Cultural Competence in Healthcare

Abstract 

Cultural competence refers to the provision of health care services that focus on social, cultural, and linguistic considerations. Culture assessments facilitate cultural competency. The African American and Indian cultures display varying cultural values hence influencing healthcare interventions. The following paper analyses cultural aspects that affect cultural competence and tailor culturally competent interventions. The two cultures are assessed regarding communication, family roles and organization, biopsychosocial-cultural characters, nutrition, pregnancy and childbearing practices, death rituals, spirituality, health care practices, and healthcare practitioners. Cultural competence influences healthcare interventions in communication, uniqueness, religion, and spirituality among other factors.

Cultural Competence

Introduction 

Cultural competence refers to the provision of healthcare services by healthcare professionals by focusing on social, cultural and linguistic considerations (Murphy, 2011). Cultural power is mandatory in the field of healthcare owing to increased intercultural associations. A culturally competent healthcare provider develops knowledge, attitudes, and skills that facilitate the identification of health practices in line with a patient’s culture. Furthermore, cultural competence informs illness perception of both patient and healthcare provider (Murphy, 2011). Cultural assessment facilitates cultural competence in a significant way.

African Americans have a long history in Texas. African Americans are descendants of Africans that moved to the United States during the colonial era. African Americans in Texas have advocated for the equality of rights, leading to significant changes in the constitution to ensure equal protection of all people under the law, regardless of their race or ethnic background. This community makes up 12% of the overall population in Texas and contributes significantly to the state’s social and cultural heritage through music and sports (Dulaney, 2018). African Americans occupy two-thirds of North Texas, in the counties of Dallas and Fort-Worth.

On the other hand, the Indian community in Texas continues to increase, as Indians become the largest Asian population in the country. Indian people in Texas have doubled up with significant growth being witnessed in Collin, Dallas, Denton, Rockwall and Tarrant (Boardman, 2012). Indians influence the culture in Texas through Indian theatre, Indian restaurants and grocery stores (Boardman, 2012). Furthermore, the Indian sub-group of Caddos has a standing history in east Texas. Both Indians and African Americans portray varying cultures that inform cultural competence. A comparison of the two cultures using elements of developmental assessment depicts the cultural differences and their significance in healthcare provision.

Communication 

Communication is vital in healthcare provision. It should be direct and straightforward to allow a patient to fully comprehend healthcare provision (Eiser & Ellis, 2007). A nurse familiar with a patient’s culture is most preferred to communicate to the patient, as they relate culturally and understand the relevant social cues. African Americans’ primary dialect and language is known as African American Vernacular language, composed of sounds and sentence structures different from Standard English. Indians mostly speak Hindi as their central dialect.

Both communities value emotional display. African Americans believe that high emotion profoundly promotes authenticity (Elliott, 2007). Indians also use metaphors to display their emotions (Elliott, 2007). When it comes to nonverbal cues such as eye contact, African Americans maintain direct eye contact when speaking and lose the connection when listening. The case is different for Indians as direct eye contact is considered disrespectful. Eye contact is maintained for only a second, after which it becomes uncomfortable and regarded as rude (Elliott, 2007). Another non-verbal cue is tone which, for African Americans, is determined by the situation in which a conversation is being held. Indians tend to maintain a low tone as it is considered ideal (Elliott, 2007). The implications of emotional display and non-verbal cues in healthcare provision are significant because health care providers need to communicate in a manner that upholds each community’s values on eye contact and emotional display to enhance client satisfaction.

The use of touch, body language, and personal space vary between the two communities. For African Americans, touching is allowed, and it is dominant among friends. Furthermore, African American adults tend to touch children more when conversing and for a longer time (Elliott, 2007). Indians have a different belief on touch as it is considered non-existent due to its rarity (Elliott, 2007). Body language is dominant in both communities as it is used in communication. However, the perceptions of personal space vary between the communities. Adult African Americans maintain a greater distance as compared to the children, who stand close to each other when conversing (Elliott, 2007). In the Indian community, personal space is highly valued as people are required to stay at arm’s length of each other.

