Minority Americans are expected to make up more than 40 percent of the U.S. population by 2035. A large body of literature has documented significant racial and ethnic disparities in health care and health outcomes, with minority Americans generally receiving less health care and suffering worse health. Many minority Americans, especially those with limited English proficiency, face barriers to accessing health care and getting appropriate treatment. Addressing the needs of an increasingly diverse population has become a major challenge to clinicians, health systems and plans, and public policymakers.
A conceptual model developed by Cindy Brach, M.P.P., and Irene Fraser, Ph.D., of the Agency for Healthcare Research and Quality, shows how cultural competency techniques have the potential to improve the ability of health systems and clinicians to deliver appropriate services to their minority patients. According to the model, the practice of culturally competent health care could overcome barriers to care by improving clinician/patient communication, increasing trust between clinicians and patients, creating greater knowledge of differences among racial and ethnic groups in epidemiology and treatment efficacy, and enhancing understanding of patients' cultural behaviors and environment. For example, providing interpreter services could result in more accurate medical histories and lead to a reduction in diagnostic errors and unnecessary diagnostic testing.
Harmful interactions between prescribed drugs and folk or home remedies could be avoided by training clinicians to ask patients whether they're using such remedies. Health promotion and education materials that reflect culture-specific attitudes and values could result in more successful patient education and increased adherence to treatment regimens.
The authors reviewed the literature on a variety of cultural competency techniques—including interpreter services, recruitment and retention of minority staff, training, coordination with traditional healers, use of community health workers, and culturally competent health programs—for evidence that bears upon the model. They found evidence that providing professional interpreters reduces disparities in satisfaction, adherence, and outcomes, but they found little in the way of rigorous research evaluating the impact of other cultural competency techniques on outcomes, including the reduction of racial and ethnic disparities. The researchers conclude that although there is substantial evidence to suggest that cultural competency techniques should in fact work, there is little evidence about which cultural competency techniques are effective and under what circumstances.
See "Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model," by Ms. Brach and Dr. Fraser, in the November 2000 Medical Care Research and Review 57(Suppl. 1), pp. 181-217.
Reprints (AHRQ Publication No. 01-R007) are available from the AHRQ Publications Clearinghouse.