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Cultural Diversity in Healthcare Poses Risks During COVID-19

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

Healthcare professionals continue to provide care to a multicultural society under conditions complicated by the COVID-19 pandemic. Ensuring safe and quality healthcare for all patients requires providers to understand how sociocultural background affects an individual’s health beliefs and behavior.

Providers and healthcare systems must also respond to the factors that make racial and ethnic minority groups more vulnerable to getting sick and dying from COVID-19. Factors include an individual’s living and working conditions, which can affect underlying health by making it difficult to access needed medical care and tests. These circumstances can be compounded by additional barriers—literacy, language, or socioeconomic (such as lack of insurance, little or no access to transportation, or even immigration status). The CDC provides additional information on its Health Equity Considerations and Racial and Ethnic Minority Groups page.

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.

A recent CDC study, Social Determinants of Health-Related Needs During COVID-19 Among Low-Income Households with Children, highlights the health and social challenges faced by vulnerable groups during the pandemic. The study may aid providers in understanding the social needs of low-income families.1

The CDC’s What We Can Do to Promote Health Equity page offers strategies to help healthcare professionals and delivery systems promote access to care. Physicians would be advised to 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.

Screening patients for social needs is essential. The American Journal of Managed Care’s podcast, Addressing Social Determinants of Health During COVID-19, discusses ways that clinicians can help patients with unmet social needs. A recent commentary in NEJM Catalyst, “Screening for Unmet Social Needs: Patient Engagement or Alienation?,” provides an overview for screening patients that includes available training modules and use of tablets and questionnaires.

When working in a culturally diverse community, staff should be on the lookout for individuals who may be infected or have been exposed to COVID-19 and assist them in understanding the need for isolation and preventive techniques. This may be especially difficult when multiple families or multigenerational families live in close contact.

The convergence of influenza and COVID-19 is another factor that may have an effect on care. Although a vaccine for influenza is readily available, some individuals may not have access to or the ability to pay for it. This puts them at a higher risk of contracting both respiratory-borne illnesses—a situation that could delay the appropriate diagnosis by a healthcare provider. For more information about preventing missed or delayed diagnosis of these illnesses, see our article “Flu or COVID-19? Convergence of Two Viruses Creates Risk of Diagnostic Errors.”

Some practitioners may find that patients are more willing to use telehealth options if transportation is an issue, but treating patients via telehealth brings certain specific risks. For more information on this topic, see our article “Top Seven Tips for Telehealth.”

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 more about how to proactively implement office procedures for multilingual patients by reading our article “Cultural Diversity Creates Language Barriers: Reducing Claims with Multilingual Patients.”

Steps You Can Take

Consider implementing the following strategies:

  • Provide accurate information in the patient’s preferred language about where to obtain tests.
  • Teach your staff to be aware of racial and ethnic minorities’ needs and barriers.
  • Ensure staff follows best practices for infection-control and helping patients to do the same.
  • Access community resources for multicultural populations.
  • Be aware of and respect the individual’s culture when providing care and testing.
  • Provide education and educational materials about COVID-19 for non-English speakers and those with low literacy or intellectual disabilities.
  • Evaluate any personal attitudes, beliefs, biases, and behaviors that may influence your patient care.

For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.


Reference

  1. Sharma SV, Chuang R, Rushing M, Naylor B, Ranjit N, Pomeroy M, et al. Social determinants of health-related needs during COVID-19 among low-income households with children. Prev Chronic Dis. 2020;17:200322. DOI: http://dx.doi.org/10.5888/pcd17.200322

Resources

Agency for Healthcare Research and Quality, What Is Cultural and Linguistic Competence?

Centers for Disease Control and Prevention, COVID-19 Information for Specific Groups of People

U.S. Department of Health and Human Services, Office of Minority Health, Think Cultural Health, A Physician’s Practical Guide to Culturally Competent Care

U.S. Department of Health and Human Services, Health Resources and Services Administration, Culture, Language, and Health Literacy Resources

U.S. Department of Health and Human Services, Office of Minority Health, Think Cultural Health and National Culturally and Linguistically Appropriate Services (CLAS) Standards


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.

J13252 02/22

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