Cultural Competence: An Overview _____________________________________________________________
that treatment planning is a dynamic process that evolves along with an understanding of patient history and treatment needs. 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 [36]. RACIAL BACKGROUNDS Race and color impact the ways in which individuals interact with their environments and are perceived and treated by oth- ers. Race is defined as groups of humans divided on the basis of inherited physical and behavioral differences. As part of the cultural competence process and as a reflection of cultural humility, practitioners should strive to learn as much as pos- sible about the specific racial/ethnic populations they serve [37]. However, considerable diversity exists within any specific culture, race, or ethnicity [37]. Cultural beliefs, traditions, 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 persons interact with their environments and specific social contexts are also often present. As with all patients, it is vital to actively listen and critically evaluate patient relationships. All practitioners should seek to educate themselves regarding the experiences of patients who are members of a community that differs from their own. Resources and opportunities to collaborate may be available from community organizations and leaders. Finally, preferred language and immigration/migration sta- tus should be considered. Interpreters should be used when appropriate, with adherence to best practices for the use of interpretation services. Stressing confidentiality and privacy is particularly important for undocumented workers or recent immigrants, who may be fearful of deportation. 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” [38]. According to the U.S. Census, African Americans number 46.9 million as of 2020 [39]. By 2060, it is projected they will comprise 17.9% of the U.S. population [40]. This group tends to be young; 30% of the African American population in the United States is younger than 18 years of age. In 2019, the median age for this group was 35 years [41]. In terms of educational attainment, 89.4% of African Americans 25 years of age or older had a high school diploma or completed college in 2020 [39]. Texas has the largest African American popula- tion, at 3.9 million [41].
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 mind that research is limited on the cross-cultural applicabil- ity of specific test items or questions, diagnostic criteria, and concepts in evaluative and diagnostic processes [36]. Typically, culturally responsive care establishes holistic treat- ment goals that include objectives to improve physical health and spiritual strength; utilizes strengths-based strategies that fortify cultural heritage, identity, and resiliency; and recognizes
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