5.4 Cultural Sensitivity & Competence
The following video shows the definition of cultural sensitivities and disparities, and the second video demonstrates the patient and healthcare interactions related to this. These videos show one aspect of diversity related to cultural sensitivity and the effect or disparities our patients can encounter and experience through interaction and care.
Video: “Cultural sensitivity” by Aisha Khalaf [2:23] is licensed under the Standard YouTube License. Music only, text on screen. Text Transcript
Cultural Competence
Ability of healthcare professionals to understand, respect, and respond appropriately to the cultural, linguistic, and social needs of patients from different backgrounds.
Cultural competence ensures that healthcare services are tailored to patients’ values, beliefs, and preferences, promoting better communication, patient satisfaction, and health outcomes (Purnell, 2019). Cultural competence plays an important role in enhancing patient outcomes by providing effective communication, promoting patient-centred care and addressing healthcare disparities. By recognizing and accommodating the cultural diversity of patients, healthcare providers can deliver care that respects patients’ values, improves communication, builds trust, and ultimately leads to better health outcomes for all individuals, regardless of their cultural backgrounds. This section reviews some cultural interactions a health care provider may encounter and continues to educate themselves on knowing.
Language barriers
Language barriers may come in many forms in healthcare and can result in:
- Communication breakdown
- Limited history taking
- Reduced quality of care
- Patient discomfort
- Ethical Concerns
(Al Shamsi et al., 2020)
Health care practice should include strategies that would help with language barriers. Using Interpreters, the use of visual aid and/or technology may be helpful. Speak slowly and clearly and use non-verbal gestures when appropriate while always confirming the patient understands. It may be helpful to have the patient’s family or friend involved to help with understanding. In using any of these strategies, consider the role cultural differences play.
Religious and Spiritual Diversity
Religious beliefs and practices may influence a patients’ healthcare decisions. A healthcare professional must respect patients’ spiritual preferences while providing care. Some treatments might be perceived as conflicting with religious teachings or beliefs and may be rejected or accepted based on this. Access to care may focus on prayer or faith-based healing (Padela et al., 2017). Beliefs can influence the timing of medical care or the timing to seek that care—for example, Ramadan (when fasting from sunrise to sunset) or prayer times. Holistic choices and alternative therapies may lead patients to opt for alternative or complementary therapies that align with their faith.
Holistic choices and well-being can include three main areas: physical (body’s needs, sleep, exercise), emotional (this is how someone may be stimulated with wonder or curiosity) and spiritual (worship or rituals). It may be common practice for family involvement and their role in patient decisions.
Demonstrate respect for patients’ spiritual preferences while providing care.
- Inquire about beliefs
- Listen
- Respect
- Non-judgmental
- Accommodate
- Sensitivity to rituals
- Educate yourself
Gender and Sexual Diversity
2SLGBTQI+Canadians tend to have “less access to primary care and more unmet health care needs than the rest of the population” (Organek & Weisdorf, 2023). Challenges faced by this community include a history of discrimination and stigma from healthcare providers, creating a barrier to healthcare access by 2SLGBTQI+ patients. Misgendering and privacy concerns (not disclosing information about the patient’s 2SLGBTQI+ status) are also challenges this community faces. Lack of awareness and training for health care professionals can exasperate this.
Applying inclusive language and practice to create a welcoming environment for all patients, regardless of their gender identity or sexual orientation, through the use of preferred pronouns, avoiding assumptions and providing visible support. Training and education should be readily available to ensure inclusive language and practices are being used.
Examples of inclusive language can be found in the following articles:
How to Use Inclusive Language in Healthcare
Canada’s First Federal 2SLGBTQI+ Action Plan
Recognize the Impact of Race and Ethnicity
When exploring the diversity of race and ethnicity, we first want to understand the historical and social factors and have a fair understanding of historical/social factors that can contribute to health disparities. “Health disparities among racial and ethnic groups are influenced by a complex interplay of historical and social factors that have contributed to systemic inequalities in healthcare access, outcomes, and treatment” (Williams & Mohammed, 2009).
Health Disparities result from multiple factors:
- Historical factors: Slavery, colonization, and forced migration have led to persistent inequalities in resources, education, and opportunities, affecting health outcomes (Gee & Ford, 2011).
- Socioeconomic status: including income, education, and employment opportunities.
- Cultural differences: Cultural norms and practices can influence health behaviours, attitudes toward healthcare, and willingness to seek medical care.
- Healthcare access barriers include limited transportation and geographical location (CDC, 2023).
Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources (CDC, 2023).
Health disparities result from multiple factors, including:
- Poverty
- Environmental threats
- Inadequate access to healthcare
- Individual and behavioural factors
- Educational inequalities (CDC, 2023)
Diversity of Patients: Age-related Considerations
Working in health care means working with all ages, where the health priority/focused needs will differ with age-related considerations. Pediatric Patients’ needs will differ with a focus on overall growth and development and preventative care. Communicating playfully using simple terms may help with the approach while often at times managing parents’ information and relatable communication. Adolescent Patients may still be under parental supervision but looking for more independence. Build a rapport with this demographic. Adult Patients have a goal of leading an overall healthy lifestyle, and it is best to provide clear explanations with follow-up. Geriatric Patient’s needs may increase with age-related health issues including, but not limited to, hearing, mobility, confusion, frustration and side effects from medications. Be patient and adaptable to these limitations.
Support Accessibility and Inclusivity for Patients with Disabilities
Implement strategies to ensure equal services for patients with disabilities.
Disabilities are defined as any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities and interact with the world around them (participation restrictions)
“Patients with disabilities face barriers when they attempt to access health care. These barriers include physical barriers to entering health care establishments, lack of accessible equipment, lack of a safe method for transferring the patient to an examination table, and the lack of policies that facilitate access” (Lagu., et al. 2015).
The inclusion of people with disabilities into everyday activities involves practices and policies designed to identify and remove physical, communication, and attitudinal barriers that hamper individuals’ ability to participate fully in society, the same as people without disabilities. Inclusion involves:
- Getting fair treatment from others (nondiscrimination);
- Making products, communications, and the physical environment more usable by as many people as possible (universal design);
- Modifying items, procedures, or systems to enable a person with a disability to use them to the maximum extent possible (reasonable accommodations); and
- Eliminating the belief that people with disabilities are unhealthy or less capable of doing things (stigma, stereotypes).
Disability inclusion involves input from people with disabilities, generally through disability-focused and independent living organizations, in program or structural design, implementation, monitoring, and evaluation (CDC, 2024).
Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:
- Provide interpreter services
- Recruit and retain minority staff
- Provide training to increase cultural awareness, knowledge, and skills
- Coordinate with traditional healers
- Use community health workers
- Incorporate culture-specific attitudes and values into health promotion tools.
- Include family and community members in healthcare decision-making
- Locate clinics in geographic areas that are easily accessible to specific populations
- Expand hours of operation
- Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials.
(Health Policy Institute, n.d.)
Adapted from “Diversity of Patients” by Walton & Darch in DENT-1005: Patient Care Procedures, © Fanshawe College 2023.
