section name header

Information

Author(s): AngelitoTacderas

Culture is more than nationality or race. It also includes the aged, the illiterate or those lacking education, and persons with physical limitations. Culture influences a person’s reasoning, decisions, and actions. It is the accumulation of learned beliefs, values, habits, and practices. Culture influences decision making, thoughts, what is approved or disapproved, and what is normal or not, which is acquired from close personal relations (family/members of society) over time.

Cultural diversity exists when groups of different cultures must coexist within an environmental area (family, neighborhood, township, city, or country). Knowing that there are differences in cultures and not assigning values between different cultures reflect cultural sensitivity. However, significant differences may exist in the way healthcare is perceived and practiced because of the differing values and beliefs regarding health and illness inherent among people of varying cultural backgrounds.

Contributing Factors to Cultural Diversity

  • Fewer White non-Hispanic children.
  • Increasing immigration.
  • Efficiency in transportation and travel.
  • Increase in the homeless and the poor population.
  • Increase in divorce rate.
  • Increase in single parenting.
  • Grandparents raising grandchildren.
  • Substance abuse.
  • Violence.
  • Transgender sex changes.
  • LGBT acceptance.
  • Information explosion/high technology.
  • Illiteracy.
  • Increase in non-English-proficient healthcare providers.
  • Federal regulations.
  • Physical limitations (disabilities).

Cultural sensitivity is the responsibility of all healthcare providers. Each office visit is an opportunity to gain more knowledge about a client’s health beliefs and practices. Inadequate awareness of the client’s health beliefs and practices influenced by culture could lead to mistrust. This may result in barriers including inappropriate delivery of care, increased cost, noncompliance, and seeking care elsewhere. Thus, this may eventually lead to even more barriers to healthcare access. Studies also suggest that there is a correlation between healthcare illiteracy and increases in noncompliance and medication errors. In addition, those with physical disabilities often have unpleasant experiences with healthcare encounters, which may affect their decisions to seek appropriate care.

Title VI of the Civil Rights Act is very specific about providing services that are less than the existing standard of care to anyone based on race, age, sex, or financial status. According to this law, “No person in the United States shall, on the grounds of race, color, or national origin, be excluded in the participation in, be denied the benefits of, or be discriminated under any programs or activity receiving federal financing assistance” (U.S. Department of Justice [DOJ], 2015).

Thoughtful Consideration

The provision of care without being sensitive to the needs of a culturally diverse client may suggest that the healthcare provider’s values and beliefs are superior to those of the client’s and may lead to disparity of care. Implementing evidence-based guidelines to a culturally diverse population whose healthcare practices are not always based on scientific studies remains a constant challenge. The limited patient involvement in care may result in noncompliance, placing patients at greater risk for health-related complications. The delay in provision of healthcare can result in life-threatening complications.

Numerous resources are available throughout the literature and the Internet. Preferences for educational/assessment tools are within the healthcare provider’s prerogative.

The following are guidelines for promoting cultural sensitivity in the clinical setting.

  1. Provide a cultural diversity self-assessment/practice organization:
    1. Online Internet self-assessment tools, for example, the CDC website (see the following section).
    2. Download self-assessment tools from public sources (see the following section).
    3. Use existing self-assessment tools and make necessary changes to fit the need (see Exhibit 3.7).
  2. Identify the need of the population served:
    1. Understand the community and its health status.
    2. Evaluate resources, attitudes, and barriers inside the communities and practice location:
      1. Access to resources.
      2. Notification of assistance.
      3. Range of assistance options:
        1. Transportation.
        2. Communication; consider an interpreter (personal versus automation):
          • Identify bilingual staff.
          • Use family members or personal acquaintance as interpreters (adults only).
          • Provide multilingual written materials.
        3. Education (meaningful/multilingual).
        4. User-friendly technology.
  3. Educate staff to cultural diversities:
    1. Assessments should include patient’s health values and beliefs (see Exhibit 3.8).
    2. Communication should be meaningful:
      1. Be precise and clear.
      2. Maintain eye contact when speaking.
      3. Use plain language.
      4. Observe facial expressions and body language.
      5. Use short sentences to explain lengthy information.
  4. Schedule longer appointments if needed.
  5. Clarify limitations of healthcare provider.
  6. Clearly identify alternatives offered by healthcare provider.