Whitney Wall

Patient-Centered, Culturally Sensitive Health Care

In recent years, there have been increasing national calls for patient-centered, culturally sensitive health care (PC-CSHC). The impetus for these calls include (a) the reality that health care providers are increasingly having to provide health care to a more culturally diverse patient population without the necessary training to do so effectively, (b) the growing evidence that culturally insensitive health care is a major contributor to the costly health disparities that plague our nation, and (c) the fact that racial/ethnic minorities and individuals with low household incomes are more likely than their non-Hispanic white and higher-income counterparts to experience culturally insensitive health care and dissatisfaction with health care—health care experiences that have been linked to poorer health outcomes. This article (a) presents literature on the definition of PC-CSHC and the need for this care, (b) presents research on assessing and promoting this care, and (c) offers research-informed strategies and future directions for customizing and institutionalizing this care.

Patients' Perceived Cultural Sensitivity of Health Care Office Staff and Its Association with Patients' Health Care Satisfaction and Treatment Adherence

Research suggests that patients’ interactions with their front desk office staff and patient-centered culturally sensitive health care are important factors in diverse patients’ overall health care satisfaction. Yet, patient-centered culturally sensitive health care research has focused almost exclusively on provider care. This study tested the hypothesis that patient-perceived cultural sensitivity of front desk office staff has a significant positive association with patient treatment adherence and that this relationship is mediated by patient health care satisfaction. Study participants were a culturally diverse sample of 1,191 patients from health care sites across the U.S. Results of a meditational analysis supported the tested hypothesis. Patient health care satisfaction fully mediated the relationship between patient-perceived cultural sensitivity of front desk office staff and patient treatment adherence. The patient satisfaction and cultural sensitivity variables explained 10% of the variance in patient treatment adherence. Training front desk office staff in patient-centered culturally sensitive health care may improve patients’ health care satisfaction and treatment adherence.

Patient Perceived Cultural Sensitivity of Clinic Environment and Its Association With Patient Satisfaction With Care and Treatment Adherence

Research suggests that patient-centered culturally sensitive health care may be an important precursor to patient satisfaction and treatment adherence. Data from this study are a subset from the data collected for the Patient-Centered Culturally Sensitive Health Care and Health Promotion Research Project. The present study was designed to (a) explore the relationship between patients’ perceived patient-centered cultural sensitivity of their health care sites (ie, the physical and social environment and clinic policies) and their self-reported adherence to treatment and (b) investigate whether this relationship is mediated by satisfaction with health care experienced. Participants consisted of a low-income, culturally diverse sample of 1581 patients from 67 health care sites across the United States. A significant positive relationship between patients’ perceived patient-centered cultural sensitivity of their health care sites and their self-reported treatment adherence to a prescribed regimen was observed. Patient satisfaction with care partially mediated the relationship between these 2 variables. Assessing the level of patient-centered cultural sensitivity patients perceive in their health care sites might provide guidance to health care administrators as to how to make their sites more culturally sensitive from the perspective of patients. This, in turn, might increase patients’ treatment adherence, leading to improved health outcomes.

Testing of a Model with Latino Patients That Explains the Links Among Patient-Perceived Provider Cultural Sensitivity, Language Preference, and Patient Treatment Adherence

IntroductionDisparities in treatment adherence based on race and ethnicity are well documented but poorly understood. Specifically, the causes of treatment nonadherence among Latino patients living in the USA are complex and include cultural and language barriers.PurposeThe purpose of this study was to examine whether patients’ perceptions in patient-provider interactions (i.e., trust in provider, patient satisfaction, and patient sense of interpersonal control in patient-provider interactions) mediate any found association between patient-perceived provider cultural sensitivity (PCS) and treatment adherence among English-preferred Latino (EPL) and Spanish-preferred Latino (SPL) patients.MethodsData from 194 EPL patients and 361 SPL patients were obtained using questionnaires. A series of language-specific structural equation models were conducted to test the relationship between patient-perceived PCS and patient treatment adherence and the examined mediators of this relationship among the Latino patients.ResultsNo significant direct effects of patient-perceived PCS on general treatment adherence were found. However, as hypothesized, several significant indirect effects emerged. Preferred language appeared to have moderating effects on the relationships between patient-perceived PCS and general treatment adherence.ConclusionThese results suggest that interventions to promote treatment adherence among Latino patients should likely include provider training to foster patient-defined PCS, trust in provider, and patient satisfaction with care. Furthermore, this training needs to be customized to be suitable for providing care to Latino patients who prefer speaking Spanish and Latino patients who prefer speaking English.

