Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

Culture affects our view of health, wellness, illness, and death. As a Primary Care Provider, it is essential you have some awareness of your patient’s and family’s culture. Studies have shown that incorporating cultural awareness and sensitivity significantly improves patient compliance. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

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Select a culture and discuss the following:

How does this culture view health promotion and disease prevention (such as immunizations)?
How does this culture’s spiritual beliefs impact the view of health?
How does this culture affect your patient care?
Communication
Patient education
Anticipatory guidance
Treatments such as medications

The United Nations state “the world is on the move, and the number of international migrants today is higher than ever before.” [1]. The associated growing diversification of societies offers many opportunities for societal and economic growth but often presents a challenge for receiving countries. Consequences can include inequalities and discrimination in different areas [2]. The European Union (EU) and the Constitution of the World Health Organization (WHO) ratified the universal right to health as a fundamental human right. Nevertheless, inequalities in access to healthcare exist worldwide and are related to the legal and socioeconomic status of each individual and the laws and policies of each country [3, 4]. In fact, culturally and linguistically diverse patients (CLDP) access healthcare services less than the host populations and are confronted with different barriers [3–7]. These barriers include the organization and complexity of healthcare systems, legal restrictions on access to certain health services, linguistic and cultural barriers, discrimination and limited competencies or unawareness of providers. These are often intertwined with individual factors such as low health literacy, employment status, fear of stigma, language barriers or differences in health beliefs and behaviors [2–7]. Betancourt identified three levels of sociocultural barriers to healthcare: organizational barriers, structural barriers and clinical barriers. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay Organizational barriers, which affect availability and acceptability of healthcare for CLDP, refer for instance to the degree to which the population’s cultural and linguistic diversity is represented in the leadership and workforce of healthcare organizations. Structural barriers emerge from the complexity and bureaucracy of healthcare systems. Specifically, the absence of interpreter services and of culturally and linguistically adapted materials, increased wait times among CLDP populations and problems in referrals to specialist care cause dissatisfaction and inequalities. Clinical barriers occur in patient/provider interactions and can be seen as sociocultural differences which are not identified, accepted or understood. These can lead to mistrust, dissatisfaction, decreased adherence and poorer health outcomes [8].

The implementation of cultural competence in healthcare facilities seemed to be the answer to these disparities, and traditional receiving countries have been working towards it [8–12]. Indeed, the demand for culturally competent healthcare systems has reached the political levels of diverse countries. The National Culturally and Linguistically Appropriate Service Standards (CLAS Standards) were introduced in 2000 in the United States [13], and in 2005 the Australian government published “Cultural competency in health: A guide for policy, partnerships and participation” [14]. In 2007 the “cultural opening” of healthcare facilities was demanded by a representative of the German federal government [15] and the NHS has offered the migrant health guide since 2014 [16]. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

There are different definitions, names and implementation guidelines for the concept of cultural competence or cultural competency [12, 17]. The most commonly used definition is the one by Cross et al. (1989): „Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations” [18]. This definition emphasizes that cultural competence is implemented on different levels of care. Corresponding to their identified barriers, Betancourt et al. (2003) differentiate between three levels of interventions: organizational, structural and clinical cultural competence interventions [8]. Fung et al. (2012) take a systemic approach and define cultural competence on macro, meso (institutional and programmatic) and micro levels, by which macro reflects the societal level, meso the organizational and micro the individual clinical level [10]. The German concept of “cultural opening”describes the process of adapting or “opening”facilities and is hence a process of organizational development which includes interventions on different levels within facilities [19]. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

Existing systematic reviews have focused on defining theoretical concepts [8, 9, 20] or on the effectiveness of cultural competence interventions [11, 12, 17, 21, 22]. Individual cultural competence among healthcare providers was examined most frequently [12, 20]. A systematic review of reviews on cultural competence in healthcare found moderate positive effects of individual cultural competence trainings on provider outcomes (knowledge, skills, attitudes) and on access and utilization outcomes but only weak effects on patient outcomes (satisfaction, health status) [12]. Other interventions that were often identified by authors of existing reviews were the recruitment of bilingual staff, the use of interpreters and the translation of treatment materials [9, 11, 12, 20]. All together these reviews were not able to determine the effectiveness of interventions because of the lack of comparative studies and objective outcome measures [11, 12, 17, 21–23]. A number of systematic reviews were conducted which often focused on conceptual models and definitions or broad categories of cultural competence and derived interventions or strategies from those. We chose a bottom-up approach in order to extract culturally competent components or strategies from healthcare interventions designed to be culturally competent. The methodology of a scoping review appears appropriate for capturing the presumed diversity of components and strategies to provide culturally competent healthcare to CLDPs. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for CLDPs within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions.