Both communities have the same perception of time. Both Indians and African Americans believe in the concept of “the right time.” The African American culture is more relationship-oriented, whereas Indians think that time is cyclical, thus will return (Elliott, 2007). The aspect of time may prove to be challenging for healthcare providers due to the need for preserving time.

Greetings are different for the two communities, despite sharing one commonality of the use of body language. When greeting African Americans, one should display familiarities as it comes out as offensive (Elliott, 2007). In the Indian community, no touch is allowed between men and women. Moreover, African Americans value privacy more than Indians. African Americans prefer handling their issues either personally or with a direct support system. However, Indians do not appreciate privacy as much as their counterparts. Thus when providing health care, nurses uphold the confidentiality and culture of the two communities. Nurses should maintain formal communication to avoid offending patients from either side. Furthermore, African Americans consider seeking medical help to be a very private thing, hence should be accorded the same privacy by healthcare providers.

Family Roles and Organization 

Understanding the family structure of each community is vital in healthcare provision. Healthcare providers need to understand the uniqueness of the family structure of each community. The head of the household in the Indian community is the father because the family structure takes a patriarchal form (Chadda & Deb, 2013). This is different from the African American community, whereby both the father and the mother are the heads of the household. Moreover, decisions in the Indian community are made by family members who cooperate to make decisions, due to the community’s regard for collectivism (Chadda & Deb, 2013). The case is different for African American communities whereby either the father or mother makes decisions.

Gender roles differ between the two communities. Women in the Indian society are subordinate to men, while men are superior and required to meet the needs of other members of the family (Chadda & Deb, 2013). The African American community lacks defined gender roles such that women are independent of men and are not limited to domestic chores (Jardine, 2012). Both men and women in this community are breadwinners. This cultural diversity presents a nurse with the necessary information on how to address and treat patients coming from either background.

The extended family and the old play a significant role in both communities as they provide emotional and economic support. The extended family and the elderly are accorded respect in both populations (Chadda & Deb, 2013). In the African American community, the elderly also care for their grandchildren.

Indians also have an autonomous individual and family status in the community such that they are not responsible for others (Chadda & Deb, 2013). On the other hand, African Americans feel accountable for others hence a heteronomous individual and family status in the community. Additionally, Indian children and adolescents are subjected to early marriage; therefore sexual relationships form the basis of their developmental tasks. On the other hand, African American adolescents have a developmental task of discovering their sense of identity (Brittian, 2012).

Indians are also less accepting towards alternative lifestyles such as divorce or children born out of wedlock, because of the high regard accorded to marriage. Contrarily, African Americans are more accepting of alternative lifestyles that have led to the increasing number of single mothers. Healthcare providers should utilize strategies that highlight the strengths of each community, by also considering the cultural limitations.

Biopsychosocial-Cultural Aspects 

The two communities display different biological variations regarding their skin color. African Americans have dark skin while Indians have brown skin. Both communities also possess Mongolian spots on their faces, while exhibiting lactose intolerance (Stanhope & Lancaster, 2014). The two communities compare regarding genetic and hereditary diseases. African Americans are prone to sickle cell anemia and keloid formations, while Indians are prone to Thalassemia (Stanhope & Lancaster, 2014).

Indians also do not cut their hair as they consider it a sign of modesty. After they cut their nails, they store away their fingernail clippings while preserving self-care. They value their dressing such that they cannot touch medicine bags and get someone else to do it on their behalf (Stanhope & Lancaster, 2014). While black Americans are alcohol tolerant, Indians are alcohol intolerant. However, both communities consume drugs with African Americans having a high prevalence of drug use. Healthcare practitioners should identify cultural factors that contribute to poor health and formulate strategies that incorporate cultural practices.

