Health Literacy Universal Precautions Toolkit, 2nd Edition

Consider Culture, Customs, and Beliefs: Tool #10

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Religion, culture, beliefs, and ethnic customs can influence how patients understand health concepts, how they take care of their health, and how they make decisions related to their health. Without proper training, clinicians may deliver medical advice without understanding how health beliefs and cultural practices influence the way that advice is received. Asking about patients' religions, cultures, and ethnic customs can help clinicians engage patients so that, together, they can devise treatment plans that are consistent with the patients' values.

Here are some examples of how religion, culture, and ethnic customs can influence how your patients interact with you.

  • Health beliefs: In some cultures, people believe that talking about a possible poor health outcome will cause that outcome to occur.
  • Health customs: In some cultures, family members play a large role in health care decisionmaking.
  • Ethnic customs: Differing roles of women and men in society may determine who makes decisions about accepting and following through with medical treatments.
  • Religious beliefs: Religious faith and spiritual beliefs may affect health care-seeking behavior and people's willingness to accept specific treatments or behavior changes.
  • Dietary customs: Disease-related dietary advice will be difficult to follow if it does not conform to the foods or cooking methods used by the patient.
  • Interpersonal customs: Eye contact or physical touch will be expected in some cultures and inappropriate or offensive in others.

Learn from patients.

  • Respectfully ask patients about their health beliefs and customs, and note their responses in their medical records. Address patients' cultural values specifically in the context of their health care. For example:
    • "Is there anything I should know about your culture, beliefs, or religious practices that would help me take better care of you?"
    • "Do you have any dietary restrictions that we should consider as we develop a food plan to help you lose weight?"
    • "Your condition is very serious. Some people like to know everything that is going on with their illness, whereas others may want to know what is most important but not necessarily all the details. How much do you want to know? Is there anyone else you would like me to talk to about your condition?"
    • "What do you call your illness and what do you think caused it?"
    • "Do any traditional healers advise you about your health?"
  • Avoid stereotyping based on religious or cultural background. Understand that each person is an individual and may or may not adhere to certain cultural beliefs or practices common in his or her culture. Asking patients about their beliefs and way of life is the best way to be sure you know how their values may impact their care.

Learn from other sources.

  • High-quality online resources provide education about cultural competence, both as a general topic and as related to specific groups.
    • Courses
    • Web sites
      • EthnoMed is a Web site containing information about cultural beliefs, medical issues, and other related issues pertinent to the health care of recent immigrants.
      • Culture Clues are one-page tip sheets that offer insight into the health care preferences and perceptions of patients from 10 different cultures and special needs groups (including the deaf and hard-of-hearing). The Web site also covers end-of-life issues.
      • The Culture, Language, and Health Literacy Web site provides an exhaustive list of resources regarding cultural competence issues for specific ethnicities, religions, and special populations.
  • Community organizations such as religious institutions and cultural organizations can often provide information and support to help make your practice more "culture-friendly."
    • Invite a member of a relevant cultural group to attend a staff meeting and share observations about how cultural beliefs may impact health care.
    • Invite an expert to conduct an in-service training to educate staff about cultural competence.
  • Integrate cultural competence into orientation and other trainings. Take advantage of opportunities to integrate cultural competence into all of your training activities.
  • Use interpreters as cultural brokers. Interpreters can eliminate language barriers as well as help you and your patients avoid misunderstandings due to cultural differences. Go to Tool 9: Address Language Differences for more information about interpreters.

Help staff learn from each other.

To raise awareness about cultural competence among your staff, you could:

  • Hire staff that reflects the demographics of your patient population. These staff members can help contribute to a comfortable environment for patients and can share insights with other staff regarding the customs of their religious or ethnic groups.
  • Encourage staff to complete online cultural competence trainings and share what they learned with each other during a staff meeting.

Track Your Progress

Before implementing this Tool, count the number of staff members who have completed a cultural competence training session. Repeat after 2, 6, and 12 months.

On a regular basis, randomly select some medical records and see what percentage have notes on the patient's culture, customs, or health beliefs.

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Page last reviewed February 2015
Page originally created February 2015
Internet Citation: Consider Culture, Customs, and Beliefs: Tool #10. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD.
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