Why is cultural competency important?
Culture shapes our language, our behaviors, our values, and our institutions. In health care settings, culture and language differences can result in misunderstandings, lack of compliance, particularly with a home exercise program or some instruction that we are giving to the patient, or other factors that can negatively impact the clinical situation. Delivering care in a culturally and linguistically appropriate manner is a key way that you as a therapist can help improve the quality of care for diverse patients that you serve, improve the quality of services, increase patient safety, and increase patient satisfaction (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006; Betancourt, 2006; Brach & Fraser, 2000; Thom, Hall, & Pawlson, 2004.
Providing culturally appropriate care is especially urgent, because again, research is showing that many cultural and linguistic groups received lower quality health care even when socio, economic, and access-related factors were controlled or the same (IOM, 2003; HHS OMH, 2001; HHS OMH, 2013). Cultural groups encompass not only racial, ethnic, or linguistic groups, but also religious, spiritual, biological, geographical, or sociological characteristics. Linguistic minorities include people with limited English proficiency, as we already said, people with limited literacy skills, and those who are deaf or hard of hearing. Bias, stereotyping, prejudice, and other clinical uncertainties contribute to these disparities in health care (IOM, 2003). We need to keep that in check as we deliver care.
There are some additional terms with which you should be familiar. Bias is a preference or an inclination, especially one that inhibits impartial judgment or an unfair act or policy stemming from prejudice (IOM, 2003). An assumption is an underling assumption that is an unconscious, taken-for-granted belief and value that helps determine behaviors and perceptions (Schein, 2010). Prejudice is a negative attitude toward a specific people, like a race or religion (Pincus, 2006). A stereotype is an oversimplified conception, opinion, or belief about some aspect of an individual group of people (Purnell, 2005). Discrimination are actions that deny equal treatment to persons perceived to be members of some specific group (Pincus, 2006). Everyone has biases and make assumptions about other people. These biases and assumptions become problematic when they result in prejudiced treatment, discrimination, or some other sort of unfair treatment.
The Institute of Medicine (2001) recommends that we, as health care providers, adopt as our explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the functioning of individuals. We need to provide health care that is:
To reach this goal, we need to aim to provide health care that is safe, so we are avoiding injuries to our patients from care that is actually intended to help them. Care needs to be effective, so we are providing services based on the best available evidence. Care that is patient-centered means we are providing care that is respectful of and responsive to individual preferences, needs, and values. It is timely, so we are reducing waits and sometimes harmful delays. It is efficient, avoiding waste in particular of equipment or supplies. Finally, the health care needs to be equitable; providing care that does not vary in quality just because of personal characteristics like gender, ethnicity, geographic location, or socioeconomic status. Again, as health care professionals, we want to learn as much as we can about diverse population groups and continuously examine and enhance our awareness, knowledge, and skills related to those differences.