Methods
The review was guided by the question “What are components or strategies extracted from evaluated culturally competent healthcare interventions that were designed to provide healthcare for culturally and linguistically diverse patients (CLDP) in healthcare organizations?” Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

Search strategy
A systematic literature search was carried out in following databases: Pubmed, PsycINFO and Web of Science. The search was conducted in August 2016 and updated in January 2017 to include studies published during/after August 2016. No restrictions were set. Furthermore, lists of references of relevant articles were manually examined for the purpose of identifying further eligible studies.

The PICO criteria were adapted [24] in order to formulate the research question and to systematically choose relevant search terms. We concentrated on the criteria Population (e.g., migrants, culturally and linguistically diverse patients), Intervention (e.g., program, standard, strategy) and Outcome (e.g., increasing cultural competences or cross-cultural opening). The search string is available in the S1 File. More precisely, we searched for studies which evaluated cultural competence interventions quantitatively or qualitatively in order to increase cultural competence in healthcare facilities. Additionally, we included the criterion Setting (e.g., hospitals, clinics, health centers) because we were exclusively interested in interventions implemented in healthcare facilities. Analyses of Medical subject Headings (MeSH) and of key terms of related articles were used to identify search terms. These were discussed by the authors and combined to a search string, which was adapted for each database. As recommended by Arksey and O’Malley (2005) we started the search with a wide approach in order to create a comprehensive map of the field. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

Eligible criteria and assessment
The selection process was divided into two screening phases. First, a screening of titles and abstracts was conducted followed by full text screening.

In the first screening phase, studies evaluating interventions located at healthcare organizations and aiming to improve cultural competence of healthcare facilities and/or healthcare for CLDP were included. Studies reporting the existing level of cultural competence of healthcare facilities or studies evaluating interventions in other facilities (e.g., schools, community centers) were excluded. In the event that the setting of the intervention was not identifiable in title or abstract, studies were nonetheless included in order to be examined in full text screening. Studies evaluating cultural competence trainings on an individual provider level were excluded because systematic reviews have already shown their positive effect on provider outcomes (e.g., knowledge, skills and attitudes) and their satisfying effect on patient outcomes (e.g., satisfaction, health status) [12]. At this stage all study types as well as all publication types except for reviews and meta-analysis studies were deemed eligible. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

The title and abstract screening was carried out by three independent raters. Prior to this first screening phase all raters screened 100 randomly chosen articles each and reached an interrater reliability of ĸ = 0.7 (main author—first rater) and ĸ = 0.8 (main author—second rater). Disagreement was discussed in regular meetings and screening criteria were specified along the screening process.

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Eligible criteria for full text screening were specified and iteratively adapted during the second screening phase [25]. The criteria were divided into the following categories: Design, Recipient Population, Content, Method and Context. The category Design (criterion 1) included only studies with a sample size of more than two and only studies using primary data. Hence, reviews, meta-analysis studies, study protocols and letters to the editors were excluded. The Recipient Population consisted of migrants, CLDP, ethnic minorities (e.g., Latino population, Native Americans, South Asian Americans) or refugees (criterion 2). In order to be considered eligible regarding their content, studies had to examine interventions that aim to improve healthcare utilization, provision or treatment for CLDP and/or cultural competence in healthcare facilities (criterion 3). Additionally, they needed to be evaluated with quantitative or qualitative research methods (Method; criterion 4). Furthermore, studies that only focus on (psychometric) evaluation of instruments were not eligible. Interventions had to be implemented explicitly in inpatient or outpatient settings such as hospitals; health or medical centers; health facilities; health organizations; (medical) trusts or sites or clinics in order to meet the Context criterion (criterion 5). If study participants were recruited in healthcare facilities, but the intervention was located elsewhere, these studies were excluded. Studies located in general practice or community centers were excluded, as well. Only studies published in English or German and meeting all criteria were included. Detailed screening criteria are available in the S1 Table. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

