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Enhancing the cultural competence of both clinicians and clinics may work synergistically to reduce care disparities

Culturally competent clinicians are more likely to understand and respect the language, values, and beliefs of diverse racial and ethnic groups, and to have the attitude and skills to care for them in a way that communicates that respect and understanding. A new study is the first to link provider cultural competence with the cultural competence of the clinics where they work.

Researchers found that culturally competent clinicians are more likely to work in clinics with a higher percentage of nonwhite staff and those offering cultural diversity training and culturally adapted patient education materials. Thus, enhancing the cultural competence of both clinicians and clinics may be a synergistic approach to reducing health care disparities, suggest the Johns Hopkins University researchers. They surveyed 49 providers from 23 clinics in Baltimore, Maryland, and Wilmington, Delaware. The survey included items assessing provider and clinic cultural competence in the areas of attitudes, self-reported behavior, and knowledge. Providers were more apt to be very confident in caring for ethnic minorities (55 percent) than in providing care to disadvantaged patients (37 percent).

Providers who reported a higher percentage of staff who were black, Hispanic, Asian, or another racial/ethnic group in their clinics and availability of culturally and linguistically tailored patient education materials had more culturally competent attitudes and increased frequency of self-reported culturally competent behaviors than their counterparts in other clinics. For example, they were more likely to strongly agree that they were motivated to learn about cultures within their practice and society, and were more neutral about statements of white advantage in society or the need for conformity to white customs and values. They also reported seeking culture-related information and feedback about their cross-cultural interaction skills 26 to 50 percent of the time and adapting care to patients' cultural and social situation 51 to 75 percent of the time.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13645).

See "Provider and clinic cultural competence in a primary care setting," by Kathryn A. Paez, R.N., M.S.N., M.B.A., Jerilyn K. Allen, Sc.D., R.N., F.A.A.N., Kathryn A. Carson, Sc.M., and Lisa A. Cooper, M.D., M.P.H., in the March 2008 Social Science & Medicine 66, pp. 1204-1216.

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