Liberty University

HSCI 715

 Cultural Competency in Health Sciences

Jonathan Giles

5th March 2023

HSCI 715 Significance of Cultural Competence to Access to Care among African Americans in the US

Introduction

In the United States, cultural competence is fundamental, especially concerning healthcare. As Spector (2017) observes, the right to access healthcare services is a fundamental right for every citizen. In a bid to provide for this right, the federal legal framework instructs all healthcare service providers to dispense services without any form of discrimination based on any disparities such as age, gender and race, level of education, language competencies, or ethnic background (Spector,  2017, p. 10). However, a review of trends in healthcare access literature in the US indicates that access to healthcare and the quality of care is differentiated among different groups of people (Dickman et al., 2022). Such categorizations as ethnicity, financial capacity, social classifications, gender, race, cultural beliefs, and expectations about health influence access to health services. In this light, whether an individual is a member of a minority group or not is a significant determinant of how easily one accesses healthcare in the US. Although this trend is against the primary expectation of the Federal Law and the principles of equality embraced in the US, current studies indicate that its prevalence cannot be ignored (Squires,

2018).

As a consequence, the need to investigate what are the causes is critical. This discussion has the potential to pave the way to solutions that may see every citizen in the US accessing healthcare equally. The conversation is crucial in the US because of the growing diversity resulting from globalization and war in various parts of the world (Spector, 2017). As a result of these factors, people holding cultural beliefs about health that differ from the norms in the US is increasing. Amongst the many diverse groups of people in the US are African American. As a result of the social, historical, and economic factors, this group of people differs from the others

– classified as a minority group.

Therefore, members of African American community groups are vulnerable to differentiated treatment in the US. Besides, the distribution of social determinants of health also influences their capacity to access care (Hudelson  & Vilpert, 2022). The historical and social economic factors are associated with the erosion of trust and communication values among people from various cultural backgrounds in the US. Besides, language and literacy challenges also contribute to the failed attainment of equality in the US. Again, people hold varying belief systems concerning health. These factors, combined with a lack of cultural competence among healthcare providers and African Americans, compound the healthcare access problem for this group. In this light, this essay will examine the significance of cultural competence in enhancing care access among African Americans in the US because this is an important aspect of American values and principles of equality.

Social, Economic, and Historical Factors Influence Access to Care

Historical and social economic factors have significantly limited access to healthcare for African Americans in the US. According to Dickman et al. (2022), there has been a persistent disparity in healthcare use between black and white persons in the US, with African Americans experiencing significantly lower rates of access to care. The authors attribute this disparity to social and economic factors such as poverty, unemployment, and lack of health insurance. The historical legacy of slavery, segregation, and racism has also contributed to the marginalization of African Americans and the resulting unequal access to healthcare.

The lack of access to healthcare for African Americans adversely affects their health outcomes, with higher rates of chronic diseases and mortality compared to white Americans.

Healthcare policymakers implemented the Affordable Care Act (ACA) to address some of these disparities by increasing access to healthcare for all Americans, including those with lower incomes and pre-existing conditions. However, the ACA has faced significant challenges, including efforts to repeal or weaken it, and disparities in access to care persist.

Historical Injustices

The history of African Americans in the US manifests historical injustices, discrimination, and racism that continue to impact their social and economic status today (Henry Akintobi et al., 2020). For instance, slavery, Jim Crow laws, redlining, and racial segregation were some historical injustices that disadvantaged African Americans in the US (Hill, 2016). These injustices resulted in the segregation of African Americans in specific neighbourhoods with limited access to healthcare facilities and other social amenities. According to LavizzoMourey et al. (2021), these injustices have contributed to the persistent health disparities between African Americans and other populations in the US. African Americans are more likely to suffer from chronic diseases, such as diabetes, hypertension, and heart diseases, compared to other populations in the US. Additionally, they have lower life expectancies than other populations (Lavizzo-Mourey et al., 2021).

