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3. acquire and incorporate cultural knowledge into their interventions and interactions, and to develop multicultural skills;
4. adapt to diversity and to the cultural contexts of their clients, and
5. value diversity
It is important to understand the community demographic and to seek cultural insight through literature and training.
Equally critical is being aware of disparities and taking action in individual practice and interaction with patients. The HCP’s
understanding of their racial/ethnic minority patients can be enhanced through educational programs and the use of tools
designed to refine interactions between the HCP and the community that they serve.
Cultural Competence and the HCP/Patient Relationship
Experts on the impact of multiculturalism in psychology, such as Dr. Lillian Comas-Díaz, author of
Multicultural care: A
clinician’s guide to cultural competence
(2012), teach that cultural competence involves commitment to gaining knowledge
and awareness of the patient’s perspective enabling the HCP to intellectually empathize and demonstrate cultural
sensitivity.
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In Comas-Diaz’s book (Multicultural care, 2012) the explanatory model of distress (EM) is presented as a
culturally relevant tool that creates an opportunity for patients to provide personal explanations of their health beliefs to aid
HCPs with understanding how they “make sense of their illness and their experiences” to promote a collaborative clinical
experience, improve outcomes, and increase patient satisfaction.
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The first explanatory model was devised by Dr. Arthur Kleinman and involved asking open-ended questions through an
exploratory process. He recommended an approach that answered the questions:
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• What do you call the problem?
• What do you think has caused the problem?
• Why do you think it started when it did?
• What do you think the sickness does? How does it work?
• How severe is the sickness? Will it have a long or short course?
• What kind of treatment do you think the patient should receive?
• What are the chief problems the sickness has caused?
• What do you fear most about the sickness?
EMs can be used alone or as a complement to techniques as a means to essentially provide the most appropriate patient
education and negotiate a treatment plan that will be acceptable and effective for the patient to follow.
Although the goal is to obtain a transparent view of the patient’s reality, it often proves to be a challenging endeavor if
the encounter is not approached with authenticity by the HCP. As such, when asking questions the HCP should seek to
appreciate the patient’s perceptions rather than solely focusing on diagnosis and treatment.
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To do this Comas-Diaz offers
preparing for interactions with multicultural patients by using Pamela Hays’s ADDRESSING self-assessment.
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Hays’s
ADDRESSING self-assessment is a mnemonic tool for examining one’s own biases and influences that include:
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• Age and generational influences
• Developmental disabilities
• Disabilities acquired later in life
• Religion and spirituality
• Ethnic and racial identity
• Socioeconomic status
• Sexual orientation