Healthcare outcomes prove to be inconsistent in a multicultural environment, raising the concern regarding the need to develop cultural competency among healthcare providers. Cultural sensitivity promotes communication even among multi-cultural environments, which enhances responsiveness to healthcare challenges and subsequently resulting in increased benefits to the patients. In recent years, there has been increasing awareness of the need for cultural competency, and increased activism towards promoting provider willingness to develop their cultural competencies. Accordingly, there are speculations that healthcare outcomes can be improved through better communication. This study was aimed at determining the impacts of cultural competency on health outcomes within a multicultural environment. As part of conventional social practice, healthcare service delivery benefits from cultural competency by reducing healthcare disparities across cultural groups. Through an understanding of the impacts of cultural competency in such a social environment, the study will conclude by providing future directions for the measurement, operations, and testing healthcare practices that can be used to test communication practices in the environment.
The concept of cultural competency is often mentioned in the contemporary healthcare service environment, with the perception that improved competency results in better health outcomes. Globalization has resulted in increasing cultural diversity, which make cultural competency all the more important, particularly in healthcare where human lives are constantly at stake. Cultural competency defines communication practices and how they affect human relationships and is thus a crucial skill for social service providers to possess. Lin, Lee and Huang (2017) described cultural competency as the ability to identify, appreciate and also to respect the expressed and preferred needs of clients. It could also be defined as the ability to resolve differences through processes that reduce interference from cultural factors. Based on the range of diverse cultures that currently define work environments even in healthcare, cultural competency would encompass open-mindedness and value for families, people and variable societies from different cultural backgrounds (Lin et al., 2017). Ability to translate cultural knowledge and skills into healthcare practice enhances cultural appropriateness in healthcare.
Dimensions of Cultural Competency
Cultural competency is classified into three main dimensions. According to a study by Lin et al. (2017), the three dimensions include cultural knowledge, skill, awareness and sensitivity. Each of these dimensions addresses particular aspects of professional practice in the social service environment. Cultural awareness is described as the level of knowledge and skills that providers possess about other cultures and differences between cultures. Lin, Mastel-Smith, Alfred and Lin (2015), point out the importance and prevalence of cultural awareness among healthcare providers, particularly Taiwanese nurses. In their study, Lin et al. (2015) describe knowledge of other cultures as an essential part of improving healthcare outcomes. Cultural competence is described in ranges from low to high, with individuals of high cultural competency portraying qualities such as high cultural awareness and sensitivity. Those whose cultural awareness is rated as low to moderate are also described as having a low cultural competency. Another study by Horevitz, Lawson, and Chow (2013) also alluded to the concept of cultural awareness through the assertion that cultural competency is central to operationalizing healthcare delivery efficiency, and is composed partially of the sensitivity to the existence of other cultures. Lin et al. (2017), while explaining the concept of cultural awareness and sensitivity, posit that healthcare providers can conceive cultural awareness through the recognition of the prevalence of cultural differences and the fact that those differences can result in varying healthcare outcomes. Accordingly, the authors provide five different subscales of cultural awareness which include cognitive awareness, comfort with interactions, educational experience, patient or clinical issues and research issues in healthcare. Cultural sensitivity entails being aware of and respecting other cultures and the differences they create in healthcare service delivery (Lin et al., 2015). From the evidence provided by past studies, it appears that there are no precise boundaries to cultural awareness.
The second dimension of cultural knowledge relates to an understanding of concepts, evaluation methods and theories in healthcare (Lin et al., 2017). According to Horevitz et al. (2013), the most common practice in evaluating cultural knowledge is through self rated questionnaires. However, this may not be the most appropriate method since most respondents would probably respond to questions using socially acceptable answers. Moreover, Ambrose, Lin, and Chun (2013) report that cultural knowledge is theoretical and may not imply cultural sensitivity in practice. Lin et al. (2017) describe cultural skills in the context of healthcare service delivery as the application of cultural knowledge to clinical practice. This description fills the gap pointed out by Ambrose et al. (2017) by giving a different definition to the capability of a healthcare provider to translate theoretical knowledge into practice. The distinction also has the implication of clearly defining the scope of cultural competency in the healthcare environment. For the healthcare providers, clinical practice may call for the performance of culturally based diagnoses and effective use of resources in a way that not only recognizes diverse ethnicity but also respects diversity (Lin et al., 2017). In this also, the shortcomings of self-evaluation are mentioned.
