Addressing Cultural Determinants of Health for Latino and Hmong Patients with Limited English Proficiency: Practical Strategies to Reduce Health Disparities

Abstract

We explored how addressing culture may improve patient-provider relationships and reduce health disparities for racial and ethnic individuals with limited English proficiency (LEP). We analyzed qualitative data collected to explore health disparities in preventive cancer screenings for Hmong and Spanish-speaking LEP patients in a large Midwest healthcare system. We interviewed 20 participants (10 from each group) and the audiotaped interviews were transcribed verbatim, then back translated focusing on meaning. Data was analyzed using content analysis. Two themes are: conversation is relational and quality time is valued. Good communication skills involve the amount of conversation, clear explanations, and engaging with the patient. Quality of time meant physical time spent with patient and the task-oriented nature of the encounter. Cultural literacy in healthcare practice helps to understand the whole patient rather than focusing on the symptoms of illness. Patients should not be treated in isolation of their culture. A patient-centered approach to care means physicians should not remain culturally neutral but be more culturally sensitive. We propose steps to reduce disparities by increasing the awareness of cultural literacy for physicians to improve patient-provider relationship.

Las Dos Cosas Versus Exclusive Breastfeeding: A Culturally and Linguistically Exploratory Intervention Study in Hispanic Mothers Living in Kentucky

“…We believe the personalized education and home visiting is highly recommended for this population that most of the time report lack of time or transportation issues to visit the clinic or another place (Kaiser Family Foundation, 2018). Additionally, building of trust between the IBCLC and PC with the participant was encouraged with the individualized culturally/linguistically tailored support and home visiting (Park, Schwei, Xiong, & Jacobs, 2018). The Department of Human and Health Services has reported the effectivity of implementing home visiting in minority groups (Sama-Miller et al, 2017).…”

“…An important implication for practice is that the cultural/linguistically appropriate intervention, which included home visits by the PC and IBCLC to support the Hispanic mothers were able to produce the behavioral change needed. It is evidence that when mothers are from a cultural background different from the health provider, additional challenges are described including language, different cultural beliefs, mistrust, and limited illiteracy (Lutenbacher et al, 2018;Park et al, 2018;Sobel & Metzler Sawin, 2016). Therefore, cultural sensitivity is encouraged in health providers to be responsive to the health beliefs, practices, cultural and linguistic needs of diverse patients with the goal to help bring positive health outcomes (Park et al, 2018).…”

The Identification of Novel CYP2D6 Variants in US Hmong: Results From Genome Sequencing and Clinical Genotyping

“…For example, only until recently, investigators ( Hernandez et al, 2014 ; De et al, 2018 ) have acknowledged the critical importance to incorporate ethno-specific variants in pharmacogene unique to individuals of African descent that must be included when considering genetic-guided dosing of warfarin ( Johnson et al, 2017 ). Hmong individuals residing in Minnesota represent another example where this under-served and under-resourced population whose life circumstances have led to limited engagement in research, especially research evaluating the safety and efficacy of medications ( Park et al, 2018 ).…”

Patient–Provider Relationships Among Vulnerable Patients: The Association With Health Literacy, Continuity of Care, and Self-Rated Health

“…A previous study shows that the patient–provider relationship has a statistically significant effect on health-care outcomes ( 27 ). It is helpful to reduce health disparities for patients with limited English proficiency if physicians are culturally sensitive ( 28 ). Improving patient–provider relationships can be potentially related to better health outcomes for vulnerable patients.…”