Racism and discrimination against African Americans are still evident today, leading to health disparities and limited access to healthcare services. According to Zambrana and Williams (2022), racism is a fundamental cause of health disparities between African Americans and other populations. Discrimination in the healthcare system can lead to mistrust between African

Americans and healthcare providers, limiting their access to quality healthcare services. African Americans are also more likely to face language and literacy barriers, making accessing health information difficult (Henry Akintobi et al., 2020).

Overall, historical injustices and systemic racism have significantly impacted the health and well-being of African Americans in the US. The resultant disparities in health outcomes have limited their access to healthcare services. It is imperative to acknowledge the impact of historical injustices and racism on the healthcare system to address the healthcare disparities and improve healthcare access for African Americans.

History of Discrimination in Access to Healthcare

Historical discrimination against African Americans has profoundly impacted their access to healthcare in the United States. Discrimination in various sectors, including access to care, education, housing, and employment, has contributed to significant health disparities between African Americans and other groups. Fuller-Rowell et al. (2018) attribute these disparities to various factors such as discrimination, bias, and racism in the healthcare system.

Studies have shown that African Americans are more likely to receive inadequate or no care at all, leading to higher morbidity and mortality rates than other racial groups (Shepherd et al., 2018). Hill (2016) argues that the adverse effects of racial discrimination on African Americans' health outcomes are not limited to their physical health but also extend to their psychological and emotional well-being. Additionally, Lavizzo-Mourey et al. (2021) highlight that the history of discrimination has contributed to a mistrust of the healthcare system among African Americans, leading to reduced healthcare-seeking behaviours.

The COVID-19 pandemic has further highlighted the impact of historical injustices and discrimination on access to care among African Americans. Henry Akintobi et al. (2020) suggest that African Americans have been disproportionately affected by the pandemic due to existing health disparities, lack of access to healthcare, and socioeconomic factors.

Poor Access to Employment Undermines Access of Care

According to Dickman et al. (2017), poor access to employment and economic opportunities significantly contributes to health disparities between Black and White Americans. Due to systemic racism, many Black Americans have limited access to quality employment and economic opportunities, leading to financial strain and difficulty accessing costly and highquality healthcare services. That can result in delayed care, inadequate treatment, and poorer health outcomes for Black Americans due to limited health insurance. Addressing employment disparities and promoting economic equity is essential in improving access to healthcare services for Black Americans and reducing health disparities.

Discriminated Distribution of Social Determinants of Health

Discriminated distribution of social determinants of health is a significant factor contributing to health disparities between Black and white Americans (Fuller-Rowell et al., 2018; Garg et al., 2022; Zambrana & Williams, 2022). Social determinants of health are the conditions in which people are born, grow, live, work, and age, and a wide range of social and economic factors, such as income, education, housing, transportation, and access to healthy food, shapes them. The Black population in the US is more likely to live in neighbourhoods with poor housing quality, limited access to healthy foods, inadequate public transportation, and lowquality schools than their white counterparts (Fuller-Rowell et al., 2018). Additionally, Black Americans experience discrimination and racism in various areas of life, including housing and employment (Fuller-Rowell et al., 2018); the result is disproportionate exposure to environmental hazards, such as air pollution and lead poisoning. These factors and other forms of social and economic disadvantage make it harder for Black Americans to achieve and maintain good health.

Addressing social determinants of health is critical to reducing health disparities between Black and white Americans. To achieve this, policies and interventions must address the root causes of social and economic disadvantage, including racism and discrimination (Zambrana & Williams, 2022). One way to address these issues is through a value-based model, which aligns healthcare payment and delivery with a focus on improving health outcomes and reducing healthcare costs (Garg et al., 2022). This model recognizes the importance of addressing social determinants of health in improving health outcomes and provides financial incentives for healthcare providers to address these issues. Addressing social determinants of health and racial discrimination is essential for achieving health equity and reducing health disparities in the US.

