Cultural competency can help improve health equity

When we think of a visit to the doctor or a mental health specialist, a common experience emerges. In the case of the doctor, questions are asked, knees are tapped, hearts are listened to, and height and weight measured. With a mental health clinician, questions are asked, questions are answered and a meaningful conversation ensues.

However, what may seem like a common experience, in fact, may not be one. The clinical activities may be the same, but based upon one’s ethnicity or cultural background and the provider’s manner of delivering those clinical activities, the understanding and response to them may not be. Culture can refer to “group membership, such as racial, ethnic, linguistic or geographical groups, or as a collection of beliefs, values, customs, ways of thinking, communicating and behaving specific to a group,” according to the Centers for Disease Control and Prevention.

As Beacon Health Options recognizes July as Minority Mental Health Awareness Month, we want to highlight culture’s importance to healthcare. It informs concepts of health and healing; how illness and its causes are perceived; behaviors of individuals seeking care; and attitudes towards providers. If those perceptions are not understood by providers, then a healthcare visit — physical or mental — is not as effective as it should be. Cultural competence, therefore, is the ability to interact effectively with people from different cultures.

The importance of communication

Effective communication is critical to cultural competency. Communication techniques can range from translation services to eye contact to asking the right questions and listening appropriately to the answers. Excellent communication is more than a positive experience. According to The Joint Commission, it has been linked to:

  • An increase in patient and clinician satisfaction
  • Better adherence to treatment recommendations
  • Improved health outcomes overall

Excellent communication is particularly important as approximately one-third of people have limited health literacy — the ability to obtain and understand basic health information and services needed to make decisions based on individual needs. In other words, people with limited health literacy are unable to take care of their health well. More specifically, limited health literacy is associated with poor management of chronic diseases, an inability to adhere to medication regimens, increased hospitalizations, and poor health outcomes. As we become more culturally competent, we can communicate information in a way that is appropriate and meaningful to the patient, thus improving health literacy.

Improving cultural awareness

Communication techniques come in many forms, both verbal and nonverbal. Consider the following tips from the health Industry Collaboration Effort for enhancing your communication skills.

Styles of speech: People of different backgrounds will vary in the speed of their speech and willingness to interrupt.

Tip: Listen to the volume and speed of speech as well as the content and modify your own speech to match your patient’s to help that person feel more comfortable.

Eye contact: Eye contact is very much connected to cultural background and life experience.

Tip: While European-based cultures interpret the failure to look someone in the eye as a sign of dishonesty or disrespect, many other cultures consider direct eye contact as rude. Therefore, never force a patient to make eye contact.

Body language: Sociologists say that 80 percent of communication is non-verbal, which can vary by culture, gender and age.

Tip: Follow the patient’s lead on physical distancing and touching. If you need to touch your patient, ask for permission. Also, gestures mean different things to different people so be conservative in your use of them.

Interpreter services: When speaking with someone with limited English proficiency, many of us make common mistakes, such as speaking more loudly or too rapidly. Sometimes, we rely on a family member to interpret when we shouldn’t.

Tip: Be sure to use telephonic or in-person interpretation services. Speak slowly and look at the patient while doing so, not the interpreter. Be sure to give the interpreter time to translate fully.

Reducing health disparities is within reach. The tips provided here are steps we can take today to help build one’s cultural competency to provide more effective, equitable care.


33 Comments. Leave new

Mary Grace Ventura
July 8, 2020 7:56 pm

Thank you. This information was well taken and very informative.

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Victoria Frantz
July 8, 2020 7:57 pm

I am well versed in cultural competency and realize it is imperative knowledge to have in our treatment of our clients.

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As behavioral health providers it is our duty to do no harm and meet our clients where they are. That being said if we are unfamiliar with a background we can always ask our client to share more about where they come from and how this is effecting them as part of the psychosocial process. As a system trained clinican knowing where the supports are for each individual is key. As providers we should be take our time to learn about differences to make us more competant as Providers. Access to care is important to keep on one’s radar and may be interdependant on indiviudal’s presentation and barriers to care. Society never stops evolving, it is always good to sharpen ones therapeutic skills ongoing by being culturally aware, that is what makes a good provider…if we don’t know we need to ask and keep on learning!

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Gia Bernini
July 8, 2020 8:24 pm

Funding for in person medical interpretation Is key to reduction of health disparities and health access disparities for non or limited English speaking communities.
Also recruitment and facilitating credentialing for mental health providers with cultural and language competence is critical to Increase access and cultural competent service provision.
Historically there is a lot of talk but no true commitment or policy changes around these changes, because they cost money. I’m not convinced Beacon health options will pay for in person medical interpretation because telephonic interpretation is cheaper even though I have clients who avoid appointments and delay treatment because they feel they get more confused with the telephonic translation.

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Care equality is important and training is key. Thank you!

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Joan Israel
July 8, 2020 8:31 pm

Thank you for the reminder, as I had forgotten that most cultures do not make eye contact.

