Cultural Competency Discussion

Explain the importance of Cultural Competency and provide 2 examples in healthcare setting by your own words

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Reducing health disparities and achieving equitable health care remains an important goal for the U.S. healthcare system. Cultural competence is widely seen as a foundational pillar for reducing disparities through culturally sensitive and unbiased quality care. Culturally competent care is defined as care that respects diversity in the patient population and cultural factors that can affect health and health care, such as language, communication styles, beliefs, attitudes, and behaviors.1 The Office of Minority Health, Department of Health and Human Services, established national standards for culturally and linguistically appropriate services in health and health care (National CLAS Standards) to provide a blueprint to implement such appropriate services to improve health care in the U.S.2 The standards cover areas such as governance, leadership, workforce; communication and language assistance; organizational engagement, continuous improvement, and accountability.

A lack of conceptual clarity around cultural competence persists in the field and the research community. There is confusion about what cultural competence means, and different ways in which it is conceptualized and operationalized. This confusion leads to disagreement regarding the topic areas and practices in which a provider should train to attain cultural competence.3 The populations to which the term cultural competence applies are also ill-defined. Cultural competence is often seen as encompassing only racial and ethnic differences, omitting other marginalized population groups who are ethnically and racially similar to a provider but who are at risk for stigmatization or discrimination, are different in other identities, or have differences in healthcare needs that result in health disparities. This broader concept may be termed diversity competence. In keeping with this broader view and AHRQ’s commitment to a comprehensive approach to priority populations, this systematic literature review considers, alongside race and ethnicity, two of these less considered populations: persons with disabilities and persons identifying as lesbian, gay, bisexual, transgender, queer/questioning, and/or intersex (LGBTQI).

The most popular and most well studied type of cultural competence intervention is cultural competency training for healthcare providers. Two general approaches have been used in creating educational interventions to address cultural competence: programs aimed at improving knowledge that is group-specific, and programs that apply generic or universal models. Concerns have been raised about cultural competency programs that use a group-specific approach to teach providers about the attitudes, values, and beliefs of a specific cultural group leading to stereotyping and oversimplifying the diversity within a particular priority group.4 The universal approach to training proposes that cultural competence can be taught through reflective awareness, empathy, active listening techniques, and the cognitive mechanisms contributing to cultural insensitivity or blindness, such as implicit biases or stereotype threats. Therefore, of interest is identifying the effect of varying types of cultural competence training on patient-level outcomes.

In addition to education and training, changing clinical environments can also be key to purposeful change in behavior. The National CLAS includes several standards that address the organizational level rather than the patient/provider relationship.1 Changes in provider knowledge, attitudes, and skills is a necessary step, but for those gains to translate into culturally competent behaviors there also needs to be changes in the structures and culture of health care systems and organizations. This review is intended to focus on the effectiveness of interventions and the provider and system level, but not at the level of policy which, while important, is beyond the scope of this review.

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What outcomes are considered high priority and final patient-centered outcomes differ by priority population. For example, while access is important to all priority populations, people from the disability culture may face multiple levels or forms of access barriers, such as transportation to facilities and whether the exam room and its contents is physically accessible. Similarly, linguistic competence means something different to a provider treating a person for whom English is a second language than to a provider treating a transgendered person.

Comparative effectiveness reviews evaluate the evidence for both benefits and harms, or adverse effects, of interventions in order to provide decisionmakers with the balance of net benefits. In the case of cultural competence interventions, harms may include unintended consequences of an intervention. For example, while cultural competence interventions often aim to improve cultural sensitivity by reducing stereotyping and stigma, there remains the possibility that some interventions may inadvertently induce different stereotyping behaviors by inducing a provider to create new scripts, or ways of categorizing people, that result in negative consequences.

The review was requested by Senior Advisors in AHRQ’s Division of Priority Populations. The request originally derived from general concerns regarding pervasive disparities in care for adults and children that may be associated with gender, disability and race/ethnicity. In addition, the consideration of cultural competence is usually focused on racial or ethnic minority adults, thus creating a gap in evidence-based information in racial or ethnic minority children, persons with disabilities, and LGBTQI people. This systematic literature review will consider the effect of cultural and diversity competence interventions on three populations with varying degrees of cultural identification and visibility: LGBTQI adolescents and adults, children and adults aging with disabilities, and racial/ethnic minority children and adults.

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