User:Tiwong11/Cultural competence in healthcare

Clinical practice
To provide culturally sensitive patient-centered care, physicians should treat each patient as an individual, recognizing and respecting his or her beliefs, values and care seeking behaviors. However, many physicians lack the awareness of or training in cultural competence. With the constantly changing demographics, their patients are increasingly getting diverse as well. It is utterly important to educate physicians to be culturally competent so that they can effectively treat patients of different cultural and ethnic backgrounds.

Ignorance of these cultural differences could manifest in discomfort for the patient, subpar healthcare, incorrect diagnosis, and even racism, all which lower patients’ access to quality healthcare. Studies stress culturally sensitive training and education programs in healthcare settings that will impart to physicians how culture can affect healthcare treatment. Additionally, when interacting with patients of different cultures, specifically East Asian culture, it is important to “bridge the health care system with more traditional Eastern medical care… entail[ing] education for health professionals as part of a broader curriculum on providing culturally competent care.” Within western healthcare, there are also large amounts of inaccuracies and misperceptions of health risks for different minority groups, which could be addressed through further linguistically and culturally appropriate health education.

The differences in responses from healthcare professionals to black patients versus white patients is drastic, indicated by subconscious negative perceptions of various races. In a study that evaluated physicians' immediate assumptions made about different races "two-thirds of the clinicians subconsciously formed a bias against Blacks (43% moderate to strong) and Latinos (51% moderate to strong)". Without intentionally concocting stereotypes about patients, these clinicians are indirectly negatively affecting the patients they mistreat. To remedy this, the study expresses support for clinicians to form a stronger connection with each patient and to focus on the patient at hand, rather than considering their race or background. This will help to prevent negative attitudes and tones when speaking with patients, creating a positive atmosphere that allows for equal environments and treatments for all patients, regardless of race or physical appearance.

These subconscious negative perceptions of different races could also potentially lead to mistrust of western healthcare by minority populations. Mistrust of the government or Western medicine is a big reason that many immigrant/minority populations do not seek out healthcare, leading them to believe that equitable, affordable, quality healthcare is not a resource that is available to them. A program called Minnesota Immunization Networking Initiative (MINI) was started “in 2006 to reduce vaccination barriers of underserved populations” like African-Americans, Hispanic-Americans, etc. MINI succeeded in increasing vaccination and trust within these communities. Their success came from engaging the community, establishing strong partnerships with service providers, and actively involving and communicating with community partners, and holding clinics in trusted community facilities. Other research studies have also recommended that providers build trust with clients by making efforts to establish relationships with patients and “keeping in mind unique cultural profiles."

Community Health Clinics
Because of insurance, costs, and a variety of other reasons, the types of services needed to meet the needs of minority communities are not usually offered at private hospitals. Federally qualified health centers (FQHCs) are legally mandated to provide primary care for medically underserved communities, and thus are ideal settings to implement and provide culturally and linguistically inclusive services to immigrant communities.

Community Health Centers, at their most basic level, provide low to no cost primary medical care to low-income, minority, and underserved communities. They are usually located in underserved communities and neighborhoods, with the idea to increase access, reduce travel and wait times, and to combat gentrification. They were meant to be of the people, by the people.

In an Integrated Care Model that allows clients to get an all-in-one-experience, the CHC model was unique in that it offered a wide range of auxiliary services in addition to primary care, such as dental, behavioral, social services, etc. CHC’s also “pride themselves equally on providing community-accountable and culturally competent care aimed at reducing health disparities associated with poverty, race, language, and culture”, as seen by their offered translation, interpretation, transportation, and social services. According to research, CHC’s have successfully increased health service utilization in low-income areas, as well as lowered hospital admissions and readmissions (a positive metric) compared with other major providers of primary care in these areas.

Language barriers
The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care developed by the Office of Minority Health (OMH) are intended to advance health equity, improve quality and help eliminate health care disparities. The three themes of the fifteen CLAS standards areGovernance, Leadership, and workforce; Communication and Language Assistance; and Engagement, Continuous Improvement, and Accountability. The standards clearly emphasized that the top levels of an organizational leadership hold the responsibility for CLAS implementation, and that language assistance should be provided when needed, and quality improvement, community engagement, and evaluation are importance.

