No abstract

Pharmacists are caring for more individuals of diverse age, gender, race, ethnicity, socioeconomic status, religion, sexual orientation, and health beliefs than in previous decades. Not all residents of the United States equally experience long life spans and good health. Health disparities in various cultures have been documented. One critical aspect of reducing health disparities is moving health care providers, staff, administrators, and practices toward increased cultural competence and proficiency. Effective delivery of culturally and linguistically appropriate service in cross-cultural settings is identified as cultural competence. Culture is a dynamic process, with people moving in and out of various cultures throughout their lives. The failure to understand and respect individuals and their cultures could impede pharmaceutical care. Incongruent beliefs and expectations between the patient and pharmacist could lead to misunderstandings, confusion, and ultimately to drug misadventures. Models and frameworks have been developed that provide descriptions of the process by which individuals, practice settings, and organizations can become culturally competent and proficient. This article, the first in a five-part series, presents an overview of issues related to cultural competence in health care with an emphasis on the pharmacy profession. Also provided are definitions for cultural competence and related terms, a brief overview of health disparities and challenges to the common morality, and a discussion of models and frameworks that describe pathways to cultural competence and proficiency.

Partnerships were established with the University of Arizona's Healthcare Partnership to train promotores--Spanish-speaking community health workers--as tobacco cessation counselors. Tobacco Free El Paso certified promotores to help identify tobacco users and offer tobacco cessation counseling services. The project certified 89 participants, of whom 95% were promotores; 88% were Hispanic/Latino, 67% were females, and 62% indicated Spanish as their primary language. Participants who completed Técnicas Básicas, Treatment Specialist, and Déjate de ese Vicio certifications significantly increased self-confidence levels to deliver brief smoking cessation interventions (P < .05). Satisfaction scores (scale = 1-5) were also relatively high for each certification (Técnicas Básicas, mean = 4.8; Treatment Specialist, mean = 4.7; Déjate de ese Vicio, mean = 4.6). The results suggest that promotores understood the concepts and methodologies presented.

As the United States becomes more diverse, a patient's cultural influences on health outcomes and health care decision-making and delivery need to be considered. Cultural influences affect a patient's decision to take drug therapy and concomitant alternative therapies. Seven components have been identified to improve culturally competent care in a variety of practice sites. The first component to developing culturally competent practices involves the analysis of self and system attitudes and practices toward various cultures. In the second component, health care providers should increase their knowledge about the cultures they serve through different patient assessment techniques, readings, and community activities. The third component involves improving crosscultural communication by being aware of differences in social norms, assessing health literacy, using interpreters, knowing another language, and using bilingual patient education materials. In the fourth component, pharmaceutical care plans should accommodate cultural preferences such as the use of herbs, spiritual healers, and additional family decision-makers. Therapeutic plans should be negotiated between patient and provider to optimize outcomes. The fifth component discusses health care provider and system involvement in the community through health fairs, ethnic festival participation, and communication with cultural decision-makers to help provide culturally competent care by fostering communication ties. In the sixth component, knowing and following regulations such as the federal Culturally and Linguistically Appropriate Services and the Joint Commission standards for organizational cultural competency can help enhance care for patients from various cultures. In the last component, quality assurance assessments of procedures to improve care for various diverse cultures should be conducted, with findings (in terms of strengths and areas of improvements) shared with other providers and systems. Pharmacists and pharmacy technicians in a variety of systems and practices can improve care to patients with differing cultures by using these seven components to enhance culturally competent care.