Cultural Diversity in Health Care: Tips for Improving Patient-Centered Care
Even with a multitude of health care practitioners, facilities and insurance options available, there are still glaring health disparities among diverse populations in the United States. Members of some ethnic groups are more prone to contract or develop certain conditions than members of other groups. Individuals who hail from foreign countries may encounter difficulties when trying to obtain health care services, such as language barriers or practitioners not acknowledging their unique cultural customs or beliefs. And those who lack financial resources may not be able to afford primary health care services or may lack access to quality facilities or health care providers.
Addressing and resolving these disparities is not an easy task. Many are rooted in large, complex societal issues. But professionals working in today’s health care system can still help to make a positive impact by embracing cultural diversity. This entails more than just treating all patients with the same processes and procedures. It also requires understanding how each person’s unique cultural history, heritage and background impacts his or her health and the type of services and treatments he or she should receive.
What Is Cultural Diversity in Health Care?
To properly address disparities in health care, it is crucial that health care practitioners have a firm understanding of cultural diversity and how to embrace it when working with various patient populations.
Definition of Cultural Diversity
Culture refers to the specific beliefs, practices and customs that a group or population adheres to. Observant followers of a religion, such as Christianity, Islam, or Judaism, tend to practice cultural customs relating to that religion, such as only eating certain types of foods or taking time at different points in the day to pray. Individuals who are of certain racial or ethnic backgrounds, such as people who are Latinx or Vietnamese, may follow their own cultural customs.
Cultural diversity refers to the differences that exist among people of varied cultures. In a health care context, cultural diversity refers to how these specific variances in culture impact the access and effectiveness of the treatment and services they receive.
Benefits of Cultural Diversity
Because there are so often health care disparities among different patient populations, there are benefits that come from embracing cultural diversity within health organizations. According to the National Institutes of Health, “the concept of cultural respect has a positive effect on patient care delivery by enabling providers to deliver services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients.”
Additionally, hospitals and health organizations that embrace cultural diversity within their own ranks, such as by seeking to hire and recruit individuals of diverse backgrounds, can generate more positive relationships with patients who come from similar cultures. Writing for Johns Hopkins Medicine, Paul B. Rothman, MD, dean of the medical faculty, states in reference to studies regarding patient and practitioner diversity, “when the physician is the same race as the patient, patients report higher levels of trust and satisfaction. The visits even last longer — by 2.2 minutes, on average. When patients enter our hospitals, they want to see staff members and physicians who resemble them.” This does not necessarily mean that every hospital or clinic should only hire staff from specific groups, but rather that health organizations should fully welcome individuals of unique cultural backgrounds as part of their staff and teams.
Addressing racial and cultural disparities in health care can also prove to have a positive economic benefit on patients and health organizations alike. Writing for the Harvard Business Review, John Z. Ayanian, MD, discusses how reducing disparities in access to outpatient mental health services “could reduce costs, particularly for people on Medicare or Medicaid, by limiting emergency room visits and hospitalizations for mental illness and other medical conditions such as diabetes and heart disease.” There clearly can be an initial and a long-term economic benefit from addressing disparities by embracing cultural diversity.
Examples and Applications of Cultural Diversity
Strong cultural diversity within a health care organization can include ensuring that individuals of diverse backgrounds not only receive the best care but also feel welcomed throughout their time at a facility.
Take, for example, a hospital that operates in a neighborhood where individuals from many different backgrounds reside, where many languages are spoken and where various cultural customs are practiced. Within this diverse neighborhood, though, individuals are facing their own unique health issues. Some may not have health insurance, others may be more contagious or at a higher risk of contracting a certain disease or condition and additional others may adhere to religious practices that conflict with them receiving what are considered to be conventional types of care.
That hospital could prepare for these culturally diverse challenges in various ways. Knowing that many languages are spoken within the surrounding neighborhood, the hospital or health organization could hire the services of multiple translators or interpreters, as well as have signage and reading materials available in the languages spoken in the community. Aware that some patients may be more prone to certain afflictions, doctors could prepare themselves to provide specialized treatment options to these individuals. And for those whose religious or ideological beliefs may interfere with certain practices or treatments, practitioners could seek out alternative ways of providing treatment while still being cognizant and respectful of those patients’ beliefs.
There are dozens of ways in which cultural diversity can be acknowledged and embraced in health organizations. This is possible so long as they are rooted in the acknowledgement that the health concerns of the members of each culture must be understood and respected by practitioners and health care staff.
Embracing Cultural Diversity to Improve Patient-Centered Care
Many practitioners and staff members would likely agree on the importance of cultural diversity in health care and its ability to improve patient-centered care. What some of those practitioners may not understand, though, are the best ways to effectively embrace diversity and help all patients achieve the best outcomes.
