Intercultural Competence and Patient-Centered Care _ _____________________________________________
In some cases, patients are not recommended health care services (e.g., cancer screenings) because they do not have a primary care provider or because they live too far away from healthcare providers who offer them. Interventions to increase access to healthcare professionals and improve communica- tion—in person or remotely—can help more people get the care they need [34]. SOCIAL AND COMMUNITY CONTEXT People’s relationships and interactions with family, friends, co-workers, and community members can have a major impact on their health and well-being. Many people face challenges and dangers they are not able to control, including unsafe neighborhoods, discrimination, or trouble affording the things they need. This can have a negative impact on health and safety throughout life. Positive relationships at home, at work, and in the community can help reduce these negative impacts. But some people (e.g., children whose parents are in jail, adolescents who are bullied) often do not get support from loved ones or others. Interven- tions to help people access the social and community support they need are critical for improving health and well-being [34]. Healthy People 2030 objectives in this category focus on increasing the proportion of children and adolescents who have an adult they can talk to about serious problems, improv- ing community health literacy, increasing the likelihood that an individual talks to friends or family about their health, and expanding access to online healthcare services [34].
fact, in 2016, Mississippi and Tennessee passed laws allowing health providers to refuse to provide services if doing so would violate their religious beliefs [35]. However, it is important to remember that providers are obligated to act within their profession’s code of ethics and to ensure patients receive the best possible care. BEST PRACTICES FOR CULTURALLY RESPONSIVE CARE 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 [36]. The first step is to engage patients. In nonemergent situations, it is important to establish rapport before asking a series of assessment questions or delving deeply into history taking. Providers should use simple gestures as culturally appropri- ate (e.g., handshakes, facial expressions, greetings) to help establish a first impression. The intent is that all patients feel understood and seen following each interaction. Culturally responsive interview behaviors and paperwork should be used at all times [36]. When engaging in any patient teaching, remember that indi- viduals may be new to the specific language or jargon and expectations of the diagnosis and care process. Patients should be encouraged to collaborate in every step of their care. This consists of seeking the patient’s input and interpretation and establishing ways they can seek clarification. Patient feedback can then be used to help identify cultural issues and specific needs. If appropriate, collaboration should extend to include family and community members. Assessment should incorporate culturally relevant themes in order to more fully understand patients and identify their cultural strengths and challenges. Themes include [36]: • Immigration history • Cultural identity and acculturation • Membership in a subculture • Beliefs about health, healing, and help-seeking • Trauma and loss In some cases, it may be appropriate and beneficial to obtain culturally relevant collateral information, with the patient’s permission, from sources other than the patient (e.g., family or community members) to better understand beliefs and practices that shape the patient’s cultural identity and under- standing of the world. Practitioners should work to identify screening and assess- ment tools that have been translated into or adapted for other languages and have been validated for their particular population group(s). An instrument’s cultural applicability to the population being served should be assessed, keeping in
BARRIERS TO PROVIDING CARE
Culturally diverse patients experience a variety of barriers when seeking health and mental health care, including: • Immigration status • Lower socioeconomic status • 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
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