Culturally-Competent Healthcare Practice in Action: What Do Providers Do?

Background/Purpose: The older adult population continues to grow in numbers and in diversity, and research documents the positive impact of culturally-competent healthcare practices on their care outcomes. As such, a broad literature exists discussing educational initiatives to teach cultural competence to healthcare professionals, as well as describing practice models. Yet, less is known about the exact practices of healthcare professionals working with older adults from diverse backgrounds. To help address this gap, we systematically reviewed the literature describing culturally-competent practices employed by healthcare providers serving older adults. The review sought to answer the research question, “What are the specific practices healthcare professionals engage to provide culturally-competent care?”

Methods: Using PRISMA guidelines, authors searched Abstracts in Social Gerontology, Academic Search Premier, CINAHL Plus Full Text, ERIC, MEDLINE, PsychInfo and SocIndex for peer-reviewed publications between 2010-2020 in the U.S. (given specifics of healthcare context). Examples of the terms searched include: cultural competen* AND old age OR older adult* AND behavior* OR actions OR practic*. The initial searches yielded 5,240 unduplicated publications. After screening articles for relevance based on titles and abstracts, 22 publications were retained for full review. A total of 13 articles met inclusion criteria and were included in this review.

Results: The articles reviewed describe unique considerations and provide specific examples of information providers should consider in order to deliver culturally-competent care. This includes taking into account patients’ past experiences, and preferences regarding language, communication, and family involvement. Providers are encouraged to conduct comprehensive assessments that explore these areas and then to use information gathered to inform the selection of evidence-based services appropriate for the population, as well as to guide their practices broadly (e.g., outreach and care navigation initiatives; built environment). The articles describe intake information containing patients’ race, ethnicity, level of education, and preferences in language and pronouns as crucial to informing providers on how to tailor their patient care. Further, the studies describe the need to engage in ongoing self-reflection and self-education that includes past and present issues affecting client groups (e.g., history of healthcare mistrust among African Americans), as well as emerging research evidence describing validated practices and tools for use with different client groups. All of this allows providers to tailor their services to ensure they are delivering patient-centered, culturally-competent care.

Conclusion/Implications:The results of this systematic review indicate that culturally-competent practice begins with a comprehensive assessment of the patient’s system, followed by the provision of individualized, person-centered care to meet their needs. While this is consistent with training priorities emphasizing cultural competency, there remains a need to advance the widespread adoption of best practices in field, to ensure culturally-competent behaviors are practiced consistently and to enhance care outcomes for older adults from diverse groups. Similarly, reimbursement structures that prioritize good quality care interactions need to be further advanced. As liaisons among patients, families, and the healthcare system, social workers have the opportunity to be a part of this change, to advance culturally-competent policies and practices across the healthcare system.