Cultural Competency Interventions
After doctors, nurses and other health care practitioners graduate from their respective colleges and universities and enter their chosen fields, they may find themselves working with an unexpectedly diverse community of patients and populations. As such, those practitioners may not understand or be prepared for how to effectively communicate and provide treatment to some of these individuals.
In these situations, cultural competency training, programs and interventions can be beneficial. This could include introductory seminars to new staff regarding best practices on interacting with and treating members of diverse communities as well as recurring programs for longtime hospital staff on how to effectively understand new and emerging societal and cultural trends.
A study published in BMC Health Services Research reviewed the benefits of different types of intervention programs and noted that “although several positive outcomes were reported across the included studies, consistent evaluation approaches are needed to build the evidence base on intervention impacts.” This could potentially indicate that intervention programs themselves need to constantly and consistently evolve to ensure that the most positive impacts are being delivered through such programs and that the programs themselves are frequently being updated to consider new evolving cultural trends.
Remaining Cognizant of Diverse Patient Health Needs
In 2016, Cigna, the health insurance organization, published a white paper regarding cultural competency in health care. In it, various health care needs and challenges among diverse populations were discussed, such as how adults with disabilities are more likely to be obese, how there is a physician shortage among certain geographic areas in the United States, and how nonwhite individuals tend to spend more time driving to and waiting at clinics than their white counterparts.
But many practitioners may not immediately recognize or acknowledge these diverse cultural health care needs or challenges. A doctor could see dozens of patients in a given day, each with his or her own specific condition or ailment that requires treatment, and that doctor potentially may not be considering what cultural issues are impacting each patient’s health care needs. This extends beyond the practitioners, as other hospital and clinic staff members may similarly ignore cultural issues when communicating with multiple patients and individuals every day.
Health care practitioners and staff, though, can still help to remedy these disparities by remaining cognizant of the specific health needs of individuals who belong to diverse cultural groups. This does not necessarily mean that practitioners should automatically assume patients’ conditions or situations are being directly impacted by their larger cultural background, but they should acknowledge that culture can play an often significant role in patient health.
Understanding Health Care Gaps Among Diverse Populations
There may be patients who hail from regions or countries where specific diseases and ailments are widespread and vaccinations are infrequent. There may be groups who come from poor socioeconomic backgrounds and do not have a firm understanding of what is considered to be common health literacy, such as the need to maintain a healthy diet or the specific harms of alcohol or tobacco products. And even those individuals who come from more advantaged economic backgrounds and have access to quality health care may still belong to cultural groups that are associated with higher risks of specific diseases or conditions.
Additional Tools and Strategies to Embrace Cultural Diversity
In health care, cultural diversity is a complex subject. Even with a slew of resources and guidelines available to practitioners, there are still additional challenges that must be met.
Preparing for Future Challenges in Health Care
The signing of the Affordable Care Act (ACA) into law in 2010 provided new insurance options to those who may have been previously uninsured. However, there have been ongoing proposed or enacted changes to the ACA since that time. This has required health care professionals to prepare to address the impacts of any potential or actual change to the law on their facility or their patients.
Changes to health insurance, though, aren’t the only challenges that health care will face in the future. Emerging technology can help to make certain procedures more efficient and effective, but diverse patients could potentially be reluctant to be treated with that technology. Changing economic trends, such as unemployment or downturns in the financial sector, may alter the availability of health care services to diverse individuals.
There isn’t necessarily a “right” way to deal with any of these specific challenges; what matters is that practitioners remain aware of the array of issues that may await them, their facilities and their health staff in the future and have a plan in place for handling them.
Constantly Learning About Cultural Diversity
There is no single doctor, nurse, hospital administrator or other health care staff member who knows every single item, custom or detail regarding every culture or background. Those cultures themselves are constantly evolving as well, adopting new practices and potentially revising and revamping old or traditional customs.
There is always an opportunity to learn about new cultures and to understand and acknowledge new and emerging trends. This can be done through individuals’ own exploration, such as engaging and forming relationships with diverse members of their own communities, as well as through learning opportunities provided by their health organization or other sources, such as diversity and cultural programs and seminars.
Improving Cultural Diversity Among Larger Health Care Teams
While it is important for health care professionals and practitioners to understand the importance of cultural diversity, their larger organizations need to make wide efforts to ensure diversity is being taken seriously among staff. This can include creating multiple means of reporting if discrimination or harassment have taken place against diverse staff members, providing consistent educational and awareness seminars and ensuring that diverse staff members and patients themselves feel welcome.
An article published in Insight into Diversity focused on the best diversity practices that could be adopted at nursing schools. The same or similar practices could generally be applied at larger hospitals or health care organizations. The practices include cultural competency exercises; mentorship programs; advancement specialists and opportunities; and resources and materials that can be accessed, understood, and appreciated by diverse individuals.
As diversity continues to be recognized and embraced by health care organizations and their respective teams, the quality of care provided by practitioners, as well as the quality of life of their patients, will continue to improve.