_____________________________________________________________ Cultural Competence: An Overview
Promoting healthy choices will not eliminate these and other health disparities. Instead, public health organizations and their partners must take action to improve the conditions in people’s environments. Healthcare providers play a role by identifying factors affecting the health of their patients, providing resources (when appropriate), and advocating for healthy environments.
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 to gain a better understanding of 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 includes holistic treatment goals that aim to improve physical health and spiritual strength; utilize strengths-based strategies that fortify cultural heritage, identity, and resiliency; and recognize 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, an overview of some of the most commonly marginal- ized populations are outlined in the following sections [36].
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’ diverse 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. Since the mid-2010s, several states have passed laws allowing individual health providers to refuse to provide services if doing so would violate their morals or 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.
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