Patient-Centered Culturally Sensitive Maternity Care Begins at Home

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Patient-centered culturally sensitive healthcare (PC-CSHC) is critical to providing high-quality maternity care to diverse populations, eliminating health disparities, and achieving health equity.1,2 In particular, women who are low-income, are from racial and ethnic minority communities, and have limited access or fragmented care and are at risk for poor pregnancy outcomes.3 The costs of racial disparities in health outcomes are associated with substantial economic losses in excess of $235 billion a year.4 Although the root causes and factors contributing to health disparities are complex, there are evidence-based approaches and tools available to providers to help address some of these issues.2 Among those methods include the improvement of the cultural awareness and sensitivity of the healthcare workforce.2 This column reviews key resources and tools available to healthcare providers to incorporate and improve their own PC-CSHC skills.
Culturally sensitive care is integral to patient-centered care. Patient-centered care is defined by the Institute of Medicine as care that is respectful of, and responsive to, individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions.5 There are 8 identified principles and practices of patient-centered care that improve the patient experience: (1) respect for patients' values, preference, and expressed needs; (2) coordination and integration of care; (3) information and education; (4) attention to physical comfort with pain management, assistance, and in the environment; (5) emotional support and alleviation of fear and anxiety; (6) involvement of family and friends by providing accommodations, in decision making, supporting and recognizing the needs of family; (7) continuity in transitions, particularly in discharge planning through provision of ongoing physical and financial support; and (8) access to care when needed as perceived by the patient, including location of hospitals, clinics, and offices, availability of transportation, ease of scheduling appointments, access to specialists, and clear instructions on referrals.6 Patient-centered care is meant to be both engaging and empowering.
Cultural humility is a construct for understanding and developing cultural sensitivity, awareness, and competency.7 It is process oriented and guided by 3 factors. The first is that it is a lifelong commitment to self-evaluation, critique, and learning.8 The second feature of cultural humility is the desire to correct unnecessary power imbalances.8 Finally, cultural humility includes the development of community partnerships, with people and groups that advocate for others.8 In essence, cultural humility is the ongoing developmental journey toward cultural competence.
Self-awareness is the initial step in this developmental process. A personal inventory of values and perspective includes critical self-reflection. Reflexivity is a process to explore personal beliefs and their influence on judgment.9 In particular, it is a tool utilized in qualitative research by the researcher to alleviate bias.10 Specifically identifying one's own values, beliefs, culture of origin, and how they may influence perspective is critical to reflexivity. Some suggested self-reflection questions are outlined in Table 1.
To continue with a thorough self-assessment of cultural awareness, the Georgetown University National Center for Cultural Competence has a validated online audit tool: the cultural and linguistic competence for healthcare providers assessment (CLCHPA).11 The CLCHPA evaluates 3 factors: (1) knowledge of culturally and linguistically diverse populations; (2) adapting practice for diverse populations; and (3) health promotion of diverse communities. Specific feedback is given that is based upon the individual responses. The test evaluates linguistic competence, which is defined as the ability to communicate effectively, convey easily understood information to a diverse group of individuals including those with limited language or health literacy proficiency.11 In addition, feedback is given on the capacity to recognize and address health and healthcare disparities that impact diverse patient populations within a practice setting and in the community.
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