America is one of the most culturally diverse countries in the world. In addition to racial and ethnic diversity, more than 350 languages are spoken in the U.S. In fact, 1 in 5 people speak a language other than English at home, according to the U.S. Census Bureau.
But for some people, cultural diversity means important health information can get lost in translation. Research shows that cultural barriers and language play a big role in misinformation and miscommunication between healthcare providers (HCPs) and patients.
Cultural humility vs. cultural competence
In the early 2000s, the government started requiring that HCPs learn cultural competence to help improve the quality of care.
Cultural competence in healthcare refers to a provider’s ability to understand, appreciate and engage with people across cultures. The idea is that the more HCPs know about different cultural backgrounds, the better the care will be.
In theory, cultural competence sounds good, but it has some flaws. For one, the concept suggests that there’s a core set of data that applies to specific groups of people, which can lead to bias and stereotypes. Cultural competence also suggests that a person can become fully culturally competent. But that’s not exactly the case.
“It quickly becomes apparent there’s no way that you can be culturally competent because you’re going to run into so many cultures and then variations within culture,” said Patricia Geraghty MSN, FNP-BC, WHNP, a nurse practitioner and member of HealthyWomen’s Women’s Health Advisory Council (WHAC, who has been working in women’s health delivering bilingual care for more than 20 years.
The concept of cultural competence isn’t bad, Geraghty noted, but there’s been a shift toward the practice of cultural humility in recent years.
Cultural humility is the ongoing process of self-reflection and self-critique of bias by HCPs, as well as the acknowledgment that culture is always evolving — there’s no endpoint.
“Intellectual humility is acknowledging and owning one’s own biases and limitations, and interpersonal humility is being open and prioritizing the well-being of others, which, as healthcare providers, that’s why we’re in the room,” Geraghty said.
The importance of cultural humility
Cultural humility can help enhance the relationship between the HCP and patient in different ways.
These can include:
- Increased communication
- Increased trust
- A focus on person-centered care
- Reduced stereotypes and bias by providers
“When someone who is part of a marginalized group feels like their provider is listening and understanding what’s important to them — that does a lot,” Geraghty said.
Trust can help people feel more secure and open and lead to better health outcomes. In addition to more personalized and effective care, cultural humility can help foster a more equitable healthcare system.
What is health equity?
Health equity is basically the idea that everyone has the same opportunity to live their healthiest life possible regardless of social, economic, geographical background. Social determinants of health (where you’re born, live, work, play and age) as well as biological determinants (e.g., being a woman or a person assigned female at birth) affect the potential for a healthy life.
Unfortunately, there are many factors that challenge health equity today. These can include:
- Discrimination
- Poor access to healthcare
- A lack of educational opportunities
- Unsafe environment
- Living in a low-income household
Structural, social and institutional disparities are often made worse by stereotypes and discrimination.
Cultural humility can help HCPs take steps toward greater health equity through trust, listening to lived experiences and education to eliminate racism and bias.
Read: Social Determinants of Health, Health Disparities and Health Equity >>
Language barriers can lead to poor outcomes
Health disparities are a complex problem, but everyone deserves reliable health resources and services in a language that they can understand. A lack of clear and reliable information can lead to serious health problems, such as errors with medication, misdiagnosis and delays in care among other concerns that could be avoided with proper communication.
Health insurance companies are a good place to start to ask for a list of HCPs that may speak your primary language. Or ask friends and family for recommendations. If there isn’t a list to choose from — don’t sweat. Most clinics and hospitals that accept federal money are required to provide free language assistance such as a translator or document translation.
Another option: download a translation app on a smartphone. One study found patients and their HCPs who used online translation tools such as Google Translate increased satisfaction for the visit by 92%.
Geraghty said translation via smartphone has come a long way, but it’s always a good idea to be proactive and let the staff know your primary language and cultural considerations before meeting with a HCP. The more information the better as it can help everyone involved be prepared to focus on what’s most important — your health.
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