Cultural Competence: An Overview _____________________________________________________________
Listening is an important aspect of rapport building with Native American patients, and practitioners should use active listening and reflective responses. Assessments and histories may include information regarding patients’ stories, experi- ences, dreams, and rituals and their relevance. Interruptions and excessive questioning should be avoided if at all possible. Extended periods of silence may occur, and time should be allowed for patients to adjust and process information. Practi- tioners should avoid asking about family or personal matters unrelated to presenting issues without first asking permission to inquire about these areas. Native American patients often respond best when they are given suggestions and options rather than directions. 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.
• “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]. GENDER Gender identity is a vital aspect of a person’s experience of the world and of themselves. It also impacts the ways in which the world perceives and treats individuals, with a clear effect on the effective provision of health and mental health care. This section will focus on persons presenting as cisgender male or female; special considerations for those who are transgender, non-binary, or gender nonconforming will be explored in the next section. An increasing amount of research is supporting a relationship between men’s risk for disease and death and male gender identity, and the traditional male role has been shown to conflict with the fostering of healthy behaviors [62; 63]. Male gender identity is related to a tendency to take risks, and the predilection for risky behavior begins in boyhood [63; 64; 65]. In addition, boys are taught that they should be self-reliant and independent and should control their emotions, and societal norms for both boys and men dictate that they maintain a strong image by denying pain and weakness [62; 64; 65]. Issues related to male gender identity have several important implications for health. First, risky behavior is associated with increased morbidity and mortality. Second, the concept of masculinity leads to inadequate help- and information-seeking behavior and a reduced likelihood to engage in behavior to promote health [62; 64; 65]. These behaviors appear to be rooted in a decreased likelihood for men to perceive them- selves as being ill or at risk for illness, injury, or death [62]. Third, male gender identity, coupled with lower rates of health literacy, creates special challenges for effectively communicat- ing health messages to men [66; 67; 68]. Gender differences
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 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]:
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