Understanding health literacy and perceptions of substance use disorder among racial and ethnic minority communities: Insights from the health belief model

Introduction

In 2022, approximately 23.1% of U.S. adults had a substance use disorder (SUD). In the same year, approximately 17.7% of Kansas adults had a SUD. Racial and ethnic minority communities often experience disproportionate impacts of SUD, including greater prevalence and mortality. Limited research exists on how individuals in these communities conceptualize SUD. The current study sought to: 1) assess SUD health literacy among individuals from racial/ethnic minority communities, 2) describe how members of four racial/ethnic communities (specifically American Indian/Alaska Native, Asian/Asian American, Black/African American, and Hispano/Latino) define SUD, and 3) characterize perceptions of SUD through the lens of the Health Belief Model.

Methods

Semi-structured, one-hour qualitative interviews were conducted virtually or by phone with participants from each racial/ethnic community.

Results

Eighty-one interviews were completed with adults residing in Wichita, Kansas, who identified within one of the groups. Across all groups, participants defined SUD as “dependence,” a “lack of control,” and a means of coping with daily stressors. Perceptions of SUD prevalence, overall and within one's own racial/ethnic community, were greater among American Indian/Alaska Native, Black/African American, and Hispanic/Latino participants than among Asian/Asian American participants. All groups identified historical trauma, grief, discrimination, and mental health challenges as contributing factors to SUD. Depression was emphasized by Black and Hispanic/Latino participants. Across all four racial/ethnic groups, it was most reported that they would consider seeking treatment if SUD began to significantly interfere with daily life or if encouraged by loved ones.

Conclusion

Participants' definitions of SUD were shaped more by cultural background, education, and personal or familial exposure, rather than clinical definitions. Definitions emphasized the impact of SUD on the family rather than on mental and physical health implications. Perceptions of SUD revealed both shared and distinct views across communities. All groups identified perceived benefits of abstaining from substance use (e.g. improved health, longevity, functional ability), which may inform culturally sensitive prevention and outreach efforts.

This study underscores the importance of tailoring interventions to reflect the cultural values and lived experiences of racial/ethnic communities. Understanding how these communities conceptualize and perceive SUD is critical to designing culturally responsive health literacy materials.