__________________________________________________________________ Maternal Health Disparities
or jargon and expectations of the diagnosis and care process. Patients should be encouraged to collaborate in every step of their care. Practitioners should also work to identify screen- ing and assessment tools that have been translated into or adapted for other languages and have been validated for their particular population group(s). Typically, culturally responsive care establishes holistic treatment goals that include objectives to improve physical health and spiritual strength; utilizes strengths-based strategies that fortify cultural heritage, iden- tity, and resiliency; and recognizes that treatment planning is a dynamic process that evolves along with an understanding of patient history and treatment needs. As part of the cultural competence process and as a reflection of cultural humility, practitioners should strive to learn as much as possible about the specific racial/ethnic populations they serve. However, considerable diversity exists within any specific culture, race, or ethnicity [45]. Cultural beliefs, tradi- tions, and practices change over time, both through generations and within an individual’s lifetime. It is also possible for the differences between two members of the same racial/ethnic group to be greater than the differences between two people from different racial/ethnic groups. Within-group variations in how people interact with their environments and specific social contexts are also often present. In addition to these general approaches, specific considerations may be appropriate for specific populations. While discussion of every possible patient subgroup is outside of the scope of this course, some of the most common factors are outlined in the following sections. BLACK PATIENTS “Black” or “African American” is a classification that serves as a descriptor; it has sociopolitical and self-identification ramifi- cations. The U.S. Census Bureau defines African Americans or Black Americans as persons “having origins in any of the Black racial groups of Africa” [46]. Historical adversity and institutional racism contribute to health disparities in this group. For the Black population, patient assessment and treatment planning should be framed in a context that recognizes the totality of life experiences faced by patients. In many cases, particularly in the provision of mental health care, equality is sought in the provider- patient relationship, with less distance and more disclosure. Practitioners should assess whether their practices connect with core values of Black culture, such as family, kinship, com- munity, and spirituality. Generalized or Eurocentric treatment approaches may not easily align with these components of the Black community [47]. Providers should also consider the impact of racial discrimination on health and mental health among Black patients. Reports indicate that expressions of emotion by Black patients tend to be negatively misunderstood
In order to reduce Black maternal mortality, the Centers for Disease Control and Prevention recommends that healthcare providers:
• Ask questions to better understand their patient and things that may be affecting their lives. • Help patients, and those accompanying them, understand the urgent maternal warning signs and when to seek medical attention right away. • Help patients manage chronic conditions or conditions that may arise during pregnancy, like hypertension, diabetes, or depression. • Recognize and work to eliminate unconscious bias in themselves and in their office on an ongoing basis. • Respond to any concerns patients may have. • Provide all patients with respectful quality care. (https://www.cdc.gov/healthequity/features/ maternal-mortality. Last accessed October 16, 2023.) Strength of Recommendation : Expert Opinion/ Consensus Statement INTERCULTURAL COMPETENCE AND CULTURAL IDENTITY Cultural identity is defined as the “shared characteristics of a group of people, which encompasses place of birth, religion, language, cuisine, social behaviors, art, literature, and music” [42]. Cultural identity is important as it influences how we respond to different situations. In health care, cultural identity can influence the behaviors one exhibits, the barriers upheld, and professional decisions, interactions, and performance. Cultural identity can evolve, and even if one does not consider their culture consciously, it is exhibited subconsciously [43]. It is important to remember that one’s cultural identity should not impede the care provided to patients. For example, religion can influence one’s practice but it should not determine how one practices or the type or quality of care given. Providing culturally responsive care can help to avoid prac- tice that is influenced by explicit or implicit biases. The U.S. Department of Health and Human Services has outlined steps important to incorporate in evaluation and treatment planning processes to ensure culturally competent clinical and programmatic decisions and skills [44]. The first step is to engage patients. When engaging in any patient teaching, remember that individuals may be new to the specific language
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