Why Cultural Competency Matters In Healthcare: The Other Half of Healing

Writer: Farwa Tashin

Editor: Zahin Zaman

In a city that is as diverse as New York, medical care doesn’t start in the textbooks or diagnosis, but rather through being able to understand and communicate with each other. In the melting pot that we call New York City, where we have people from all around the globe, with different languages, traditions, and cultures, the importance of cultural competence is often overlooked in healthcare. Not every patient follows the “cookie cutter” template and it can be life changing to recognize one’s individual background and the ways it shapes how we care for them, and as a result, their mental and physical wellbeing. Being culturally competent is not just a soft skill to add on your resume, but rather a requirement in order to provide personalized care for patients.

Cultural competency is often misunderstood. People think that it means being bilingual or knowing everything about every country and its culture, which is of course unreasonable and impossible at the same time. Rather, cultural competency involves recognizing that an individual’s beliefs, values, and communication styles may influence what they know or don’t know, how they understand the diagnosis, how they describe the symptoms, and how they choose to move forward with their treatment of choice. Cultural competency also includes respecting “patient and family preferences, values, cultural traditions, language and socioeconomic conditions” [1]. It also demands accepting the importance of cultural humility, an attitude that emphasizes continuous learning, transparency, and an awareness of one’s own possible biases or unfamiliarities. Rather than expecting healthcare professionals to be experts on cultures in the way that anthropologists are, cultural competency and cultural humility urges providers to approach each patient with an open mind without assumptions and be ready to learn and understand treatment from the patient’s perspective.

This matter must be addressed because cultural gaps or discrepancies in medical treatment promptly translates into disparities in medical results and quality of life. For example, more than “twenty-one million Americans are limited in English proficiency (LEP)” and there have been multiple studies conducted showcasing how the quality of care is compromised when LEP patients are not provided with an interpreter [2]. Patients who struggle to communicate efficiently with providers are more likely to experience more medical mistakes or misunderstandings, confuse instructions regarding discharge and continued care at home, and have avoidable future appointments or readmissions. Furthermore, studies and research have shown that Black and Latino patients regularly report lower patient satisfaction than white patients, even when all external factors were the same such as insurance coverage and an ability to pay the copay or deductible [1]. Such gaps in the medical setting can even extend as far as our diet. Culture influences not only what we eat, but how we eat, as well as when we eat. Recent research explored the variations within diet among different cultures. Dietary habits across Mexican, Japanese, Chinese, and Indian cultures highlighted just how different nutrition can be among people. For example, the studies presented that Chinese culture relies heavily on rice and bread, which contains tons of carbohydrates, but they also consume soy sauce frequently, which can result in a high sodium intake [3]. On the other hand, grains are a primary staple in Indian cuisine, especially because most people from India follow a lacto-vegetarian diet. However, this causes them to lack vitamin B12, which is found most often in meats and eggs [3]. In comparison, Mexican cuisine includes rice, beans, corn, and large amounts of protein, which can be high in sodium and fat [3]. Japanese cuisine is similar in that it is rich in protein such as fish and other seafood, but these foods also contain high amounts of the polyunsaturated fatty acid, omega-3 [3]. Dietary patterns and behavior based on culture determine how illnesses such as diabetes and hypertension are managed, and conventional nutritional advice that excludes traditional foods often results in lessened commitment, and as a result, worse outcomes.

On another note, mental health has various meanings and stigma across different cultures, influencing whether and how people seek help. Mental health problems may be perceived as a sign of weakness or a lack of discipline in many Asian cultures, which can lead people to reinforce stigma and refuse treatment even when they are in need of it. In Chinese culture, for example, mental illness is usually linked to stressful situations or conflict within the family, which causes shame or guilt or further deters people from seeking help [6]. Mental illness may also be viewed through a supernatural lens in various contexts, such as Ethiopian culture, where it is associated with curses, evil eye, and bad spirits [6]. This interpretation affects how patients describe their symptoms and how providers approach care and treatment.

To add on, gender expectations, sexual orientation, and attitudes about autonomy, death, and end of life care add on an extra degree. For example, in many societies, women are expected to defer medical and health choices to the men in the family, which might restrict their autonomy If LGBTQ+ patients are afraid of prejudice or discrimination, they may also be reluctant to reveal sexual orientation, as well as other medically necessary information. Similarly, whereas Western practice presumes autonomy for each patient, many Latino and East Asian families favor collaborative decision-making for important medical conditions [8]. When providers ignore these cultural realities, whether intentionally or unintentionally, misconceptions build and reinforce existing disparities in healthcare.

While providers most certainly have a responsibility to practice cultural competency, patients too can help bridge these gaps. Patients advocating for themselves include being confident in asking for further clarification, repeating the information they were counseled on in their own words to ensure comprehension, and discussing any cultural customs, beliefs, or religious commitments that may affect the diagnosis or treatment. Patients can help providers in delivering individualized treatment by offering important information that is medically relevant such as nutrition, family planning, gender preferences, substance use, boundaries regarding treatment options, and more. When patients communicate openly and honestly, providers can better grasp how to move forward.

At the same time, providers are responsible for increasing their cultural understanding. This includes utilizing skilled medical interpreters when required, asking questions that are open-ended, and actively avoiding assumptions. It also entails learning about the cultural populations they serve, acknowledging that health beliefs such as people’s interpretations about symptoms and their decisions regarding treatment, are influenced by a variety of factors and being open about uncertainty rather than filling gaps with stereotypes and misconceptions. Good cultural competence and humility is about building trust, listening without judgment, and allowing for unique experiences.

References:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC7011228/

2. https://pubmed.ncbi.nlm.nih.gov/15894705/

3. PMC7727853

4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7011228/

5. https://hpi.georgetown.edu/cultural/

6. PMC10220277

7. https://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=1905&context=honors

8. https://pubmed.ncbi.nlm.nih.gov/15712625/