Introduction
Cultural competence is the ability of organizations to provide health care services that consider the socio-cultural and linguistic needs and values of patients. It can improve the quality of care, which leads to better health outcomes with the prospect of reducing racial and ethnic disparities. Hispanics are the largest minority group in the United States which strongly contribute to the economic and cultural diversity of the country.
Assessing their health care needs based on social-ecological risks and epidemiologic profile helps to guide health policy and provide culturally competent care to the population. This paper will discuss the health needs and disparities of the Hispanic population in the United States and provide methods of delivering culturally competent care and improving the nursing process.
Population Health Care Needs and Disparities
Hispanics comprise approximately 17.4% of the US population, predicted to increase to 28.6% by 2060. This group includes individuals immigrating from Latin America, the Caribbean, and Spain (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis & Escamilla-Cejudo, 2016). The population is disproportionately affected by poverty and adverse living conditions, which are defined by economics, education, occupation, and support systems (including health care) that are social determinants of health. In turn, this leads to chronic stress, which results in behavior such as unhealthy diets, sedentary lifestyles, and substance abuse that disrupt biological processes. Therefore, the Hispanic population’s health risk profile is overwhelming due to ecological conditions as well as adverse behaviors.
Almost 27% of Hispanics are uninsured, with the rate growing to 37% amongst the poor (Velasco-Mondragon et al., 2016). A significant number of immigrants are undocumented, which leads to fear of deportation and lack of protection at places of employment. Social realities, which imply a lack of proper education and employment with inadequate access to health care due to financial and cultural factors, result in a strong marginalization of a demographic group in terms of health care delivery.
Social determinants of health are a direct cause of health inequalities affecting the Hispanic population. Most of these specific to Hispanics are most often directly correlated to socioeconomic status. Risk factors for non-communicable diseases without proper access to healthcare result in vulnerability to morbidity and mortality. Obesity remains a primary risk factor for multiple health issues amongst Hispanics. Hispanic youth have the highest rate of obesity at 21.9%, with the overall population showing a staggering 42.5% rate (Velasco-Mondragon et al., 2016).
Obesity leads to numerous health complications amongst Hispanics, including cardiovascular disease and stroke, hypertension, and diabetes. Metabolic syndrome and insulin resistance caused by diabetes are disproportionately prevalent amongst Hispanics. Substance abuse is prevalent amongst Hispanics, with higher rates of alcohol and tobacco usage in comparison to other populations. Cancer is the leading cause of death amongst Hispanics, with a case-fatality rate of 30% (Velasco-Mondragon et al., 2016).
Despite a wide range of psychosocial and physical health disparities that are caused by poverty and lack of access to healthcare, the Hispanic population displays overall better physical health and lower mortality rates than non-Hispanic Whites. This epidemiological event is known as the Hispanic/Latino health paradox. Life expectancy is higher despite increased health risk profile due to living conditions and health behaviors. This phenomenon can be potentially explained by socio-cultural resilience, which explains that social networks and Hispanic cultural identity can be tied to moderate health advantages (Ruiz, Hamann, Mehl, & O’Connor, 2016).
Delivering culturally competent care to the Hispanic population should consider this as a critical factor in order to form a strategy that is supportive of the existing epidemiological status quo. The Hispanic health paradox offering advantageous outcomes will be offset by the rapidly increasing prevalence of adverse health conditions. Improving health care access and delivery can tremendously benefit the community and improve the quality of life for a population that has shown resilience despite an abundance of health risks.
Delivering Culturally Competent Care
A multifaceted approach combining social policy with health care services on the ground is necessary to address health disparities affecting Hispanics. Since social, ecological, and biological factors impact the epidemiologic profile of the population, a collaborative approach should be focused on implementing health equity into policy. That includes addressing social determinants of health with adverse effects through aspects such as economic stability, education, environment, community socialization, and most importantly, access to health care. While the Affordable Care Act has expanded access to Hispanics, factors such as citizenship status, cultural discrepancy, and geographic mobility remain as barriers. Cultural sensitivity and health literacy are critical to ensuring the utilization of health services for improving behaviors and preventing and controlling chronic or deadly diseases (Velasco-Mondragon et al., 2016).
