The Appeal and Problems of a Cultural Competence Approach to Reducing Racial Disparities

Malat, Jennifer

doi:10.1007/s11606-013-2363-y

Cited by 11 publications

(10 citation statements)

References 6 publications

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“…Conversely, treating a client as though they identify strongly with a particular culture when they do not may produce the effect opposite to what practitioners seek, which is to better empathize with the person seeking service. We acknowledge and recognize the critical stance that cultural competence programs may actually serve to reinforce stereotypes (10). Malat advocated for practitioners to fully comprehend the individual experience to ultimately reduce racial disparity in practice (10).…”

Section: Affirmative Care With Individualsmentioning

confidence: 99%

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Affirmative Care Across Cultures: Broadening Application

Mendoza

Moreno

Hishaw

et al. 2020

FOC

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Affirmative practice is an approach to health and behavioral health care that validates and supports the identities stated or expressed by those served. Affirmative care requires the practitioner to actively honor and celebrate identity while at the same time validating the oppression felt by individuals seeking services. Validation and empathy fundamentally result from increased understanding of individuals' history, cultural context, and lived experiences. Origins of the approach honored the experience of those in LGBTQ+ communities; however, affirmative care should be valued across cultures, systems, and settings in which health and behavioral health care are offered. Affirmative care principles should be applied across cultures and communities while recognizing the worth of the individual and avoiding stereotyping. Along with delineating historical and demographic contexts, the authors offer recommendations for affirmative care in practice with African American, Asian, Indigenous, and Latinx individuals, as well as those living in rural communities.

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Section: Affirmative Care With Individualsmentioning

confidence: 99%

“…We acknowledge and recognize the critical stance that cultural competence programs may actually serve to reinforce stereotypes (10). Malat advocated for practitioners to fully comprehend the individual experience to ultimately reduce racial disparity in practice (10).…”

Section: Affirmative Care With Individualsmentioning

confidence: 99%

Affirmative Care Across Cultures: Broadening Application

Mendoza

Moreno

Hishaw

et al. 2020

FOC

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“…Interventions might focus on directly offering providers concrete ways that they and their organization can help reduce health care disparities and improve patient care (such as improving patient–provider communication), rather than focusing squarely on the issues of racial bias. In contrast, it could be argued that interventions that bypass systemic racism inherent in health care and the larger society 39,40 reinforce an individualistic ideology, dominant in the United States, in which individuals (e.g., patients) are responsible for fixing their own problems. 41 In the short run, however, it may be more effective for health care organizations to understand what values and motivations held by providers, such as their feelings of responsibility for addressing disparities, will be most fruitful to target, if real change is to occur.…”

Section: Discussionmentioning

confidence: 99%

Veterans Affairs Providers' Beliefs About the Contributors to and Responsibility for Reducing Racial and Ethnic Health Care Disparities

Eliacin

Cunningham²,

Partin

et al. 2019

Health Equity

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Purpose: Providers' beliefs about the causes of disparities and the entities responsible for addressing these disparities are important in designing disparity-reduction interventions aimed at providers. This secondary analysis of a larger study is aimed at evaluating perceptions of providers regarding the underlying causes of racial health care disparities and their views of who is responsible for reducing them. Methods: We surveyed 232 providers at 3 Veterans Affairs (VA) Medical Centers. Results: Sixty-nine percent of participants believed that minority patients in the United States receive lower quality health care. Most participants (64%) attributed differences in quality of care for minority patients in the VA health care system primarily to patients' socioeconomic status, followed by patient behavior (43%) and provider behaviors (33%). In contrast, most participants believed that the VA and other health care organizations (75%) and providers (70%) bear the responsibility for reducing disparities, while less than half (45%) believed that patients were responsible. Among provider-level contributors to disparities, providers' poor communication was the most widely endorsed (48%), while differences in prescribing of medications (13%) and in provision of specialty referrals (12%) were the least endorsed. Conclusions: Although most providers in the study did not believe that providers contribute to disparities, they do believe that they, along with health care organizations, have the responsibility to help reduce them. Interventions might focus on directly offering providers concrete ways that they can help reduce disparities, rather than focusing on simply raising awareness about disparities and their contributions to them.

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“…However, a critique of the Provider Success frame, which has been levied against the cultural competency paradigm, is that it focuses on the behaviors of the patient of color, rather than on systemic biases inherent in healthcare and the larger society [35,36], and thereby could reinforce an individualistic ideology, dominant in the United States, in which individuals (e.g., patients) are responsible for fixing their own problems [37]. By contrast, the Provider Bias frame is consistent with newer recommendations for cultural competency programs and interventions to address disparities among providers.…”

Section: Practice Implicationsmentioning

confidence: 99%