Cultural competence is described by the Office of Minority Health as having the capacity to function effectively within the context of the cultural beliefs, behaviors, and needs of consumers and their communities. Culture is influenced by a variety of factors, including age, educational level, income level, place of birth, length of residency in a country, individual experiences, and identification with community groups.
Culture Care Connection Initiative
From 2009 to 2010, Stratis Health provided technical assistance to a group of primary care clinics to assist them in enhancing their ability to provide culturally competent care to all their patients.
We provided technical assistance to 23 clinics across Minnesota—both urban and rural—and a public health agency to measure and enhance their cultural competence. The clinics are assessed on how well they were addressing the 14 national Culturally and Linguistically Appropriate Services (CLAS) standards.
- Customized demographic information regarding the changing nature of the populations they serve
- Offered online training for physicians, nurses, and office staff
- Providing ongoing consultation and recommendations
Results: Statistically significant performance improvement on all 14 CLAS standards (Updated in 2010 to 15 standards), between baseline and remeasurement, for all participating clinics combined.
In 2011, we replicated the initiative with an additional 20 clinics. (UCare grant 2008-2010, 2011-2013)
As part of this initiative, Stratis Health produces the quarterly Culture Care Connection electronic newsletter, with articles about specific racial and ethnic populations, the health issues unique to those populations, recommendations for successfully working with, treating, and communicating with patients from multicultural and other underserved populations, as well as tools, resources, education and training opportunities, and multicultural events taking place in your community.
Culture Care Connection
This online learning and resource center, developed by Stratis Health, supports health care providers, staff, and administrators in their ongoing efforts to provide culturally competent care in Minnesota. The site provides information on cultural competence concepts, health topics, ethnicities, and stakeholder organizations and resources that are most reflective of the needs of Minnesota’s diverse populations as well as the health care organizations that serve them. (UCare grant 2008-2011)
Culture Care Connection provides actionable, evidence-based tools to assist organizations in achieving their goals in relation to cultural competence. Key features include:
- Profiles of each Minnesota county with key demographic, socioeconomic, and health status data so health care practitioners can learn more about the characteristics of the communities they serve.
- A free, online CLAS Assessment, to assess how well health care organizations meet national cultural and linguistic standards.
- Information sheets to help health care providers learn more about the background, religious and cultural beliefs, and common health issues of the predominant minority populations in Minnesota.
The importance of cultural competence
Evidence shows that racial and ethnic minorities tend to receive a lower quality of health care than non-minorities―even when factors related to access such as patient insurance and income are controlled. The Institute of Medicine's 2002 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care revealed that failing to support and foster culturally competent health care can increase costs for the individual and society through increased hospitalizations and complications.
Health care providers across Minnesota are now providing care to an increasingly more diverse patient population that may not speak English, may not be familiar with Western medical customs, and may be distrustful of the American way of delivering health care. The Minnesota Population Projections by Race and Hispanic Origin 2000-2030 (January 2005) shows that the percent of Minnesota's population that is nonwhite is projected to rise to 13% by 2015 and to 16% by 2030, with the Hispanic population projected to triple by 2030. Minnesota has the largest Somali and Liberian populations in the U.S., and its Hmong population is second only to California, with St. Paul home to the largest urban population of Hmong in the world.
Stratis Health has a long record of success in reducing health disparities among communities of color and underserved populations. Our disparities reduction efforts include projects with specific populations and targeted clinical conditions, improving health literacy throughout the community, and increasing the cultural competency and effectiveness of health care providers serving culturally diverse populations.
Improving cultural competency
From 2006 to 2009, we worked with 23 adult primary care clinics across Minnesota―both urban and rural―to help them become more culturally competent.
- Assessed how well they were addressing the 14 national Culturally and Linguistically Appropriate Services standards-baseline and remeasurement
- Conducted training for their physicians, nurses, and office staff
- Customized demographic information for their community/region regarding the changing nature of the populations they are and will be serving
- Provided ongoing communication and technical assistance
Results: Statistically significant performance improvement on all 14 CLAS standards, between baseline and re-measurement, by the 23 participating clinics. (CMS contract 2006-2009)
Stratis Health produced a DVD series intended to help providers build their skills and capacity to provide culturally-appropriate care to three major growing populations in Minnesota: Hispanic/Latino, Hmong, and Somali. (UCare grant and CMS contract, 2009)
Reducing clinical disparities
We led a quality improvement project focused on reducing the disparities in diabetes care for African Americans in Hennepin and Ramsey Counties. Multiple interventions were developed and implemented.
