Health Disparities and Culturally Competent Care

KEY POINTS

DETERMINANTS OF HEALTH
Determinants of health are those factors that influence the health of individuals
and help to explain the difference in health among persons. They can either improve a
persons
They can either improve a persons health status or put an individual at risk for
disease, injury, and mental illness.
Determinants of health include education, health behaviors, social and physical
environment, socioeconomic status, genetics, and access to health care.
Health status describes the health of a person or community. Community health
status measures include birth and death rates, life expectancy, and morbidity and
mortality rates.

HEALTH DISPARITIES AND HEALTH EQUITY

Health disparities are differences in the incidence, prevalence, mortality, and
burden of diseases that exist among specific population groups in the United States. The
population groups include those based on gender, age, ethnicity, socioeconomic status,
place, sexual orientation, disability, or special health care needs.
The terms ethnicity and race are subjective and based on self-report.
Disparities also exist in the amount and quality of health care received by some
groups.
Disparities in care are related to stereotyping, prejudice, discrimination, and bias
that affect nursing and patient behaviors and decrease patient safety and well-being.
Health equity is attained when all people have access to health care and the
opportunity to reach their full health potential.
Use of standardized evidence-based guidelines may contribute to reducing health
disparities and improving health equity.
Sexuality is defined as a persons romantic, emotional, or sexual attraction to
another person.
Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health
disparities.
Barriers to high-quality health include the current lack of providers who are
knowledgeable about LGBT health needs and fear of discrimination in health care
settings.
Interpersonal skills such as active listening, relationship building, and effective
communication are basic to the delivery of high-quality and equitable health care.

CULTURE
 Culture encompasses the knowledge, values, beliefs, art, morals, law, customs,
and habits of the members of a society, including the systems of technology, education,
social structures, and political practices. Culture is a way of life for a group of people.
Values are the sets of rules by which individuals, families, groups, and
communities live. They are the principles and standards that serve as the basis for beliefs,
attitudes, and behaviors.
Each person is culturally unique, resulting from different perspectives and
interpretations of situations. These differences may be based on age, gender, marital
status, family structure, income, education level, religious views, and life experiences.
Cultural practices change over time through processes such as acculturation,
assimilation, and biculturalism. The practices of ethnocentrism, stereotyping, and cultural
imposition can negatively affect patient care.
Ethnocentrism refers to the belief that ones own culture and worldview are
superior to those of others from different cultural, ethnic, or racial backgrounds
Acculturation is the lifelong process of incorporating cultural aspects of the
contexts in which a person grows, lives, works, and ages.
Stereotyping refers to an overgeneralized viewpoint that members of a specific
culture, race, or ethnic group are alike and share the same values and beliefs.

CULTURAL COMPETENCE
Cultural competence is a multiple-step process that involves the integration of
knowledge, attitudes, and skills to enhance a working relationship with an individual who
is from a different culture.
Cultural competence is the ability to understand and work effectively with
patients, colleagues, and others whose beliefs, values, and histories differ from yours.

CULTURAL DIVERSITY IN THE HEALTH CARE WORKPLACE

A diversity gap exists between the ethnic composition of the health care
workforce and the overall population in the United States.
When HCPs from different cultures work together as members of the health care
workforce, opportunities for miscommunication and conflict naturally occur. The cultural
origins of miscommunication and conflict in the workplace are often interconnected with
cultural beliefs and values.

CULTURAL FACTORS AFFECTING HEALTH AND HEALTH CARE

The demographics and cultural composition of the United States are diverse.
Therefore it is important for you to be aware of cultural differences of patients in health
care settings.
Certain culture-related factors that must be considered in health care settings
include the use of folk healers, spirituality, religious beliefs, communication styles,
familial roles, personal space, touch, nutrition, disease susceptibility, immigration status,
language barriers, medication interactions, and psychologic factors.
Many cultures have folk healers, who are also known as traditional healers.
Culturally assess verbal and nonverbal communication.
 Recent immigrants may be at risk for physical and mental health problems. This
may be related to their country of origin or exposure to various factors such as
discrimination and bias in their new location.
Culture-bound syndromes are illnesses or afflictions that are recognized only
within a cultural group.

NURSING MANAGEMENT: REDUCING HEALTH DISPARITIES AND INCREASING

CULTURAL COMPETENCY
Transcultural nursing is a specialty that focuses on the comparative study and
analysis of cultures and subcultures.
The first step in providing culturally competent care is for you to assess your own
cultural background, values, and beliefs related to health and health care.
A cultural assessment should be done to determine the patients health beliefs and
health care practices and to determine the patients perspective of the meaning, cause, and
preferred treatment of illness.
Using standardized evidence-based care guidelines may reduce the number of
disparities in diagnosis and treatments.
Improving interpersonal skills is an important first step in providing culturally
competent care. A medical interpreter should be used when you do not speak the patients
primary language.