A Cultural Framework Is Essential in Patient Care

Following the struggles of the COVID-19 pandemic across the world, health care has become increasingly global in scope. Today, it has become clear that different patient groups across the world have different health outcomes from the same health condition; this is no different in the United States. To provide care that acknowledges these different experiences of health conditions and health care more broadly, there is an increasing need for improved cultural sensitivity in patient care throughout health systems.^1-5

In health care, culture plays a significant role in how patients and providers perceive and approach health care.⁶ An individual's cultural background can influence their comfort when seeking care, describing symptoms, selecting treatment options, and following care recommendations.⁶ Similarly, providers also bring their own cultural orientations, including that of the culture of medicine and pharmacy. To provide quality patient care, it's essential to become aware of one’s own cultural orientations to better respect, which involves delivering services that are respectful and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients.⁵

An individual's cultural background can influence their comfort when seeking care, describing symptoms, selecting treatment options, and following care recommendations. Image Credit: © Rethea Boer/peopleimages.com - stock.adobe.com

Is Cultural Respect Important?

The influence of culture plays a significant role in many aspects of life, including health care practices, decision-making, and approaches to wellness and recovery.⁷ For health care professionals to provide personalized care and achieve the best health care outcomes in a patient-centered, culturally sensitive manner, they must have a comprehensive understanding of their own beliefs as well as their patient’s beliefs.⁷ In fact, just recently, the public health and health communication sectors have recognized the critical role of culture in health and health behaviors. Culture is also considered a potential means of enhancing the effectiveness of health communication programs and interventions.⁸ Furthermore, the field of cultural competency is constantly evolving, encompassing new terminology, philosophies, frameworks, and techniques. Health care professionals should strive for cultural sensitivity, as it is unlikely for one person to be competent in all cultures. To facilitate learning and practice with different cultures, the term "cross-cultural education" is now being used.⁹

Recognizing and valuing cultural differences is crucial in addressing health disparities. It promotes equitable access to excellent health care that considers and responds to the unique needs of diverse patients. By adopting cultural respect as a guiding principle, health care systems, organizations, and professionals can work together more effectively to cater to the health information and care needs of various communities.⁵

The importance of culture is in line with national health goals that seek to eliminate disparities that exist across various population subgroups in terms of a wide range of health-related outcomes, behaviors, and conditions.⁸ It is widely acknowledged that a thorough understanding of a particular group's cultural traits can help tailor public health and health communication initiatives and services to cater to that group’s specific needs.⁸ Showing cultural respect is crucial in promoting positive health outcomes and benefiting consumers, stakeholders, and communities. Inaccurate results in medical research can occur when cultural elements such as behaviors, language, customs, beliefs, and perspectives are not taken into account during planning. Therefore, it is essential to prioritize cultural respect in medical research to ensure accuracy and inclusivity.⁵

Furthermore, it is crucial to prioritize health equity, as certain communities are burdened by a variety of social factors and systemic barriers that can reduce their lifespan by up to 20 years compared to those living just a few miles away. These risks begin at birth and persist throughout a person's life due to the unequal distribution of stable housing, quality education, reliable employment, and accessible health care. Establishing a culture of health requires collective efforts to eliminate structural racism and other barriers, ensuring that everyone has the opportunity to lead a healthy life.

Cultural Competence and Patient Safety

Unfortunately, disparities in health care extend to the area of patient safety as well. A recent study has shown that patients with limited English proficiency are more likely to experience harm during adverse events (AEs) than those who are proficient in English.¹⁰ Additionally, the harm experienced by non-English speaking patients is often more severe.10 This trend also extends to pediatric populations, where Latino children have a higher likelihood of experiencing AEs compared to non-Latino white children.¹¹ The failure to address cultural, linguistic, and health literacy issues can result in patient safety events such as diagnostic errors, missed screenings, and unexpected negative reactions to medication. Other potential consequences include harmful treatment interactions from the simultaneous use of traditional medicines, health care-associated infections, adverse birth outcomes, inappropriate care transitions, and inadequate patient adherence to provider recommendations and follow-up visits.¹² An example of such an event occurred when a hospitalized Asian woman could not provide consent for a necessary surgery due to a lack of understanding that she would only communicate when a male family member was present.¹³ With growing diversity in patient populations across the country, the risk of missed care opportunities and safety events increases due to differences between patients and providers.^12,14

Cultural competence plays a vital role in patient safety outcomes, not only by reducing medical errors and harm but also by enhancing patient engagement. By implementing cultural and linguistic competence strategies like language assistance and cultural brokers, health care providers can effectively communicate with diverse patients, thereby involving them as active partners in their care. Moreover, cultural competence training can equip providers with the skills to understand patients' experiences, bridge cultural differences, and build trust, ultimately improving patient engagement.¹⁵

The health care industry acknowledges the difficulty of meeting the growing number of diverse health needs of various racial, ethnic, and linguistic groups, each with its unique cultural characteristics and health concerns.⁵ Though they can never be fully controlled, understanding them better and shaping them intentionally is necessary. Medical groups and organizations recognize and understand the significance of implementing research advancements to promote better health outcomes for all Americans. Ongoing research endeavors aim to identify additional connections between minimizing health disparities and providing effective health care and health information.⁸

Conclusions

Culture is a commonly used metaphor to describe an organization's perceived characteristics. Nevertheless, recognizing that culture is a multifaceted concept can lead to more careful and thoughtful use of the term. Given the increasing diversity of the United States and the impact of culture on patients' attitudes towards health and illness, it is vital to incorporate patient-centered, culturally sensitive health care knowledge to improve the health and wellness of all Americans.

References

1. National Healthcare Quality and Disparities Reports. Agency for Healthcare Research and Quality. National healthcare disparities report. Last updated December 2023. Accessed May 13, 2023. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr22/index.html
2. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003. doi:10.17226/12875
3. Native American health care disparities briefing executive summary. Office of the General Counsel US Commission on Civil Rights. February 2004. Accessed May 13, 2023. www.law.umaryland.edu/marshall/usccr/documents/nativeamerianhealthcaredis.pdf
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5. Cultural Respect. NIH. Updated July 7th, 2021. Accessed May 13, 2023. https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/cultural-respect
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9. Reitmanova S. Cross-cultural undergraduate medical education in North America: theoretical concepts and educational approaches. Teach Learn Med. 2011;23(2):197-203. doi:10.1080/10401334.2011.561761
10. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60-67. doi:10.1093/intqhc/mzl069
11. Stockwell DC, Landrigan CP, Toomey SL, et al. Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children. Hosp Pediatr. 2019;9(1):1-5. doi:10.1542/hpeds.2018-0131
12. Brach C, Fraser I. Reducing disparities through culturally competent health care: an analysis of the business case. Qual Manag Health Care. 2002;10(4):15-28. doi:10.1097/00019514-200210040-00005
13. Boisvert S. Cultural Diversity in Healthcare: Strategies for Culturally Appropriate Patient Care. thedoctors.com. June 2023. Accessed May 14, 2023. https://www.thedoctors.com/articles/challenges-of-cultural-diversity-in-healthcare-protect-your-patients-and-yourself/
14. Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100(11):1275-1285. doi:10.1016/s0027-9684(15)31505-4
15. Beverley M. Connect Patient Engagement and Cultural competence to Drive Health Management. Taylor Communications. August 14, 2014. Accessed May 14, 2023. http://www.engagingpatients.org/patient-centered-care-2/connect-patient-engagement-cultural-competence-drive-health-management/