"I Sometimes Ask Patients to Consider Spiritual Care": Health Literacy and Culture in Mental Health Nursing Practice.

While health literacy influences better outcomes of mental health patients, sociocultural factors shape the nature of the relationship. On this matter, little is known about how sociocultural factors affect health literacy practices of nurses, especially in low-income countries. This paper examines how local precepts, within culture and language, shape mental health nurses' (MHNs) practice and understanding of patients' health literacy level in Ghana. The study used a qualitative descriptive design involving 43 MHNs from two psychiatric hospitals. Conventional content analysis was used to analyze the data. Although the MHNs acknowledged the importance of health literacy associated with patients' health outcomes, their practice was strongly attributed to patients' substantial reliance on cultural practices and beliefs that led to misinterpretation and non- compliance to treatments. MHNs shared similar sociocultural ideas with patients and admitted that these directed their health literacy practice. Additionally, numerous health system barriers influenced the adoption of health literacy screening tools, as well as the MHNs' low health literacy skills. These findings suggest MHNs' direct attention to the broader social determinants of health to enhance the understanding of culture and its impact on health literacy practice.