Module 11: Cross-Cultural Understanding

"Cultural competence… is an acknowledgment and incorporation of the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs on the part of clinicians and health-care systems. Some clinicians state that they interact with all patients in the same manner. Indeed, being culturally competent implies that clinicians not treat patients the same, given the cultural dynamics each brings to the encounter.”(1) The way a person understands and explains sickness is embedded in and influenced by their beliefs, social values, philosophies and culture. If a healthcare provider does not know how a person perceives their problem, it will be much harder for them to understand their response to it and tailor their care accordingly.(2) Cross-cultural understanding and cultural competence in healthcare is essential to overcoming cultural barriers between patients and healthcare providers in order to ensure effective healthcare delivery and medical adherence.

Cultural competence in doctor-patient interactions can increase positive health-seeking behaviors and comfort with doctors’ visits. Patients are more willing to seek care from providers whom they feel accept and understand their cultural beliefs surrounding illness, and doctors who respond judgmentally or negatively toward folk cures may be avoided. For example, cupping, the process of applying suction cups to the body in order to increase the flow of chi, may leave bruises or circular marks; if patients fear that these marks may be misinterpreted as child abuse, they will be much less likely to seek medical care for an illness.(3) In contrast, a doctor who is familiar with the patient’s understanding of their illness and the associated folk treatment will be better able to explain a biomedical treatment without alienating the patient. Even cultural values that may seem unrelated to health can have an impact on a patient’s comfort. For example, some cultures place a large value on family, and thus decisions about medical care and treatment directives are made by the oldest member of the family.(4) Patients may feel uncomfortable making medical decisions without first discussing the consequences and costs with their family. If a doctor encourages them to make decisions without consulting the family, it may deter the patient from returning to the doctor. By creating a sense of safety and belonging, a medical provider can greatly influence a refugee’s willingness to seek health care.

A culturally competent provider is also better able to tailor medical advice to the needs of the patient. For example, if a doctor is attempting to give nutritional advice to a Southeast Asian refugee, they must understand the kinds of foods that Southeast Asians typically consume; otherwise, the patient may have difficulty applying the nutritional instructions to their own diet.(5)

Overall, cultural competence increases patient satisfaction, responsibility, and empowerment. Because of increased respect toward the medical provider, cultural competence paves the way for free-flowing and honest communication. When doctors lack cultural understanding, patients feel patronized and dissatisfied. In contrast, when patients feel heard and understood, they report higher levels of satisfaction and are more likely to take charge of their own health by participating in preventative health care and attending regular doctors’ appointments.(6)(7)

Ensuring Cross-Cultural Understanding in the Medical Field

Learning all aspects of every culture that could influence a medical interaction would not only be impractical but also fails to take into consideration the heterogeneity that exists within cultural groups. It is impossible to completely understand or know a culture. Therefore, in order to demonstrate cross-cultural understanding, a physician should recognize the individual biases in a particular situation and be aware of the different social and cultural factors that influence a patient’s understanding of health and illness. It is often helpful for physicians to explore the meaning of an illness with their patients by asking them questions such as, “what do you think has caused your problem?”, “what kind of treatment do you think would work?”, and “how can I be most helpful to you?”(8) In addition, it is also useful for physicians to ask if the patient has seen anyone else about a given problem or used any nonmedical remedies or treatment. Similarly, many cultures associate stigmas and pride with certain health afflictions, so doctors need to exercise caution and respect when discussing culturally controversial diseases, especially concerning HIV/AIDS and other STIs.

Cross-Cultural Understanding and Refugees

The principles of culturally competent health services are especially important and applicable to the delivery of healthcare to refugee populations. Refugees not only come from different cultures and countries, but they also have faced many stressors and traumas, spent prolonged periods of time in refugee camps, and have unique social situations. Learn more about Cultural Competency in the Cultural Competency Certificate Program.

Footnotes

(1) Kodjo, C. “Cultural competence in clinician communication.” Pediatrics in Review. 30.2 (2009):57-63.

(2) Nyagua, J., Harris, A. “West African refugee health in rural Australia: complex cultural factors that influence mental health.” Rural and Remote Health. 8 (2008):884.

(3) Uba, L. “Cultural barriers to health care for southeast Asian refugees.” Public Health Reports. 107.5 (1992): 544-548.

(4) Hoang, G., Erickson, R. “Cultural barriers to effective medical care among Indochinese patients.” Annual Review of Medicine. 36 (1985): 229-239.

(5) Uba, L. “Cultural barriers to health care for southeast Asian refugees.” Public Health Reports. 107.5 (1992): 544-548.

(6) “Increasing diversity in the U.S.: The importance of cultural competence in healthcare.” MedCom Trainex. https://www.medcomrn.com/index.php/articles/healthcare-cultural-competence/.

(7) Paez, K., Allen, J., Beach, M., Carson, K., Cooper, L. “Physician cultural competence and patient ratings of the patient-physician relationship.” Journal of General Internal Medicine. 24.4 (2009): 495-498.

(8) Carrillo, J., Green, A., Betancourt, J. “Cross-Cultural Primary Care: A Patient-Based Approach.” Annals of Internal Medicine. 130 (1999): 829-834.