A cultural-driven healthcare system or cultural competence in health care services pertains to approaches aimed at delivering health care services in consideration of the cultural sensibilities of different stakeholders and communities.
The World Health Organization first recognized the importance of culture to health in 2015. More specifically, it included a so-called cultural dimension to its 2030 Agenda for Sustainable Development to promote the importance of awareness of cultural contexts in offering new models of care that consider more than just biology and medicine.
Importance of Cultural Competence in Healthcare: Cultural Dimensions and Specific Cultural Factors Influencing the Effective Delivery of Health Care Services
1. Language and Communication
The existing body of literature provides a wealth of information regarding cultures and cultural factors related to healthcare delivery. Several studies have described language both as a barrier and an enabler of effective care delivery and related decision-making.
Researchers R. F. I. Meuter et al. noted that proper communication between health care workers and public health officials is essential not only in providing appropriate services but also in raising awareness and educating the patients and the public.
Consider language barriers as a collective example of how culture affects the delivery of health care services. Miscommunications could be life-threatening. The language barrier between care providers and patients could result in improper diagnoses, unfulfilled provision of service requirements, and alienation of involved parties.
Note that migrant patients from other countries and the influx of foreign-trained health care workers raise the importance of addressing barriers to patient-provider communications.
2. Socio-Cultural Preferences
Socio-cultural preference toward traditional medicine and unscientific practices could also influence modern medicine. J. Bussey-Jones and I. Genao explained that there are individuals or groups of individuals who prioritize seeking assistance from community healers or taking food supplements with no therapeutic claims.
The case study of Bussey-Jones and Geneao showed how language barriers and socio-cultural preferences toward traditional medicine could endanger the quality of service delivery and the lives of patients.
Specifically, the case involved a Mexican immigrant who had been misdiagnosed in several hospitals due to a lack of multilingual providers and another patient whose condition worsened when he took herbal medicines to supplement his medical treatment for a prior accident.
3. Religion and Beliefs
Another cultural dimension similar to socio-cultural preference is religion. Researcher Puchalski mentioned that the spiritual and religious beliefs of individual patients could affect the decisions they make about their health and their specific choices about their treatment options.
Religious inclinations predetermine the preference of individuals. Some patients would refuse to undergo medical procedures unaligned with their religious beliefs. Others would also resort to faith healing rather than science-based medicine. There are those who feel alienated from modern medicine because of the lack of sensitivity of their care providers.
A prime example is a Western nutritionist recommending more intake of animal-based protein to an undernourished Hindu patient. Note that a large number of adherents of Hinduism are vegetarian. Most Hindus also consider cattle sacred and refusing to consume them is part of their adherence to non-violence.
4. Educational Attainment
Education could also be considered a cultural factor in influencing healthcare and effective delivery. For starters, it determines the competency of health care professionals. L. D. Gruppen, R. S. Mangrulkar, and J. C. Kolars noted their level of educational attainment and the quality of training they have received, as well as the extent of skills and knowledge imparted unto them, define their capabilities as providers of care, and has positive impacts on global healthcare.
It is also important to note that the education and literacy levels of patients affect their capacity to make rational health choices. Z. Fereidouni et al. explained that awareness provides them with the tools needed to make the right decisions about their health.
The study of Gruppen, Mangrulkar, and Kolars showed that poor patient education remains an obstacle to quality healthcare in Iran. A large number of Iranians are having a hard time grasping scientific and medical concepts because of their lack of a considerable level of educational attainment and the incapability of healthcare providers and public health authorities to communicate effectively.
5. Lifestyle or Way of Life
Another cultural dimension relevant to understanding the importance of cultural competence in health care services is the lifestyle or way of life of a particular individual and his or her community. A review by D. Fardhud revealed that 60 percent of related factors to individual health and quality of life are correlated to lifestyle.
The prevailing way of life in a particular community includes socio-cultural norms and customs about dominant food choices, work setups and work-related behaviors, common activities and prevalent habits, community involvement and other dimensions of social relationships, and overall attitudes about health and well-being.
It should be noted that societies in which unhealthy eating habits are rampant, coupled with poor lifestyle choices such as the prevalent use of alcohol and tobacco, have higher proportions of citizens suffering from so-called lifestyle diseases.
Even those communities in which professional lives are characterized by a high-pressure working environment, dense population, and busy streets also suffer from a greater proportion of physically and mentally unwell citizens.
Summary and Takeaways: Reiterating the Importance of Cultural-Driven Health Care Services Delivery and Cultural Competence in the Healthcare System
The World Health Organization recognizes the need for health care workers to be culturally aware, specifically the necessity of awareness of cultural contexts in approach service delivery and implementing new models of care.
Nevertheless, in consideration of the importance of understanding cultural contexts when it comes to the delivery of health care services, health care workers need to cultural competence that would allow them to be culturally aware and culturally responsive.
Examples of specific competencies include learning a secondary language, developing cultural and religious sensibilities, and learning how to become an effective public health communicator. It is also worth mentioning that the five cultural factors described above— language, socio-cultural preference, religion, education, and lifestyle—collectively represent opportunities and challenges pertaining to access to quality healthcare.
Note that these cultural factors can either be a barrier or an enabler. For example, language could either promote or obstruct communications between patients and care providers, while lifestyle could either serve as an entry point or endpoint for promoting public health and patient education. Hence, it is essential to equip the health care workers with specific capabilities aimed at turning these cultural dimensions and factors into their advantage.
The concepts of patient-centric approach and population-centric approach to health care services delivery is also fitting. Adherents of these approaches believe that quality healthcare depends on a strong relationship between the patients and their providers, as well as a focus on addressing the specific healthcare needs of the people and their communities.
An awareness of cultural contexts also translates to patient-centeredness and people-centeredness, as well as the provision of precision medicine and personalized medicine, because it involves providers of health services to step in the shoes of their patients to provide services that are culturally sensitive, considerate, appreciative, and appropriate.
FURTHER READINGS AND REFERENCES
- Bussy-Jones, J. and Genao, I. 2003. “Impact of Culture on Health Care.” Journal of the National Medical Association.95(8): 732-735
- Farhud, D. D. 2015. “Impact of Lifestyle on Health.” Iranian Journal of Public Health. 44(11): 1442-1444
- Fereidouni, Z., Sarvestani, R. S., Hariri, G., Kuhpaye, S. A., Amirkhani, M., and Kalyani, M. 2019. “Moving Into Action: The Master Key to Patient Education.” The Journal of Nursing Research. 27(1): 1-8. DOI: 1097/jnr.0000000000000280
- Gruppen, L. D., Mangrulkar, R. S., and Kolars, J. C. 2012. “The Promise of Competency-Based Education in the Health Professions for Improving Global Health. Human Resource for Health. 10(43): DOI: 1186/1478-4491-10-43
- Meuter, R. F. I., Gallois, C., Segalowitz, N. S., Ryder, A. G., and Hocking, J. 2015. “Overcoming Language Barriers in Healthcare: A Protocol for Investigating Safe and Effective Communication When Patients or Clinicians Use a Second Language.” BMC Health Services Research. 15(1). DOI: 1186/s12913-015-1024-8
- Puchalski, C. M. 2001. “The Role of Spirituality in Health Care.” Baylor University Medical Center Proceedings. 14(4): 352-357. DOI: 1080/08998280.2001.11927788
- The World Health Organization. 2017. Culture Matters: Using a Cultural Contexts of Health Approach to Enhance Policy-Making. The World Health Organization
