The social determinants of health, such as living and working conditions and access to quality medical care, are not the same for everyone. Health inequities pose a serious challenge to the healthcare community, but healthcare professionals have a powerful tool at their disposal: cultural competence. Cultural literacy in health care addresses the inequalities that people from different racial and cultural backgrounds often experience. You can ensure that all patients receive the care they need to live a healthier life.
What is cultural competence in health?
Cultural competence in health means providing effective and quality care to patients with different beliefs, attitudes, values and behaviors. This practice requires systems that can personalize health care according to cultural and linguistic differences. It also requires understanding the potential impact that cultural differences can have on health care delivery.
For example, race, socioeconomics, health literacy and other factors can affect:
- How patients perceive symptoms and health conditions
- When and how patients seek help
- patient care expectations
- Patient preferences regarding procedures or treatments
- Willingness of patients to follow medical recommendations or treatment plans
- Who do patients think should be involved in making health decisions?
While cultural competence in health was originally related to meeting the needs of people from different ethnic and racial groups, it is now also related to meeting the needs of people with disabilities, people from different socioeconomic backgrounds, and members of the LGBTQ community.
The need for cultural literacy in healthcare
Differences between healthcare professionals and patients can affect communication. This, in turn, can influence the treatment decisions of physicians and patients. For example, a physician may misinterpret a patient's silence as a lack of interest in treatment. As a result, the clinician may not order a diagnostic test when the patient's response truly reflects their idea of respectful behavior.
When healthcare professionals fail to recognize the differences between themselves and their patients, they can unwittingly provide substandard care. Developing skills that enhance intercultural communication can play an important role in providing equitable care.
In addition, collaborating with healthcare professionals who reflect the diversity of the patient populations served can also improve cross-cultural communication. Diverse teams have a broader base of cultural knowledge to share. As a result, they tend to be empathetic to patients' unique cultural needs.
Language accessibility is also crucial. Language barriers prevent patients from accurately describing their symptoms and providers from explaining diagnoses. Language barriers can also create unsafe and inappropriate situations in other ways.
For example, doctors can rely on children to act as interpreters, enabling young people to tell their parents that they have cancer. As another example, clinicians may rely on abusive spouses to interpret their abusive partners. Both situations raise significant problems.
Combining cultural competence with cultural humility
Healthcare professionals are striving to develop a multicultural focus to provide culturally sensitive care and improve communication. However, even when health professionals have a comprehensive understanding of a culture, they cannot predict their patients' behavior and attitudes simply based on their cultural background. This is because people are unique and their behaviors and beliefs do not always reflect those of their culture.
Against this backdrop, medical professionals need to focus on developing cultural competence and cultural humility. Cultural humility recognizes the limitations of people's knowledge of others. It also recognizes that even people who have cultivated their cultural awareness may still have unconscious and unintentional biases against cultures other than their own.
Cultural humility involves an ongoing process of self-assessment. By exploring and reflecting on their own beliefs and behaviors, healthcare professionals can increase their awareness of implicit biases and promote a patient interaction characterized by openness and curiosity towards each new patient.
Objectives of cultural competence in health
Cultural competence aims to break down barriers that prevent patients from receiving the care they need. It also strives to ensure a better understanding between patients and their providers.
The growing diversity of the US population requires the health care system to expand its capacity to meet the needs of patients. Cultural competence provides a pathway and framework for achieving the goal of better health for all patients.
Culturally and Linguistically Appropriate Services (CLAS) cater to each patient's individual preferences and needs. They also help improve health outcomes and reduce health disparities.
According to the US Department of Health, Office of Minority Health, the primary standard of CLAS includes the provision of equitable care, namely:
Importance of cultural competence in health
Cultural competence greatly benefits healthcare organizations and patients. This leads to greater patient engagement and engagement, fostering respect and better understanding, which can result in:
- Greater patient safety
- reduced inefficiencies
- less differences in care
- reduced costs
Better outcomes for patients
Cultural competence improves communication, which makes patients safer. Clear communication allows healthcare professionals to collect accurate medical information. It also encourages active dialogues where patients and healthcare professionals can ask questions, correct misunderstandings and build trust.
Studies have shown that lack of culturally competent care can lead to preventable errors and adverse events.
For example, a recent Hospital Pediatrics study examining patient safety in US hospitals suggests that patients who are not proficient in English experience more unwanted safety incidents during their stay than those who are fluent in English. The events they experience are also often more serious.
Examples of better patient outcomes
On the other hand, the use of culturally competent strategies can lead to significant improvements in health outcomes. FORAnotherThe study, which reviewed culturally competent strategies, found numerous examples of interventions that produced notable differences.