Communication and Trust have a Critical Influence on how African Americans Relate with

Healthcare Providers

Effective communication and trust are essential components of quality healthcare delivery, and their absence can lead to significant disparities in health outcomes. For African

Americans, systemic racism and a long history of medical mistreatment amplify those disparities. According to Henry Akintobi et al. (2020), community engagement is critical to bridging the gap between healthcare providers and African American patients. Such an engagement should build trust, promote two-way communication, and address health literacy issues that hinder effective healthcare delivery.

Language barriers also significantly challenge effective communication and trustbuilding between healthcare providers and patients, particularly in multilingual societies. For instance, Olani et al. (2023) found that language barriers hindered the ability of Afaan Oromoospeaking patients in Addis Ababa to access and receive quality healthcare services. The study identified a lack of interpreters, inadequate translation of health information materials, and limited proficiency of healthcare providers in the local language as some of the factors responsible for the language barrier. The study findings are relevant and applicable to the healthcare case of American society, which is inherently multilingual and multicultural.

Relationship between Communication, Trust, and Healthcare is Crucial to Attain Equality

Communication and trust between healthcare providers and patients have a crucial influence on attaining equality in healthcare. Developing a strong relationship between the patient and the healthcare provider builds trust in healthcare, enhancing communication and ultimately leading to better health outcomes (Robinson, 2016). On the other hand, the lack of trust leads to poor communication, dissatisfaction, and a decline in healthcare utilization. Furthermore, a lack of trust can decrease patient compliance with medical recommendations, as patients may not believe their healthcare providers have their best interests at heart.

African Americans, in particular, face unique challenges in developing trust and building strong relationships with healthcare providers. Historical and current experiences of racism and discrimination have led to deep-rooted mistrust and a lack of confidence in the healthcare system. The COVID-19 pandemic has further highlighted these disparities and the need for increased community engagement, transparency, and communication to build trust (Henry

Akintobi et al., 2020).

To address these issues, it is necessary to establish culturally competent communication that recognizes and respects patients' beliefs, values, and cultural norms (Butler & Sheriff, 2022). Moreover, it is essential to address language barriers as an additional challenge to communication and trust-building (Olani et al., 2023). It may involve using professional interpreters, providing translated educational materials, and encouraging patients to bring family members or friends who can serve as interpreters. Ultimately, trust and communication are integral components of healthcare, and a strong relationship between healthcare providers and patients can enhance the delivery of high-quality care.

Development of Trust Depends on Language Use Competences

Developing trust between healthcare providers and patients is essential in promoting effective healthcare delivery, and language barriers can hinder this process. According to Squires (2018), language barriers pose a significant challenge to effective communication in healthcare, leading to low patient satisfaction and poor health outcomes. Healthcare providers' use of patients' preferred language is critical in ensuring that patients receive high-quality care, which fosters the development of trust. Handtke et al. (2019) state that culturally competent healthcare providers should be able to communicate effectively with patients from diverse cultural and linguistic backgrounds, including using interpreters and translated materials.

Furthermore, Hudelson and Vilpert (2022) highlight that healthcare providers' attitudes and practices toward language barriers vary, affecting patient trust. Healthcare providers receptive to patients' linguistic and cultural needs tend to foster a more positive patient-provider relationship. They are also more likely to develop trust with their patients, leading to better health outcomes. Therefore, creating trust between healthcare providers and patients is critical in promoting effective healthcare delivery, and healthcare providers must be able to communicate effectively with patients, regardless of their language or cultural background.

African Americans with LEP still Experience Language Barriers Undermining Healthcare

Access

Language barriers due to Limtied English proficiency (LEP) can significantly affect the healthcare experiences of African Americans and limit their access to healthcare services.

Omenka et al. (2020) note that African immigrants in the United States face numerous healthcare challenges, including language barriers, which limit their access to healthcare services. Rodriguez et al. (2021) found that limited English proficiency was a significant barrier to telehealth use among California patients. Similarly, Mavi and Kingsley (2022) report increasing trends of LEP patients in a pediatric dental school patient population, which has implications for access to care. These studies suggest that language barriers are a significant issue affecting African Americans' healthcare experiences and their access to healthcare services. It is, therefore, essential to address language barriers to ensure that African Americans have equal access to healthcare services.

