Challenges, Barriers and Enablers for Cultural Competence in Health Care - Essay Example

CRITICAL ANALYSIS OF CHALLENGES, BARRIERS AND ENABLERS FOR CULTURAL COMPETENCE IN HEALTH CARE Critical Analysis of Challenges, Barriers and Enablers for Cultural Competence in Health Care Author Author’s Affiliation Date There has been an upsurge in cultural differences on the national level due to which the healthcare organizations, policy developers and healthcare service providers have encountered a number of new challenges and barriers in the way of providing good healthcare facilities. With a lot of cultural differences, the need for providing culturally skilled healthcare services is aroused and then another important area emerged out of it. From providing the people with an access to the quality health care services, the cultural competence has appeared lately. Meanwhile, it is an evolving arena, there is a lot of research dedicated to explaining and apply this approach in a cross cultural healthcare environment[Bet05]. Though, the requirement of this field is well explained and thoroughly researched, but there are a lot of challenges and barriers to cultural competence in practice that must be addressed. The purpose of this essay is to critically analyze one of the main challenges, barriers and enablers for cultural competence in health care when working in a cross-cultural environment. The term ‘Cultural Competence’ can be defined from the health care perspective as, “…the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs…”[Jos02]. The definition posits the major issues in the way of cultural competence that must be handled by the healthcare providers for better health care services, such as to cope with the differences of values, beliefs, language, and attitudes. As the culture is a set of these values, beliefs, languages, and behaviors, where the people are majorly different on these bases. So, to be a cultural competent, it is important to manage these differences, especially in the healthcare in which human interactions happen quite intimately affecting on the patient’s health and recovery as argued by (Betancourt, Green, & Carrillo, 2002). There are some important challenges faced by cultural competence as discussed in the literature. The major challenges to the healthcare providers are explained by [Cam02], where it is argued that the world has seen alterations in the demographics and it has become a multicultural world, where the people have lasting differences in the health situations with respect to the different cultural and ethnic environments. These challenges have made the cultural competence to be a main concern, where the main barriers for cultural competence can be identified in the literature, which include; the biasness, cultural and language differences[Sin09]. In addition to these barriers, some other barriers are discussed by [Leh08] in their paper regarding the cultural diversity and cultural competency in health care setting, where it is argued that the health care provider’s cultural beliefs, behaviors, attitudes, and rituals can affect the cultural competency in the health care organization, as well as the residents, organization, family and community differences can also be major challenges for the cultural competency[Leh08]. The health care provider can have different beliefs, attitudes, and rituals that result in stereotyping, omnipotent regarding technology or any special kind of treatment or illnesses, disrespecting the opposite beliefs, not meeting the expectations, and miscommunications. These barriers are mainly based on the cultural differences, and so can be counted in the cultural barriers. While the residents, organization, family, and community differences are mainly based on the language differences[Wit95] as well as cultural differences, where the poor communication and lack of knowledge of different languages from these sides can be a challenge for a culturally competent health care provider[Nai94]. Thus, there are three major barriers, interlinked with each other, which can be quite challenging for cultural competency in the cross-cultural working environment; biasness, cultural differences, and language differences, as identified by the literature. Among the barriers of the cultural competence, Biasness can be a major barrier for the cultural competence, where the healthcare provider can be a cultural competent but become biased while interacting with people from some specific cultural backgrounds. This barrier is explored well in the literature, where, according to [Joh04], the health care provider can be biased in the patient treatment due to his different ethnicity and race, or the patient can also have biased perceptions about the treatment of health provider due to his race and ethnicity difference. Furthermore, it is also argued in the literature that the biasness is not much discussed for the cultural and ethnic differences effects on cultural competency, but it can be an appropriate explanation for these differences, as it is important to discuss this barrier separately from different perspectives[Sow03]. Thus, biasness can be a hurdle in the way of cultural competency, where the provider can be biased in communications with the patients and also in taking some important medical decisions. Another important barrier is the Cultural differences, where the healthcare providers fail to cope with these differences by miscommunicating and not tailoring the patients’ requirements according to the cultural context. In case when providers do not consider the patients' values, beliefs, and the perceptions regarding the disease and treatment. This can be a barrier for cultural competency, as (Betancourt, Green, & Carrillo, 2002) have stated in their report, “…the core of both cultural competency and patient-centered care emphasizes unconditional respect for the patient as an individual, in which a rapport is developed through consideration of the patient's beliefs, values, and meaning of illness…” (p. 5). In addition, the lack of effective communication among the patients and healthcare providers from different cultural contexts can lead towards the culturally incompetent (Betancourt, Green, & Carrillo, 2002). The communication is also affected by the patients’ perceptions based on its specific culture. In line with this argument, it can also be asserted that patients’ perceptions