Providing Culturally-Informed Care in a Primary Care Setting

In the United States, marginalized communities face vast disparities in healthcare—meaning they interact with the healthcare system in a different way due to social, economic or environmental disadvantages. From healthcare costs and provider accessibility to discrimination and language barriers, these disparities lead to devastating outcomes. As healthcare professionals, it’s our duty to provide culturally-informed care.  

People of color and marginalized or underserved groups, including the LGBTQIA+ population, underserved rural communities and people living with poverty, disability or mental health conditions often experience higher rates of illness and death across a wide range of conditions.  

In 2016, U.S. Surgeon General Vivek Murthy reported on concerns with youth mental health treatment. 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. 

Recommendations 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. 

• Patient family background - Be direct in learning about your patients’ cultural background. 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 and offer support for 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. 

• 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. 

• 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 care, and providers will be better able to build trust with diverse patients. Patients will feel more open to share 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: 

• Health equity (apa.org) 

• CDC on Health Equity 

• Cultural Considerations | Patient Centered Care and Trauma Informed Care for Pediatric Patients - HEALTHCARE TOOLBOX