A core aim of cultural competence in health care is achieving health equity, which means providing the same level of quality care to every patient, regardless of race, ethnicity, cultural background, language, or level of health literacy. Cultural competence includes optimizing health care delivery to patients from varied social and cultural backgrounds, including those from underrepresented racial and ethnic groups, and helping linguistically diverse populations navigate the U.S. health care system.
Health care organizations that understand the role of cultural competence in addressing the challenges posed by disparities in health and health care can play a pivotal role in improving health outcomes in underserved communities and help eliminate health disparities.
Health disparities continue to persist in the U.S. Health disparities are defined as differences in health care access, quality of care received, and outcomes between groups based on race, ethnicity, culture, gender, economic status, and other factors. Another disparity involves health insurance coverage. Race-based inequalities in health insurance remain an issue even after the Affordable Care Act (ACA) helped reduce uninsured rates across all racial and ethnic groups. According to a 2020 Brookings report, approximately half of the 30 million Americans who remain uninsured are people of color.
Other common factors contributing to health care disparities include cultural, racial, ethnic, social, and language or communication barriers. For example, access to health care providers who understand their cultural characteristics is essential to patients from minority racial and ethnic groups, according to National Health Statistics Reports.
A low level of health care literacy is another important factor that contributes to health disparities. According to the Centers for Disease Control and Prevention (CDC), patients with low health literacy are more likely to visit an emergency room, are less likely to follow treatment plans, have more hospital stays, and experience higher mortality rates. As the U.S. population grows more diverse, cultural competence becomes an increasingly pressing area of focus in addressing health care disparities. Pew Research reports that more than 40 million people now living in the U.S. were born outside the country. Among U.S. immigrants ages 5 or older, a little over half are proficient English speakers. The need for health care strategies that address immigrant and non-English-speaking populations is clear.
Health care organizations can begin by implementing the CDC’s seven-goal national action plan to improve health literacy, which focuses on:
● Providing accurate and actionable health information to everyone
● Ensuring health information and services are focused on people
● Promoting good health through learning and skills development
Resources: Importance of cultural competence in health care
The following resources expand on the importance of cultural competence in health care.
● Health Policy Institute, “Cultural Competence in Health Care: Is It Important for People with Chronic Conditions?”: Research and data supporting the role of cultural competence in improving health care quality
● National Institutes of Health, Cultural Respect: A description of the NIH’s strategies for promoting cultural competence, including the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care
●National Prevention Information Network, Cultural Competence in Health and Human Services: A CDC resource that lists the eight principles of cultural competence and provides links to various additional resources
A culturally competent health care organization recognizes the importance of culture in delivering patient care and focuses on reducing disparities in health care due to race, ethnicity, culture, gender, economic status, and other factors. Depending on the organization and community served, health care workers may face different scenarios in working with patients with backgrounds different from their own. Consider these examples of cultural competence in health care:
● Patient preference for traditional treatment. Instead of taking prescribed medication for hypertension, a patient born in China expresses a preference for traditional Chinese medicine. A culturally competent health care professional practices active listening to understand the patient’s concerns before explaining the benefits of the prescribed treatment. This process can help earn the patient’s trust and help them feel safe and recognized — an essential factor for treatment acceptance. If health care practitioners can build a trust-based relationship with a patient’s family or friends, they may be able to help the patient understand the importance of taking the prescribed medication.
● Changing demographics. A hospital that has served its community for decades is seeing a cultural shift in its patients, with a large percentage of the population now speaking another language. A culturally competent health care organization surveys census data to understand who lives in the surrounding communities, then identifies community groups that can help with communication needs and hires interpreters. With the input of community organizations, the hospital can adjust its materials and other forms of communication to improve health outcomes in the community.
● Religious beliefs and care delivery. A patient who follows a diet prescribed by their faith doesn’t want to take medicines made with animal products. Another patient prefers working with health care professionals of the same gender due to their religious beliefs. Patients often rely on their faith to reduce their anxieties when making difficult health care decisions. A culturally competent health professional recognizes the vital role faith plays in providing comfort to patients. They listen to their patients when they share their religious and spiritual beliefs, and they adjust treatment plans to accommodate their patients’ needs while ensuring high-quality care.
For organizations building their cultural competence, a critical first step is assessing their current cross-cultural relationships and determining if their health care services are designed to meet the unique needs of various groups. This assessment can involve feedback from community groups, patients, health care employees, and others. The findings can lay the groundwork for culturally competent policies and programs to promote health access and improve health outcomes for all patients.
When a health care organization prioritizes cultural competence, it:
● Aims to understand the impact of cultural differences
● Expands its cultural knowledge
● Adapts to meet culturally unique needs of patients
● Recognizes cultural competence as an essential means of reducing racial and ethnic disparities in health care
Each organization will implement programs based on their unique circumstances, but culturally competent health care organizations share similar traits:
●Investment in diversity. Implementing programs that promote cultural competence can achieve more success when embracing diversity is at the core of the organization’s mission.
● Openness to self-assessment, including determining biases. Unconscious biases can affect health care professionals and how they perform their duties. Organizations must be willing to face underlying biases in their systems and work to make the systems equitable for all patients.
● Interest in acquiring cultural knowledge. An organization focused on promoting cultural competence looks for opportunities to learn about different cultures. This starts at the top, with executives making efforts to learn about the community they serve. At the point of care, health care professionals interacting with patients should work to learn more about the patients’ cultures.
● Dedication to cultural education. Cultural education through training programs that include self-reflection and critical thinking enables health care professionals to identify areas for improvement and prevent health care disparities in their work.