In the full-text screening the remaining articles were screened by two independent researchers. They reached an interrater reliability of k = 0.8, which was considered to be satisfying. Both raters met on a regular basis throughout the screening process to ensure a high level of consensus and to discuss any uncertainties.

Data extraction and summary
Data extracted from the studies were summarized into two spreadsheets. One spreadsheet describing the characteristics of healthcare interventions included following information: Authors, name and location of the intervention, target group and components of the interventions. (S2 Table) [26]. The second spreadsheet incorporated study characteristics and results: outcome measures, study type, study participants (N, ethnicity) and main results (S3 Table). To assure the accuracy of extracted data, they were verified by two independent researchers. Single components and strategies for providing culturally competent healthcare extracted from studies were clustered and organized into a model. In order to determine their effects, studies were checked for results relating to single components. Descriptive statistics were used to summarize the data. Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay

Global migration is higher than ever before, with migrants accounting for more than ten per cent of the total population in Europe, Northern America and Oceania (United Nations, 2017). As a result, populations are culturally diverse (World Health Organization, 2016). Cultural diversity not only relates to a person’s country of birth, but also to their ancestry, the country of birth of their parents, languages spoken, Aboriginal descent, religious affiliation, ideas, belief systems, customs and social behaviour (Australian Bureau of Statistics, 2017). Cultural diversity can create many challenges in the provision of healthcare (State of Victoria, 2016). Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay
Since the 1990s, global population and socioeconomic changes have resulted in an increased number of hospitalised patients from diverse backgrounds (United Nations, 2017). Clinicians must be cognisant of patients’ individual healthcare preferences that are influenced by cultural diversity, and the importance of communication to ensuring safety and equity in the provision of healthcare (Bellamy & Gott, 2013).
Cultural sensitivity requires an awareness of cultural diversity, including how culture may influence patients’ values, beliefs and attitudes, and involves acknowledging and respecting individual differences (Crawley, Marshall, Lo, & Koenig, 2002). Yet, culturally sensitive communication may be more difficult to define. Research suggests that clinicians may not know how to communicate with persons from culturally diverse backgrounds (Beckstrand, Callister, & Kirchhoff, 2006; Efstathiou & Clifford, 2011), and when communication is not culturally sensitive, there is a potential for it to negatively impact the care provided, and patient and family satisfaction (Williamson & Harrison, 2010). The purpose of this paper is not to prescribe how culturally sensitive communication is to be used in diverse situations. Rather, the purpose is to explore and explain the concept of culturally sensitive communication.
2. Background
It is assumed that clinicians have the knowledge and skills to communicate in a culturally sensitive way (Betancourt, Corbett, & Bondaryk, 2014). Culturally sensitive communication demonstrates understanding and respect for individuals and promotes patient and family satisfaction (Claramita, Tuah, Riskione, Prabandari, & Effendy, 2016; Douglas et al., 2011). Through verbal and nonverbal communication, clinicians attempt to identify individualised patient needs; yet, culturally sensitive communication also relies on clinicians being able to critically reflect on their own values, beliefs, preferences and culture, as well as understandings of traditions, perspectives and practices of culturally diverse individuals, families and communities (Douglas et al., 2011). An assumption is made that clinicians are educationally prepared to use culturally sensitive communication in care provision (Williamson & Harrison, 2010). Yet, evidence suggests that clinicians are ill-prepared to communicate with cultural sensitivity, and opportunities for clinicians to undertake education in this area are often limited to isolated opportunities (Fleckman, Dal Corso, Ramirez, Begalieva, & Johnson, 2015; Maier-Lorentz, 2008; Narayanasamy, 2003). Incorporating Cultural Awareness And Sensitivity To Patient Compliance Essay