Approaches to nursing care should consider cultural values in Hispanics that can be respected in clinical settings. These include kindness and respect. The culture values personal connection and politeness with respect given to people of status or age. Modesty is also a factor with physical examinations occurring after explicit agreement from the patient, preferably by a physician of the same sex. Hispanics often use alternative medicine and religious practices to address health issues, which should be respected and most often can be safely combined with traditional medical treatments.
A caring environment should be created that offers flexible scheduling, evening hours, and ensuring the lack of immigration status will not result in consequences for patients. A strong effort should be made towards offering the bilingual experience by hiring Hispanic staff, having interpreters, conducting cultural sensitivity training, and offering information or forms (both physical and virtual) in Spanish. Communication efforts with patients are necessary to ensure patient activation on adhering to treatment plans and changing lifestyle behaviors. Due to the language barrier, it may be helpful to use the teach-back technique to ensure the patient fully understands the provided care. Providers can dictate practical change at the systemic level by offering more free clinics and screening services prevalent amongst Hispanics (Juckett, 2013).
These principles can be applied to nursing practice by using a “connectedness” model. It combines the positive control of treatment and decision-making that occurs when a patient takes charge of personal health, including at home with vulnerability due to language barriers and lack of awareness. Patients seek to improve the process the health care by understanding the language and challenges of the system that is part of cultural adaption.
With language being the primary barrier to interaction, communication is the key component to culturally competent care. Nurses should attempt to interact closely with patients and instill confidence, self-reliance, and understanding in patients (Sobel & Metzler Sawin, 2014). Due to the structure of the U.S. health care system, a patient-centered approach is the most competent in delivering high-quality care to Hispanics.
Improving Health Care Delivery
A wide variety of assessment tools exist to evaluate systemic and personal cultural competency in practice. Cultural competence is a fluid process that requires active learning, fosters workplace diversity and harmony, and promotes the delivery of the highest quality of care to patients who may not be socioeconomically privileged. Instruments to improve cultural competence in clinical settings include training and workshop programs for staff, culturally specific education for patients, interpreter services, patient navigators, and peer education. Provider-focused training focuses on knowledge and attitudes related to cultural competency.
This consists of understanding the community’s ethnic background, health issues, as well as having necessary communication skills. Cultural self-efficacy and multicultural counseling are additional factors that are critical for nurses working with minorities. Training for clinical staff shows improvement in cultural competence through better awareness and knowledge on how properly deliver care by accepting and navigating cultural differences with patients. Health care utilization increases significantly with the use of bilingual community health workers and interpreters, which can bridge the gap between providers and the target communities. (Truong, Paradies, & Priest, 2014).
Conclusion
Minorities like the Hispanic/Latino population are disproportionately burdened by increasing morbidity and mortality rates from chronic diseases. Lack of access to health care, linguistic and cultural differences, and poor standards of medical practices are some of the challenges experienced by Hispanics. It is critical to address these issues through comprehensive policy as well as changes to the delivery of care and nursing practice which can be specially adapted to work with the intricacies and specific needs of the population.
References
Juckett, G. (2013). Caring for Latino patients. American Family Physician, 87(1), 48-54. Web.
Ruiz, J. M., Hamann H. A., Mehl, M. R. & O’Connor, M. (2016). The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. Group Processes & Intergroup Relations, 19(4), 462-476. Web.
Sobel, L. L., & Metzler Sawin, E. (2014). Guiding the process of culturally competent care with Hispanic patients: A grounded theory. Journal of Transcultural Nursing, 27(3), 226-232. Web.
Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14(99). Web.
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, J. A. (2016). Hispanic health in the USA: A scoping review of the literature. Public Health Reviews, 37(31), 1-27. Web.