For example, after a medical center brought in a bilingual Russian internist to break down language barriers, Russian-speaking diabetics experienced significant reductions in blood pressure and cholesterol levels.
In another example, an inpatient psychiatric unit that included Spanish proverbs in therapy sessions found greater participation, greater motivation, and greater willingness to explore emotional issues in Spanish-speaking patients.
Better patient experiences
Healthcare environments that demonstrate awareness and respect for differences create more satisfying experiences for patients. When providers tailor treatments to patient needs and preferences, patients take notice and their overall experience improves.
ANDAnotherThe review found that black men rated provider behavior and attitudes significantly higher after the clinic provided cultural skills training to its providers.
Another study published recently inSports Rehabilitation Magazinefound that cultural competence has a positive impact on how patients experience healthcare. In addition to increasing patient satisfaction, it increases the likelihood that patients will follow medical advice. The more culturally competent patients find their providers, the better their experience will be. The study also showed that patients treated by professionals who speak their language were also happier.
When a healthcare professional uses unfamiliar medical jargon with a patient or makes assumptions about a patient because they use public health insurance, the patient is likely to become frustrated. On the other hand, when clinicians are open-minded about differences, actively listen, and make an effort to make sure patients understand them, their patients are more likely to be satisfied with their treatment.
Examples of cultural competence in health
The following examples of cultural competence in health illustrate how healthcare organizations address cultural differences in the delivery of care, even when barriers and different perspectives exist. Consider the following situations:
Dealing with a challenging birth
A pregnant farm worker from Mexico arrives at an emergency room with medical issues. Doctors discover that the patient's placenta has separated from the uterine wall, necessitating an urgent caesarean section. The patient answers "yes" to all questions, although she appears to have little understanding.
After the cesarean section, doctors admit the newborn to the NICU because the baby is premature and has respiratory distress syndrome. The patient, her husband and mother, all indigenous, speak little Spanish and no English. Spanish-speaking staff try to get a clear story about the mother and explain the baby's condition to the family, but communication is difficult.
As the baby's condition worsens, the family wants to call in a traditional healer to heal the baby's illness.
culturally competent responses
In this case, providing culturally competent care requires an interpreter who speaks the patient's native language. Only then can healthcare professionals collect a complete medical history from the patient, educate themselves about possible pesticide exposure through their work, and allow the patient to fully understand the medical condition of the mother and child.
Additionally, with an on-site interpreter, healthcare professionals can explain their medical perspective and engage the patient and family in a conversation to understand their perspectives and cultural preferences in care. This conversation gives the family an opportunity to express a desire to bring in a traditional healer, as well as any other wishes or concerns.
Once the medical team has better information and direct communication, they can recommend culturally appropriate care and negotiate a plan of action that everyone agrees on.
Adapting to a new patient population
A local hospital is seeing an influx of ultra-Orthodox Jewish patients, while a newly established Hasidic community is growing nearby. Hospital staff have little knowledge of the customs or traditions of this growing segment of the facility's patient population.
However, the team has already noted:
- Situations of patients who refuse to eat
- Complaints that visitors unable to use the elevators on Jewish holidays were not allowed access to the stairs
- Confused exchange when members of the Orthodox community refused to shake hands with health workers of the opposite sex
culturally competent responses
The hospital invites representatives of the Hasidic community to meet with administrators and staff to openly discuss traditions and customs that may be relevant to their medical care. The hospital also asks community representatives to explain the specific needs of their community.
In this way, the hospital receives ideas and suggestions for already established solutions that the community already has to deal with customs, such as not having electricity on Shabbat. The hospital also learns about other customs, such as refraining from physical contact between members of the opposite sex.
Based on the discussions, the hospital proposes policies and procedures that may best meet the needs of the Hasidic patient population. He then discusses these policies and procedures with community representatives to ensure the proposals are appropriate.
Respect the patient's decisions
A critically ill 80-year-old patient discovers that one of his heart valves is no longer working. In order to survive, they will need surgery to replace the valve. The patient has a history of excessive bleeding. This requires doctors to administer blood transfusions during the operation.
The patient is a devout Jehovah's Witness. According to their religious beliefs and interpretations, the Bible does not allow blood transfusions of any kind, which is why the patient refuses the surgery.
culturally competent responses
The patient's medical team includes the patient, his family, and trusted members of the patient's religious community in discussions about the nature of the surgery and the risk that the patient will not survive without it. Once the patient is given all the information and appears to understand all the risks, the medical team respects his decision not to have the surgery.
