Begin Removing Barriers

BARRIERS TO CULTURALLY COMPETENT CARE

 

REMOVING BARRIERS: UNDERSTANDING THE CULTURE
Culture includes all aspects of an individual including ethnicity, race, gender, nationality, socioeconomic class, age, religious affiliation and sexual orientation. Many of the visible aspects of culture are associated with stereotypes. When used as the sole source of information, these stereotypes can lead to inaccurate assumptions and result in barriers to healthcare.

Culturally competent healthcare means optimizing quality care by being respectful of and responsive to the cultural factors that influence patients’ attitudes and behaviors at the institutional and the individual level. At the institutional level, this means that the organization’s operations and supporting policies are consciously set up to meet the needs of people from different cultures. At the individual level, this means that providers recognize and respect each patient’s unique set of values, beliefs and lifeways.

To ensure the best possible health outcomes, it is important to know the various cultures of your patients and to ask respectful and nonjudgmental questions rather than making assumptions. The manner in which a person presents for care; their style of communication (e.g., how symptoms are described and the importance placed on those symptoms); access to medical services and the type of services available; the level of trust placed in the medical system, including acceptance of a diagnosis; compliance with treatment plans; and, ultimately, the outcome of medical encounters, are all examples of the effects of culture on health concerns.

The role of the health care provider is to bridge the gap between the system and the patient. The first step is to know yourself — who you are culturally. Being aware of your areas of personal privilege (e.g., gender, skin color, native language, economic advantage, education) and using these in respectful and responsible ways are important steps on the journey toward cultural competency.

An understanding of some of the cultural nuances is important to build rapport with patients of minority groups. Gay men and lesbians have created celebrations, symbols, social meeting places and arts that reflect and celebrate their differences, and recognize and honor their community.

• Celebrations: Gay Pride parades and events in June to commemorate the 1969 Stonewall riots where LGBT people fought back against a police raid at the Stonewall Inn in New York City
• Symbols: Rainbow flags and pink triangles
• Places of safety and acceptance: Bookstores, bars, community centers, local and national advocacy organizations like the Mautner Project
• Music and art: Gay and lesbian fiction, comedy, performers, musical groups, and film festivals
• Language: Terms like butch, femme, queer, dyke, “in the life”

Population Estimate of Lesbians and WPW

A study published by Laumann et al. in 1994 estimated that 2 to 6% of women were lesbians, including women who self-identify as lesbian or those who have same-sex sexual behavior without identifying as “lesbian.” Using this estimate and extrapolating from the 2000 US Census, there are more than 6 million adult lesbians in the United States. It is safe to assume that if you are treating women, you are treating lesbians.