Roles of Perceived Provider Cultural Sensitivity and Health Care Justice in African American/Black Patients’ Satisfaction with Provider

The present study tests a refined first component of the Patient-Centered Culturally Sensitive Health Care (PC-CSHC) Model—the evidence supported component that links perceived provider cultural sensitivity to patient satisfaction with provider care and identifies trust of provider as the mediator of this linkage. The refined first component of the PC-CSHC Model tested in the present study is novel in that it includes the three dimensions of provider cultural sensitivity and includes perceived provider impartiality (fairness), a core aspect of perceived health care justice, as a mediator in addition to trust of provider (the other core aspect of perceived health care justice). Study participants were 298 African American/Black primary care clinic patients with low household incomes. Mediation analyses revealed that the three dimensions of patients’ perceived provider cultural sensitivity were significant predictors of the participating patients’ reported satisfaction with their provider, and that some of these predictive relationships were partially mediated by (1) patients’ perceived provider impartiality (fairness), and (2) patients’ trust of their provider. Implications of these findings for providers’ interactions with patients, development of the PC-CSHC Model, and the roles of psychologists in facilitating patient-provider interactions are discussed.

Validation of a patient-centered culturally sensitive health care office staff inventory.

AIM/BACKGROUND Research suggests that patient-perceived culturally sensitive health care encompasses multiple components of the health care delivery system including the cultural sensitivity of front desk office staff. Despite this, research on culturally sensitive health care focuses almost exclusively on provider behaviors, attitudes, and knowledge. This is due in part to the paucity of instruments available to assess the cultural sensitivity of front desk office staff. Thus, the objective of the present study is to determine the psychometric properties of the pilot Tucker-Culturally Sensitive Health Care Office Staff Inventory-Patient Form (T-CSHCOSI-PF), which is an instrument designed to enable patients to evaluate the patient-defined cultural sensitivity of their front desk office staff. METHODS A sample of 1648 adult patients was recruited by staff at 67 health care sites across the United States. These patients anonymously completed the T-CSHCOSI-PF, a demographic data questionnaire, and a patient satisfaction questionnaire. Findings Confirmatory factor analyses of the TCSHCOSI-PF revealed that this inventory has two factors with high internal consistency reliability and validity (Cronbachs αs=0.97 and 0.95). CONCLUSIONS It is concluded that the T-CSHCOSI-PF is a psychometrically strong and useful inventory for assessing the cultural sensitivity of front desk office staff. This inventory can be used to support culturally sensitive health care research, evaluate the job performance of front desk office staff, and aid in the development of trainings designed to improve the cultural sensitivity of these office staff.

Validation of a Patient-Centered, Culturally Sensitive, Clinic Environment Inventory Using a National Sample of Adult Patients

The purpose of this study was to determine the factor structure, internal consistency reliability, and validity of the Tucker Culturally Sensitive Health Care Clinic Environment Inventory–Patient Form (T-CSHCCEI-PF), a novel instrument designed to assess an aspect of health care often ignored in health care quality research: the cultural sensitivity of health care center policies and environment as perceived by adult, racially/ethnically diverse patients. Using ratings on this inventory by a culturally diverse national sample of adult patients (N = 1,639) from 67 health care sites across the United States, a confirmatory factor analysis of the T-CSHCCEI-PF was conducted, and its reliability and validity were determined. The T-CSHCCEI-PF was shown to be a reliable and valid inventory for culturally diverse patients to provide feedback to the administrators at their health care centers regarding the degree to which these centers have characteristics that are reflective of patient-centered culturally sensitive health care.

