The following resources have been gathered to supplement the Curricula Enhancement Module Series.

Return to the table of contents to navigate to resources from other modules.

The Process of Inquiry -- Communicating in a Multicultural Environment Resources

Selected Resources
Resources on Communication and Disabilities
Resources on Translation & Interpretation 
Language and Health
Literacy Resources
Resources on Social Context, Culture, Health, and Mental Health
Process of Inquiry—Communities
Summary of DHHS Guidance (Appendix)

Selected Resources

Video Resources

Disability is Natural
This video is used as a training tool for a wide audience, including parents, people with disabilities and their families, policy makers, and providers. According to their Web site, “the messages in this video question today’s conventional wisdom, pose provocative questions, and describe positive scenarios that can occur when we realize disability is natural. The combination of these revolutionary ideas coupled with the inspirational music create an unforgettable experience.” See http://www.disabilityisnatural.com/store/index.html

Quality Interactions: A Patient-Based Approach to Cross-Cultural Care
The Manhattan Cross Cultural Group, a training and research organization headed by three physicians, Joseph Betancourt, Emilio Carrillo, and Alexander Green, has developed an interactive, 2-hour e-learning course, Quality Interactions: A Patient-Based Approach to Cross-Cultural Care. Based on curricula taught at several leading medical centers, the course allows users to obtain continuing medical education credits. It responds directly to the recommendations of the IOM reports Unequal Treatment and Crossing the Quality Chasm. The course is being made available by Critical Measures, LLC, at http://www.criticalmeasures.net.

That’s Not What I Meant: Language, Culture, and Meaning
Two videos presenting content on language, culture, and resolving misunderstanding. See http://www.georgetown.edu/faculty/tannend/videos.htm#Thats_Not_What_I_Meant_Language.

Videos From Kaiser Permanente
Kaiser Permanente, in collaboration with The California Endowment, has developed a set of 20 trigger videos that focus on a variety of issues in cross-cultural communication with patients in a variety of clinical settings. The topics include problems encountered in using untrained interpreters, initial clinician reluctance to use telephonic interpreting, communication around sensitive issues such as domestic abuse, gestational diabetes, prostate exams, sexually transmitted diseases (STDs), gay adolescents, alternative medicine use, literacy, somatization, end-of-life decision making, and traditional folk medical practices and concepts of healing. Each video is accompanied by contextual background materials and a facilitator's guide for debriefing the video. Each trigger video and materials can be used for a training session of 30–45 minutes.

The set of 20 trigger videos and accompanying materials sells for $105. For information and order forms, contact Gus Gaona at (323) 259-4776 or by mail: Gus Gaona, Kaiser Permanente National Video Communications and Media Services, 825 Colorado Boulevard, #301, Los Angeles, CA 90041.

Video (VHS or DVD)
In Plain Language: The Need for Effective Communication in Medicine and Public Health, http://ncsall.gse.harvard.edu/video.html, from the National Center for the Study of Adult Learning and Literacy (NCSALL).

Internet Resources

An Overview of Empathy (2003), by J. T. Hardee, The Permanente Journal (2003). Retrieved March 31, 2005, from http://xnet.kp.org/permanentejournal/fall03/cpc.html

Communicate to Make a Difference: Exploring Cross-Cultural Communication, a free, online course designed for public health professionals, hosted by the New York and New Jersey Public Health Training Center. To register, see http://www.nynj-phtc.org/cc/default.cfm

Communicating with Patients, A Quick Reference Guide for Clinicians, Association of Reproductive Health Professionals. Retrieved March 31, 2005, from http://www.arhp.org/healthcareproviders/onlinepublications/QRGPACC.cfm

Developing Print Materials for Low Literacy Individuals at http://www.cancer.gov/cancerinformation/clearandsimple

Health…in brief (on language access strategies in California with examples from other states) (2003), The California Endowment, at
http://www.calendow.org/reference/publications/pdf/cultural/Language_HIB03.pdf

Partnership for Clear Health Communication, see http://www.askme3.org/PFCHC

The Principles and Recommended Standards for Cultural Competence Education of Health Care Professionals (2003), M. Jean Gilbert, Editor, and A Manager’s Guide to Cultural Competence Education for Health Care Professionals (2003), M. Jean Gilbert, Editor.

