• Fitness & Health
• Sport & Exercise Science
• Physical Education
• Strength & Conditioning
• Sports Medicine
• Sport Management
• Dance

Seven cultural competence techniques to reduce health disparities

This is an excerpt from Patient-Centered Care in Sports Medicine by Rene R Shingles,Lorin A Cartwright.

The following seven cultural competence techniques, based on the ones originally suggested by Brach and Fraserirector (2000), could help reduce racial and ethnic health disparities:

1. Use of interpreter services
2. Recruitment and retention of staff members of color
3. Cultural competence and other diversity, equity, inclusion, and belonging (DEIB) training
4. Coordination with traditional healers
5. Inclusion of family and community members in decision making
6. Immersion into other cultures
7. Administrative and organizational accommodations

The techniques are discussed briefly in the following paragraphs.

• Use of interpreter services. As athletic trainers, learning to access and use interpreter services as well as health education material written in the patient’s primary language is important (Agency for Healthcare Research and Quality, 2020). Such services improve communication, which in turn helps providers gain a more thorough and accurate medical history and allows patients to better understand treatment regimens (Brancaleone & Shingles, 2015). Improved communication also helps patients navigate a health care system’s intake process, referral mechanism, and continuity of care (Betancourt et al., 2003). Interpreter services can also improve patient education and patients’ care-seeking behavior and demonstrates patient-centered care (Brach & Fraserirector, 2000). For a deeper discussion on interpreter services, see chapter 5.
• Recruitment and retention of staff members of color. The presence of athletic trainers from the patient’s racial or ethnic group can enable shared cultural understanding. Brach and Fraserirector (2000) suggest that shared group membership helps increase the quality of communication, rapport, and understanding of cultural nuances and reduces the chance of racial and ethnic discrimination (Agency for Healthcare Research and Quality, 2020). Some suggestions for recruitment and retention include the following: (1) establish scholarship, residency, and fellowship programs for People of Color, (2) hire search firms owned by People of Color, (3) expand affirmative action programs to recruit health care providers who match the racial and ethnic demographics of the patient population, (4) create a welcoming environment in which to work, (5) have senior executives mentor employees of color, (6) evaluate and compensate senior executives based on a process established to match hiring to community needs, and (7) assess employee satisfaction by racial and ethnic group (Brach & Fraserirector, 2000). Other recommendations from the Josiah Macy Jr. Foundation (2020) include (1) evaluating which practices and policies create barriers and cause attrition and which ones support success and retention, (2) retaining providers of color through the provision of pathways for advanced opportunities and promotion, and (3) creating pipeline programs and funding STEM-focused education for kindergarten through 12th grade students.
• Cultural competence and other diversity, equity, inclusion, and belonging (DEIB) training. Cultural competence training has been demonstrated to change physicians’ behavior and has also been found to be effective in improving knowledge, attitude, and skill in other health care providers (Beach et al., 2005; Brach & Fraserirector, 2000). As a result, cultural competence training should be a fundamental part of health care curricula and professional certification programs, as well as a requirement for administrators and executives (Josiah Macy Jr. Foundation, 2020). When included in continuing education, training should be specific to the health care provider and relevant to the patient population (Horner et al., 2004).
  Training may vary in scope and duration. For example, knowledge-based training may cover topics such as social determinants of health, prevalence and incidence of illness and disease, and definitions of DEIB terms. Attitude-based training helps clinicians become aware of their own biases, the impact of sociocultural factors on patients’ behaviors and values, and effects on patient outcomes. The focus of skill-building training may be to teach clinicians how to communicate effectively or use interpreters (Coronado, 2013).
  The Commission on Accreditation of Athletic Training Education (2020) is in the process of adding cultural competence, diversity, equity, and inclusion as standards to be included in the curriculum. However, more research is needed to determine whether cultural competence training affects patient outcomes other than satisfaction (Beach et al., 2005; Coronado, 2013).
• Coordination with traditional healers. Patients often do not tell their physicians or athletic trainers about their use of traditional healers. Brach and Fraserirector (2000, p. 199) suggest “expressing familiarity with cultural beliefs, folk illnesses, and traditional practices and open nonjudgmental questioning” may help patients overcome their reluctance to report the use of alternative or complementary practices. Athletic trainers should therefore be aware of traditional healers in the community and, where possible, develop referral networks and direct collaboration opportunities (Brach & Fraserirector, 2000; Carrese & Rhodes, 2000).
• Inclusion of family and community members in decision making. One of the dimensions of patient-centered care is the provision to include family and friends, particularly in decision making (Gerteis et al., 1993; Mead & Bower, 2000; Institute of Medicine, 2001). Family members can help support the patient as well as may play a particular role in the social organization of the family regarding health care decisions (Brach & Fraserirector, 2000, Carrese & Rhodes, 2000). Engaging family members may help improve communication and increase trust between the patient and provider (Brach & Fraserirector, 2000) and the patient and the health care organization (Fisher et al., 2018). For a deeper discussion on family engagement, see chapter 7.
• Immersion into other cultures. Brach and Fraserirector (2000) suggested immersion into other cultures might minimize ethnocentrism, help develop sensitivity, skills, and cultural awareness for working with other cultures. Similarly, Campinha-Bacote’s model (2020, 2022) of cultural competemility includes the concept of cultural encounters. Cultural encounters involve the health care provider directly participating in face-to-face cross-cultural engagements. The purpose is to modify one’s existing belief about different cultural groups, to prevent or minimize stereotyping.
• Administrative and organizational accommodations. Organization and administrative policies and procedures can “affect access to and utilization of health care” (Brach & Fraserirector, 2000, p. 187). Example policies include when the facility is open, the location of the facility, or the physical environment and whether space is welcoming. Thus, when health care systems collaborate with patients and empower patients and communities to participate in decisions affecting patients and patient care, they engage in patient-centered care (Santana et al., 2018). For a deeper discussion on patient-centered care in athletic training facilities, see Chapter 8.

Additionally, the Josiah Macy Jr. Foundation (2020) ultimately suggests four recommendations for reducing disparities in health care (p. 7):

1. Build an institutional culture of fairness, respect, and anti-racism by making diversity, equity, and inclusion top priorities
2. Develop, assess, and improve systems to mitigate harmful biases and eliminate racism and all other forms of discrimination
3. Integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination, racism, and all other forms of oppression
4. Increase the numbers of health professions students, trainees, faculty, and institutional administrators and leaders from marginalized and excluded populations.

For example, health organizations should identify processes, metrics, and strategic plans that promote a diverse, equitable, inclusive, and patient-centered environment. Additionally, health professions leaders should create, implement, and measure systems for reporting complaints of bias and discrimination and resolving the complaints. Because a diverse, equitable, inclusive (DEI) culture is linked to quality and safety, health care leaders should be held accountable for institutional performance related to DEI goals, outcomes, and indicators (Josiah Macy Jr. Foundation, 2020). In short,

We need to focus on systems change, on structural change. It is not enough to address discrimination when we see it. We need to replace a system that was designed to be unfair with a system that protects, respects, and values vulnerable patients, students, faculty, and others. If we want to build a socially responsible workforce, we all need to understand the deeply entrenched barriers that people face working, learning, and seeking care in our health system. (Josiah Macy Jr. Foundation, 2020, p. 6)

More Excerpts From Patient-Centered Care in Sports Medicine

---