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Overview

Culture—including customs, beliefs, and values—can influence how people understand health concepts, how they take care of their health, and how they receive medical advice and make health decisions. People can be part of more than one culture, based on their racial, ethnic, religious, political, gender, or sexual identity, as well as their age, family composition, what language they speak, where they were born, where they live, what their occupation is, and other factors. Clinicians can learn to develop treatment plans with patients that are consistent with and respectful of their cultures.

Actions

Learn from patients.

• Respectfully ask patients about their health beliefs and customs and note their responses in their medical records. Address patients' cultural values specifically in the context of their healthcare. For example:
  • "I would like to be respectful—what do you like to be called and what pronouns do you use?"
  • "Tell me about things that are important to you. What should I know that would help us work together on your health?"
  • "Lots of people visit providers outside the clinic. Who else do you visit about your health?"
  • "Tell me about the foods you eat at home so we can develop a plan together to help you reach your goal of losing weight."
  • "Your condition is very serious. Some people like to know everything that is going on with their illness, whereas others may want to know what is most important but not necessarily all the details. How much do you want to know? Is there anyone else you would like me to talk to about your condition?"
  • "What do you call your problem? What do you think caused it? How do you think it should be treated?"
• Do not stereotype. Understand that each person is an individual and may or may not adhere to certain cultural beliefs or practices common in his or her culture. Do not make assumptions based on group affiliations or how people look or sound. Asking patients themselves is the best way to be sure you know how their culture may impact their care.

Learn from other sources.

High-quality online resources provide education on how to provide culturally appropriate services.

• Courses and websites
  • Think Cultural Health offers several for free continuing education credit, as well as fact sheets on ways to improve care for diverse populations.
  • The Centers for Disease Control and Prevention (CDC) offers free continuing education credit for .
  • The offers educational programs, toolkits, training videos, and over 50 webinars that provide continuing education credit.
  • contains information about cultural beliefs, medical issues, and other related issues pertinent to the healthcare of recent immigrants.
• Community organizations such as religious institutions and cultural organizations often can provide information and support to help make your practice more "culture-friendly."
  • Invite a member of a relevant cultural group to attend a staff meeting and share observations about how their culture may impact healthcare.
  • Invite an expert to conduct an inservice training to educate staff on how to deliver culturally appropriate services.
  • Build ongoing relationships with leaders in the community who can serve as cultural brokers.
• Integrate cross-cultural skills into orientation and other trainings. In addition to training dedicated to improving cross-cultural skills, you can weave those skills into all training activities.

Help staff learn from each other.

To increase understanding about cultural diversity:

• Hire clinical and other staff who reflect the demographics of your patient population. They can help contribute to creating a comfortable environment for patients and can share insights with others in the practice regarding the customs of their cultural groups.
• Have staff take cross-cultural skills trainings and set aside time for them to share what they learned.

Practice cultural humility.

• Reflect on your own values, beliefs, and cultural heritage; how that affects your personal health practices; and how you interact with the healthcare system.
• Analyze the ways the dominant and medical cultures shape how your practice delivers healthcare and consider changes to make it more inclusive of the patient populations you serve.
• Do not make assumptions. You cannot tell a person’s race, ethnicity, gender, or other cultural identities by looking at them. Treat everyone as an individual and ask people to tell you about themselves.
• Reduce the power differential between healthcare professionals and patients by: 
  • Being humble and respectful. 
  • Recognizing patients’ expertise about themselves and what they want for their health.
  • Adopting a more open, less authoritarian style. 
• Commit to being a lifelong learner who values diversity and seeks to make healthcare more equitable.

Track Your Progress

Before implementing this Tool, count the number of staff members who have completed a cultural competence training session. Repeat after 2, 6, and 12 months.

On a regular basis, randomly select some medical records and see what percentage have notes on the patient's culture, customs, or health beliefs.

Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions. 

Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.