The SHARE Approach—Taking Steps Toward Cultural Competence: A Fact Sheet
Cover Note: The SHARE Approach is a 1-day training program developed by the Agency for Healthcare Research and Quality (AHRQ) to help health care professionals work with patients to make the best possible health care decisions. It supports shared decisionmaking through the use of patient-centered outcomes research (PCOR).
Cultural competence is essential for effective shared decisionmaking
Providers striving to deliver high-quality care to all patients understand that cultural factors influence patients' health beliefs, behaviors, and responses to medical issues. This fact sheet provides guidance for how to consider cultural differences as you build effective relationships with your patients during shared decisionmaking.
Learn how to interact with diverse patients
- Keep an open mind. Remember that each patient has a unique set of beliefs and values, and they may not share yours.
- Ask patients about their beliefs regarding their health condition. (e.g., "What do you think caused the problem? What do you fear most about the sickness? Why do you think it started when it did?") This information will allow you to make the most of your interactions during shared decisionmaking. Recognize and understand that the meaning or value of health prevention, intervention, and treatment may vary greatly among cultures, specifically for behavioral health.
- Attend cultural competence training at your organization or through a continuing education program.
- Be aware of your own culture and how that may affect how you communicate with your patients.
- Reach out to cultural brokers to help you learn more about the differences and similarities between cultures. They can tell you how to better address the patients you serve regarding cultural appropriateness, beliefs about health, and barriers to communication. Cultural brokers might include health care and social service workers and cultural group leaders. Ask them to suggest resources you can use to learn more about your patients' cultures.
- Know what you don't know. You won't be able to learn about every aspect of every patient's culture. Don't be afraid to let your patients know that you are unfamiliar with their culture. Invite them to explain what is important to them and how getting and staying well works in their community.
Keep in mind that culture is not homogenous. There is great diversity among individuals—even in the smallest cultural group. Remember, culture changes over time, especially when one cultural group is exposed to and influenced by another culture.
Provide culturally appropriate decision aids
- Ask your patient about his or her learning preferences to help you present information better during shared decisionmaking. Find out if your patient prefers for you to offer materials in print, video, or audio format. Ask your patient if he or she would like you to explain by talking, using a model, making a drawing, or demonstrating how to do something. You may find your patient wants you to present information in a variety of ways.
- Make sure that multimedia decision aids (videos, DVDs, CDs, audiotapes), other health resources for treatment, and other intervention materials reflect the cultures of the patients you serve.
- When possible, offer decision aids, treatment summaries, and educational materials that have culturally relevant descriptions of risks and benefits of treatment options. The best decision aids meet cultural, and health literacy or plain language standards.
- Assess the quality of decision aids by using the International Patient Decision Aids Standards (IPDAS) Collaboration Criteria Checklist. http://ipdas.ohri.ca/index.html
Provide qualified medical interpreters
- Provide qualified medical interpreters for patients whose English proficiency is limited. The use of unqualified interpreters—such as a family member, friend, or unqualified staff member—is not advisable. Never use a minor child to interpret. Using unqualified interpreters is more likely to result in misunderstandings and medical errors. Refer to Overcoming Communication Barriers With Your Patients: A Reference Guide for Health Care Providers (Tool 3).
- You can sometimes expose cultural misunderstandings by asking patients to say in their own words what you have taught them. Refer to Using the Teach-Back Technique: A Reference Guide for Health Care Providers (Tool 6).
Work to build trust
- Show respect for your patients in culturally appropriate ways. Make it clear that your role is to help them choose from among the options, not to make the decision for them.
- Recognize that in many cultures, family members are deeply involved in health decisions. Involve extended family members, when appropriate, in shared decisionmaking and when planning care
- Encourage patients to ask you questions. Explain that asking questions is a good way to learn about health problems and options for treatment. Say, "What questions do you have for me today?"
- Choose signs, magazines, brochures, and other printed materials that reflect your patients' cultures. This will help put them at ease.
Nodding and saying "yes" does not always mean comprehension has been achieved. Gently ask patients or family members to convey the information in their own words to make sure they understand.
Learn more about cultural competence
For health care provider resources, visit:
- The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations.
- The Culture, Language, and Health Literacy Overview video relays effective health care communication policies and practices, including provider health literacy, which contribute to improving the quality of services for culturally and linguistically diverse populations, as well as people with limited health literacy skills.
Cultural competence is critical to reducing health disparities and improving access to high-quality health care—health care that is respectful of, and responsive to, the needs of diverse patients. Learn about and understand the principles and practices of cultural competence and begin applying them with the patients you serve.
Use teach-back whenever you explain an important concept—such as treatment options, participation in a clinical trial, weighing benefits and risk, or adherence to a treatment plan.
For culturally appropriate interactive decision aids from the Agency for Healthcare Research and Quality, visit:
For consumer research summaries that compare treatment options for a variety of health conditions (most in both English and Spanish), visit:
A limited number of copies are available at no cost through the AHRQ Clearinghouse. All AHRQ resources are freely available online.
This tool is to be used in conjunction with the Agency for Healthcare Research and Quality's SHARE Approach workshop. To learn more about the workshop, visit www.ahrq.gov/shareddecisionmaking.
Goode T. Adapted from Promoting Cultural Competence and Cultural Diversity in Early Intervention and early childhood setting. June 1989. Revised 2009. Georgetown University Center for Child & Human development, University Center for Excellence I Development Disabilities, Education, Research, & Service.
Seibert P.S., Stridh-Igo P., Zimmerman C.G. A checklist to facilitate cultural awareness and sensitivity. J Med Ethics 2002 Jun;28(3):143-6. PMID: 12042396.
Six Steps Toward Cultural Competence: How to Meet the Health Care Needs of Immigrants and Refugees. Recommendations from the Minnesota Public Health Association's Immigrant Health Task Force. Minnesota Department of Health. Minneapolis, MN. September 2000 Retrieved at: https://www.ucare.org/providers/Documents/6StepsCulturalCompetence.pdf (PDF File, 790.34 KB).