Nutrition 

The meaning of food in the Indian community is a cultural representation (Thomas, 2015), while in the African American community it represents family and unity. Indians have a fixed meal pattern that sees the intake of two full meals in a day, supplemented by snacks (Thomas, 2015). African Americans do not have a definite meal pattern such that their feeding habits are dependent on the external conditions. Common foods among Indians include chapatti, milk, meat, legumes, and beverages. A food ritual incorporated into their culture is the use of seasoning and spices. Moreover, methods of food preparation among Indians include steaming, boiling frying and braising (Thomas, 2015).

Both communities’ diets present nutritional deficiencies. The Indian diet is deficient in iron, zinc, proteins, and vitamins due to their vegetarian nature, while the African American diet is deficient in vitamins. The African American diet is high in salt and fats, thereby posing health risks. When sick, Indians resort to cooked white rice whereas African Americans resort to vegetables and fruits (Thomas, 2015). The Indians highly avoid beef as cows are considered sacred. Health interventions should be based on nutritional interventions based on the communities’ values.

Pregnancy and Childbearing Practices 

Culturally, Indians believe in the fertility of a woman hence shying away from family planning services and relying on more natural methods. The onset of menstruation prevents sexual activity, thus exposing a woman to a high fertility rate. Contrarily, African American women are also reasonably receptive to family planning methods considering that the practice is culturally unsanctioned. Pregnancy for Indians is viewed as a means of continuing the family thereby prompting purifications and rituals for protection against evil spirits (Withers, Kharazmi & Lim, 2018). In the African American community, pregnancy is viewed as a pathway to motherhood. Pregnant African American women feel the need to connect with other mothers for care (Abbyad & Robertson, 2011). Healthcare providers dealing with African American women should realize the necessity of incorporating a treatment plan that includes support from family and friends.

During pregnancy, Indian women are required to carry out their daily activities as usual and are encouraged to be more active than before (Withers, Kharazmi & Lim, 2018). Pregnant women also prefer massages by traditional birth attendants that help during the birthing process. During the birthing process, women are required culturally to take hot foods such as butter, milk or tea among others, which provide a warmth that facilitates labor (Withers, Kharazmi & Lim, 2018). Women in the post-partum period are considered polluted, hence restricted from primary activities such as preparing food, collecting water among others (Withers, Kharazmi & Lim, 2018). Furthermore, Indian women prefer to give birth from home and only seek medical attention when it is dangerous. Healthcare practitioners should consider improving the experience these mothers feel and develop treatment plans that involve traditional birth attendants.

Death Rituals 

The two communities display a variety of death rituals. According to Indians, death is viewed as a pathway to immortality and eternal freedom (Patel, 2008). Indians are also skeptical of euthanasia, but would, however, consider it if a patient requested it. On the other hand, African Americans view death as the fulfillment of God’s will, and they are also receptive to euthanasia.

When preparing for death, African Americans seek out the services of a clergyman who is meant to bless their souls and allow them passage into heaven. After death, African Americans conduct a wake before the funeral, which provides for the viewing of the body as people pay their last respects (Brooten et al., 2016). This community also strongly believes in burial as ordained by the church. Seemingly, Indians have their rituals after death. Men strictly perform the rituals while mourners wear white cotton clothes (Patel, 2008). Contrary to their counterparts, Indians believe in cremation as it is a way of the fire God informing the ancestors of the reception of a soul.

Both communities allow a bereavement period whereby bereaved families are entitled to commune with friends and other family members (Brooten et al., 2016). In this period, Indians then perform religious ceremonies. Healthcare providers need to develop strategies that facilitate the different beliefs about death.

Spirituality 

The main religion among Indians is Hinduism whereas African Americans are mostly Christians. Hinduism presents various rituals and beliefs including worship, meditation, pilgrimages among others. African Americans also uphold the beliefs and rituals of Jews and Christians (Carter, 2002). Moreover, the two communities believe in spiritual healing. Indians believe in Ayurveda, a form of spiritual medicine, and exorcisms. African Americans believe in praying as a means of spiritual healing, which happens through God (Carter, 2002). Understanding the influence of religious beliefs on treatment choices would prompt the formulation of treatment plans in line with the religions for better treatment results.