The California Endowment, http://www.calendow.org has made available two downloadable resources cited above, edited by M. Jean Gilbert, to aid health care organizations in determining appropriate training and curricula for the cultural competence education of health care professionals. See http://www.calendow.org/reference/publications/cultural_competence.stm

Tips for Talking: A Guide to Inclusive Communication for Physicians, Medical Students, and Educators (1997), by Sophia Lee, Lucia Beck Weiss, and Sandra P. Levison, Women’s Health Education Program, see http://webcampus.med.drexel.edu/whep/tipstalking.htm

Working on Common Cross-cultural Communication Challenges, by Marcelle DuPraw, National Institute for Dispute Resolution, and Marya Axner, Consultant in Leadership Development & Diversity Awareness. See http://www.wwcd.org/action/ampu/crosscult.html

Print Resources

A Strategy To Reduce Cross-Cultural Miscommunication and Increase the Likelihood of Improving Health Outcomes (2003), by M. Kagawa-Singer and S. Kassim-Lakha, Academic Medicine, Volume 78, No. 6, 577–587.

Culture and Parental Expectations for Child Development: Critical Concerns for Language Development and Early Learning, edited by S. Rosenkoetter and J. Knapp-Philo. In Learning to Read the World: Language and Literacy in the First Three Years (2005), by W. Jones and I. Lorenzo-Hubert. Washington: Zero to Three Publishing.

Health Communication in Practice: A Case Study Approach (2005), edited by E. B. Ray. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Improving Chronic Disease Care in the Real World: A Step-by-Step Approach (1999, October), by B. White. Family Practice Management, 38–43. See http://www.aafp.org/fpm/991000fm/38.html

Intercultural Communication (2001), by F. E. Jandt. Thousand Oaks, CA: Sage.

Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary-Cambridge Guides (2003), by S. Kurtz, J. Silverman, J. Benson, and J. Draper, Academic Medicine, Volume 78, No. 8, 802–809. See http://www.academicmedicine.org/cgi/content/full/78/8/802

Orality and Literacy: The Technologizing of the Word (1988), by W. J. Ong. (New Accents Series). New York: Methuen.

That’s Not What I Meant: How Conversational Style Makes or Breaks Relationships (1987), by D. Tannen. New York: Ballantine Books.

The Development of Language (2005), by J. Gleason. (6th ed.). New York: Allyn and Bacon.

The Role of Culturally Competent Communication in Reducing Ethnic and Racial Healthcare Disparities (2004), by S. L. Taylor and N. Lurie. American Journal of Managed Care, 10 Spec No: SP1-4.

Toward Culturally Competent Care: A Toolbox for Teaching Communication Strategies (2002), by S. Mutha, C. Allen, and M. Welch. San Francisco: Center for the Health Professions, University of California, San Francisco.

Understanding Misunderstanding: Barriers to Dealing with Diversity (1989), by K. Cushner, and G. Tifonovitch, Social Education, Volume 53, No. 5, 318–322.

User-Friendly Materials and Alternate Formats at http://www.ncddr.org/du/products/ufm/user_friendly4.pdf

Resources on Communication and Disabilities

Internet Resources

Accessible Web design from the U.S. Department of Health and Human Services at http://www.usability.gov/

Administration on Developmental Disabilities
See http://www.acf.dhhs.gov/programs/add/

American Speech-Language-Hearing Association
See http://www.asha.org/default.htm

Association of University Centers on Disability
See http://www.aucd.org/

Center for Spoken Language Understanding
See http://cslu.cse.ogi.edu/general/whatiscslu.html

Developing Print Materials for Low Literacy Individuals
See http://www.cancer.gov/cancerinformation/clearandsimple

