_____________________________________________________________ Cultural Competence: An Overview
Recommended best practices when caring for Asian American patients include: • Create an advisory committee using representatives from the community. • Incorporate cultural knowledge and maintain flexible attitudes. • Provide services in the patients’ primary language. • Develop culturally specific questionnaires for intake to capture information that may be missed by standard questionnaires. • Emphasize traditional values and incorporate traditional practices (e.g., acupuncture) into treatment plans, when appropriate and desired. • Explore patient coping mechanisms that draw upon cultural strengths. Latino/a/x or Hispanic Patients In 2022, the Hispanic population in the United States included 63.7 million individuals, or 19.1% of the U.S. population [45]. In 2021, 37.2 million individuals in the U.S. Hispanic popu- lation group identified as being of Mexican descent (58.4%), followed by Puerto Rican (9.1%), Salvadoran (3.9%), Domini- can (3.8%), and Cuban (3.8%) [46]. They are a young group, with a median age of 30.7 years [45]. In terms of educational attainment, 75.2% of Hispanic individuals in the United States had a high school diploma or equivalency, and 20.9% had a bachelor’s degree in 2022 [46]. Geographically, among the 63.7 million Hispanic individuals in the United States, 25% reside in California, followed by Texas (19%), Florida (9%), New York (6%), and Arizona (4%) [47]. When involved in the care of Latinx/Hispanic individuals, practitioners should strive to employ personalismo (warm, genu- ine communication) and recognize the importance of familismo (the centrality of the family). More flexible scheduling strate- gies may be more successful with this group, if possible, and some patients may benefit from culturally specific treatment and ethnic and gender matching with providers. Aspects of Latino culture can be assets in treatment: strength, persever- ance, flexibility, and an ability to survive [36]. American Indian/Alaska Natives (AI/AN) The American Indian/Alaska Native (AI/AN) population is extremely diverse. According to the U.S. Census, the terms “American Indian” or “Alaskan Native” refer to individuals who identify themselves with tribal attachment to indigenous groups of North and South America. Other terms used include “Native American” or “Native,” although individual preference on how a person or group would like to be identified should be taken into consideration [38; 40]. In the United States, there are 574 federally recognized tribal governments and 324 federally recognized reservations [57].
In 2020, it was reported that there were 9.7 million AI/ AN individuals in the United States. In general, this group is young, with a median age of 31 years, compared with the general median age of 38.2 years [57]. In terms of education attainment, 74% of AI/AN individuals in the United States had a high school diploma or equivalency, and 16.8% had a bachelor’s degree in 2023 [40; 41]. As of 2020, the states with the greatest number of residents identifying as American Indian are California (11.7%), Oklahoma (11.7%), Arizona (9.5%), New Mexico (9.1%), , and Texas (5.9%). Alaska Native individuals make up 67.1% of the population in Alaska [58]. Listening is an important aspect of rapport building with AI/ AN patients, and practitioners should use active listening and reflective responses. Assessments and histories may include information regarding patients’ stories, experiences, 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. Practitioners should avoid asking about family or personal matters unrelated to presenting issues without first asking permission to inquire about these areas. Native American/Alaska Native patients often respond best when they are given suggestions and options rather than directions [36]. White American Patients In 2023, 75.3% of the U.S. population identified as White alone [48]. 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]. The White population in the United States is diverse in its religious, cultural, and social composition. The greatest proportion of this group reports a English ancestry (25.5 million), followed by Irish (10.9 million), German (15.4 million), and Italian (6.6 million) [49]. The median age of White individuals is 44 years. In terms of education attainment, 95.2% of White-only individuals in the United States had a high school diploma or equivalency, and 41.8% had a bachelor’s degree in 2022 [40] 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 [36]. 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 multiracial/ multiethnic heritage, if present, and how this might affect fam- ily relationships and social experiences. Assumption of White race should be avoided, as White-passing persons of color have their own unique needs [36].
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