There are many factors that influence patient care outcomes for people with chronic diseases. While both the patient and the healthcare provider can influence outcomes, the educator has the greater responsibility to affect change. They can do this by recognizing and respecting the values, traditions, and practices of the patients they serve.

Since the role of the health educator is one of a teacher, mentor, and coach, this role is best achieved when cultural differences are appropriately addressed. Empowering patients with knowledge within their cultural context may reduce their resistance to making healthy lifestyle changes and lead to healthier outcomes.  This process is particularly important in the management of diabetes, where significant health disparities exist among racially and ethnically diverse populations in America.

Dealing with cultural “issues”

An important consideration educators must explore in treating patients of different racial/ethnic groups is the cultural “issues” on the part of both the health care provider/educator and the patient.  In other words, “we all have issues.”  

Often, healthcare providers lack cultural competency, which hinders their ability to understand and respond effectively to the cultural needs of their patients and influence positive patient outcomes.  Examples of such barriers include false assumptions such as: 

• patients who do not practice healthy behaviors do not care about their health
• traditional beliefs should be changed rather than built upon through education. 

These barriers can motivate patients not to disclose the cultural issues influencing treatment for fear of being ridiculed or having their cultural beliefs discounted by health care providers.  Overall, this response is counterproductive to the self-management education process.

Here are 6 practical tips to get on track

1. Build trust and respect with patients of different racial or ethnic groups than your own.  Remember, patients may have inhibitions about asking questions of their healthcare provider due to language barriers or “respect” for them.  If possible, use an interpreter when needed.  Address patients as Mrs., Senora, or Mr., Senor, etc. particularly the elderly, in order to demonstrate respect your for them.  Instruct administrative and/or clinical assistants to do the same.
2. Remember that family is an important motivator for women. This is particularly true for African American and Hispanic American women. Include the patient’s family in decisions and encourage them to be supportive.
3. For patients who require nutritional changes, begin with portion control and calorie reduction within their cultural dietary choices. This displays a respect for the cultural influences on meals and can build patient trust in the educator.
4. Ask your patient how their spiritual or religious beliefs can be incorporated into their management plan. Inquire of local clergy or spiritual tribal leaders regarding support groups in the congregations or communities where patients reside. 
5. Encourage the use of cultural music and dance where appropriate as a means of engaging in enjoyable physical activity.  Keep in mind that some patients may perceive their outdoor environment as unsafe, therefore, recommend physical activity that can be accomplished indoors (walking up stairs or briskly around the house or apartment several times). 
6. Address potential fears or beliefs patients may have about the economic and social impact of their disease, particularly in low-income or immigrant populations.  Reassure them that any assistance provided free of charge will not require later payment.  Inform patients that having a diagnosis of a chronic disease does not negatively affect their immigration status.

Improving cultural competence enhances the educator’s relationship and communication with their patients.  Demonstrating a respect for patients’ values, traditions, and practices increases rapport and creates a fertile environment for improved health outcomes.

References:

Assuring Cultural Competence in Health Care: Recommendations for National Standards and An Outcomes-Focused Research Agenda.  Part One:  Recommendations for National Standards.  Office of Minority Health Public Health Services, DHHS. www.omhrc.gov/CLAS.

American Diabetes Association. Diabetes Statistics 2004. www.diabetes.org.

Amy Rogowski Drug Store News Fall 2003

The Provider’s Guide to Quality and Culture. Management Sciences for Health. Sponsored by: U.S. Department of Health and Human Services;  Health Resources and Services Administration and the Bureau of Primary Health Care; http://erc.msh.org

Lipton RB et al. Diabetes Educator 1998; 24: 67-71

Brown SA et al. Diabetes Care 2002; 25: 259-268

Liburd LC. Diabetes Spectrum 2003; 16: 160-165

Sisters Together Move More Eat Better. NIDDK, NIH Publication No 01-4903

CDC Diabetes Program: Seeing Faces, Hearing the Stories, Learning From Our Communities.

For more information on cultural issues and health, review The Provider’s Guide to Quality and Culture at http://erc.msh.org.