Children's Hospital Colorado

Providing Culturally-Informed Care in a Primary Care Setting

Our country is becoming increasingly culturally and linguistically diverse by the minute. It is projected that people of color will account for over half of the U.S. population by 2050. It is no longer an option to become culturally informed, it’s a necessity. Building culturally-informed practices in the primary care setting will in turn create opportunities that lead to the best health outcomes for children and families.

In the current state, the pandemic and mental health crisis have brought to light vast healthcare disparities for marginalized groups in this country. These groups include ethnic or racial minority and LGBTQIA+ population groups, underserved rural communities and people living with poverty, disability or mental health conditions.

Some contributing factors to the healthcare inequities include: healthcare costs, discrimination and bias within healthcare systems, provider availability and accessibility, and health literacy and language barriers.

The disparities are leading to devastating outcomes. People of color and marginalized or underserved groups are experiencing higher rates of illness and death across a wide range of health conditions. One example is highlighted by the U.S. Surgeon General who reported on concerns with youth mental health treatment. In 2016, only half of the 7.7 million children with mental health disorders received adequate treatment. One tragic outcome of this healthcare gap is that suicide rates among Black children are increasing rapidly compared to those of white counterparts.

For disparities in youth mental health treatment and healthcare as a whole, the contributing factors can feel insurmountable. Many systems are at play and must make significant changes to address the inequities.

Primary care providers can address the contributing factors today by providing culturally-informed care. Making intentional efforts to respond to known barriers and interact with cultural competency can improve access to care and build trust that will ultimately lead to improved health outcomes. Research indicates that patients report improved health behaviors, less symptoms, improved quality of life and satisfaction with their treatment when they experience trust in their providers.

The following steps are recommended to increase access, foster relationships and build trust with patients of diverse backgrounds.

  • Awareness - Learn about the diverse makeup of your community. Follow current events and legislation that directly impacts youth.
  • Accessibility - Offer a variety of times for patient visits before and after the school and workday. Remember that telehealth can be easy for some and an obstacle for others. Consider offering healthcare events at local places of worship and community centers.
  • Competencies - Provide regular cultural competency training for staff. Learn about microaggressions and create a culture of “calling in” when they occur in the workplace. Approach patients with trauma-informed practices. Use inclusive language, such as person-first language. Refer to patients by their identified pronouns and names.
  • Inclusive Environment - Use signage in multiple languages. Display images of children and families of diverse backgrounds and abilities. Introduce yourself with your identified pronouns so patients feel more comfortable sharing their identity with you. Be mindful of your body language.
  • Ask About Your Patient’s Culture - Be direct in learning about your patients. Invite them to share about their culture and beliefs with open-ended questions. Ask about their thoughts and preferences related to their health and treatment. Learn about and support with social and financial stressors. Remember not to make assumptions or generalizations.
  • Health Literacy - Explain conditions and treatment plans in words or text that are easily understood. Check for understanding and allow time for questions.
  • Overcome Language Barriers - Utilize in-person, video, or phone interpreters for visits with patients and families that are non-English speaking. Translate after-visit summaries, treatment plans, educational documents and assessment measures or have the interpreter read them to the family. Remember that children should not be asked to interpret for their caregivers.
  • Community Resources and Care Coordination - Compile a list of resources in the community. Partner with community organizations to improve access to and follow through with recommended services.
  • Activism - Engage in larger efforts for change within local, state and federal initiatives.
  • Caring for Colleagues - Communicate often, problem-solve together, offer support and recognize the value in one another.

In putting these culturally-informed practices into action, primary care providers will increase opportunities for their patients to live their healthiest lives. Patients will face less obstacles to needed care and providers will be better able to build trust with diverse patients. Patients will feel more open to share about their concerns, more receptive to health information and more likely to engage in the care plan. Patients will ultimately benefit with improved healthcare experiences and health outcomes.

Resources for Providers: