__________________________________________________________________ Maternal Health Disparities
(13%), English (10%), and Italian (7%) [61]. Providers can assume that most well-accepted treatment approaches and interventions have been tested and evaluated with White American individuals, particularly men. However, approaches may need modification to suit class, ethnicity, religion, and other factors. Providers should establish not only the patient’s ethnic back- ground but also how strongly the person identifies with that background. It is also important to be sensitive to a person’s multiracial/multiethnic heritage, if present, and how this might affect their family relationships and social experiences. Assumption of White race should be avoided, as White-passing persons of color have their own unique needs. BARRIERS TO INCLUSION Culturally diverse patients experience a variety of barriers when seeking health and mental health care, including: • Immigration status • Lower socioeconomic status
tors listen with their ears and focus on what is being said [63; 65; 66]. Western culture, including the United States, can be classified as a low-context culture. On the other hand, groups from collectivistic cultures, such as Asian/Pacific Islanders, Hispanics, Native Americans, and Black Americans, are from high-context cultures [63]. Communicators from high-context cultures generally display
the following characteristics [64; 65; 66; 67]: • Use of indirect modes of communication • Use of vague descriptions • Less talk and less eye contact • Interpersonal sensitivity • Use of feelings to facilitate behavior • Assumed recollection of shared experiences
• Reliance on nonverbal cues such as gestures, tone of voice, posture, voice level, rhythm of speaking, emo- tions, and pace and timing of speech • Assimilation of the “whole” picture, including visual and auditory cues • Emotional speech • Use of silence • Use of more formal language, emphasizing hierarchy between parties On the other hand, low-context communicators can typically be described as [64; 65; 66]: • Employing direct patterns of communication • Using explicit descriptions and terms • Assuming meanings are described explicitly • Utilizing and relying minimally on nonverbal cues • Speaking more and often raising their voices (more animated, dramatic) • Often being impatient to get to the point of the discussion • Using more informal language; less emphasis on hierarchy, more equality between parties (more friendly) • Being more comfortable with fluidness and change • Uncomfortable using long pauses and storytelling as a means of communicating Understanding the distinctions between individuals who come from high- and low-context cultures can promote cultural sensitivity. However, it is vital that practitioners take heed of several words of caution. First, it is important not to assume that two individuals sharing the same culture (e.g., low-context culture) will automatically have a shared script for commu- nicating. Second, it is important to not immediately classify an individual into a low- or high-context culture because of their ethnicity. Third, a major criticism of the discussion of low-/high-context cultures is that they reinforce dualism and ultimately oversimplify the complexities and nuances of com-
• Language barriers • Cultural differences • Lack of or poor health insurance coverage • Fear of or experiences with provider discrimination • Mistrust of healthcare systems
Such obstacles can interfere with or prevent access to treatment and services, compromise appropriate referrals, affect compli- ance with recommendations, and result in poor outcomes. Culturally competent providers build and maintain rich refer- ral resources to meet patients’ assorted needs. Encountering discrimination when seeking health or mental health services is a barrier to optimal care and contributor to poorer outcomes in under-represented groups. Some providers will not treat patients because of moral objections, which can affect all groups, but particularly those who are gender and/or sexual minorities, religious minorities, and/or immigrants. In fact, in 2016, Mississippi and Tennessee passed laws allowing health providers to refuse to provide services if doing so would violate their religious beliefs [62]. However, it is important to remember that providers are obligated to act within their profession’s code of ethics and to ensure all patients receive the best possible care. CULTURALLY RESPONSIVE COMMUNICATION Styles of communication can be classified from high- to low- context [63]. High-context cultures are those cultures that disseminate information relying on shared experience, implicit messages, nonverbal cues, and the relationship between the two parties [64; 65]. Members of these cultural groups tend to listen with their eyes and focus on how something was said or conveyed [63; 66]. On the other hand, low-context cultures rely on verbal communication or what is explicitly stated in the conversation [64]. Consequently, low-context communica-
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MDNJ1525
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