Disability Etiquette in PDF format, by the United Spinal Association, at http://www.unitedspinal.org/pages.php?catid=7&pageid=472

Disability Etiquette from Easter Seals at http://www.easterseals.com/site/PageServer?pagename=ntl_etiquette

Disability Etiquette Handbook, including communication tips, from the City of San Antonio, Texas, Planning Department and the Disability Advisory Committee at http://www.sanantonio.gov/planning/disability_handbook/disability_handbook.asp?res=1280&ver=true

Guidelines for Professionals Dealing With Persons With Intellectual Disabilities from the American Association on Mental Retardation at http://www.aamr.org/Policies/guidelines.shtml

Health & Wellness links for people with disabilities
http://www.allabilities.com/health.html

National Institute on Disability and Rehabilitation Research
See http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr

Oregon Health & Science University, Oregon Institute on Disability and Development,
University Center for Excellence in developmental disabilities education, research, and service. See http://www.oidd.org/

People First Language, a Web article by Kathie Snow. Retrieved April 22, 2005, from http://www.disabilityisnatural.com/peoplefirstlanguage.htm

The American Indian Disability Technical Assistance Center at http://aidtac.ruralinstitute.umt.edu

The Memphis Center for Independent Living has a Web site with etiquette, communication, and relationship-building tips at http://www.mcil.org/mcil/mcil/etiqu01.htm

The Rehabilitation Research and Training Center: Health & Wellness has a newsletter available as well as information and links from http://www.healthwellness.org/whatsnew/newsletters.htm

The Research and Training Center on Disability in Rural Communities at http://rtc.ruralinstitute.umt.edu

University of Montana Rural Institute’s Food On Film (copyright), refined the 24-hour diet recall method to include the use of still photographs. This method is potentially useful for nutrition professionals working with any population in which cognitive or communication barriers affect the quality of food intake assessments.
See http://mtdh.ruralinstitute.umt.edu/Publications/FoodonFilm.htm

User-Friendly Materials and Alternate Formats
See http://www.ncddr.org/du/products/ufm/user_friendly4.pdf

Print Resources

Culturally Competent Professionals in Therapeutic Alliances Enhance Patient Compliance (1999, February), by N. Langer, Journal of Health Care for the Poor and Underserved, Volume 10, No. 1, 19–26.

L’Institut Roeher
See http://www.roeher.ca, which includes the publication: Literacy, Disability and Communication: Making the Connection (1999), by L’Institut Roeher. York University, Toronto, Ontario: L’Institut Roeher.

Resources on Translation & Interpretation

California Pan-Ethnic Health Network (CPEHN) has made access to quality translation and interpretation a priority area. See http://www.cpehn.org/whatwedo.php. CPEHN wrote a policy brief in December 2004, entitled Limited English Proficient Enrollee Access to Health Plan Grievance Systems, which documents problems and offers solutions. This report is available for download directly from http://www.cpehn.org/policybriefs.php

Hablamos Juntos provides many resources at http://www.hablamosjuntos.org/resources/default.resources.asp

Language Access: Giving Immigrants a Hand in Navigating the Health Care System, from the National Conference of State Legislatures. See http://www.ncsl.org/programs/immig/SHNarticle.htm

Quality of Care for Underserved Populations, a program area of The Commonwealth Foundation that offers resources on language services, including Providing Language Services in Small Health Care Provider Settings: Examples from the Field (Youdelman & Perkins, 2005), available from the program Web site at http://www.cmwf.org/programs/programs_list.htm?attrib_id=9133 or directly from http://www.cmwf.org/usr_doc/810_Youdelman_providing_language_services.pdf

Thoughts on Live vs. Telephone and Video Interpretation (1997), by Ines Swaney, Proteus, Volume 6, No. 2. See http://www.najit.org/proteus/back_issues/swaney.htm

What a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency, a report by The Access Project, available at http://www.accessproject.org/camspublications.htm

Print or Other Resources

National Coalition for Quality Translations in Health Care, formed in 2004 by Kaiser Permanente’s National Linguistic & Cultural Programs of National Diversity. For additional information, contact Gayle Tang at (510) 271-6386 or Sunny Pak at (510) 271-6868 or call National Diversity hotline at (510) 271-6663.

