Towards Culturally Competent Care: Perspectives From Both Physicians and Patients
ambulatory/outpatient care, racial/ethnic differences in health and health care, qualitative research, patient experience/satisfaction
Background: Patient satisfaction has become an increasingly important health care quality indicator and been widely used to compare quality across health care organizations and providers. At a large multispecialty ambulatory care practice in California, a notable difference across regions has been recognized, with sites serving higher proportions of Asian patients tending to receive significantly lower satisfaction scores. The current study aims to identify the key drivers of this issue and provide recommendations for strategies to improve culturally competent care across health systems.
Methods: We conducted 18 focus groups and 32 interviews with a total of 69 Chinese and 40 South Asian patients as well as 7 in-depth interviews with primary care physicians serving a significant proportion of Chinese and South Asian patients. All data were transcribed verbatim and coded with Dedoose, a multifunctional qualitative analysis software. First, data were coded by aspects of care. Then, an inductive thematic approach was used to identify themes around language barriers and racial/ethnic/cultural differences in relation to care. Further, patient-reported themes were triangulated with physicians’ accounts to draw recommendations for expanding culturally competent care.
Results: Both patients and providers emphasized that an understanding of Asian patients’ beliefs about health and illness, which are fundamentally different from Western medicine, is an imperative to deliver culturally competent care. Knowledge of the social norms in interpersonal and family interactions also was considered important. For Chinese and South Asian patients in particular, more education is needed on the use of lab tests, imaging and antibiotics. Moreover, patients with lower English proficiency in both groups reported language as a barrier to satisfactory experience. Translation services were not favored by either patients or physicians because they are perceived to be time-consuming and of low quality. While patients reported frustration in scheduling with physicians who understand both their language and culture, such physicians reported being overwhelmed with workload. Physicians also voiced the need for more medical assistants and receptionists with the language capacity to support their care.
Conclusion: Culturally competent care requires knowledge of cultural beliefs and practices in relation to health as well as language support from the care team and the health system.
Liang S, Hung LW, Hernandez Y, Gillespie K, Halley M, Chung S. Towards culturally competent care: perspectives from both physicians and patients. J Patient Cent Res Rev. 2017;4:195-6.