Valuing Cultural Competence

• Culturally competent services require that health care providers assess their clients' beliefs or practices. This helps providers anticipate how to overcome potential barriers to effective health care. Culturally responsive health care methods can prevent misdiagnosis caused by misunderstandings, improve outcomes, and increase client and provider satisfaction.4 During the transition period, when sensitivities may be increased, it is important that providers make every effort to facilitate communication and collaboration with patients and their families.
• The provider who is designated to assist the family members in the transition process should be very familiar with them, their language, and their cultural needs. This person may be a member of the existing team or someone who has worked very closely with the family.
• Transitioning to greater levels of independence in health care may be viewed differently by patients, providers, and families. American Indian/Alaska Native (AI/AN) families may expect that they will remain a constant partner in the health care decisions of a young adult family member based on cultural values of relationship. Be sure to check in with families of pediatric patients as you prepare to transition them to adolescent or adult services. The change from family-centered care to individually focused care will likely require some discussion.
• In many Black/African American and Latino families, older family members have assumed care of their adult children or grandchildren. These older family members are often living with chronic illnesses such as hypertension or diabetes. In some cases, the medical team may have been like a family member, providing additional social support. In these instances, it is important to help adolescents establish a network as they transition from pediatric care.
• For AI/AN families, transferring responsibility for care to an adolescent may need to occur in steps and may require additional time to be carried out effectively.
• Good listening skills are important during this transition period. Providers must be sensitive to fears, beliefs, and values that are influencing family and patient decisions. AI/AN patients, in general, have a more positive response to an emotionally receptive provider who has good listening skills.
• Practice the LEARN model presented in the introductory module in order to better understand the role of the family's culture, if any, in the treatment of the youngster with HIV. The LEARN model9 encourages providers to:
  • Listen to the patient's explanation of the problem.
  • Explain your perspective on the problem.
  • Acknowledge differences between the provider and patient perspective.
  • Recommend treatment to the patient.
  • Negotiate treatment by collaborating with the patient to find an intervention that addresses their concerns and those of the provider.
• Young women living with HIV infection have special gynecological needs. If their pediatric clinic does not have gynecologic care, they may begin their relationship with an adolescent clinic by accessing these services there. Thus, they may be receiving treatment at two clinical sites. This arrangement can be utilized to facilitate their movement from one to the other.

References

4. Chodon T. The Role of Culture in HIV/AIDS Health Care--A Practical Guide for Providers Serving Asian and Pacific Islander Americans. New York: Asian and Pacific Islander Coalition on HIV/AIDS; 2001.
9. Berlin EA, Fowkes WC. A teaching framework for cross-cultural health care--Application in family practice, In: Cross-cultural Medicine. West J. Med. 1983, 12: 139, 93-98.