regarding the disease, doctors, and other healthcare providers are developed in context of their culture, and the cultural differences can have negative impacts on the treatment and result of that treatment. For instance, as [Rob99] have argued that the western drugs have a different scientific base, however there are some native Americans who have belief that good health can be attained with the help of spirituality[Rob99]. Thus, the differences in the perceptions, beliefs regarding the causality, analysis and dealing with illness the or in other words the cultural context can be a barrier to cultural competency. The healthcare providers can break this barrier and become culturally competent with the effective communication, but in order to effectively communicate with the different cultured people, the major barrier is the language difference. Language difference is one of the main barrier that must be cope for cultural competency, as it is the main requirement for effective cross-cultural communication in the interaction of the provider and patient[Sch02]. Furthermore, Bowen (2001) has conducted a research over the language barriers in access to the healthcare services, where it is argued that the healthcare organizations or providers face more service utilization when they have more language fluency. In addition to this, it is also contended that the language barriers as well as communication barriers have their effects on the disease analysis and conduct, which in result affect the cultural competency[Bow01]. Language differences can be the biggest hurdle, where these differences in languages as well as gestures and motions in non-verbal communication have their effects on the patient and provider interactions. As stated by Hayes (2010) that “…Speaking different languages or using different non-verbal expressions or cues can lead to communication barriers that may impact the service being provided…” (p. 12). While in order to address these barriers, there is a need for high cooperation among the healthcare provider, the organization, and the patients. The lack of this cooperation between these entities can be a major barrier for the cultural competency[Rob07]. Furthermore, Hayes (2010) has argued that these language barriers can encounter the providers with a number of challenges, where the exact analysis of the disease cannot be made, the explanation regarding the consent and care options can be negatively affected, or persuading a patient for a different kind of treatment that he does not understand[Max10]. Thus, for culturally competent, these language and cultural barriers must be overcome at every point where the patients and provider interactions happen, and for that purpose, there is need better cooperation among the whole organization, staff and patients. There are some enablers for the cultural competency that must be used when working in a cross cultural environment. For overcoming these barriers, there must be proper training and development programs for the healthcare providers, where the training must be given for better interactions and communication. Especially for overcoming the most important barrier of language differences, the provider must be fluent in the primary language of that specific area, and then they can use interpreters for the secondary language people, as suggested by [Pér97]. In the same way, Hayes (2010) has suggested that the use of qualified health interpreters has positive effects on the whole procedure of health care, especially, when the prevention is being used for patient or other patient treatments[Max10]. Many researches have indicated that the interpreters can play a great role in enabling a cultural competency, and among these, some findings by [Bak96] have suggested that the patients who do not have much excellence in the primary language were about 87% that feel the requirement of an interpreter in their provider patient interaction. [Bak96] further argued that there is usually lack of training among these interpreters that has negative effects on the cultural competency and patient provider interactions. Thus, there must be proper training sessions and programs for these, and such formal training can enable them to overcome the language differences barrier[Flo00]. Another very important enabler is the cultural awareness, or in other words, the cultural knowledge, where the providers must have knowledge about the cultures of different people. The knowledge of cultures can make better communication and interaction with the patients based on their specific cultural context as argued by [Sow96]. In addition, the healthcare provider must not use their own culture as a benchmark for evaluating and learning about other cultures[Sow96]. This may lead towards the biasness which is also another barrier for the cultural competency, thus the self-superior concept should not be adopted, and rather every culture must be given a respectful place. Furthermore, [Leo00] have suggested that the cultural awareness is the heart of the cultural competency, where the awareness of one’s own and other culture can lead towards the better care services to the patients and their families. Patient-centered care can also be provided for enabling the cultural competency. The patient centered care means the delivery of care and healthcare services as according to the patient needs and requirements. This can be achieved by evaluating and resolving the cross cultural problems, finding out the meanings and perceptions of the disease in the patient context, knowing the patients’ social context and involving in the intercession with the patient to support the observance[Sol01]. Moreover, [Leh08] also suggested the enablers for the cultural competency, where the cultural awareness, training and education, appropriate leadership, and community outreach are the main enablers for cultural competency. Also the cooperation between the organization, health care providers, and the patients are also needed, along with the proper leadership. In conclusion, it can be said that the cultural competency is crucial for the cross cultural working environment in health care, while it faces some challenges and barriers, such as biasness, language differences, and culture differences, which can be overcome by leadership, cultural awareness, use of interpreters, and training. 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