Introduction
The world is continuously evolving and changing. Apparently, these changes and evolutions affect all sectors of the society, which include the healthcare sector. Over the recent past, the healthcare sector has experienced numerous changes, which affect the nature of service delivery in healthcare centers. Some of the changes include the issue of culture and lifestyles demonstrated by patients. The fact that the world is gradually becoming a global village has made it possible for individuals to move from one place to another and interact with minimal interferences (Maddalena, 2009). It is imperative to explain that when people move from one place to another, and in some cases, acquire citizenship of a respective country they retain some aspects of their cultural and religious orientations.
The Implication of Cultural and Religious Orientation in Healthcare
The implication of cultural and religious orientation in the healthcare sector initiates complexities in the nature of service delivery. According to Betancourt, Green, and Carrillo (2002), complexities occasion because while doctors attend to patients with professionalism some elements deemed fine with some communities might be offensive to others. The essence of cultural competence has increased in the present society because of its emphasis on the challenges experienced by health care practitioners. In the process of delivering services, medical practitioners interact with patients, who come from various communities. These individuals have values associated with their culture and religion. Failure to respect or understand these values leads to complexity in service delivery and affects the overall process of treatment. Therefore, cultural competence is very important in advancing the quality of treatment provided by the healthcare sector.
The dynamics demonstrated by modern societies has compelled the health care sector to introduce the concept of cultural competence in the quest to advance the quality of services delivered by healthcare practitioners. Fundamentally, by incorporating the concept into the sector, patients enjoy an advanced quality of health care. Since cultural competence focuses on understanding the various orientations demonstrated by diverse communities and patients, the quality of healthcare advances. Maddalena (2009) highlights that when healthcare practitioners understand the values, lifestyles, and beliefs, which are core in a particular society they deliver services in a manner that is not offensive to them. Additionally, healthcare practitioners undertake the services professionally and communicate with patients from the respective communities in a wise manner. Choice of words, verbal and non-verbal communication will focus on aspects that are not offensive to the communities in relation to their cultural, ethnic, and religious values.
Principally, patients feel respected and participate in the healing process if the practitioners demonstrate assertiveness in the nature of service delivery. When practitioners respect the values of the patients concerning their culture, lifestyle, and religion, patients enjoy the treatment that they receive, and in turn, take part in ensuring that they recover. In cases where the healthcare practitioners fail to respect the values, which are core to a given community, patients dislike the treatment offered by the practitioners and the center. It is vital to explain that when patients dislike the treatment services provided by a given center, the process of service delivery become challenging. The challenge transpires because of the dissatisfaction that emanates from failure to understand and respect the diversity presented by patients from the respective communities. Lehman, Fenza, and Smith (2010) explain that good relationship with patients in relation to their culture and lifestyle is one of the crucial aspects that boost the process of service delivery in healthcare. Therefore, before delivering treatment services, practitioners who undertake their activities in communities, which have diverse cultures need to understand their religious, cultural, ethnic, and educational inclinations.
Cultural competency in health care is arguably more relevant now in relation to the previous times. For instance, in the US, the number of immigrants continues to increase, especially those from non-English-speaking countries. Additionally, studies such as Feagin and Bennefield’s (2014) work among others have indicated that religious and ethnic discrimination exists in healthcare. Feagin and Bennefield (2014) provide evidence of the presence of systemic racism in health care. Such racial discrimination in health care affects service delivery. It often disadvantages Americans of color. Unequal distribution of resources that is founded on religious and cultural differences is one of the major symptoms of the racist nature of the US. This phenomenon has been replicated in the global health care sector. Health care facilities in predominantly non-White communities are more likely to lack basic equipment and qualified personnel compared to facilities found within the white neighborhoods (Kershaw, Albrecht, & Carnethon, 2013). Feagin and Bennefield (2014) reveal how consistent discriminatory health care policies are the major cause of systemic religion and ethnic-based racism in healthcare facilities.
