As a result of rapidly growing ethnic and racial minority populations in the United States, “cultural competence” is emerging as an important issue for the nation’s healthcare providers and systems. According to the American Medical Association, cultural competence is “the knowledge and interpersonal skills that allow providers to understand, appreciate and care for patients from cultures other than their own.”

Based on data from the 2000 U.S. Census, racial and ethnic minorities make up 30% of the American population. This figure is expected to rise to 40% by 2030. Today, one in four Americans is a person of color; one in three children in this country is African American, Hispanic or Asian; and one in 10 residents is foreign-born. In California, the proportion of racial and ethnic minorities is even greater, with Hispanics and Asians comprising 35% and 12% of the population respectively.

Research indicates that significant disparities exist in the provision of quality healthcare to our diverse population. Access to physicians and medical facilities as well as language barriers and cultural expectations can affect the diagnosis of illness, treatment options and patient compliance. And, while the individuals in each ethnic, cultural and racial group have significant barriers in accessing the healthcare system, a 2003 Institute for Safe Medication Practices (ISMP) article “Cultural Diversity and Medication Safety” notes that these groups also tend to have different expectations and attitudes than Americans regarding their medical care.

Beliefs and Attitudes
Family involvement varies greatly among different cultures, according to the ISMP article. In Hispanic families, for instance, the mother or grandmother (especially the husband’s side) usually makes healthcare decisions. Similarly, during an illness, the opinions of Asian family members are greatly respected.

Many Chinese consider Western medicine to be quick and effective in removing symptoms, but not a permanent cure, the ISMP article notes. Some Chinese patients may use American physicians for acute illness or surgery, but turn to traditional Chinese practitioners and medicines for long-term treatment.

And, the ISMP article continues, while many Hispanic and Asian patients expect quick relief from symptoms by using prescribed medications, they often decrease their medication dosages to avoid even minor side effects. Beliefs and attitudes may also play a role in the early discontinuation of prescribed medications. For example, many African Americans and Native Americans stop taking drugs like antibiotics and antidepressants when symptoms ease. Hispanics also tend to believe that an absence of symptoms means they are cured.

This is especially problematic in treating a disease like diabetes, an illness that is prevalent in the Hispanic community. When symptoms abate, many Hispanic patients often stop taking their medication, according to the ISMP article. Diabetes is a challenge for many Asians as well. The disease is uncommon in Asia, so it is difficult for some Asian patients to grasp the relationship between blood sugar and diet. Recommended dietary changes may not fit in with cultural attitudes about food.

Cultural preferences may also affect adherence with medications in other ways. Some women from Islamic and African cultures who have vaginal yeast infections may prefer oral drugs to vaginally inserted medications, according to the ISMP. Often, Latin Americans prefer injections as many believe that oral medications are less effective. Some cultures practice religious fasting, which can affect medication schedules or interfere with drug absorption. Some Mexican and Puerto Rican patients’ concern about the addictive effects of medications can lead to their reluctance to take them for long periods of time.

Lack of Acculturation
Even individuals who were born or have lived in this country for many years and appear to be fully acculturated may—to some degree—still hold the beliefs, values and behaviors of their or their parents’ culture. According to the book “Communicating with Today’s Patient” by Joanne Desmond and Larry R. Copeland M.D., many minority patients will still find eye contact, body posture and other forms of nonverbal communication from American healthcare providers troublesome, especially if a language barrier exists.

Desmond and Dr. Copeland note that many Asian patients, in particular, may be accustomed to having a highly formalized relationship with healthcare providers. A physician’s casual appearance, attire or attitude could impede the development of a trusting relationship with these patients. Using first names, displaying a jovial attitude and engaging in hearty gestures, such as a backslapping, may be viewed as inappropriate.

When interacting with multicultural patients, Desmond and Dr. Copeland recommend

• First gain patients’ trust by showing an interest in their country and culture.
• When speaking to patients with limited English proficiency, talk slowly and pause frequently to give them time to mentally translate what you are saying. Otherwise, they may nod politely, but will not tell you they don’t comprehend what you’re saying.
• Before leaving, ask the patient to repeat your instructions. You may need to confirm comprehension by having the patient act out how he or she will follow your recommendations—for example, taking pills or using an inhaler.

Finally, a note of caution: It is easy to oversimplify the beliefs and attitudes of various racial, ethnic and cultural groups. All healthcare providers should keep in mind that every patient is a unique human being, not a stereotype of his or her culture. Practitioners should strive to provide healthcare in ways that demonstrate an understanding of—and respect for—their patients’ varying cultural beliefs and individuality.