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Cultural Diversity in Healthcare Poses New Risks During COVID-19

Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education

Updated October 23, 2020: Physicians are increasingly faced with providing care to a multicultural society complicated by the COVID-19 pandemic. Ensuring safe and quality healthcare for all patients requires physicians to understand how each patient’s sociocultural background affects his or her health beliefs and behavior. In the light of the pandemic, physicians and healthcare systems will need to respond to factors that put racial and ethnic minority groups at a greater risk of getting sick and dying. The conditions where people work and live affect underlying health conditions and also make it more difficult to access needed medical care and tests. This can be complicated by literacy and language barriers along with socioeconomic barriers, such as lack of insurance, lack of access to transportation, and even immigration status.

Consider the following scenario: An elderly female Asian patient was noncommunicative with the physicians and staff during the first three days of her hospitalization. She would not maintain eye contact or talk, even when an interpreter was provided. The staff and physicians—concerned with privacy issues—generally spoke with the patient when family members were not present. After several days of delayed treatment because consent for a necessary but experimental COVID-19 therapy could not be obtained from the patient, a visiting chaplain of the same nationality explained the cultural requirement that a male family member be present for a female’s care.

The Centers for Disease Control (CDC) offer some suggestions to change how we care for these populations. Physicians should undertake a leading role in working with community and faith-based organizations, public health agencies, and others that have a part in promoting fair access to care.

When working in a culturally diverse community, the staff should be on the lookout for individuals who may be infected or exposed and assist them in understanding the need for isolation and preventive techniques. This may be especially difficult in areas where multiple families or multigenerational families live in close contact.

Another factor that may impact this population’s care is the convergence of influenza and COVID-19. Although there is a vaccine for influenza, certain racial and ethnic groups may not have access to or the ability to pay for the vaccine. This puts them at a higher risk of contracting both respiratory-borne illnesses, which may delay the appropriate diagnosis by the physician. 

Some physicians may find this population is more willing to use telehealth options if bus or car transportation is not an option, but there are risks in treating patients via telehealth during this pandemic.

With many patients speaking a language other than English at home, language barriers also raise the risk for an adverse event. The Doctors Company’s closed claims studies have shown that inadequate provider-patient communication is a frequent contributing factor to patient noncompliance, poor patient outcomes, and litigation. Effective provider-patient communication leads to an increase in patient satisfaction, better compliance, and improved outcomes. In multicultural and minority populations, the issue of communication may play an even larger role because of behavioral, cognitive, linguistic, contextual, and cultural barriers that preclude effective patient-provider communication. Research has shown that services for minorities can be improved by removing language and cultural barriers.

Learn how to proactively implement office procedures for multilingual patients

Steps You Can Take

Consider taking the following steps:

  • Provide accurate information on where to obtain tests and information in the community’s local language.
  • Teach your staff to be aware of racial and ethnic minorities' needs and barriers.
  • Ensure staff are using best infection-control practices and help patients do the same.
  • Understand and utilize community resources for these populations.
  • Be aware of and respect the individual’s culture when providing care and testing.
  • Provide education and education materials about COVID-19 for non-English speakers, low literacy, or intellectual disabilities.
  • Evaluate any personal attitudes, beliefs, biases, and behaviors that may influence your care of patients.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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