The cultural background of an individual has a significant impact on access and utilization of healthcare in the United States. There are significant disparities and inequities in health, associated with elements such as racism or structural cultural barriers within health organizations that are connected to poor health outcomes. Culture oftentimes defines the approach to health, affecting aspects such as the value of healthcare, relationships with providers, and compliance with treatment among other factors. Healthcare research and leadership has grown to recognize this impact in recent years leading to the importance of overcoming cultural barriers in healthcare management to ensure equitable and culturally competent approaches to healthcare among diverse populations.
The first major barrier in multicultural healthcare is language. Healthcare providers are caring for patients from diverse backgrounds, many of which have little to no proficiency in English. Language is important in every stage of healthcare provision including communicating patient complaints, providing treatment, investing the patient in the decision-making process, and ensuring comprehension and compliance post-treatment (Squires, 2018). From a healthcare management perspective, a range of communication strategies should be developed and implemented in cases that language barriers arise. Depending on location and populations served, providers can determine which languages are likely to arise. It is recommended to use a blended strategy of hiring medical interpreters or certified staff fluent in the language alongside digital tools to facilitate communication. Some eHealth applications and multimodal digital tools provide interpretations that can be helpful for patient communication and subsequent outcomes (Schouten et al., 2019). However, it is critical to use appropriate digital tools, not translation applications, and ensure all HIPPA regulations are followed in the process (Squires, 2018).
Another barrier that goes beyond language proficiency is cultural competency and comprehension. For example, Tackett et al. (2018) discuss how Muslim women have certain beliefs and approaches to healthcare such as modesty and privacy, family involvement, religious practices, and gender preference for providers. Similar and other expectations can be seen from a variety of other cultures and religions. Healthcare management approaches to this issue are to create culturally competent, client-centered systems in the provision of optimal healthcare. Embedding cultural competence within the healthcare system is possible with service-level policies and quality improvement strategies. These can include cultural competence activities and education, culturally appropriate services, consumer and family education, and other client-centered instruments (McCalman et al., 2017).
Finally, there is the issue of structural barriers such as access to healthcare or inadequate support for cultural minorities or immigrants. This issue ties in closely with the previous two, regarding language availability and cultural competence – factors that may strongly defer utilization of the healthcare system by cultural minorities if not present. Health management can make structural changes, particularly increasing network integration across levels of health behavior and employing community health workers who can be provided support to navigate community cultures to meet the needs of multicultural clients using appropriate health care structures (Palmer-Wackerly et al., 2019). Furthermore, taking into account the solutions to the first two issues, resources should be allocated for dispersal of information and to facilitate the integration of migrants and cultural minorities into the health care system and society, thus overcoming barriers to access to health services (Kuan et al., 2020).
It is evident that the healthcare system needs to adapt to serve the increasingly multicultural population in the U.S. There are numerous barriers including language, cultural competence, and structural access to health care which prevent or strongly discourage participation from cultural or ethnic minorities. It is important to apply the patient-centered approach emphasized by healthcare policies to all patients and develop appropriate services or tools to aid clinicians and providers in overcoming the cultural barriers to healthcare provision.
References
Kuan, A. S., Chen, T.-J., & Lee, W.-C. (2020). Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis. Journal of the Chinese Medical Association, 83(1), 95–101.
McCalman, J., Jongen, C., & Bainbridge, R. (2017). Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature. International Journal for Equity in Health, 16(1).
Palmer-Wackerly, A. L., Chaidez, V., Wayment, C., Baker, J., Adams, A., & Wheeler, L. A. (2019). Listening to the voices of community health workers: A multilevel, culture-centered approach to overcoming structural barriers in U.S. Latinx communities. Qualitative Health Research, 30(3), 423–436.
Squires, A. (2018). Strategies for overcoming language barriers in healthcare. Nursing Management (Springhouse), 49(4), 20–27.
Schouten, B. C., Cox, A., Duran, G., Kerremans, K., Banning, L. K., Lahdidioui, A., van den Muijsenbergh, M., Schinkel, S., Sungur, H., Suurmond, J., Zendedel, R., & Krystallidou, D. (2020). Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. Patient Education and Counseling.
Tackett, S., Young, J. H., Putman, S., Wiener, C., Deruggiero, K., & Bayram, J. D. (2018). Barriers to healthcare among Muslim women: A narrative review of the literature. Women’s Studies International Forum, 69, 190–194.