One of my first experiences with the challenges of cultural competency in healthcare came in one of my early clinical rotations, when I was treating an elderly Hispanic woman with poorly controlled diabetes. My basic Spanish was just not adequate and so the patient’s granddaughter helped to bridge the language gap. However, the initial patient interview was awkward and lengthy and I remember feeling uncomfortable with having to rely on a third person in order to talk to my patient. I was not sure about how much of what I was saying was even getting across.
Cross-cultural healthcare presents a number of significant challenges to providers — but the good news is there are several techniques to bridge what feels like an insurmountable divide.
The Challenges — and Importance — of Cross-Cultural Healthcare
Cross-cultural healthcare can be challenging for a number of reasons.
First, minorities can be at greater risk for a number of chronic conditions: according to the Center for Disease Control (CDC) Division of Nutrition, Physical Activity, and Obesity, research has found that obesity rates are higher for African Americans (38.4%) and Hispanic Americans (32.66%) than for whites (28.6%) and that these higher rates of obesity increase the risk for a number of chronic conditions, including type 2 diabetes, heart disease, strokes, and certain forms of cancer.
Second, many minorities groups have higher rates of being uninsured. The Kaiser Family Foundation (KFF) found that as of 2018, rates of being uninsured are greater for American Indian/Alaskan Natives (21.8%), Hispanics (19.0%), and African Americans (11.5%) than for whites (7.5%). In addition, Nursing Management notes that limited proficiency in English can lead to a number of negative health outcomes, including longer hospital stays and higher 30-day re-admission rates.
However, despite these significant challenges, cultural competency in healthcare is increasingly important. For one thing, America is becoming increasingly diverse. According to Statista, by 2060, non-Hispanic whites will comprise 44.5% of the population (down 16.98%) while Hispanics will comprise 27.5% (up 9.71%), African Americans 15% (up 1.69%) and Asians 9.1% (up 3.43%) compared to 2016 levels. This means that doctors will be working with an increasingly diverse population of patients and families and that culturally competent care skills will be increasingly necessary.
There are a wide variety of benefits to culturally competent carel Becker’s Hospital Review notes that these benefits can include increased use of preventative care services, decreased number of missed medical appointments,
A Practical Approach to Cross-Cultural Care
Having a variety of tools to resort to in order to improve your cross-cultural competency is a good idea, because the situations will change dramatically depending on your particular patient. Effective tools for healthcare professionals working with a diverse population include:
Interpreters and Translated Materials
Translators and interpreters can be an important part of cross-cultural care and can help to overcome language barriers that prevent linguistic access to vital healthcare information, whether oral or written. However, this is not foolproof. The Centers for Disease Control and Prevention (CDC) reports that, for example, translated materials are not helpful for patients who have low reading skills even in their native language and interpreters who are not sensitive to the backgrounds of their clients may speak too technically for their clients to understand them.
That said, well-translated materials can help to increase minority access to important healthcare information and agencies like the National Institute on Minority Health and Health Disparities (NIMHD) do offer health information on a variety of medical topics for those who have limited English proficiency.
The L.E.A.R.N. Method
The Canadian Pediatric Society (CPS), among others, promotes the L.E.A.R.N. method to improve cross-cultural care. You put this method into practice when you:
- Listen. Actively listen to the patient when they are telling you about their condition; this can give you important information about their understanding of their health as well as clues to their language proficiency. Active listening also helps to establish the culture of respect that you need to establish with your patient.
- Explain. Talk to your patient about how you understand the condition, keeping in mind that it might differ from the way the patient understands it. Be sure to discuss this at the level that your patient will understand.
- Acknowledge. Respectfully acknowledge that there might be differences in the way you and your patient view their health; at the same time, be prepared to find areas of common ground on which you can base your therapeutic relationship.
- Recommend. Discuss the plan of care that you recommend for your patient, but be prepared that that patient may or may not adhere to all your recommendations.
- Negotiate. If there are parts of the plan of care that might not fit into your patient’s particular culture or belief system, be prepared to discuss this openly and to try to come up with a solution that is acceptable to both you and your patient.
In short, whether you are working in a large, urban hospital or a small rural clinic, the increasing diversity of the United States will mean that you are more likely to be working with patients who are from vastly different cultures than your own. Getting familiar with tools you can use in this kind of situation can help to raise your comfort levels when interacting with patients from different cultures and this comfort communicates itself to the patient and can make them more comfortable in turn.
Want to learn more about cultural competency in healthcare? Explore:
- “Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice” in The Health Care Manager
- “Cultural Competence and Ethnic Diversity in Healthcare” in Plastic and Reconstructive Surgery
- “One Size Does Not Fit All: Multicultural Considerations in Managing Autism” on AudioDigest
- “Cultural Effectiveness for the Pediatrician” on AudioDigest