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Cultural Competency and the Medical Home

July 12, 2013
By Julie Eisen

Image courtesy of Nestlé on Flickr
Image courtesy of
Nestlé on Flickr

At Caring Health Center (CHC) in Springfield, Mass., delivering culturally appropriate healthcare isn’t an option, it’s a necessity.
 
As the only refugee health assessment site in Western Massachusetts and the largest in the state, CHC serves an extremely diverse and constantly changing population of individuals and provides on-site translation services in 19 different languages.
 
“Everything from health insurance to the overall American health system is brand new and foreign to many of our patients. A lot goes into ensuring that care is culturally competent and comprehensive in terms of refugee health needs,” says Cristina Huebner Torres, vice president at CHC. “Healthcare needs to be delivered in a way that is meaningful and appropriate.”
 
CHC is one of 13 pediatric practices in the CHIPRA Massachusetts Medical Home initiative. Since 2011, these health centers have been making practice-level policy changes to become patient-centered medical homes. Increasingly, the medical home has become a highly regarded model of care for its focus on putting the patient and family first and meeting them where they are. Grounded in delivering compassionate, coordinated care, the medical home model encourages providers to create a culturally sensitive healthcare experience that honors families’ beliefs and traditions and tailors materials to their levels of health literacy.

Cultural Competency vs. Cultural Humility


Building an office atmosphere of cultural competency starts with recognizing who the patient populations are and how their cultural beliefs can influence their healthcare needs and expectations. Is the patient’s family familiar with the purpose of preventative health care or well visits? Is the patient’s family accustomed to a traditional set of foods and, if so, how does that impact making dietary recommendations? Is the patient’s family familiar with continuing to administer a medication to their child even if it appears symptoms have resolved? These are the types of questions that are critical to consider when delivering effective care to a diverse patient population.
 
To answer these types of questions, providers at Martha Eliot Health Center in Jamaica Plain, Mass., another practice in the CHIPRA Massachusetts project, go directly to the patients by conducting focus groups and discussing issues in a newly formed parent and family advisory group. In one case related to nutrition counseling, providers were finding that the healthy food recommendations they were making to families from the Dominican Republic were not sticking.
 
“They just weren’t the types of foods that parents and grandparents were used to feeding their kids,” says Erin Kelly, resource specialist at Martha Eliot. As a result of conversations with parents to better understand how to make effective nutrition recommendations, the care team shifted their focus to suggesting reducing portion sizes and offering healthy ways to alter traditional recipes. “They definitely appreciate that we use models of the types of food they typically eat rather than trying to completely change their diets.”
 
After building an atmosphere that understands the patient population, the next step is to understand individuals. It’s important to keep in mind that members of a similar ethnic or language group are not all the same, even though within one group or even across groups there might be similar challenges that people are facing.
 
“I often talk about cultural humility as opposed to cultural competency because it honors and represents the idea of a power dynamic that patients are experiencing most of the time when they are sitting with a provider,” says Huebner Torres. Cultural humility encourages providers to constantly self-critique their own perceptions of cultural norms and acknowledge the power imbalance between patients and providers. By exercising cultural humility, providers are able to more effectively establish partnerships with their patients in order to let their needs and beliefs inform care decisions.
 
It’s important, however, to avoid pigeon holing patients into a monolithic group. For example, for some Muslim female patients if a doctor asks if the patient smokes, uses drugs or has female partners, these questions are considered so offensive that the provider is probably risking any element of trust with the patient.
 
How though do you make sure a visit doesn’t offend a patient without missing the people, such as a Muslim gay woman, who are also experiencing health disparities because of their need to remain invisible? This is where this patient-centered medical home model comes into play.
 
“You have to hear from your patient and navigate conversations carefully to see if they are dealing with their own issues of disparity,” says Huebner Torres. By going one step further into cultural competency, health centers can work with patients to deliver truly patient-centered care. “This is the great opportunity I see from the medical home. It is a chance to reach our diverse patients and those who are most vulnerable to health disparities.”


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