Abstract
Extensive evidence of health disparities and systemic racism has prompted scholars to examine constructs that may account for differences in the burden of disease. One such construct is health literacy, which has been posited to have four components: print literacy, oral literacy, numeracy, and cultural and conceptual knowledge. Consistent with historical trends related to culturally based constructs, the latter component has garnered the least attention in the published literature, despite its pervasive influence on health care outcomes. We engage in a reformulation and conceptual analysis of cultural and conceptual knowledge, defined as the filter through which individuals obtain, process, and understand health information and options for diagnosis and treatment. We propose the construct of cultural schema, and operationalize the construct as having cognitive (knowledge, beliefs) and affective (attitudes, emotions) components. As we strive to achieve a more complex understanding of influences on behavioral outcomes, a greater focus on these culturally based factors is essential. In this article, we present a conceptual analysis that seeks to advance the field by: (a) providing distinct definitions for each component that can be applied across fields of study and theoretical frameworks, (b) offering measurement considerations consistent with their conceptualizations, and (c) making recommendations for future theory, research, and practice. We hope that with greater conceptual and measurement clarity of cultural schema, more consistent results will be obtained, constructs and processes that affect health outcomes will be identified, and more personalized intervention will be possible, optimizing the limited resources available for health promotion efforts.
•Cultural schema is introduced as a component of the health literacy model.•This construct is an advance and reformulation of cultural and conceptual knowledge.•Cultural schema's components include knowledge, beliefs, attitudes, and emotions.•Components are defined, operationalized, and suggestions presented for measurement.•Conceptual clarity will facilitate health promotion and lowering health disparities.