Pay Now or Pay Later: Providing Interpreter Services in Health Care (2005), by L. Ku and G. Flores, Health Affairs, Volume 24, No. 2, 435–444.

Language and Health

Language Services Access Kit (2003), developed by the National Health Law Program and The Access Project. See http://www.accessproject.org/projects.htm

Overcoming language barriers to health care (1999), by Jane Perkins, Popular Government, Volume 65, No. 1, 38–44. See https://iogpubs.iog.unc.edu/ for viewing or ordering information.

Policy Fact Sheet on Persons with Limited English Proficiency (2003), The Association of Asian Pacific Community Health Organizations. See http://www.aapcho.com/links/policypaper2003LEP.pdf

Summary Brief from Hablamos Juntos on providers’ perspective regarding the health impact of language barriers. See http://www.hablamosjuntos.org/resourcecenter/pdf/00606272003.pdf

Literacy Resources

Internet-Based Resources

Addressing health literacy: A description of the intersection of functional literacy and health care (2001), by David Foulk, American Journal of Health Studies, Volume 17.1. PDF download available at no cost as retrieved on April 14, 2005, see http://ajhs.tamu.edu, past issues.

An updated overview of medical and public health literature addressing literacy issues: An annotated bibliography of articles published in 2000, by J. Greenberg, Harvard School of Public Health, National Center for the Study of Adult Learning and Literacy. Retrieved April 8, 2005, from http://www.hsph.harvard.edu/healthliteracy/annotations.html

California Literacy Web site with resources on health literacy at http://www.caliteracy.org/healthliteracylinks.html

Functional health literacy: Improving health outcomes (2004, May 1), by Allen Hixon, American Family Physician, Volume 69, No. 9. Available online at http://www.aafp.org/afp/20040501/medicine.html

Harvard’s Health Literacy Studies page http://www.hsph.harvard.edu/healthliteracy/

Health literacy and interpretation: An issue of cultural competence, by Francesca Gany, Alexis Rourk, Ephraim Shapiro, and Abraham Aragones. A paper presented on November 10, 2004, at the American Public Health Conference, “Public Health and the Environment,” description and learning objectives online at http://apha.confex.com/apha/132am/techprogram/paper_88377.htm

Health literacy beyond basic skills (2003), by Sandra Kerka. ERIC Digest. Columbus, OH: ERIC Clearinghouse on Adult Career and Vocational Education. http://www.ericdigests.org/2004-1/health.htm

Literacy and Health in America, available for download directly from http://www.ets.org/research/pic/literacy&health.pdf or purchase copies for $15 (prepaid) by writing to the Policy Information Center, ETS, MS 19-R, Rosedale Road, Princeton, NJ 08541-0001; by calling (609) 734-5694; or by sending an e-mail to pic@ets.org

Literacy and Health Outcomes (2004, January), from the Agency for Healthcare Research and Quality, see http://www.ahrq.gov/clinic/, under Evidence-Based Practice; Quality Improvement and Patient Safety or summary at http://www.ahrq.gov/clinic/epcsums/litsum.htm

Print Resources

Health Literacy: A Prescription to End Confusion (2004), from the Institute of Medicine, National Academy Press. To order, see http://www.nap.edu/catalog/10883.html

Literacy and Health in America (2004), by R. E. Rudd, I. Kirsch, and K. Yamamoto. Princeton, NJ: Educational Testing Services.

Resources on Social Context, Culture, Health, and Mental Health

Print Resources

Actual Causes of Death in the United States, 2000 (2004, March 10), by A. H. Mokdad, J. S. Marks, D. F. Stroup, and J. L. Gerberding, Journal of the American Medical Association, Volume 291, No. 10, 1238–1245.

