Although telehealth is a convenient platform for some, it may not be easily accessible to patients with limited English language proficiency (Young, 2022). Language barriers can prevent patients from fully participating in their care and hinder patient–provider communication. Ideally, patients should participate in services with practitioners who have fluency in their primary language. However, the scarcity of bilingual providers often makes it difficult for patients to find and engage with practitioners who speak and understand their preferred language. Meaningful interactions become crucial for culturally competent service delivery and validating healthcare experiences (Young, 2022). Cultural Competence and Expected Treatment Outcome Cultural competence significantly impacts the process and outcome of counseling - cultural factors like age, religion, and ethnicity impact how patients perceive symptoms and health conditions. Cultural differences influence patients’ expectations of care. Trust is an essential component of patient-physician relationships. A patient’s level of trust in his or her provider plays a significant role in patient-provider interaction and the patient’s adherence to treatment recommendations. Patients are much more likely to be involved in improving their healthcare if they trust their providers. Moreover, trust in care is closely tied to the likelihood that patients will seek medical attention, adhere to prescribed treatment plans, and maintain positive relationships with their providers (Boulware, 2003). Cultural factors impact the communication between provider and patient and influence patients’ satisfaction with healthcare treatments. Data reveals that African American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than those who see physicians of other races (Cooper et al., 2003). When individuals feel appreciated and understood will be more likely to be satisfied with their treatment experience. The cultural competence of health professionals does affect patients’ experiences and satisfaction. vBrunett and Shingles (2018) examined the impact of cultural competence on patient satisfaction. Their findings show that the more cultural competence a health professional displayed, the more beneficial it was to patients’ experiences. Findings reveal that more cultural competence resulted in higher patient satisfaction. They also found that patients tended to be more open with and trusting of the healthcare staff if the professionals showed cultural competence. Other findings revealed that patients who perceived their provider as culturally competent were more likely to follow the provider’s medical advice. Additionally, a provider who can speak the same language as the patient correlates with higher patient satisfaction. Other findings indicate that social workers displayed cultural humility and addressed intersectionality if they demonstrated a genuine interest in the client’s culture (Okeke, 2022). Failing to identify, respect, and understand the influence of cultural beliefs, values, and experiences can lead to miscommunication and poor outcomes in counseling. Recent findings show that enacting cultural humility contributes to resolving relational conflicts and deepens the relationship (Zhu, 2021).
Figure 6. Barriers to Healthcare Among Adults by Insurance Status, 2019
Note: Includes nonelderly individuals ages 18 to 64. Includes barriers experienced in the past 12 months. Respondents who said usual source of care was the emergency room were among those not having a usual source of care. All Medicaid/Other Public and Employer/Other Private are statistically different from Uninsured at the p<0.05 level. SOURCE: KFF analysis of 2019 National Health Interview Survey. Telehealth provides a challenge for some populations and is seen as an access issue regarding healthcare. The same structural barriers exist regarding remote service delivery (except transportation). One can easily overlook multicultural and diversity issues when patient characteristics and identity markers (i.e., disability status, signals of socioeconomic status/class) may not be as visible through digital technology as it might be the case in the therapy room. As telehealth services have become a mainstay after the pandemic, practitioners need culturally competent guides for remote service delivery. While telehealth services offer a convenient way for patients to connect with providers, some individuals have limited or no access to reliable broadband. In particular, economically disadvantaged patients may not be able to afford the high cost of broadband internet. In contrast, patients who live in some rural areas may not have access to broadband services (Cortelyou-Ward et al., 2020). Unreliable internet service may result in failed connections and delays in video feeds, decreasing telehealth services’ effectiveness and leading some patients to end services prematurely (Cortelyou- Ward et al., 2020). Thus, culturally competent telehealth care requires that therapists consider the most effective ways to make their telehealth platforms more accessible to vulnerable populations. A common misperception holds that older adults have limited interest in technology or do not know how to use telehealth platforms (American Psychological Association Committee on Aging, 2020). However, some older adults have a high level of comfort navigating technology, while others have less familiarity or comfort. Older adults may experience cognitive functioning, vision, memory, hearing, and mobility changes that can impact their technology use (American Psychological Association Committee on Aging, 2020). Do not assume that older adults will feel resistant to remote services. Instead, practitioners should provide older adult patients with the option to participate in treatment via telehealth and address the pros and cons. If the patient wishes to engage in telehealth services, practitioners should allow them to choose the platform they prefer.
Combining Cultural Competence with Cultural Humility Mental health providers should strive to develop a multicultural orientation to deliver culturally sensitive care and improve communication. However, even when mental health professionals have a meaningful understanding of a culture, they still cannot predict the behaviors and attitudes of their patients based on their cultural backgrounds.
That is because people are unique, and their behavior and beliefs might not always reflect those of their cultures. Given this, mental health professionals must focus on building cultural competence and humility.
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