Communication between physicians and patients presents an issue for one in five individuals receiving healthcare in the United States [1]. This percentage rises to an alarming 27 percent among Asian Americans and 33 percent among Hispanics [1]. Furthermore, population admixture in the US is accelerated now more than ever [2]. How do we then address the issues that arise when healthcare providers treat patients with cultural values which present an obstacle in delivering their treatment plan? Research on patient-centered care has shown that the proper use of language has improved the quality of healthcare through cultural sensitivity, and consequently, through increased patient engagement [3, 4]
Culture encompasses a multitude of behaviors that are composed of material and non-material aspects that humans have used to communicate with each other as a tool for survival [3]. Over generations, these survival tools have evolved into adaptive behavioral strategies that differ amongst peoples, societies, and subcontinent [3]. In healthcare, culture plays an integral role in the perception of the patient experience as it allows for the separation of objective disease from subjective stress through its influence on diagnosis and treatment plans [3]. The area of diverse complications arises from the range of transforming behaviors, traditions, restrictions, norms, rituals, and political beliefs [3]. Consequently, these shifts in ideas result in major challenges when healthcare providers work with patients from a variety of cultural backgrounds. Although a universal approach that encapsulates all cultural differences would be ideal, this is simply not feasible due to culture’s very complexity [3]. This makes competency something akin to trying to capture a fleeting bubble.
In order to understand cultural competency in healthcare, we must define it. Cultural competence includes four facets: cultural awareness, attitudes, knowledge, and skills [3]. In this theory, competence is something that can be achieved through a finite understanding of culture. It implies that an awareness and mastery of diverse backgrounds is sufficient to allow for communication between the patient and provider. However, this may also lead to stereotyping and standardization of ethnic groups. Contrastingly, cultural humility emphasizes a process-oriented approach to understanding at-risk groups and the social disadvantages that lead to poor health outcomes [3]. It involves an “intrapersonal and self-reflective dimension as well as an interpersonal dimension that includes respect for others, lack of superiority, and a focus on others rather than self" [3]. Cultural humility requires an in-depth understanding of one’s own background and how it influences their perspective and formation of knowledge [4].
Cultural humility in healthcare actualizes as the ability to understand the beliefs a patient communicates by supporting and validating decision-making in regards to screening, treatment, and care options [4]. This care must meet the social, cultural, and linguistic needs their patients possess. Most importantly, this process is ongoing and requires an ability to collect health-related information and respond in a way that displays an intrinsic motivation to hold space for a conversation about the patient’s needs [4]. Consequently, the increase in patient engagement validates and increases patient contribution to the decisions being made regarding their health. Claiming to achieve competence in any cultural background is untrue and potentially harmful to patients [5]. Thus, an appreciation of implicit bias demonstrates the need to prioritize the development of cultural humility to begin to create more efficient patient-provider experiences.
References
Brach, Cindy, and Irene Fraser. “Reducing Disparities through Culturally Competent Health Care.” Quality Management in Health Care, vol. 10, no. 4, 2002, pp. 15–28., https://doi.org/10.1097/00019514-200210040-00005.
Anderson, Apryl N, et al. “Pharmacogenomics and Clinical Cultural Competency: Pathway to Overcome the Limitations of Race.” Pharmacogenomics, vol. 23, no. 6, 2022, pp. 363–370., https://doi.org/10.2217/pgs-2022-0009
Yancu, Cecile N., and Deborah F. Farmer. “Product or Process: Cultural Competence or Cultural Humility?” Palliative Medicine and Hospice Care - Open Journal, vol. 3, no. 1, 2017, https://doi.org/10.17140/pmhcoj-3-e005.
Harrison, Reema, et al. “What Is the Role of Cultural Competence in Ethnic Minority Consumer Engagement? an Analysis in Community Healthcare.” International Journal for Equity in Health, vol. 18, no. 1, 2019, https://doi.org/10.1186/s12939-019-1104-1.
Lekas, Helen-Maria, et al. “Rethinking Cultural Competence: Shifting to Cultural Humility.” Health Services Insights, vol. 13, 2020, p. 117863292097058., https://doi.org/10.1177/1178632920970580.