Cultural Competence in Health Care and Its Implications for Pharmacy

Abstract

Pharmacists are caring for more individuals of diverse age, gender, race, ethnicity, socioeconomic status, religion, sexual orientation, and health beliefs than in previous decades. Not all residents of the United States equally experience long life spans and good health. Health disparities in various cultures have been documented. One critical aspect of reducing health disparities is moving health care providers, staff, administrators, and practices toward increased cultural competence and proficiency. Effective delivery of culturally and linguistically appropriate service in cross-cultural settings is identified as cultural competence. Culture is a dynamic process, with people moving in and out of various cultures throughout their lives. The failure to understand and respect individuals and their cultures could impede pharmaceutical care. Incongruent beliefs and expectations between the patient and pharmacist could lead to misunderstandings, confusion, and ultimately to drug misadventures. Models and frameworks have been developed that provide descriptions of the process by which individuals, practice settings, and organizations can become culturally competent and proficient. This article, the first in a five-part series, presents an overview of issues related to cultural competence in health care with an emphasis on the pharmacy profession. Also provided are definitions for cultural competence and related terms, a brief overview of health disparities and challenges to the common morality, and a discussion of models and frameworks that describe pathways to cultural competence and proficiency.

Addressing Competencies for the Future in the Professional Curriculum

“…[38][39][40][41] Various pharmacy organizations have recognized the need for pharmacists to be culturally competent, realizing pharmacists must draw on information that is not just scientific when dealing with patients, caregivers, and other healthcare providers from diverse cultural backgrounds. Although the literature has revealed several risks of allowing pharmacists without cultural competency to provide pharmaceutical care, the ultimate concern is poor patient outcomes.…”

A Cross Sectional and Longitudinal Study of Pharmacy Student Perceptions of Readiness to Serve Diverse Populations

“…1,2 The Accreditation Council for Pharmacy Education (ACPE) Standards 2016 mandate that pharmacy curricula prepare students for provision of care to culturally diverse populations. 3 Service to diverse patient groups includes recognition of social determinants of health and social group affiliations.…”

“…4 Patient-centered, culturally-competent care to diverse groups encompasses tailored delivery of health care services (as needed) in consideration of patients' race and ethnicity, gender, sociocultural barriers, sexual orientation, nationality, geography, religion, age, language, ableism/disability, and health beliefs. 2,[5][6][7][8][9][10] Conceptual frameworks identify self-assessment as the first step in any cultural competence process because of the importance of understanding one's own culture and the profession's culture. 2,6,[11][12][13] Wells' Cultural Development Model describes phases of individual progress along the cognitive (knowledge and awareness) and affective (skills and behavior) continuum of culturally-appropriate care.…”

Addressing Cultural Competency in Pharmacy Education through International Service Learning and Community Engagement

“…The literature on health disparities suggests that culture is a predictable contributing factor irrespective of an individual's access to the healthcare system, yet despite a steady improvement in health over the past several decades, there is increasing recognition that health inequities continue to be a problem among vulnerable and marginalized groups, such as the physically and mentally disabled, people living in poverty, aboriginal people, those living in rural and remote populations and immigrants [1][2][3]. The movement towards cultural competence has gained international attention, creating an impetus for post-secondary health professional programs to introduce curricula that cultivate such competence [1,2,4].…”

“…Nursing and medicine have been leaders in developing situated placements, including international service learning to promote cultural awareness in their curricula [7][8][9][10][11][12][13][14][15]. The need for cultural competency training has also been articulated in the pharmacy education literature, with the acknowledgement that practicing pharmaceutical care without cultural competency can put patients at risk of poor patient outcomes [3,4,[16][17][18]. With this acknowledgement, pharmacy organizations in North America have introduced policies or statements addressing the need for cultural competence training within their curricula [18][19][20][21].…”