Research emphasizes the need for culturally and linguistically sensitive services in providing healthcare to immigrant/minority populations, and studies show that interpreters and translation services could decrease linguistic barriers for minorities in clinical health settings. Communities who don’t speak the dominant language would have a hard time accessing and understanding healthcare, especially when it comes to insurance. Immigrant communities might face even higher barriers to access because of cultural differences and not knowing how things work. In these cases, interpreters and language services are especially important.

Variability in interpreter use
Though the standard of interpreter use in medical discourses has been perceived to be the solution for cross-linguistic encounters within the hospital flow, a close analysis of the social role of the translator uncovers varying effects on the quality of care and accuracy of medical advice. A previous study of 83 U.S. public and private hospitals reported an average of 11 percent of the patient population requiring interpreter services. At one particular hospital, only seven full-time Spanish-English interpreters were hired to attend to the linguistic needs of 33,000 patients in need of Spanish interpretation. The high demand but low value for this position generates interpreters who may be ill-fit for the responsibility, consistently running late and not having the adequate training to perfectly translate the patient's needs or the doctors orders. Ad hoc translators were found to display a higher level of error frequency in their patient interactions with 77% of the translations being found to some level of inaccuracy. This is relatively higher compared to professional medical translators. Ad hoc translators are nurses, family members, or other available bilingual staff that are utilized on the spot for translation purposes. However, in the same study, professional translators were still found to exhibit error in 53% in their evaluated interactions. In a review of 28 in-site research studies conducted, use of professional interpreters was associated with overall improved clinical care in four categories: communication, utilization, clinical outcomes, and satisfaction. Of the twenty-eight, only six were found to have an overall patient rating of "satisfactory" or higher in the context of their clinic care with the use of a professional translator.

One of the big problems with language services is that it is maintained by the hospitals and clinics, and is the first to be cut in financial strain. Health insurance also does not reimburse the use of interpreters. It is shown from these studies that professional translation and interpreter services, coupled with language education, are not enough to overcome these cultural and linguistic hurdles. Clough et.al suggests that “culturally competent guidance provided by navigators from a patient’s own ethnic community [patient navigators] might play a major role in overcoming barriers to healthcare.”

Community Navigators (also known as community health workers, patient navigators, health advocates, and a variety of other names) are healthcare workers who are trained to provide culturally appropriate support to populations with historically limited access to healthcare. Community Navigators work as the bridge between patients and providers, and help patients overcome language barriers, financial barriers, unfamiliarity with the healthcare system, cultural and religious differences, and more. In studies, Community Navigators have been found to improve primary outcomes relating to chronic disease management. For example, in studies, Community Navigators at Federally Qualified Health Clinics helped improve the cancer diagnosis and screening process and timeline among underserved, vulnerable populations. Many clinical practices, especially Federally Qualified Health Clinics, employ Community Navigators.

Diversity
One factor that impinges on delivery culturally competent care is the degree in which the leadership and workforce of the physician population reflect the rates of minority groups in the United States. Research has shown that for minority patients, racial similarity between patient and physician correlates with a greater sense of patient satisfaction. On a study conducted on a cohort of 147,815 primary care physicians, the Black, Hispanic, and Native American groups together constituted 13.4 percent of the population as compared. However, since 2018, these groups comprised a total of 33 percent of the population of the United States. Despite the small pool of Black and Hispanic physicians, studies show that 25 percent of Black patients participating in a study and 23 percent of the Hispanic patients had primary care physicians that coincided with their racial identity. Given their connections and experiences, minority health professionals are more likely to develop care models that more effectively meet the needs of the communities they serve. The lack of diversity and sociocultural awareness risks the chance of stereotyping patients or having lack of attentiveness to the individual needs of their patients.

A study of Asian American children showed that ethnic match between mental health provider and client increased the likelihood that the client would utilize the services, the number of sessions attended, and the functioning score at discharge, as well as decreased the likelihood the client would drop out of treatment. According to studies, a diverse and socially inclusive workforce is incredibly important. Thomson writes that direct provider-patient communication increases the chances of the patient’s customs and beliefs being understood and taken into account during treatment, leading to better care.