Therefore, cultural competency may be used to reverse the effects of systemic racism in health care. According to Perez and Luquis (2013), cultural competency enables healthcare workers to view treatment through the eyes of others, irrespective of their educational, ethnic, and religious backgrounds. This change of outlook may effectively negate the impact of bigotry in health care. Perez and Luquis (2013) propose the introduction of enlightening competency courses in nursing and medical schools as a way of promoting early awareness of intellectual proficiency. Saha et al. (2013) have also established a close connection between cultural competency and the quality of healthcare accorded to HIV patients depending on their race and religion. The research by Saha et al. (2013) indicates that health care quality for HIV patients is accorded based on the individual’s race, education, religion, or ethnicity where service providers possess low cultural competency skills. In contrast, among providers with high cultural competency, the service afforded to patients does not indicate any racial disparities (Saha et al., 2013).
The recent upsurge of worldwide immigration in the recent decades has also posed a unique challenge in health care (Renzaho, Romios, Crock, & Sonderlund, 2013). The impact has been that both the workforce and the client base have become ethnically diverse. Healthcare delivery in this new climate is faced by numerous challenges associated with cultural and religious diversity. Perhaps the most notable of these challenges are communication barriers and disregard of civilization differences. Cultural diversity between the provider and the client has the ability to influence the quality of healthcare because providers are human beings who have their values that are subject to prejudices. Additionally, the challenge of language barrier can be overwhelming to both the service provider and the client. Failure to appreciate the differences in cultural perspectives between immigrants and locals, including how they inform service delivery, is by itself a problem.
Addressing the Problem using Cultural Competency Models
More recently, healthcare has adopted cultural competence models in a bid to achieve a culturally sensitive treatment, especially in areas with minorities (Huey, Tilley, Jones, & Smith, 2014). As such, the social-cultural aspect is considered a priority for healthcare workers who wish to promote treatment success for their ethnic minority clients. According to Huey et al. (2014), these models primarily focus on cultural competence on the part of the practitioner as opposed to the institution level. Huey et al. (2014) have grouped the models into three categories, namely, therapists’ attributes, treatment characteristics, and therapeutic process. Regarding therapist characteristics, Huey et al. (2014) address the issue of cultural awareness on the part of the healthcare worker. The success of this model depends on the clinician’s ability to interact and evaluate the needs of the clients, taking into account their ethnic, education, and religious background.
Huey et al. (2014) refer to this model as the skill-based framework. According to the skill-based framework, a culturally competent healthcare worker possesses three characteristics. First, counselors are aware of their presumptions, biases, and individual values (Truong, Paradies, & Priest, 2014). Secondly, practitioners understand the outlook of their culturally different client. Thirdly, they have the ability to establish culturally sound interventions that will suit the client’s perspective (Saha et al., 2013). The second category, namely, adaptation model, is dependent on the treatment characteristics. This category of models is designed to modify service delivery to suit the client’s cultural needs. Hence, the models take care of the patient’s religious, ethnic, and even educational standing. Modifications may include the language used, the healthcare worker assigned to the client, and treatment methods (Huey et al., 2014). The adaptation model was deployed to administer therapy on Puerto Rican youths where the results showed a considerable symptom improvement when compared to the traditional wait-list (Huey et al., 2014).
Cultural modifications may be categorized into either ‘surface’ or ‘deep’. Surface structure modifications focus on the superficial characteristics such as the client’s native language. On the other hand, deep structure interventions target the clients’ cultural values that influence the way they view the disease etiology or treatment. A typical example of this intervention is the integration of common beliefs regarding the disease into the client’s therapy sessions (Huey et al., 2014). Recent adaptation models are more specific to the existing problem. Therefore, they are only applied where evidence shows that the existing evidence-based treatment (EBT) may not work for patients from a particular cultural or religious group.
