© Center for Health Care Strategies 2013 October 2013
Strategies to Improve Cultural Competency in Health Organizations
Provider-Patient Communication
Give guidance on nutrition and lifestyle that aligns with patients’ cultural, dietary, and/or religious values;
Respect cultural norms around body language, clothing, and gender during appointment interactions; and
Be sensitive when asking questions to clarify understanding or dispel pre-conceived notions.
Care Management
Include diverse backgrounds and skill sets in care teams to meet patients’ range of medical and social needs;
Provide culturally-relevant education and management tools to facilitate self-care and shared decision-making; and
Link patients with community-based services and supports outside of the clinic.
Health Information
Reduce the use of health industry jargon;
Translate health materials into multiple languages and provide interpreter services for in-person encounters;
Represent racially and ethnically diverse groups in the images and content of materials; and
Tailor prevention and health promotion messages to diverse communities using social marketing strategies.
Workforce Training
Increase racial, ethnic, and linguistic diversity among professional and paraprofessional providers (e.g., physicians,
physician assistants, nurses, behavioral health specialists, community health workers, peer navigators, etc); and
Train providers and front-line staff in cross-cultural communication, trust-building, and motivational interviewing.
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SPOTLIGHT ON LIMITED ENGLISH PROFICIENCY
More than 23 million Americans have limited English proficiency (LEP). While their lack of skills in English drives their low health
literacy, it is important to differentiate literacy from English-language proficiency. For example, some individuals with adequate
health literacy may be more adept at a non-English language than English, and there are many individuals who have inadequate
health literacy, even though English is their primary language. Individuals with LEP experience similar problems to those with low
health literacy, such as delay or denial of services, issues with medication management, and underutilization of preventive
services.
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Translation and interpretation services are recognized as best practices in engaging individuals with LEP.
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Title VI of the
Civil Rights Act of 1964 requires all entities (e.g., state agencies, hospitals, providers) receiving federal funds to provide these
services.
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Resources for Providing Culturally Competent Care
Visit the hyperlinks for more information.
Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence Item Set: Survey
instruments that assess provider cultural competency. Part of the suite of CAHPS Clinician & Group Surveys
developed by the Agency for Healthcare Research and Quality.
Health Resources and Services Administration – Culture, Language and Health Literacy: Resources such as
tools, assessments, and articles for health care providers, particularly those serving the uninsured, isolated or
medically vulnerable, such as Federally Qualified Health Centers, Essential Community Providers, Rural Health
Centers, and Community Health Centers.
DiversityRx: Resource website for delivering health care to minority, immigrant, and indigenous communities.
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L. Nielson-Bohlman, A.M. Panzer, and D.A. Kindig (Eds.) Health Literacy: A Prescription to End Confusion. (Washington, DC: The Institute of Medicine & The National
Academies Press, 2004).
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A.E. Volandes and M.K. Paasche-Orlow. “Health Literacy, Health Inequality and a Just Healthcare System.” The American Journal of Bioethics, 7, no.10 (2007), 5-10.
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Office of Minority Health, Department of Health and Human Services. What is Cultural Competency? Accessible at:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11
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M.K. Paasche-Orlow, D. Schillinger, S.M. Green, and E.H. Wagner. “How Healthcare Systems Can Begin to Address the Challenge of Limited Literacy.” Journal of
General Internal Medicine, 21, no.8 (2006), 884–887.
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M. Youdelman. “The Medical Tongue: U.S. Laws and Policies on Language Access.” Health Affairs, 27, no. 2 (2008): 424–433.
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A. Sampson. National Health Law Program (2006). “Language Services Resource Guide for Health Care Providers.” Available at:
http://www.healthlaw.org/images/pubs/ResourceGuideFinal.pdf.
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M. Au, E. Taylor, and M. Gold. “Improving Access to Language Services in Health Care: A Look at National and State Efforts.” Mathematica Policy Research, April 2009.
Available at: http://www.ahrq.gov/legacy/populations/languageservicesbr.pdf.