Disparities/Minority Health

Ethnically diverse patients define what cultural competence means to them

To better meet the needs of ethnically diverse patients and reduce disparities in health and health care, efforts are under way in the United States to help doctors become more culturally competent. Identifying what culturally competent health care means from the standpoint of these patients will help in the design of training programs to address the cultural factors that impact the quality of care.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS10599), conducted a series of 19 community focus groups that included 61 blacks, 45 Latinos, and 55 non-Latino whites. They asked participants about the meaning of "culture" and what cultural factors influenced the quality of their medical visits.

Definitions of culture common to all three ethnic groups included value systems (25 percent of focus group comments), customs (17 percent), self-identified ethnicity (15 percent), nationality (11 percent), and stereotypes (4 percent). All groups agreed that the factors that positively or negatively influenced the quality of medical encounters were clinicians' sensitivity to complementary/alternative medicine (17 percent), health insurance-based discrimination (12 percent), social class-based discrimination (9 percent), ethnic concordance of physician and patient (8 percent), and age-based discrimination (4 percent).

Physicians' acceptance of the role of spirituality (2 percent) and of family (2 percent) and ethnicity-based discrimination (11 percent) were cultural factors specific to non-whites. Language issues (21 percent) and immigration status (5 percent) were Latino-specific factors. Overall, participants said they felt more satisfied with physicians who demonstrated cultural flexibility, that is, who were able to elicit, adapt, and respond to patients' cultural characteristics.

See "Patients' perceptions of cultural factors affecting the quality of their medical encounters," by Anna M. Nápoles-Springer, Ph.D., Jasmine Santoyo, M.P.H., Kathryn Houston, M.A., and others, in the March 2005 Health Expectations 8, pp. 4-17.

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