Disparities in Health Beliefs and Practices

Health beliefs and practices vary among different groups of people. Schwei et al. (2016) argue that understanding these differences is essential when providing healthcare to diverse patient populations. The authors conducted a cross-sectional review of research on language barriers in healthcare and found that while progress has been made in identifying the impact of language barriers on healthcare outcomes, there is still much to learn about the specific needs and preferences of different patient groups. Health beliefs and practices are the product of cultural, social, and environmental factors and can influence the way individuals seek and receive healthcare services. For example, some cultural groups may prioritize using traditional or alternative medicine, impacting their willingness to use Western medical treatments.

Additionally, beliefs about health and illness may differ across cultures, leading to varying levels of health literacy and different understandings of illness prevention and management.Understanding diverse patient populations' health beliefs and practices are critical for providing culturally competent care. It requires healthcare providers to be knowledgeable about the cultural norms, values, and beliefs of the communities they serve and to work collaboratively with patients to develop care plans that are respectful and responsive to their unique needs.

African Americans hold Unique Beliefs and Practices

African Americans have different beliefs and practices related to health and illness compared to other majority groups in the US. It can result in differences in the way they seek and receive healthcare. According to Spector (2017), African Americans often rely on spirituality and religion to cope with illness and view health as a balance between the body, mind, and spirit. They may also prioritize communalism and family values over individualism, which can impact their decision-making in healthcare. Cultural competence is crucial in providing appropriate healthcare to African Americans (Nair & Adetayo, 2019). Healthcare providers must be aware of these cultural differences and tailor their care to meet the unique needs of African Americans.

Influence of Cultural and Religious Background on Health Beliefs and Practices

Cultural and religious backgrounds influence health beliefs and practices. Spector (2017) emphasizes that culture and religion significantly impact health beliefs and practices. For instance, cultural values, beliefs, and practices affect decisions about seeking healthcare, accepting treatments, and adhering to medical regimens. Religion can also influence beliefs and practices related to health, such as dietary restrictions and approaches to illness and healing. Understanding patients' cultural and religious backgrounds can help healthcare providers deliver more effective and culturally competent care.

Cultural Competence Facilitates Healthcare Equality

Cultural competence is a crucial aspect of healthcare providers' ability to provide equitable access to healthcare for all patients, regardless of their cultural or religious backgrounds. As noted by Spector (2017), healthcare providers need to be aware of the diversity in beliefs and practices among their patients, and they should be able to understand and respect these differences to ensure adequate care. Furthermore, cultural competence can help to improve communication, increase patient satisfaction, and reduce disparities in healthcare access and outcomes. According to Hudelson and Vilpert (2022), healthcare providers who possess cultural competence can develop positive attitudes toward linguistic and cultural diversity, recognize the importance of language use, and use appropriate strategies to communicate effectively with patients who speak different languages. Therefore, promoting cultural competence among healthcare providers is critical in ensuring all patients receive quality and equitable healthcare services.

In conclusion, this essay has explored the significance of cultural competence in enhancing care access among African Americans in the US. The findings demonstrate that African Americans continue to face several challenges when accessing healthcare services, including institutional racism, language barriers, and cultural differences. These challenges lead to disparities in healthcare access, resulting in poor health outcomes for African Americans. However, cultural competence offers a potential solution to these issues, as it promotes understanding and respect for differences in health beliefs and practices. Culturally competent healthcare providers can better meet the healthcare needs of African Americans by providing more accessible, patient-centered care. The studies cited in this essay have highlighted the importance of addressing language barriers, understanding cultural and religious beliefs, and practicing cultural competence to improve healthcare access for African Americans. Overall, cultural competence is dire in the fight against healthcare disparities, promoting equality, and improving health outcomes for African Americans in the US.

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