Culturally Competent Care - Are Health Care Providers Doing Enough?

America is arguably one of the most diverse nations in the world. While such diversity can provide opportunities for unique social and cultural interactions, it can also present opportunities for poor medical care. Many studies show that ethnic and cultural minorities do not receive the same level of care as patients in majority groups. The mental health care system, in particular, is susceptible to cultural insensitivities that may lead to substandard, inappropriate, or ineffective treatment.

Culture refers to shared values, beliefs, and perceptions. It also includes behaviors and attitudes that influence daily activities. Culturally competent care involves accepting, acknowledging, and respecting cultural differences to improve health care outcomes. If health care providers are going to provide care that is appropriate for every ethnic and racial group, they must respect a patient as an individual, with his own cultural, social, and religious customs. Additionally, the health care provider must assess and challenge his own social paradigms and preconceptions.

Health care that does not respect the cultural differences among individuals leads to mistreatment of patients. This mistreatment may include decreased patient compliance, lack of informed consent, and increased risk of liability for malpractice. Cultural differences also influence what treatment options are offered to a patient and how the services are organized and financed.

Culture is a barrier to appropriate health care among substance abuse treatment, psychiatric illness, and major depressive disorder, based on recent study findings. Cultural behaviors and attitudes impact how illness is manifested in patients, including symptoms of the disease, and whether or not the patient will seek treatment at all. Many patients describe physical symptoms more often that psychological symptoms when seeking treatment for depression or anxiety. Providers must include such assessments in a differential diagnosis.

Spiritual beliefs certainly play a role in the effective treatment of mental illness. Spiritual and religious beliefs influence patients’ understandings of the source of disease. Patients that believe in reincarnation, for example, may believe that a disease is a punishment for an act committed in a previous life. Other patients may believe that mental illness is caused by voodoo, witchcraft, or the devil himself. Such patients need validation from health care providers that may, themselves, need to examine the appropriateness of traditional Western medical practices as applied to all patients.

Language often plays a role in cultural barriers to health care. For example, some words, like “depression” and “anxiety,” do not have exact translations in some Native American languages. Further, verbal and nonverbal communication skills vary widely among cultural groups. Components such as hand gestures, eye contact, personal space, facial expression, and volume all contribute to effective communication and building rapport between patient and health care provider.

Further, an understanding of the racial and ethnic component of drug metabolism is paramount to providing effective health care. Many differences exist in the enzymes that metabolize drugs when comparing one racial or ethnic group to another. These differences may lead to some drugs being more or less effective in a particular group, or more side effects or drug interactions in another group.

Even after years of social awareness regarding cultural issues, many health care providers still are not providing the best possible care to their diverse patient populations. Recent studies indicate that few medical schools are providing adequate training and preparation in cultural competence. However, even more studies report that the greatest barrier to providing competent care is the providers’ own preconceptions about race, gender, and cultural issues.

Provider-patient relationships that include effective communication, awareness of social and cultural constructs, and respect for those differences results in better health care outcomes. Patients should not bear this responsibility themselves, but it should be the obligation of all health care providers and institutions to make access to appropriate medical care equitable across racial, ethnic, and cultural divides.

References

Gilburt, H., Rose, D., Slade, M. (2008). The importance of relationships in mental health care: A qualitative study of service users’ experiences of psychiatric hospital admission in the UK. BMC Health Services Research, 8 (1), 92. DOI: 10.1186/1472-6963-8-92

Quintero, G.A., Lilliott, E., Willging, C. (2007). Substance Abuse Treatment Provider Views of “Culture”: Implications for Behavioral Health Care in Rural Settings. Qualitative Health Research, 17 (9), 1256-1267. DOI: 10.1177/1049732307307757

QURESHI, A., COLLAZOS, F., RAMOS, M., CASAS, M. (2008). Cultural competency training in psychiatry. European Psychiatry, 23 , 49-58. DOI: 10.1016/S0924-9338(08)70062-2

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