Increasing Health-Promoting Behaviors and Health Education Efficacy Among Clinical Staff:

Reducing rates of overweight and obesity is now an international health priority. Nonphysician clinical staff are uniquely well positioned to deliver or support the delivery of interventions to promote health behaviors in Americans. Yet levels of health-promoting behaviors among clinical staff are not higher than in the general population. Moreover, clinical staff often feel unprepared to encourage health-promoting behaviors among their patients. The Clinical Staff Health-Smart Behavior Program (CS-HSBP) is an employment site-based health promotion program to increase health-promoting behaviors among health care clinical staff members. The major aims of this study are to examine whether training clinical staff to implement the CS-HSBP with a group of peers increased (a) participants’ engagement in health-promoting behaviors, and (b) participants’ sense of efficacy at educating patients on health-promoting behaviors, the percentage of patients participants educated on health-promoting behaviors, and participants’ sense of themselves as healthy lifestyle role models for their patients. Participants were 66 clinical staff members at a university-affiliated outpatient health center. Results indicate that the CS-HSBP was effective at increasing staff’s engagement in health responsibility, healthy eating, and physical activity and also staff’s perception of their capability of educating patients and their perception of themselves as role models to their patients. Results also show no significant effect of the program on stress management and the percentage of patients educated by clinical staff. Study limitations and implications for future implementation of clinical staff-focused wellness programs are discussed.

Validation of an Inventory for Providers to Self-Assess Their Engagement in Patient-Centered Culturally Sensitive Health Care

Objective: Cultural sensitivity training of health-care providers could help eliminate health disparities. The Tucker-Culturally Sensitive Health-Care Provider Inventory (T-CSHCPI) is an inventory for providers to self-assess their engagement in patient-defined/-centered culturally sensitive health care. The T-CSHCPI is novel in that it assesses providers’ strengths and areas of growth in their efforts to provide culturally sensitive care as defined by culturally diverse patients. Methods: Using ratings on this inventory by a sample of culturally diverse providers (N = 291) from 67 health-care sites across the United States, a confirmatory analysis of the T-CSHCPI was conducted, and its validity and reliability were determined. Results: Factor analysis produced a final solution with 4 factors (interpersonal skills, conscientiousness, sensitivity, and disrespect/disempowerment) that were reliable. These 4 factors are associated with cultural competence, suggesting validity. Discussion: The T-CSHCPI measures independent dimensions of patient-centered care as identified by a national sample of health-care providers. The T-CSHCPI can be used to inform training that promotes patient-centered culturally sensitive health care by providers.

Development of an Inventory for Health-Care Office Staff to Self-Assess Their Patient-Centered Cultural Sensitivity

Background: Patient-centered culturally sensitive health care (PC-CSHC) is a best practice approach for improving health-care delivery to culturally diverse populations and reducing health disparities. Despite patients’ report that cultural sensitivity by health-care office staff is an important aspect of PC-CSHC, the majority of available research on PC-CSHC focuses exclusively on health-care providers. This may be due in part to the paucity of instruments available to assess the cultural sensitivity of health-care office staff. The objective of the present study is to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF). This instrument is designed to enable health-care office staff to self-assess their level of agreement that they display behaviors and attitudes that culturally diverse patients have identified as office staff cultural sensitivity indicators. Methods: A sample of 510 health-care office staff were recruited at 67 health-care sites across the United States. These health-care office staff anonymously completed the T-CSHCOSI-SAF and a demographic data questionnaire. Results and Level of Evidence: Confirmatory factor analyses of the T-CSHCOSI-SAF revealed that this inventory has 2 factors with high internal consistency reliability (Cronbach’s αs= .916 and .912). Conclusion and Implications: The T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity. Such self-assessment data can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff and to help draw the attention of these staff to displaying patient-centered cultural sensitivity.