Impacts of Cultural Competency in Healthcare
In healthcare service delivery, the implications of cultural competency are diverse. In the contemporary society, cultural competency is one of the factors that defines clinical efficacy and promotes health outcomes. In a study by Jongen, McCalman, and Bainbridge (2018) the authors provide evidence of the impacts of cultural competency on the provider skills, knowledge and behaviors. The attitudes of healthcare providers are also affected by their level of cultural competency, which results in significant implications on healthcare outcomes. Jongen et al. (2018) provide various implications of cultural competency particularly on the communication and interpersonal relationships between healthcare service providers and the healthcare service users. Cultural issues in healthcare include linguistic issues which can inhibit communication between healthcare providers and the users, resulting in significant probable outcomes. For instance, through such miscommunication, there could be medication errors especially during the transition from hospital based care to home based care. Cicolini et al. (2015) also support the position that sufficient cultural competency results in improved communication between healthcare providers and the healthcare service users. Improved provider-client communication also fosters client satisfaction with the healthcare services. As an explanation, Cicolini et al. (2015) assert that cultural competence promotes adherence to medication schedules lifestyle recommendations, and improves the understanding of the client’s healthcare condition. All these outcomes can be attributed to the improved communication between healthcare providers and their clients.
Other outcomes associated with high cultural competency among healthcare providers include increased trust in the services delivered; better utilization of healthcare services, increased patient satisfaction, higher probability of seeking for information from healthcare service providers (Jongen et al., 2018). While the benefits of cultural competency in the healthcare environment are clearly described, various past studies have expressed concern about the need for cultural training among healthcare providers. Jongen et al. recommend that cultural training should include concepts such as the role of culture on human lives and how those cultures shape human behaviors, utilization of effective culturally adapted clinical practices, and the importance of continuously improving individual cultural awareness. Other literature by Cicolini et al. assert that there is need to go beyond cultural knowledge by finding ways of spreading cultural skills, which is essentially the transfer of knowledge into clinical practice.
Cultural competency is an essential element in any social service environment, including healthcare. In most cases, the role of cultural competency in nursing has been mentioned without necessarily touching on how cultural competency affects healthcare services delivery by other healthcare practitioners. Various articles have been reviewed to establish the role of cultural competency in the improvement of healthcare outcomes. Through those studies, cultural competency has been described as a function of three dimensions namely, cultural awareness and sensitivity, cultural knowledge and cultural skills. Each of these dimensions describes a particular concepts in the wider social service environment and particularly in healthcare. Through these dimensions, the objective of the current study, which was to determine the probable outcomes of cultural competency in healthcare, can be explored.
Considering the concept of cultural awareness and sensitivity, the recognition and respect of different cultures plays an important role in shaping human communications and interpersonal relationships. One of the common barriers to effective healthcare service delivery is linguistic challenge (Jongen et al., 2018). Linguistic challenges can come through either verbal or non-verbal communication, which result in ambiguity of meaning between the healthcare provider and the clients. This ambiguity can drive miscommunication of client conditions, medication advises and lifestyle change recommendation. Misinterpretation of any healthcare report or advise can result in adverse effects for the client, and also contribute to negative reputations for healthcare facilities. Healthcare providers therefore have the responsibility of learning cultural differences, appreciating the existence of those cultural diversities and establishing practices that not only communicate the appreciation of those cultures but also utilize that diversity to promote healthcare service efficiency. The ability to do this effectively is what is described as cultural sensitivity, and when translated into clinical practice, becomes cultural skills.
When looking at the impacts of cultural competency on better utilization of healthcare services, improved relationships between healthcare providers and their clients, and increased trust in the healthcare system, the role of healthcare providers becomes paramount. Healthcare providers are the point of contact between the clients and the healthcare system. The image portrayed by the providers therefore, can be interpreted as the image of the system as a whole. Through cultural competency, healthcare providers can develop skills to communicate and pass information to clients in the healthcare environment, without necessarily creating misunderstandings. The relationship created between the client and the healthcare provider can help shape the receptiveness of those clients to information provided by the system, and subsequently the healthcare outcomes that emerge from that information. Initial misinterpretation of any communication can result in prolonged mistrust, which also fosters poor health outcomes.
Conclusion and Recommendations
Cultural competency not only enhances communication between healthcare providers and their clients but also the quality of relationships created in the healthcare environment. Cultural competency encompasses a variety of dimensions, which cover a theoretical understanding of concepts of cultural awareness and sensitivity through to the translation of that knowledge into clinical practice. Healthcare service providers ought to understand the role of cultures in the healthcare environment and harness the power of cultural sensitivity in promoting healthcare outcomes. Various implications have been associated with high cultural competency including better communication, enhanced use of the healthcare systems, improved quality of life through improved medication adherence and better relationships between healthcare providers and their clients. Each of these outcomes is however strictly linked to the capacity to translate cultural knowledge into cultural skills.
In spite of the notable benefits of cultural competency to healthcare service delivery, healthcare facilities in most cases do not provide trainings to personnel on cultural competency. This limits the application of cultural skills by healthcare providers to self-learnt concepts, which may be limited. It is therefore recommended that healthcare facility administrations should be making efforts to improve the awareness and skills of their members towards better cultural competency. An understanding of the benefits of cultural competency can help motivate providers concerning the need for skill building. Additionally, service providers can collaborate with local communities in establishing the cultural values of the communities they work in so that they can understand the extrinsic cultural values that promote relationship building and interpersonal communication between the clients and the service providers. It is also advisable that in their efforts to develop cultural competency, the service providers should dig deeper into the emerging community problems.
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