Diversity awareness, diversity competency and access to healthcare for minority groups: perspectives of healthcare professionals in Croatia, Germany, Poland, and Slovenia

Abstract

IntroductionDue to cultural, language, or legal barriers, members of social minority groups face challenges in access to healthcare. Equality of healthcare provision can be achieved through raised diversity awareness and diversity competency of healthcare professionals. The aim of this research was to explore the experiences and attitudes of healthcare professionals toward the issue of social diversity and equal access to healthcare in Croatia, Germany, Poland, and Slovenia.MethodsThe data reported come from semi-structured interviews with n = 39 healthcare professionals. The interviews were analyzed using the methods of content analysis and thematic analysis.ResultsRespondents in all four countries acknowledged that socioeconomic factors and membership in a minority group have an impact on access to healthcare services, but its scope varies depending on the country. Underfunding of healthcare, language barriers, inadequate cultural training or lack of interpersonal competencies, and lack of institutional support were presented as major challenges in the provision of diversity-responsive healthcare. The majority of interviewees did not perceive direct systemic exclusion of minority groups; however, they reported cases of individual discrimination through the presence of homophobia or racism.DiscussionTo improve the situation, systemic interventions are needed that encompass all levels of healthcare systems – from policies to addressing existing challenges at the healthcare facility level to improving the attitudes and skills of individual healthcare providers.

Diversity in Dialogue

“…In healthcare environments, culture (and related concepts like ethnicity, race, and religion), sexuality, and gender identity are important dimensions of diversity as they coincide with multiple social and structural inequalities and inequities (Bailey et al, 2017;Howard et al, 2019;Kattari et al, 2019;Zegers & Auron, 2022). These healthcare disparities exist in the accessibility and quality of care, and in diminished care outcomes for different minoritized 2 patient populations (Buspavanich et al, 2021;Harnacke et al, 2023;Howard et al, 2019;Kattari et al, 2019;Keuroghlian et al, 2017;Lebano et al, 2020;Ramšak et al, 2023;Zeeman et al, 2019;Zegers & Auron, 2022). This means that the opportunities for receiving good care are unevenly distributed in the Netherlands and abroad.…”

“…National data also shows that from the 11% of the Dutch population who have felt discriminated against in 2021, women experienced discrimination more frequently than men and LGB people more often than heterosexual people (Akkermans et al, 2022; cultural background continue to exist in care provision, which can lead to worse healthcare outcomes and experiences (Bailey et al, 2017;Harnacke et al, 2023;Howard et al, 2019;Kattari et al, 2019;Suleman, 2023;Zeeman et al, 2019;Zegers & Auron, 2022). Additionally, blind-spots, power dynamics, and a lack of cultural competences, awareness, or humility may prevent (majoritized) healthcare professionals from providing inclusive and equitable care (Castillo & Guo, 2011;Chang et al, 2010;Ramšak et al, 2023;Zegers & Auron, 2022).…”

“…Drawing on previous research, I approach diversity-responsiveness as: being aware of and sensitive toward different, intersecting aspects of identity like culture, sexuality, or religion, and how they may affect the way care is delivered, received, and promoted in policy, (organizational) practice, research, and care services ; see also Torensma et al, 2019). Diversity-responsiveness is associated with concepts such as cultural competence (i.e., awareness, attitude, knowledge, and skills to deliberate on and respond to sociocultural differences in healthcare) and cultural humility (Anderson et al, 2003;Betancourt et al, 2003;Castillo & Guo, 2011;Chang et al, 2010;Ramšak et al, 2023;Zegers & Auron, 2022). In this thesis, diversityresponsiveness is used as an inclusive term that goes beyond culture.…”

“…The goal of diversity-responsiveness in healthcare is to promote good and just care for all, by diminishing care disparities between majoritized and minoritized patient populations and facilitating health equity on the systemic, organizational, and care provision level Ramšak et al, 2023;Torensma et al, 2019). This includes practices, policies, and equity standards that facilitate inclusion, participation, equal access, opportunities, and resources for all people that might otherwise be marginalized or excluded, also among the healthcare workforce (see also Anderson et al, 2003;Denier & Gastmans, 2013;.…”

“…Much has been written on health and care inequalities and the need to facilitate diversityresponsiveness and cultural competence among healthcare professionals in order to contribute to inclusive care and just organizational practices and work environments (see also Berger & Miller, 2021;Castillo & Guo, 2011;Ramšak et al, 2023;. Further, recent years have witnessed more and more Dutch policies and care standards to this end (Boers & Meijsen, 2016;Bulut & Fikkers, 2022;Hofhuis & Van t' Hoog, 2010;van Loenen et al, 2022;Meijsen, 2016;Huijnk, 2022;Huijnk et al, 2022;Vilans, 2020).…”