- Conducted academic detailing with targeted physicians and clinics serving significant African American populations, by having a respected African American physician provide unbiased medical information
- Mailed educational materials to physicians at clinics serving African American patients
- Facilitated community learning sessions for African American health care consumers focused on diet, exercise, emotional wellness, and community outreach
- Promoted awareness through media, fairs and festivals, and conference participation and presentations
Results: Decrease in the disparity in lipid testing for diabetes between African American and Caucasian Medicare consumers from 25.0 percent to 21.2 percent in Hennepin County and from 30.0 percent to 22.8 percent in Ramsey County. (Centers for Medicare & Medicaid Services contract 2003-2005)
Understanding barriers to access
We partnered with the University of Minnesota to develop and implement focus groups and an extensive statewide survey among African American, American Indian, Hispanic/Latino, Hmong, and Somali enrolled in state public programs, to better understand their barriers to access and services under the Minnesota Prepaid Medical Assistance Program. (Minnesota Department of Human Services grant 2002-2003)
Establishing the Minnesota Health Literacy Partnership
Stratis Health was among the founding organizations of the state's health literacy coalition, established in 2005. We continue in a leadership capacity through serving on the steering committee and providing start-up funds through our Building Healthier Communities award program.
Developing low literacy patient education materials
We provided a matching grant to the Minnesota Diabetes Collaborative to develop and disseminate "Control Your Diabetes for Life"-low literacy patient education materials that promote consistent patient education diabetes messages across settings aimed at people with limited language skills and those who prefer visual instruction aids. (2009)
National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards), 2010 The 15 CLAS standards are directed at health care organizations and individual providers to make their practices more culturally and linguistically accessible. The standards are organized by themes: Principal Standard (1), Governance, Leadership, and Workforce (Standards 2-4), Communication and Language Assistance (Standards 5-8), and Engagement, Continuous Improvement, and Accoutability (Standards 9-15).
Office of Minority Health online educational tools (6-page PDF) A Physician's Practical Guide to Culturally Competent Care is a free online educational program accredited for physicians, nurses, nurse practitioners, and pharmacists. Culturally Competent Nursing Care: A Cornerstone of Caring is a free online educational program for nurses and is accredited by the American Nurses Credentialing Center.
QualityNet An online health care quality improvement resource established by CMS.
Definition: Culturally competent care
Definition: Cultural competency
National Alliance for Hispanic Health A science based organization focusing on Hispanic Health and dedicated to community-based solutions.
Agency for Healthcare Research and Quality Consumer Information A national resource for Spanish-speaking consumers and researchers with information on clinical topics, research, data, and funding opportunities.
WWW Hmong Homepage A volunteer effort that brings together online Hmong resources and publications, including news, current events, issues, history, and culture. An official Asian Studies WWW Virtual Library Associate site.
Hmong Resource Center Document in the Hmong language.
Hmong Patient Education Materials Produced by Tufts University, this site provides access to information on a variety of clinical topics in English and Hmong.
Hmong Health Provides access to health information for Hmong people and those who provide health, education, and social services to the Hmong community.
Somali Resource Cultural information and resources for health care professionals and Somali consumers provided by the Confederation of the Somali Community in Minnesota.
Ethnomed Somali health information materials for consumers and health care professionals.
Deaf and hard of hearing resources
Do You Know if Your Patients Are Deaf or Hard of Hearing? Communication challenges between the deaf and hard of hearing and their health care providers is a significant issue and has a direct effect on patient health care and outcomes. Effective communication is key to helping your patients understand their health issues and providing them with the proper treatment.
Contact Stratis Health for assistance with your quality improvement and patient safety needs.
If your organization has projects it would like to work on, contact us to discuss how we can work together to support initiatives related to reducing health care disparities.
Mary Montury, program coordinator