As a physician, you sometimes have to have delicate personal conversations with your patients about lowering their risks of certain preventable diseases. It's not always easy to get a patient on board with lifestyle changes, such as dietary and exercise habits when discussing stroke risk.
The waters get further muddied when you bring different cultures to the table. Let's keep using strokes as an example here: Hispanic people have a higher incidence of stroke and its risk factors than non-Hispanic whites. This makes it necessary to tackle these issues through patient-centered care that includes a cultural understanding of key social and personal values.
It's important to treat the matter as a twofold discussion: The individual patient's health circumstances and the prevalence of the health condition in question for that patient's demographic group. Let's dive into this subject in depth, continuing with the same example of an Hispanic patient at risk for stroke.
Hispanics and Stroke Risk
The U.S. Hispanic population is growing quickly and steadily. In the 2000s, Hispanics accounted for more than half of the country's population growth, so it's more likely than ever that the demographic will form a sizable portion of your clientele. Because of statistical precedent summarized by the American Heart Association (AHA), Hispanics are seen as having a higher prevalence of stroke than whites. They also have high rates of stroke risk factors such as obesity, hypertension, diabetes, and metabolic syndrome.
These chronic risk-factor problems are not well controlled. The National Health and Nutrition Examination Survey found that only 42.5 percent of U.S.-born Hispanics had blood pressure figures within a healthy range, and only 37.8 percent had well-controlled diabetes (judged by hemoglobin levels). Cultural differences, access to care, and the lack of a personal connection with health providers all contribute to this inadequate control.
Awareness of stroke warning signs is also poor among Hispanics, especially when compared to the general population. A survey by the Centers for Disease Control and Prevention found that only 26.8 percent of Hispanic respondents could identify the five warning signs of stroke and therefore realize they need to call 911.
The Physician's Role in Bridging Cultural Gaps
Taking extra time to teach patients what to look for and when to seek immediate help makes a big difference in outcomes. Other factors, such as the cultural view that being a little overweight is beautiful or traditional beliefs in disease origins, can make it difficult to get through to patients about the importance of managing risk factors.
You can help patients feel more comfortable and build strong relationships through the environment you create. For patients who speak limited English, plan extra time during early visits to get to know them and make sure they understand their care plans.
A few strategies can help you provide patient-centered care that's also culturally sensitive:
- Offer language services. The language barrier is one of the most basic hindrances for Hispanics seeking care. It affects the ability to build trust, adhere to care plans, and seek early treatment for problems. Having Spanish-speaking staff or translated materials is a good first step, but it won't have the intended effects unless all communication is specific and relevant. Spanish-speaking staff should be available to answer patient calls, but if they are going to be helping you with translation during exams or in phone assessment, it is best to hire staff that are certified medical translators. If a patient worries they can't be understood over the phone, they may not call with health concerns or questions, leading to lost opportunities to improve their care. If you opt to use a translator, make sure they're providing a two-way conversation.
- Ensure understanding with the teach-back method. The teach-back method, which involves the patient repeating your instructions back to you in their own words, is helpful with any patient. This can be a challenge for patients who aren't strong English speakers, but stick with it. You'll make a bigger impact on their disease management by ensuring full comprehension of medications, risk factors, warning signs, and other care-based instructions.
- Be sensitive to cultural values. Hispanics have four common values that come into play in a health care setting: "simpatia," "respeto," "modestia," and "personalismo," meaning "kindness," "respect," "modesty," and "relationship," respectively. Hispanic patients often see the physician as being in a position of authority and deserving respect, but they also expect to receive kind, friendly care that avoids conflict.
- Be cognizant of the importance of family. Hispanics are family- and community-centered, whereas the American health system focuses on autonomy and privacy. Family members hold a lot of sway in adherence to care plans and decisions to visit a doctor or go to the hospital, so encourage family involvement in treatment decisions, and make sure health care education extends to these family members as needed.
As you make cultural understanding an essential part of patient-centered care, it's important to note that these are general guidelines. The term "Hispanic" encompasses a large group of people from varied ethnic backgrounds, and other groups of people will have different challenges and values. The best approach is to understand each patient's individual background first, but lean on demographic-based information when appropriate. By bridging communication gaps, making an effort to teach, and being respectful of cultural values, you're well on the way to an inclusive practice that ensures the best care and guidance for people of all backgrounds.