Viewpoint: Cultural Competence and the African American Experience with Health Care: The Case for Specific Content in Cross-Cultural Education

Abstract

Achieving cultural competence in the care of a patient who is a member of an ethnic or racial minority is a multifaceted project involving specific cultural knowledge as well as more general skills and attitude adjustments to advance cross-cultural communication in the clinical encounter. Using the important example of the African American patient, the authors examine relevant historical and cultural information as it relates to providing culturally competent health care. The authors identify key influences, including the legacy of slavery, Jim Crow discrimination, the Tuskegee syphilis study, religion's interaction with health care, the use of home remedies, distrust, racial concordance and discordance, and health literacy. The authors propose that the awareness of specific information pertaining to ethnicity and race enhances cross-cultural communication and ways to improve the cultural competence of physicians and other health care providers by providing a historical and social context for illness in another culture. Cultural education, modular in nature, can be geared to the specific populations served by groups of physicians and provider organizations. Educational methods should include both information about relevant social group history as well as some experiential component to emotively communicate particular cultural needs. The authors describe particular techniques that help bridge the cross-cultural clinical communication gaps that are created by patients' mistrust, lack of cultural understanding, differing paradigms for illness, and health illiteracy.

Understanding the relationship between knowledge and African Americans’ donation decision-making

“…This fear of racism is a function of daily experiences of prejudice and discrimination as well as knowledge of a history of misuse by the medical community [52][53][54][55]. The Tuskegee syphilis study is often cited as a historical event that contributes to African Americans' distrust of the health care establishment [56][57][58][59][60]. It might be the case that this fear and distrust prevents many African Americans from getting necessary treatment, participating in medical research, signing living wills, and donating organs [51,[60][61][62][63][64][65][66].…”

Racial and Ethnic Disparities Among Individuals with Alzheimer’s Disease in the United States: A Literature Review

“…Strong religious beliefs, including the belief that Cognitively Impaired illnesses can be cured or are controlled by God, may lead to delayed or forgone care. Strong spirituality has been correlated with lower medication adherence and later-stage cancer diagnosis (Eiser & Ellis, 2010). Similarly, some elderly African Americans and other nonwhite patients are more likely to use traditional or herbal medicines instead of, before, or alongside allopathic medicines.…”

“…Many individuals and cultures perceive dementiarelated symptoms as a natural part of aging (Ayalon & Arean, 2004;Chow et al, 2002;Eiser & Ellis, 2010;Gelman, 2010;Gray, Jimenez, Cucciare, Tong, & Gallagher-Thompson, 2009;Jett, 2006). For example, Gray et al (2009) asked participants whether the following statement is true: "Significant loss of memory/mental ability, commonly known as senility, is a normal part of aging. "…”

“…Cultural influences on African Americans that may cause disparities in treatment or access to medical care include the legacies of slavery, Jim Crow laws, and the Tuskegee syphilis study; the influence of religious beliefs on care-seeking behaviours; the use of home remedies; distrust of the medical system; being of a different or the same race as one's medical provider; and health literacy (Eiser & Ellis, 2010). Strong religious beliefs, including the belief that Cognitively Impaired illnesses can be cured or are controlled by God, may lead to delayed or forgone care.…”

Cultural Competence in Action: “Lifting the Hood” on Four Case Studies in Medical Education

“…1 (Betancourt 2003(Betancourt , 2006Bromley and Braslow 2008;Crenshaw et al 2011;Eiser and Ellis 2007;Fung et al 2008;Green et al 2008;Guarnaccia and Rodriguez 1996;Hayes-Bautista 2003;Hershberger et al 2008; Kirmayer 2011Kirmayer , 2012aKripalani et al 2006;Kumaş-Tan et al 2007;Lié et al 2006;Lim and Lu 2008;Lo and Stacey 2008;Núñez 2000;Park et al 2006;Park et al 2009;Shapiro et al 2006;Smith et al 2007; South-Paul and Like 2008; Sue 1998Sue , 2003Sumpter and Carthon 2011;Teal and Street 2009;Tervalon 2003;Tervalon and Murray-Garcia 1998;Wachtler and Troein 2003;Wear 2003;Whitcomb 2003).…”