Healthcare Practices 

The Indian focus of health care is preventive while for African Americans it is acute. Both communities have negative beliefs about physical illness. Indians link physical sickness to sin while African Americans link it to a state of disharmony caused by evil spirits. Stigmatization in both communities meets mental illness. Genetic defects are acknowledged due to their prevalence. Indians are receptive to genetic modifications while African Americans accept it but do not wish to participate in it (Murphy & Thompson, 2009). Physical disabilities are also met with social stigma in both communities. Healthcare interventions in both populations should, therefore, provide information that dispels the beliefs underlying the said health practices as they provide adequate health information concerning the same.

Health promotion activities among Indians are in the form of accurate and culturally tailored info gotten through the internet. For African American communities, they include health fairs that provide information and education on safe health practices. Both communities use over-the-counter (OTC) drugs and prescribed medicines. The Indian society misuses OTC drugs while African Americans use it for less chronic illnesses (Porter & Grills, 2015). Both communities rely on prescribed medicine for chronic diseases. Furthermore, Indians rely on herbal teas in the form of Ayurveda tea that serves medicinal purposes. African Americans also rely on folk medicine that is characterized by rituals and therapeutic interventions (AETC-NMC, 2018).

Additionally, symptom management in the Indian community is done through yoga. However, symptom management is challenging in the African American community due to existing cultural beliefs on healthcare. African Americans use long-term birth control, whereas Indians disregard contraception (Withers, Kharazmi & Lim, 2018). Abortion is also embraced in both communities. Sexual orientation among Indians is valued, and homosexuality is related to vaginal diseases. For African Americans, it influences contraception. Gender identities are considered as part of sexuality for both communities (Withers, Kharazmi & Lim, 2018), and menopause is viewed as a cause for relationship problems in both communities.

Public health is valued, and adequate information is provided to both communities to promote individual health responsibilities. The two communities also accept blood and blood products as blood is considered a lifesaver. However, African Americans are not taking of organ transplants citing mistrust in the doctors. Traditional healthcare practices exist in the form of black folk beliefs among African Americans and Ayurveda among Indians (Rudra, Kalra, Kumar & Joe, 2017). Healthcare interventions for both communities compare concerning changing negative attitudes towards positive health practices. However, health practices would have to incorporate the different cultural values.

Healthcare Practitioners 

Indians boast of a pluralistic medical culture whereby traditional medicine is given much prominence (Rudra, Kalra, Kumar & Joe, 2017). Traditional healthcare providers exist, and their practices serve as an alternative to modern medicine. Conventional medicinal forms include Ayurveda, Yoga, Unani and Siddha (AYUSH) (Rudra, Kalra, Kumar & Joe, 2017). Healthcare providers in the community are mostly male, with very few women practicing healthcare provision. Furthermore, individuals of low socioeconomic status and those in rural areas use and believe in healers and prefer this alternative to modern medicine.

African Americans also practice traditional healthcare provision through the use of contemporary and alternative medicine (CAM). CAM manifests in the form of home remedies, herbal medicine, and nutrition among others (AETC-NMC, 2018). African Americans also pay less attention to the gender of healthcare practitioners as they mostly consider professionalism to gender. This community also believes in a healer, often a supernatural being. God, as portrayed in the bible, is a psychic healer that African Americans think in for healing. Members of this community are spiritual believers as some avoid modern medicine and seek out divine healing. Healthcare practitioners need to understand the care alternatives and improve communication to meet the development of healthcare plans depending on a patient’s community background.

Conclusion 

In conclusion, cultural competence is vital in healthcare provision. Nurses providing healthcare services for African Americans and Indians need to be culturally competent. Aesthetic competent care for clients from the two cultures will require incorporating cultural values into the practice, enhancing communication based on cultural expectations. Nurses will also be required to identify the uniqueness of each family and apply available resources concerning the unique dynamism. They also need to take into consideration religion and spirituality to ensure adequate health provision.

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