______________________________________________ Intercultural Competence and Patient-Centered Care
White American Patients In 2021, 76.3% of the U.S. population identified as White alone [60]. The U.S. Census Bureau defines White race as person having origins in any of the original peoples of Europe, the Middle East, or North Africa [38]. While the proportion of population identifying as White only has decreased between 2010 and 2020, the numbers of persons identifying as White and another race/ethnicity increased significantly. The White population in the United States is diverse in its religious, cultural, and social composition. The greatest proportion of this group reports a German ancestry (17%), followed by Irish (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, ethnic, reli- gious, 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 persons 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. Multiracial Patients Racial labels do not always have clear meaning in other parts of the world; how one’s race is defined can change according to one’s current environment or society. A person viewed as Black in the United States can possibly be viewed as White in Africa. Racial categories also do not easily account for the complexity of multiracial identities. An estimated 3% of United States residents (9 million individuals) indicated in the 2010 Census that they are of more than one race [149]. The percentage of the total United States population who identify as being of mixed race is expected to grow significantly in com- ing years, and some estimate that it will rise as high as one in five individuals by 2050 [36; 150]. Multiracial individuals often report feeling not fully embraced by any racial or ethnic group, and mistaken identity is a com- mon issue. A small study of multiracial patients assessed their healthcare experiences and noted six commonly encountered microaggressions: mistaken identity, mistaken relationships, fixed forms, entitled examiner, pervasive stereotypes, and intersectionality [144]. It is important to avoid assuming race/ culture based only on appearance and to take into account the patient’s self-reported identity.
advice without understanding how health beliefs and cultural practices influence the way that advice is received. Asking about patients’ religions, cultures, and ethnic customs can help clini- cians engage patients so that, together, they can devise treat- ment plans that are consistent with the patients’ values [37]. Respectfully ask patients about their health beliefs and customs and note their responses in their medical records. Address patients’ cultural values specifically in the context of their health care. For example, one may ask [37]: • “Is there anything I should know about your culture, beliefs, or religious practices that would help me take better care of you?” • “Do you have any dietary restrictions that we should consider as we develop a food plan to help you lose weight?” • “Your condition is very serious. Some people like to know everything that is going on with their illness, whereas others may want to know what is most impor- tant but not necessarily all the details. How much do you want to know? Is there anyone else you would like me to talk to about your condition?” • “What do you call your illness and what do you think caused it?” • “Do any traditional healers advise you about your health?” Practitioners should avoid stereotyping based on religious or cultural background. Each person is an individual and may or may not adhere to certain cultural beliefs or practices com- mon in his or her culture. Asking patients about their beliefs and way of life is the best way to be sure you know how their values may impact their care [37]. The following sections provide a glimpse of the beliefs and practices of the major world religions. This overview is meant only to give a very simple, brief summary of the general ideol- ogy of each religion. By no means are all of the rites or beliefs described practiced by all members of each religion; likewise, not all religious rites or beliefs are discussed for each religion. As always, individualized assessment is encouraged. Judaism Judaism emerged in the Southern Levant (an area in the Middle East) in about 2000 B.C.E. [136]. There are approxi- mately 13 million Jewish people in the world—6 million in North America, 4.3 million in Asia, and 2.5 million in Europe [137]. Jewish descent is traced through the maternal line, but the choice to practice Judaism is made by the individual. In Jewish tradition, the Torah is believed to be the word of God and the ultimate authority. There are three tenets of Judaism. The first tenet is monothe- ism; there is one God who created the universe and continues to rule [138]. The second tenet is that the Jews were chosen to receive the law of God (Yahweh) and to serve as role models
RELIGIOUS, CULTURAL, AND ETHNIC BACKGROUNDS
Religion, culture, beliefs, and ethnic customs can influence how patients understand health concepts, how they take care of their health, and how they make decisions related to their health. Without proper training, clinicians may deliver medical
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