Fact Sheet - Cultural Competence
Cultural competence in health care refers to the ability of a health care system to provide equal care to patients with diverse values, beliefs and behaviors. This may include the creation of service delivery models that meet patients? social, cultural, and linguistic needs.

When health care providers fail to understand socio cultural differences between themselves and their patients, the communication and trust between them may suffer. This in turn may lead to patient frustration and dissatisfaction, poor adherence to medications and health promotion strategies, and poorer health outcomes.? When providers fail to take socio cultural factors into account, they may inadvertently engage in stereotyping, which can affect the accuracy in clinical decision-making

The notion of cultural competence in the health care system is vital to increase access to quality care for diverse patient populations and to eliminate access barriers created by linguistic, cultural and social differences.


What Are the Barriers to Culturally Competent Health Care?

Barriers among patients, providers, and health care systems in general that might affect quality and contribute to racial/ethnic disparities in care include:

  • Poor communication between health care providers and patients of different racial, ethnic, or cultural backgrounds.
  • Lack of diversity in health care?s service providers and policy makers.
  • Health care systems poorly designed to meet the needs of culturally diverse patient populations.
  • Framework for culturally competent care

In order to address issues of cultural competency there need to be mechanisms in place at all levels of the health care system. The following is a list of recommendations to improve accessibility.

Systemic cultural competence

  • Key health medical information should reflect the appropriate level of health literacy, language proficiency, and cultural norms for the populations being served. These include signage, specific programs for health promotion and disease prevention, health education materials, pre- and post-procedure instructions, and informed-consent forms among other materials.

  • Researchers should identify tools to detect medical errors that result from lack of systemic cultural competence, including those stemming from language barriers (e.g., taking a prescribed medication incorrectly); misunderstanding health education materials, instructions, or signage (e.g., inappropriately preparing for a diagnostic or therapeutic procedure, resulting in postponement or delay); and misunderstanding the benefits and risks of procedures requiring informed consent.

  • Health care regulations should incorporate standards for measuring systemic cultural competence.

Organizational Cultural Competence

Organizational cultural competence refers to the need to achieve cultural competence?within the health care leadership and workforce by maximizing diverse representation. These may be accomplished through:?

  • Establishing programs for visible minority health care leadership development and strengthening already existing programs. The desired result is a core of professionals who may assume influential positions in academia, government, and private industry.

  • Organizations should make it a priority to hire and promote minorities in the health care workforce.

  • Community representatives should be formally or informally involved in the health care organization?s planning and evaluation of health care services.? Community participation is essential to address such initiatives as conducting community assessments, developing mechanisms for community and patient feedback, implementing systems for patient racial/ethnic and language preference data collection, developing quality measures for diverse patient populations, and ensuring culturally and linguistically appropriate health education materials and health promotion and disease prevention interventions.

  • Making on-site cultural interpreter services available in health care settings where significant populations of second language speakers exist.

Clinical Cultural Competence

?In order to attain clinical cultural competence health care providers must:

(1)?? be made aware of the impact of social and cultural factors on health beliefs and behaviors;

(2)?? be equipped with the tools and skills to manage these factors appropriately through training and education; and

(3)?? empower their patients to be more of an active partner in the medical encounter. Organizations can do this through:

????????? cross-cultural training as a required, integrated component of the training and professional development of health care providers;

????????? quality improvement efforts that include culturally and linguistically appropriate patient survey methods and the development of process and outcome measures that reflect the needs of multicultural and minority populations; and

????????? programs to educate patients on how to navigate the health care system and become an active participant in their care.


(4)?? The curricula should increase awareness of racial and ethnic disparities in health and the importance of socio-cultural factors on health beliefs and behaviors;

(5)?? The impact of race, ethnicity, culture, and class on clinical decision making should be studied in order to develop tools to assess the community members? health beliefs and behaviors and develop human resource skills for cross-cultural assessment, communication, and negotiation.

(6)?? Quality improvement efforts should include culturally and linguistically appropriate patient survey methods as well as process and outcome measures that reflect the needs of multicultural and minority populations.

???? (7) Programs should be developed to help patients navigate the health care?system and become a more active partner in the clinical encounter


*? Adapted from:? CULTURAL COMPETENCE IN HEALTH CARE: EMERGING FRAMEWORKS AND PRACTICAL APPROACHES, Joseph R. Betancourt, Massachusetts General Hospital?Harvard Medical School, Alexander R. Green and J. Emilio Carrillo, New York-Presbyterian Hospital?Weill Medical College of Cornell University, FIELD REPORT, October 2002

WEBSITE: http://www.cmwf.org/


Selected resources:

Language Barriers in Access to Health Care

Health Canada?s Health Care Network has developed a report that identifies the challenges that language barriers pose to accessibility of health care system.

Queensland Health Department

The Queensland Health Department (Australia) provides a number of guidelines and information for medical professionals to keep in mind when dealing with people from different cultural backgrounds. It also provides educational material translated into different languages.

The National Centre for Cultural Competence

The National Centre for Cultural Competence based in the Georgetown University has developed a database of publications related to cultural competence.??

University Health Network

University Health Network provides information and resources for Toronto based services for both professionals and the community in general.

University Health Network

R. Fraser Elliott
190 Elizabeth St.
Toronto, ON
M5G 2C4

Information Line (416) 340-3388

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