Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care

Betancourt, Joseph R.; Green, Alexander R.; Carrillo, J. Emilio; Ananeh-Firempong, Owusu

doi:10.1093/phr/118.4.293

Cited by 806 publications

(530 citation statements)

References 60 publications

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“…Massachusetts has the 11th highest proportion of residents who speak languages other than English and mandates that hospitals provide language assistance to all patients free of cost 19, 20. Our institution has 24/7 PMI services that in fiscal year 2014 provided 53 471 face‐to‐face interpretations, 72 801 telephone‐enabled interpretations, and 7678 video‐enabled interpretations free of cost to patients 21, 22. Although GTWG‐Stroke does not routinely collect data on AIS patients’ language needs and how these were met, our hospital asks patients to identify the language in which they prefer to receive their medical care at registration and makes this information available in their medical record.…”

Section: Discussionmentioning

confidence: 99%

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Erfe

Siddiqui

Schwamm

et al. 2017

JAHA

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BackgroundThe inability to communicate effectively in a common language can jeopardize clinicians’ efforts to provide quality patient care. Professional medical interpreters (PMIs) can help provide linguistically appropriate health care, in particular for the >25 million Americans who identify speaking English less than very well. We aimed to evaluate the relationship between use of PMIs and quality of acute ischemic stroke care received by patients who preferred to have their medical care in languages other than English.Methods and ResultsWe analyzed data from 259 non–English‐preferring acute ischemic stroke patients who participated in the American Heart Association Get With The Guidelines–Stroke program at our hospital from January 1, 2003, to April 30, 2014. We used descriptive statistics and logistic regression models to examine associations between involvement of PMIs and patients’ receipt of defect‐free stroke care. A total of 147 of 259 (57%) non–English‐preferring patients received PMI services during their hospital stays. Multivariable analyses adjusting for other socioeconomic factors showed that acute ischemic stroke patients who did not receive PMIs had lower odds of receiving defect‐free stroke care (odds ratio: 0.52; P=0.04).ConclusionsOur findings suggest that PMIs may influence the quality of acute ischemic stroke care.

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Section: Discussionmentioning

confidence: 99%

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Erfe

Siddiqui

Schwamm

et al. 2017

JAHA

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“…Implementing training and supervision systems may help an organization achieve the goal of institutionalizing the skill of cultural awareness (see Betancourt et al 2003, for suggestions on cultural competency training for health care workers). The following three recommendations are based on Brodhead and Higbee's (2012) recommendations for using behavioral systems to teach and maintain ethical behavior in a human service organization.…”

Section: Increasing Cultural Awareness Within a Clinical Organizationmentioning

confidence: 99%

Developing the Cultural Awareness Skills of Behavior Analysts

Fong

Catagnus

Brodhead

et al. 2016

Behav Analysis Practice

164

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All individuals are a part of at least one culture. These cultural contingencies shape behavior, behavior that may or may not be acceptable or familiar to behavior analysts from another culture. To better serve individuals, assessments and interventions should be selected with a consideration of cultural factors, including cultural preferences and norms. The purpose of this paper is to provide suggestions to serve as a starting point for developing behavior analysts' cultural awareness skills. We present strategies for understanding behavior analysts' personal cultural values and contingencies and those of their clients, integrating cultural awareness practices into service delivery, supervision, and professional development, and becoming culturally aware in everyday practice.

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“…Organizations should seek to hire and retain a diverse workforce and should ensure that all staff, regardless of demographics, are trained and given the resources to provide culturally sensitive services. 42 Both racial and ethnic minority patients [42][43][44]92,93 and…”

Section: Staff Diversity and Concordancementioning

confidence: 99%

“…106 Tailored educational materials support patient satisfaction, understanding, and adherence to treatment. 42,43 For most minority patients, cultural tailoring goes beyond language 107 and literacy; 108 for example, LGBT-specific educational materials can help LGBT patients discuss their options and preferences with clinicians. 33,39 Materials should acknowledge the intersection of minority identities by depicting and incorporating multiple facets of diversity (e.g., sexual orientation, race, ethnicity, age, gender).…”

Section: Decision Aids and Educational Materialsmentioning

confidence: 99%

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care

Cited by 806 publications

References 60 publications

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Developing the Cultural Awareness Skills of Behavior Analysts

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

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