Question

How is cultural understanding and proficiency important in working with undeserved communities and health communication? How can health communications be more culturally proficient?

Answer 1

Culture plays a huge role in medical interactions. It influences how an individual might view an illness or treatment, for example, and affects how a physician should address an older patient. Culture may also affect the decision-making process. Cultural beliefs can affect how a patient will seek care and from whom, how he or she will manage self-care, how he will make health choices, and how she might respond to a specific therapy. Cultural issues play a key role in compliance, which is a person’s willingness to adhere to the doctor’s recommendations.

Culture influences healthcare at all levels, including communications and interactions with doctors and nurses, health disparities, health care outcomes, and even the illness experience itself. People in some cultures believe illness is the will of a higher power, and may be more reluctant to receive health care.

Cultural understanding and proficiency is defined as the cultural competency in which the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

Underserved communities have higher morbidity and mortality from chronic diseases. The consequences can range from greater financial burden to higher activity limitations. They have at least one of seven chronic conditions — asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/ depression. Although chronic illnesses or disabilities may occur at any age, the likelihood that a person will experience any activity limitation due to a chronic condition increases with age. As the population at risk of chronic conditions becomes increasingly diverse, more attention to linguistic and cultural barriers to care will be necessary.

Having a regular doctor or a usual source of care facilitates the process of obtaining health care when it is needed. People who do not have a regular doctor or health care provider are less likely to obtain preventive services, or diagnosis, treatment, and management of chronic conditions. Health insurance coverage is also an important determinant of access to health care. But in the case of undesreved communities do not have a usual source of care and do not have health insurance.

Literacy and language barriers may play a role in poor communication between doctors and patients from different cultures. The communication gap can prevent some seniors and families from getting the health information they need to make informed decisions. They may not know where to access information in another language, or they may not know how to find a health care provider that speaks the language. Language and communication barriers can affect the amount and quality of health care received. Language and communication problems may also lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care.The type of interpretation service provided to patients is an important factor in the level of satisfaction.  Underserved communities are more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities. Low literacy may affect patients’ ability to read and understand instructions on prescription or medicine bottles, health educational materials, and insurance forms. People with chronic conditions require more health services, therefore increasing their interaction with the health care system. If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care.

Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, literacy.

Some common strategies for improving the cultural proficiency in the health communication include:

• Provide interpreter services
• Recruit and retain minority staff
• Provide training to increase cultural awareness, knowledge, and skills
• Coordinate with traditional healers
• Use community health workers
• Incorporate culture-specific attitudes and values into health promotion tools
• Include family and community members in health care decision making
• Locate clinics in geographic areas that are easily accessible for certain populations
• Expand hours of operation
• Increase staff diversity
• Provide linguistic proficiency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials

In order to increase the cultural proficiency of the health care delivery system, health professionals must be taught how to provide services in a culturally competent manner. Although many different types of training courses have been developed across the country, these efforts have not been standardized or incorpo-rated into training for health profession-als in any consistent manner. Training courses vary greatly in content and teaching method, and may range from three-hour seminars to semester-long academic courses. Cultural proficiency improvement is a process rather than an ultimate goal, and is often developed in stages by building upon previous knowledge and experience.

Health plans have additional communication-based challenges and opportunities to reduce disparities. One challenge relates to understanding how patients' interpretation of disease and care-seeking behaviors may be conditioned by their cultures. Some underserved community members who are reluctant to utilize mainstream medicine may delay seeking care if their health plans do not cover complementary or alternative medical services. Some benefit design and utilization control features may need to account for the diverse needs of members from different cultural backgrounds. Everyone has a culture, and providers own cultural backgrounds may affect their communication in the care delivery process if they are unable to recognize or accept differences between themselves and their patients.