Cultural differences as barriers to patient care

By Dr. Dapo Akinsipe and Dr. (PhD) Akolisa Ufodike

Read time: 3 minutes

Currently, annual immigration into Canada amounts to about 401,000 people per year (increasing to 430,000 by 2023), one of the highest rates per capita in the world. In the 2016 Canadian census, there were almost eight million immigrants living in Canada—roughly 21.9 per cent of the total Canadian population (StatsCan, 2017). Increasingly, a large number of Canadian immigrants are black people from Africa and the Caribbean. The top five countries that Canadian immigrants come from, in order, are India, China, Philippines, Nigeria and Pakistan. With more black immigrants coming into Canada, it is imperative that the medical profession furthers its understanding of the role played by cultural influences for black patients, in addition to other immigrant communities.

We define culture as a system of beliefs, values and customs shared by a group, used to interpret experiences and direct patterns of behavior. Culture plays a large role in shaping everyone’s health-related values, beliefs and behaviors, therefore impacting clinical care. Culture is often influenced by race, ethnicity and religion.

Cultural context is important in health care since sociocultural differences between patient and provider may impede open communication with consequences for clinical decision-making. For example, black patients may be less open about mental health issues and in some instances, less open with physicians of a different gender. This can be amplified when race intersects with religion and socio-economic status. Lower-quality care may result when clinicians fail to recognize and understand sociocultural differences between their patients and themselves.

Furthermore, cross-cultural care is, in essence, the care of every patient and is not limited to encounters where the patient and clinician have different sociocultural characteristics. Rather, it focuses on the ability to communicate effectively and provide quality health care to all patients.

We propose a patient-centred approach to providing quality cross-cultural care. The patient-centred approach entails four dimensions:

• Assessing core cross-cultural issues– Core issues to be explored are: styles of communication, trust, decision-making and family/loved one dynamics, traditions and spirituality, and sexual and gender issues.
• Patient’s understanding of illness– The explanatory model represents how the patient understands their illness: its cause, meaning and consequence. This allows the clinician to adapt communication and treatment recommendations to the patient’s concerns and perspectives.
• Social context– The manifestations of a person’s illness are linked to the individual’s social environment. Four aspects of the patient’s social context have relevance to the cross-cultural clinical encounter: change in environment (such as immigration status); literacy and language; social stressors; and social networks.
• Negotiation of a mutually acceptable approach to treatment– Even when sociocultural backgrounds are similar, substantial differences may exist in expectations and values between patients and clinicians. The process of cross-cultural negotiation can be helpful in acknowledging different explanatory models or agendas and developing management strategies.

To understand patients, it is necessary we also recognize our own cultural beliefs, values and behaviors, as well as personal life experiences that have influenced the way we think about health care and make clinical decisions. This can be achieved by CPSA and other training institutions offering effective training modules that incorporate cultural awareness from African, Caribbean and other immigrant communities, recognizing that meeting the healthcare needs of Canada’s growing, diverse population comes with the inherent challenge for practitioners to be adaptable.

References

https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025b-eng.htm?indid=14428-1&indgeo=0

https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/annual-report-parliament-immigration-2020.html

The patient’s culture and effective communication; Joseph R Betancourt, MD, MPH, Alexander R Green, MD, MPH, J Emilio Carrillo, MD, MPH, UpToDateSept2021

Dr. Dapo Akinsipe is a board-certified physician in Canada and the USA. He practices as a hospitalist at Alberta Health Services and also does some outpatient clinic practice. On occasion, he does detox/addiction medicine. He is clinical assistant professor at the University of Calgary’s Cumming School of Medicine, and is on the Office of Professionalism, Equity and Diversity (OPED) Advisory Board at University of Calgary as well. He is on the board of directors for the Black Physicians Association of Alberta and on the mentorship board for the Black Physicians Association of Canada. He is part owner and sits on the advisory board for a company called Fruit Street Health. Prior to these roles, he held different leadership positions in the USA before moving back to Canada in 2018.

Dr. (PhD) Akolisa Ufodike is a licensed public accountant and founder of the Ufodike Professional Corporation. He is also an assistant professor at York University, where he teaches auditing at the undergraduate level and data analytics at the graduate level. Dr. Ufodike is also appointed to the graduate program in public policy, administration and law at York University and teaches public sector finance in the graduate program. His research interests include accountability, actor networks, common pool resources, public sector finance and public-private partnerships. He is an ad hoc reviewer for the Journal of Business Ethics, Accounting Perspectives, Chinese Management Journal and the Sustainability Journal. His research has been presented at various conferences including the British Accounting and Finance Association (BAFA), American Accounting Association and Canadian Accounting Academic Association, and he has reviewed articles for the conferences of all three organizations.