal and an organisational level.