Importance of cultural competence in healthcare

Practicing cultural competence helps strengthen the bond between provider and patient. Taking the time to understand an individual’s cultural context enhances communication, collaboration, and patient empowerment, supporting a robust therapeutic alliance that contributes to better outcomes.

This piece provides information regarding:

Today's medical practices operate in an increasingly diverse society in which racial, ethnic, and other cultural health disparities exist. Evaluating one’s cultural competence allows professionals to better serve those from cultures other than their own. Likewise, practices can assess organizational policies and work to engage non-clinical staff in supporting the delivery of culturally sensitive care at all levels.

Think Cultural Health describes cultural competency as "a developmental process in which one achieves increasing levels of awareness, knowledge, and skills along a continuum, improving one's capacity to work and communicate effectively in cross-cultural situations."

According to the American Hospital Association, cultural competence allows healthcare systems to effectively provide care for patients with diverse values, beliefs, and behaviors. For medical practices, cultural competence means that clinical and administrative staff understand, respect, and consider cultural influences on patients' health beliefs and practices, health history, health literacy levels, and communication requirements.

According to the Centers for Disease Control, culture refers to the “collection of beliefs, values, customs, ways of thinking, communicating, and behaving” of a distinct group. This includes racial, ethnic, linguistic, geographic, social, and other groups. 

Cultural context describes how being a member of a specific culture can influence someone’s:

However, having a basic knowledge of what a culture is doesn’t meet your needs as a provider. What do you need to apply to your practice to be a more inclusive and involved physician?

Everyone has more than one cultural identity that influences their sense of self. For example, an individual may identify simultaneously as part of a specific ethnic community, as having a specific gender and sexual orientation, and as a member of a specific religious affiliation. 

Cultural factors that can contribute to health disparities include:

There is also often further diversity within specific cultural and ethnic groups. 

Overlapping cultural identities can contribute to unique health disparities and limit healthcare access, thus compromising health outcomes.

Culture generally refers to a specific group's shared beliefs, values, and experiences. Social determinants of health (SDOH) refer to the conditions of the environment in which people are born, live, and work. Culture and SDOH overlap significantly. Culture influences environmental circumstances; one's environment influences values, beliefs, experiences, and culture. Therefore, the two are deeply interconnected. Integrating awareness of SDOH with cultural competence can enhance the impact providers and practices have on their patients’ health and well-being. A 2019 study by Lakshmi Nair and Oluwaseun Adetayo found that "measures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve health care outcomes in these patient populations."

Cultural humility refers to awareness and understanding of one's own assumptions and beliefs and how they impact interactions with individuals from diverse backgrounds. Practicing cultural humility means committing to ongoing self-reflection and staying open to learning and growing through encounters with people who have different beliefs, values, and/or worldviews.

Cultural humility also recognizes the unequal power dynamics of provider-patient interactions. Humble providers actively work to mitigate this dynamic by acknowledging that the patient is the best authority regarding their personal experiences and needs. This helps restore balance to the relationship and encourages patients to take responsibility for their own health and medical decisions. 

For example, one might assume that two patients of the same ethnicity would present with the same health behaviors. However, these individuals may have had different experiences growing up, just as any two neighbors are different from each other. Therefore, expecting identical health behaviors from both patients would be an oversimplification. 

Furthermore, “cultural identities aren't always obvious or visible,” says Darci L. Graves, MPP, MA, a health equity expert. She also asserts, "even if you look the same on the outside, chances are, you're still having a cross-cultural encounter." 

Since 2004, the Office of Minority Health has sponsored Think Cultural Health, an initiative supporting healthcare professionals in learning how to provide culturally and linguistically appropriate services (CLAS).  

The Think Cultural Health website features information, free, accredited continuing education courses for a variety of professionals, and resources supporting this ongoing process.

Providers can complete a cultural competence self-assessment, such as the one developed by Tawara D. Goode of the National Center for Cultural Competence at Georgetown University (NCCC), to identify areas where they can improve the quality of care provided to diverse populations. This assists providers in evaluating their physical environment, communication style, values, and attitudes.

Graves encourages providers to see cultural competence as a tool of empowerment rather than a duty. "It's not about adding something extra — it's about tweaking what you already do,” she says. “It's about making sure that the questions you're asking, as well as how you're asking those questions, is culturally appropriate," she says.

Being culturally competent and sensitive means that professionals are free to adjust questions to the person and conversation at hand. This doesn’t have to take more time but can allow for a more useful history and productive encounter. It also helps answer questions such as why a patient may not take a particular medication or follow through with treatment recommendations. In general, understanding cultural context can enhance the overall clinical picture and help providers render more informed care.

More thoughtful questions and communication can help patients feel more connected to their physicians. This, in turn, can lead to better patient engagement, compliance with medical treatment, and positive health outcomes. 

Taking patients' lived experiences seriously, trusting their authority regarding their experience in their bodies, and cultivating a collaborative relationship can improve care quality. Responding to the patient's unique needs — including their spirituality, cultural medical practices, and language requirements — contributes to patient-centered and family-focused care that can enhance both patient safety and satisfaction. All this can add up to greater patient retention, great patient reviews, and even patient referrals.

Culturally competent medical systems cultivate behaviors, attitudes, and policies that support effective cross-cultural communication. This enables all team members to respond to the patient's individual needs.

Incorporating practice-wide cultural sensitivity creates a safe, inclusive environment for all patients. Educating non-clinicians in cultural humility is critical to facilitate better patient interactions. Just as crucially, medical practices must design systems and policies that support and assist patients from diverse cultural backgrounds.

Exactly which policies and procedures might be helpful will depend on your unique practice. Practice leaders can review the NCCC’s guide for organizational self-assessments. Think Cultural Health offers a guide for healthcare administrators that includes information on planning, implementing, and evaluating effective communication and language assistance services. 

Think Cultural Health also provides a blueprint that practices can use to operationalize these principles. Providers can download a nearly 200-page blueprint that offers detailed information about the CLAS standards and how to implement them in practices. For example, the blueprint encourages practices to inform all individuals of the availability of language assistance services clearly and in their preferred language (verbally and in writing); provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area; and partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.

Community partnerships may involve community organizations, faith-based organizations, nonprofits serving marginalized groups, or local schools and businesses. Practices can ask members of these organizations to provide advice, help educate staff, and help mitigate barriers to care, for instance, to address cultural considerations.

Examples of culturally competent policies include: 

Coordinating with a community health worker (CHW) can level up care quality and cultural competency. CHW’s are public health professionals and trusted representatives who facilitate access to health and social services for members of the community they serve. Because CHWs have a deep and often personal understanding of the culture, their valuable assistance helps practices address broader cultural factors and community-specific needs. The National Association of Community Health Workers has a helpful directory of local CHW networks. The National Healthcare for the Homeless Council provides resources for medical practices about hiring and integrating CHWs into care delivery.

Taking things a step further, consider collaborating with traditional healers to integrate cultural medical practices into patient care.

Choosing patient-facing technologies — such as telemedicine — designed to enhance accessibility makes a difference in how patients from diverse cultures interact with your practice. When vetting new vendors, consider evaluating whether cultural competence is part of their business model. Vendors that value cultural sensitivity often design products that intentionally support cultural competence for providers and practices. 

Looking for additional ways to make your practice more welcoming and comfortable for your patients? Check out The Intake’s collection of information and resources about how practices can enhance patient experience.