Belief and Narrative: An Understanding Of Pain, Bereft of Its Cultural Dimensions, Is Woefully Incomplete (2005, March 28), by David B. Morris, The Scientist, Volume 19, Supplement 1.

From Neurons to Neighborhoods: The Science of Early Childhood Development (2000), by the Institute of Medicine. National Academy Press: Washington, DC.

Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences (2001), by the Institute of Medicine. National Academy Press: Washington, DC.

The Illness Narratives: Suffering, Healing and the Human Condition (1988), by Arthur Kleinman. New York: Basic Books.

The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient (1992), by S. K. Toombs, Philosophy and Medicine Series, Volume 42. Dordrecht, The Netherlands: Kluwer Academic Publishers.

Understanding the Environmental Issues in Diabetes Self-Management
Education Research: A Reexamination of 8 Studies in Community-Based Settings (2004), by Leonard Jack, Jr., Leandris Liburd, Tirzah Spencer, & Collins O. Airhihenbuwa. Annals of Internal Medicine, 140(11), 964–971.

Process of Inquiry—Communities

Internet-Based Resources

Collaborative Solutions—Engaging the Community (2005, Winter), a newsletter from Tom Wolff & Associates, available from http://www.tomwolff.com/

Relationships of a Brief Measure of Youth Assets to Health-Promoting and Risk Behaviors (2004, March), by D. A. Murphey, K. H. Lamonda, J. K. Carney, and P. Duncan, Journal of Adolescent Health, Volume 34, No. 3, 184–191.

The Wingspread Symposium: Involving Young People in Community Evaluation Research (2003, Spring), by Barry Checkoway, David Dobbie, and Katie Richards-Schuster, Community Youth Development Journal, Volume 4, No. 1. See http://www.cydjournal.org/2003Spring/checkoway.html

Youth Participation in Public Policy at the Municipal Level (2005), by B. Checkoway, T. Allison, and C. Montoya, Children and Youth Services Review. See http://www.elsevier.com/locate/childyouth or see http://closup.umich.edu/research/funded/mpp/youth-participation.html

Print Resources

Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative (2002, February), by S. A. Brown, A. A. Garcia, K. Kouzekanani, and C. L. Hanis, Diabetes Care, Volume 25, No. 2, 259–268.

Developing Local Public Health Capacity in Cultural Competency: A Case Study With Haitians in a Rural Community (2004, December), by L. D. Phelps and K. E. Johnson, Journal of Community Health Nursing, Volume 21, No. 4, 203–215.


Summary of DHHS Guidance (from http://www.hhs.gov/ocr/lep/guide.html)
(Process of Inquiry — Communicating in a Multicultural Environment: Appendix)

• Federal fund recipients should have a written language services policy and should disseminate it widely throughout the organization.

• Interpreter/translation services should be offered at no cost to individuals with limited English proficiency.

• Organizations should identify a person or department with accountability for language services.

• Health care organizations should have a system for tracking patients’ language needs, monitored and periodically reviewed.

• Organizations should notify patients of the availability of no-cost language services through signage, rights and responsibilities, membership materials, and non-English media.

• Family members and friends should be asked to provide interpreter services only after alternative, no-cost methods have been explained and the patient so chooses. This decision must be recorded in the patient chart.

• Minors should not be used to interpret.

• Federally funded organizations need to ensure the availability of interpreters on a 24-hour basis or during all hours of operation.

• Interpreters should be qualified and trained, demonstrating proficiency in both languages. Interpreter skills should be evaluated on an ongoing basis.

• Telephone interpretation should be used for rare languages and when interpreters are unavailable.

• Organizations should have translated written materials available.

Corollary to and supporting the DHHS language services guidelines are CLAS standards, which are available at the following Web site: http://www.omhrc.gov/clas/finalcultural1a.htm. Standards 4, 5, 6, and 7 deal specifically with language services:

4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.

5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

6. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).

7. Health care organizations must make available easily understood patient-related written materials and post signage in the languages of the commonly encountered group and/or groups in the service area.