The third category, process-oriented models, primarily focuses on the client-therapist interactions. Process-oriented models evaluate cultural meanings on a particular treatment. According to Huey et al. (2014), therapists’ proficiency is measured based on their ability to differentiate the cultural perspectives of clients from different backgrounds. By evaluating the client’s perspective, a therapist is in a position to better the treatment process. Therefore, process models emphasize the need for therapists to modify treatment in the context of the therapists and clients’ experiences. However, process-oriented models are rarely used in health care.
It is impossible for one healthcare practitioner to understand the cultural diversity of all of his or her immigrant patients. However, certain cultural competency models such as the process-oriented frameworks allow an easy integration of the patient’s cultural perspective into the treatment. The ease of application allows a provider to customize treatment to suit the patient’s ethnic or religious affiliations. Patient-centered care is another approach that enables providers to offer culturally sensitive treatments without experiencing much difficulty (Renzaho et al., 2013). This structure is designed to allow the health practitioner to strike and maintain a relationship that enhances effective treatment. The National Center for Cultural Competence (NCCC) recommends health care institutions to devise a set of values and policies that will foster a cross-cultural climate in these institutions (Renzaho et al., 2013).
A systemic cultural competency would be more effective compared to one that is primarily based on the skills of the individual provider. In this respect, patient-centered care resembles the adaptation models whose emphasis is placed on the nature of service extended to the client (Huey et al., 2014). However, patient-centered care is built around the appreciation that each patient has unique ethnic, education, and/or religious requirements that need to be addressed independently of the existing conceptions and trends. Renzaho et al. (2013) reveal how patient-centered care resulted in an improved patient recovery in certain healthcare settings.
The Role of Structural Competency in offering Culturally Sensitive Treatment
Studies show that culturally sensitive treatment assists patients in recovering (Huey et al., 2014; Renzaho et al., 2013). This observation dispels earlier claims that cultural capability does not affect the quality of treatment on the part of patients. The effectiveness of culturally proficient care will depend on many interrelated factors such as the existing policies and even the patient’s health status. Metzl and Hansen (2014) introduced the concept of structural competency, which they termed as the ability to discern these factors with the view of determining how they influence one another. Many seemingly unrelated factors such as urban laws and depression are closely connected. Structural competency enables a healthcare provider to evaluate the patients’ situation from an objective point. For instance, it would be difficult for a white nurse from a suburban area to understand why her black patient does not take medication with food as instructed. However, through structural competency, the same nurse may become aware that the patient is poor and that he or she may not afford adequate food.
Metzl and Hansen (2104) use the term ‘structure’ to refer to a wide array of factors that affect the relationship between healthcare providers and their clients. On one hand, the term is used to refer to infrastructural works such as buildings, water, energy networks, and roads to show their relationships with the health of the individual. The term is also used to refer to assumptions encompassed within language and attitude, which may promote or negate interaction among people, including the relationship between health care providers and clients. Volunteers have in the past made attempts to bridge the health gap in relationship to mental illnesses through building support networks (Metzl & Hansen, 2014). This move indicates a common understanding that health is greatly influenced by infrastructure other than healthcare facilities. Political lobbyists have always connected healthcare with social justice. Hansen and Dugan (2013) found that most medical schools do not engage their students in cultural awareness as part of the curriculum. Practitioners need to appreciate that structures that affect health are subject to religious, educational, financial, and legal policies. Hence, a certain degree of intervention may help to mitigate the current situation. Practitioners should consider themselves agents of change who are expected to bring forth a degree of self-drive and accountability.
Conclusion
The world of health care has become increasingly diverse in the wake of the widespread immigrations. This situation has brought with it several challenges such as language, religious, and cultural differences between health practitioners and patients. Policymakers and researchers recognize that cultural mismatch often affects the quality of health care. In the light of this awareness, various cultural competency models have been designed to promote the client-practitioner relationship as a way of promoting quality health care. Additionally, health institutions are being encouraged to adopt a more patient-centered care approach in disseminating their services.
Reference List
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