Access to primary care has been a long-standing concern among culturally diverse communities. In 2017 in New Jersey, overall, 79.2 percent of adults had a personal doctor or healthcare provider; however, this access varied among racial and ethnic groups with Hispanics, Blacks and Asians having considerably less access to a personal provider (65.2 percent, 78.2 percent and 77.6 percent, respectively) compared to Whites (84.2 percent). The Healthy New Jersey 2020 goal is to have our primary care providers reach 90 percent of our residents.1
Certainly, access to healthcare services should be available to everyone, regardless of income, education, age, racial or ethnic group, sexual orientation, religion or any other defining factors. However, one significant barrier to healthcare access is lack of cultural awareness, sensitivity and communication from the healthcare provider. Patients who are culturally or linguistically different have worse health outcomes and difficulty following medical advice and are less satisfied with their healthcare experiences than patients who do not have communication barriers.2
This issue is of particular importance in NJ where one-fifth of our residents are foreign-born and nearly one-third speak a language other than English at home. Of those, only 60 percent feel they speak English very well.3 Diverse populations bring different attitudes, expectations, beliefs and communication styles to each health encounter. Therefore, to be successful, health professionals must be sensitive to these complex issues.
Use Effective Culturally And Linguistically Appropriate Communication
Improving cultural and linguistic appropriateness is not a one-time learning experience, but an ongoing journey. It is important to know your patients’ diverse backgrounds, language preferences, cultural identities and perceptions of health and illness. Then, with culturally and linguistically appropriate communications, you can build the kind of trust that facilitates patient empowerment of self-managed care.4, 5, 6
To improve access to healthcare, the U.S. Department of Health and Human Services (HHS) Office of Minority Health developed the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. The Guide to Providing Effective Communication and Language Assistance Services is the tool grounded in these standards that provides detailed direction on culturally and linguistically appropriate communication and services. This guide can be found on the U.S. Department of Health & Human Services, Think Cultural Health website at https://hclsig.thinkculturalhealth.hhs.gov.
Below are a few strategies from this Guide to remember when caring for your culturally diverse or communication-needs patients:
- Know your patients’ language preferences. With an awareness of language differences in verbal and written communication, you can become a more effective communicator with patients who have limited English proficiency (LEP).
- Use language assistance services. Individuals with communication needs include those with LEP and those who are deaf or hard of hearing. Communication errors, such as prescription labels written in English given to non-English-speaking patients, can have negative and even life-threatening consequences. Examples of language assistance services include interpretation of oral communication and translation of written documents, signage and symbols for wayfinding. These services should be provided to patients at no cost
- Use culturally appropriate nonverbal cues. An awareness of cultural differences in nonverbal communication contributes to effective communication. Following the patient’s lead, use culturally appropriate nonverbal cues, such as gestures, facial expressions, eye contact and body language that show you are interested in what the patient has to say.7, 8
- Use effective written communication. Your written communications should use plain language that is easily understood by the patient the first time it is read. This will ensure that all patients, despite various literacy and health literacy levels, can understand the content. Many important materials need to be available in multiple languages, depending upon your patient population. It is also very important to use written symbols, such as letters and numbers, as well as pictures and graphics.9
Effective communication and language assistance services help you do your job more successfully because they help you fully understand your patients’ health conditions. These services also ensure that your patients can follow your health recommendations and therefore, rate their care as satisfactory.10, 11, 12, 13
Resource For Diversity Information
The U.S. Department of Health and Human Services has developed a useful electronic learning program entitled Think Cultural Health for physicians, physician assistants and nurse practitioners.
This program offers many resources, including videos, toolkits and fact sheets, for further information about health disparities, health equity and health resources in other languages.
The resource is available on the HHS website at https://cccm.thinkculturalhealth.hhs.gov.
As a physician and the Commissioner of the Department of Health and as the Executive Director of the New Jersey Office of Minority and Multicultural Health, we want residents to get the care they need to stay healthy; for that to happen, they need healthcare that takes into consideration their cultural backgrounds. We hope you will take time to refresh your cultural competency skills and those of your staff. Culturally competent health workers not only respect cultural differences but also incorporate them into the entire patient-care and program-planning process. To improve health outcomes for all residents, we need to ensure we are advancing cultural and linguistic sensitivity and health literacy across the state.
Amanda Medina-Forrester, MA, MPH, is the Executive Director of the New Jersey Office of Minority and Multicultural Health. Shereef Elnahal, MD, MBA, is the Commissioner of the New Jersey Department of Health.