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HeleneZimmermanLCSW
July 8, 2020 8:36 pm

My acceptance of patients is based on need, non judgmental and a lifetime of not limiting my exposure to a specific ethnicity. Growing up and attending schools in nyc has expanded my inclusion of multiple faiths.

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Brenda McCarthy Trayah
July 8, 2020 8:37 pm

I took an online course this week. I experienced new learning.

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Jada Elliott
July 8, 2020 8:44 pm

The only cure for racial inequality is to ensure People of Color have licensed professionals who look like them and share some of their similar life challenges. #blacktherapistsmatter

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Wonderful information. Every clinician should be aware!

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I’m impressed with the compassionate information!!!

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I agree understanding the individuals culture is very helpful especially in mental health setting. I would also add the tip that if unsure about something ask the individual. They will appreciate that and it will help build rapport.

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Thank you from Dr Jonathan Hoistad
CEO & Clinical Director
Natalis Outcomes
I have worked with Medical and Mental Health patients/clients and have found the “patient narative story” that you create together is the most important factor in patient outcome.
We are fortunate to have Behavioral Health Home care management between provider visits as a way of addressing total patient needs (emotional; social; housing; job; etc.). We also measure emotional functioning every three months on 14 variables (50 questions-10 minutes-6th grade reading level) to see if people are getting better; worse; or staying the same.
25 years ago i began working with Immigrants as a Mission within my practice. Hmong; Somali; Burmese; Ethiopian;etc. I believe that Immigrants are one of our most important populations to help support so that they thrive. I use Interpreters as both a community health extender and family representative and model with them to honor Immigrants in working together. I find it very difficult to get other Mental Health providers to join me in this important work. It can be help with Citizenship; Medical services; legal services; etc.
I appreciate Beacon continuing a dialogue with providers.

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When things are worded in a certain way, it reveals bias. For instance, in this article it says “one-third of people have limited health literacy — the ability to obtain and understand basic health information”. Actually, if the information was basic, most people would understand it.

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good to reinforce information like this, each area of the country and world needs listening to in a mindful way and respectful way

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barbara monnette
July 8, 2020 10:19 pm

I think that high tech video is no replacement for in person interaction regarding body language. Research has shown that a good percentage of information we get from body language involves micro facial ‘tics’ and ‘twinges’ that are perceived subconsciously, yet transmit meaning to the pre frontal cortex. These micro messages cannot be seen on a pixelated display, such as a computer monitor or a smart phone. I the video becomes a distraction on these devices, rather than a source of meaningful information. I believe phone sessions, without this disingenuous visual distraction, offer a better medium for in depth, nuanced verbal exchange.

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Kathleen Morlock
July 8, 2020 10:36 pm

Thank you for this good reminder. I’m glad you added geographical groups. I have worked in rural areas for 20 years. I grew up in the suburbs. There is a difference in mannerisms, beliefs and communication that I had to learn. As long as we keep our minds open and keep our egos in check, I think we will achieve lasting change.

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We also have to remember implicit/unconscious biases that we old hold, whether it be biases about race, disabilities, or sexual orientation. Corporate companies, Healthcare agencies, and many other entities have to be aware that this exists and that important decisions, that may be life or death, are made based on these biases that one is not aware of. Lets start to get focused on these things.

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Jarolyn Johnson
July 8, 2020 11:21 pm

Thank you. Yes, I have had many trainings in the past that taught me this.

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Good refresher tips for a clinical social worker im private practice! Thanks!

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Araceli FlanaganvLCSW
July 9, 2020 10:24 am

This is very significant in establishing a therapeutic ,trusting relationship !

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I think it is important to start having these kinds of conversations in our field
and everywhere.

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Our country is so ignorant. Sadly you had to inform people of basic human rights and integrity.
Thanks for doing this .

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Good review on this subject. I always attend to countertransference/transference. Thanks for the feedback

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J. Hardesty
July 10, 2020 7:03 pm

Wherever we happen to be in understanding, accepting and tolerating diversity, is where we are at. We will not all be at the same place in this discussion. Having the discussion, no matter how late, is a step towards a goal. We each have to keep stepping and participating, learning and evolving, otherwise, it’s just a cerebral exercise or posturing.

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A good reminder of what most of us already are fully aware of. Sincere Thanks Beacon for the reminder

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I can aspire to cultural sensitivity, awareness, compassion, own and address personal isms, lack of information, experience, understanding and be a better listener, however, I do not know that competency, “mastery”, and all that that implies, is even something that is possible. Perhaps there is another word or phrase or goal that could be identified and used.

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Joanne Zager, Ph,D.
July 14, 2020 3:31 pm

very helpful information

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I always look forward to treating patients from other cultures; i learn so much !

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Rocco R. Pizzollo LCSW
July 14, 2020 8:22 pm

Very educational

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Jackie Bashkoff
July 18, 2020 12:09 am

Very comprehensive. I conduct a number of immigration evaluations and appreciate the information.

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