● Adaptability and willingness to change. Organizations with the flexibility to evolve and manage change can meet the shifting cultural needs of the individuals and communities they serve.
Building cultural competence in health care requires participation at all levels. At the national level, the Medicare system can advance health equity by assessing the link between poor health outcomes and health inequities and investing more in mitigating the structural issues that cause those inequities.
At the local level, building a culturally competent organization requires a well-thought-out plan. Strategies for building cultural competence include the following:
● Collecting data about the race, ethnicity, and language preferences of patient populations to identify and address disparities. In addition to collecting patient health histories for electronic health records, health care organizations should acquire cultural knowledge about their patients. This information will help health care professionals see their patients from a cultural perspective and prepare providers to understand their patients’ needs better.
● Developing culturally competent programs, such as bilingual and bicultural services, and using culturally and linguistically diverse materials. These efforts build bridges between health care professionals and the communities they serve that are impacted by health disparities. Examples of materials include brochures about medical procedures and health insurance and patient forms. If hiring translators is not an option, the organization should try to secure help from community volunteers.
● Adapting human resources and recruiting processes to help increase diversity in the health care workforce. When health care workers represent the community’s demographics, it can strengthen feelings of inclusion among patients and health care professionals. Increasing racial and ethnic diversity is also important at the executive level: A 2019 study from the American College of Healthcare Executives reported that 89% of hospital CEOs were non-Hispanic or non-Latinx white.
● Forming relationships with community leaders, organizations, and institutions that serve individuals from various cultural, social, racial, and ethnic backgrounds. These relationships are critical for improving trust between patients and health care organizations.
● Making cultural competency a high priority by conducting regular assessments, promoting change, and championing cultural competency. For optimal effect, cultural competency is essential at every level of the organization, from the executive suite to front-facing workers who interact with patients.
● Increasing the cultural competence of health care workers through anti-bias and cultural competence training. Self-reflection helps address unknown biases and enables health care workers to provide care without making assumptions.
Strategies, resources, and tools for cultural competence in health care
These resources provide information about strategies, resources, and tools to help health care organizations develop cultural competence programs and initiatives:
● Agency for Healthcare Research and Quality, Patients with Limited English Proficiency: The TeamSTEPPS Limited English Proficiency module, including materials to develop a customized plan to prepare teams with core skills to help patients with language needs
● AHA Institute for Diversity and Health Equity, AHA Disparities Toolkit — Tools and Resources: Tools for health care professionals to use to reduce disparities, including patient data collection, self-assessments, language services use, and patient-centered communication
● American Hospital Association, “Becoming a Culturally Competent Health Care Organization”: A guide to enhancing cultural competence, including identifying and reporting health disparities, working with the community, and making cultural competence a top priority
● Centers for Disease Control and Prevention, “Culture & Health Literacy”: Cross-cultural communication and language access tools to improve health literacy and communication
● PLOS One, “Culturally Competent Healthcare — A Scoping Review of Strategies Implemented in Healthcare Organizations and a Model of Culturally Competent Healthcare Provision”: A review of methods organizations use to assure cultural competence in health care delivery and provide services for linguistically diverse patients
● Think Cultural Health, National Culturally and Linguistically Appropriate Services Standards: Department of Health and Human Services guidelines on eliminating health care disparities
Cultural competence creates opportunities for health care organizations to improve patient care and outcomes. When working closely with their communities to understand the community’s cultural needs, organizations are undertaking an exercise in trust-building. This trust engages patients with the health care system, translating into better services, higher health literacy, and improved satisfaction. Trust has a direct correlation to cultural competence and patient safety. When patients are more willing to listen to health care advice and miscommunication between health care practitioners and patients is minimized, health outcomes improve.
Another important element of safety is health literacy. Health literacy support often is crucial for patients in marginalized racial and ethnic groups, individuals from socioeconomically disadvantaged backgrounds, the elderly, and immigrants. Addressing health literacy challenges in these groups minimizes misunderstandings between patients and doctors, resulting in better health decision-making, reduced medical errors, adherence to medical prescriptions and advice, and overall favorable health outcomes.
In addition to improving health care outcomes, health care organizations can see business benefits from increased cultural competence, including improved efficiency and coordination. According to HealthCatalyst, ineffective management of care transitions can lead to unnecessary hospital readmission, which can cost hospitals up to $45 billion a year.
Black, Hispanic/Latinx, and Indigenous Americans are among the groups most impacted by health disparities in the U.S. Generally, data shows higher rates of chronic health conditions, mental health issues, and mortality among non-white Americans than among white Americans.
For example, the Asthma and Allergy Foundation of America reports that asthma rates are highest among Black, Hispanic/Latinx, and Indigenous Americans. A stark data point further highlights the serious negative consequences of health disparities — Black Americans are three times more likely than white Americans to die from asthma.
Government policies can help close these gaps. But local action can help address a wide range of health disparities. From language services and close relationships with community organizations representing underrepresented groups to hiring a more diverse health care workforce, cultural competence in health care at the local level can play a critical role in addressing disparities in health care.
If you’re interested in pursuing a health career, cultural competence is an important part of the required education. Actions you can take now include:
● Keeping up with diversity trends in health care
● Learning more about people with backgrounds different from your own
● Understanding the impact that cultural competence can have on improving patient outcomes
Cultural competence is but a single component of health care. Still, it is an important contributor to meeting the needs of patients from different backgrounds, particularly those with chronic conditions that require them to regularly interact with the health care system. Efforts to improve cultural competence in health care can play a pivotal role in elevating health care quality for all patients.
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