Background:
The CDC advocates improved physician cultural competence to reduce disparities in cardiovascular (CV) health. Cultural competence may be particularly important to establish an effective therapeutic alliance to mitigate CV risk. This study sought to better understand physician elements of cultural competence that can be targeted to improve cardiovascular health in minority populations.
Methods:
Family physicians, internists, cardiologists and neurologists practicing in the southern US were queried in this survey. Participants assessed their cross-cultural knowledge, skills, attitudes, and training using 5-point scales. Office managers of respondents were then invited to complete a separate survey assessing compliance with 3 Culturally and Linguistically Appropriate Services (CLAS) standards relevant to the office setting.
Results:
Among 697 respondents, 57% considered sociocultural issues important in patient interactions. Prior training was reported by 76%, but 18% considered multicultural health training of little importance. On average, self-assessed knowledge (10 items) and skill (15 items) were moderate. More than 3 of 4 physicians reported little or no knowledge of CLAS standards; more than half reported limited knowledge of traditional healing. Striking differences were noted among physicians of different racial groups with blacks consistently reporting greater self-awareness, knowledge and skill compared to whites (p< .01). Significant differences did not emerge between primary care and specialist physicians. A subset of 124 office practices participated in the CLAS assessment. Though physicians were largely unaware of CLAS standards, compliance was 98% for Standard 1 (culturally appropriate care), 67% for Standard 2 (workforce diversity) and 25% for Standard 3 (staff CLAS training).
Conclusions:
Physicians and their office staff have modest levels of cultural sensitivity as well as moderate cross-cultural knowledge and skills, but deficits, especially among physicians and particularly as a function of physician race, are present in important areas. Building upon this foundation to achieve greater proficiency in cross cultural care may improve the quality of care and reduce disparities in CV health.
Teaching Politeness Strategies