How to improve cultural competence in health
To meet the needs of all patients, organizations must learn to improve cultural competence in healthcare. You can begin to implement strategies that build and improve the cultural competence of healthcare teams.
Promote awareness and education to improve cultural literacy in health
Promoting awareness and education plays a key role in improving cultural literacy in health care. To develop cultural competence, health professionals need to recognize their beliefs and create awareness of their culture. This gives them a basis for improving their cross-cultural awareness.
Intercultural awareness makes healthcare professionals more open to unfamiliar attitudes, practices, or behaviors. It also improves collaboration with patients and helps them respond flexibly. The benefits of cross-cultural awareness include:
- improved relationship
- Customized treatment plans
- Improved patient care and compliance
How can healthcare organizations best promote intercultural awareness and other skills needed for culturally competent healthcare?
Cultural skills training
Cultural competence training teaches healthcare professionals intercultural communication skills and helps students respond more flexibly to cultural differences.
In addition, cultural competence training can help organizations uncover policies or organizational practices that act as barriers for different communities. You can customize them to ensure they meet the needs of different patients.
Accessibility leads to better cultural competence in healthcare
Cultural competence in health requires accessibility. Accessibility means ensuring that language, culture, race, and the like do not become barriers to patients receiving quality care. How can healthcare organizations make healthcare more accessible?
Build knowledge about the local community
Health organizations need to educate themselves about the populations they serve. By collecting and analyzing demographic data and submitting surveys targeted to specific communities, important knowledge is generated about local communities, putting them in a much better position to address patient needs and ensure accessibility.
In this way, a hospital may know it needs Korean or Farsi interpreters, or it may determine that a large portion of the population requires halal dietary options for hospitalizations.
Surveys and community engagement can provide other important information that makes healthcare organizations more accessible. For example, community involvement might highlight the need for staff to be familiar with Nepali culture or the need to strengthen a diabetes awareness program.
Attract and retain diverse team members
Recruiting and retaining staff members who accurately reflect the populations they serve gives healthcare organizations a distinct advantage in their efforts to provide culturally competent healthcare.
When patients meet staff members who look like them, speak their language and share their culture, they feel more welcome. Health professionals who share cultural similarities with their patients are generally better able to communicate with them, understand their perspectives and anticipate their needs.
Several team members can also share their expertise with their colleagues, enhancing everyone's ability to provide culturally competent care.
Barriers to cultural health literacy
Promoting cultural competence can present challenges. Barriers to cultural literacy in healthcare include:
Adequate knowledge of the cultural competence of an organization
To successfully address cultural competence, healthcare organizations must first measure their current performance. It is about answering questions like:
- Where is the organization failing to provide language accessibility?
- Where are there supply differences within the system?
Without knowing where the differences lie, leadership cannot properly direct its energy and resources.
Therefore, healthcare organizations that assess cultural competence need to collect data on race, language preferences, sexual orientation, ethnicity, and so on. their patients, as well as tracking differences. Patient surveys can also provide insight into an organization's cultural competence.
With the right information, healthcare organizations can focus on areas for improvement.
For example, data may show that an organization serves more patients from the LGBTQ community than previously thought. This gives leadership the ability to ensure they have enough healthcare professionals with expertise in LGBTQ healthcare.
Putting cultural competence into action
To put cultural competence into practice, healthcare organizations need to create an institutional framework that:
- Demonstrates culturally competent practices
- Cultivate intercultural awareness and communication.
- Ensures a diverse workforce
Cultural competence requires ongoing commitment and a multifaceted approach. Healthcare organizations need to build an infrastructure that supports activities and protocols that ensure culturally competent practices.
Furthermore, organizations must resist resistance from employees who may perceive cultural competence as limited to racial and ethnic diversity and already consider themselves culturally competent. In these cases, healthcare organizations can implement educational programs that expand definitions of cultural competence.
Limited resources to promote cultural literacy
Achieving cultural competence in health requires resources. Organizations must invest time, money and leadership in developing the necessary infrastructure to make cultural competence more than just a value.
This means, among other things, budgeting for:
- Materials with linguistic diversity
- Training of cultural skills
- Various personnel selection programs.
While prioritizing cultural competence comes at a cost, it ultimately provides a significant return on investment.
Health administrators play a critical role in promoting cultural literacy in health care. Their expertise in organizational behavior, financial management, and information and analytics systems enables them to build the necessary infrastructures to support culturally competent systems.
Explore how Tulane UniversityOnline-Master of Health Administrationequips graduates with the skills needed to develop culturally competent systems capable of meeting the needs of diverse communities.
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