Culturally adapted health care

Culturally adapted care tailors health care to patients’ norms, beliefs, values, language, and literacy skills (, ). Care may delve more deeply into cultural considerations such as social, psychological, and economic factors (). Culturally adapted care can include: matching specialists to patients by race or ethnicity (, Chowdhary 2014); adapting patient materials to reflect patients’ culture, language, or literacy skills (); offering education via community-based health advocates (); incorporating norms about faith, food, family, or self-image into patient care; and implementing patient involvement strategies (Kong 2014).

Expected Beneficial Outcomes (Rated)

  • Improved health outcomes

  • Improved health-related knowledge

  • Improved chronic disease management

Other Potential Beneficial Outcomes

  • Increased patient satisfaction

  • Reduced hospital utilization

  • Improved quality of life

  • Improved mental health

  • Improved adherence to treatment

  • Increased cancer screening

  • Increased tobacco cessation

  • Improved dietary habits

  • Improved weight status

Evidence of Effectiveness

There is strong evidence that culturally adapted care improves health outcomes for culturally and linguistically diverse (CALD) patients (, , , , ). There are many types of culturally adapted care, with approaches such as culturally appropriate health education programs (, ), culturally tailored life style interventions (Nierkens 2013, ), and culturally trained or bilingual health workers (Truong 2014, ) appearing especially effective. 

Evidence of improved outcomes is strongest for asthma, mental health, and diabetes treatment, cancer screening, and smoking cessation (, , Nierkens 2013, , Masi 2007). Culturally adapted care for children with asthma improves caregiver and patient understanding of asthma more than usual care. It can also lead to improvements in symptom control and reductions in hospitalization and emergency room visits (). For asthmatic adults, culturally adapted care improves self-reported quality of life () and disease management (Press 2012).

Psychotherapy adapted to a patient’s cultural understanding of illness improves psychological functioning more than standard psychotherapy (). Treatment built on patient understanding may improve patient satisfaction, expectations, adherence to treatment, and willingness to consider alternate illness explanations (). Addressing values, customs, language, and culturally relevant metaphors can also improve mental health among patients with depression (Chowdhary 2014, Fuentes 2012).

Telephone-based cessation counseling adapted to patients’ linguistic and cultural needs increases smoking cessation more than standard telephone counseling (Nierkens 2013). Interventions that include more counselor contacts and address familial influences can yield stronger effects than less intense interventions (Nierkens 2013).

Culturally adapted diabetes care improves glycemic control and diabetes knowledge more than usual care (, , Hawthorne 2010), especially when interventions include: appropriately adapted education materials; flexible implementation; local health worker support; affordable, culturally acceptable food choices; and less intense patient time requirements (). Incentives such as cash, glucose monitors, or healthy snacks can also improve patient retention and short-term glycemic control (). Effects appear strongest in communities with limited access to diabetes education and services (, ).

Culturally adapted obesity interventions can improve diet and weight status for black women, especially when patients are involved in the planning and recruitment phases of these interventions (Kong 2014). However, additional evidence is needed to determine whether such interventions outperform usual care (Nierkens 2013).

Adapting care to patient linguistic and cultural needs can improve breast cancer knowledge and increase screening rates more than usual care, especially among women with lower incomes. Addressing financial and transportation barriers, language, and literacy skills can yield stronger effects (Masi 2007).

For patients with limited English proficiency (LEP), interpretation is associated with better quality care and improved health outcomes. Professional interpreters appear to make fewer clinically significant errors than ad hoc interpreters such as family, friends, or untrained staff, and lead to higher patient satisfaction (Karliner 2007). Remote, real-time interpretation can also reduce errors and increase patient satisfaction (CWF-Cooper 2004).

The cost of culturally adapted care varies by intervention and condition. Diabetes care interventions have demonstrated costs per patient between $150 over six months and $384 over one year, and appear cost effective in terms of QALYs saved (, Hawthorne 2010). In a Boston-based study, asthma care cost an estimated $2300 for 11 children, and saved about $4700 in averted emergency department visits (). In a Massachusetts-based study, interpretation services cost about $280 per patient (Jacobs 2004).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Many health care organizations use culturally adapted care (Truong 2014). In 2014, the Centers for Disease Control and Prevention (CDC) awarded grants to 11 American Indian tribes to implement culturally adapted care initiatives and to 12 tribal organizations to provide leadership, technical assistance, training and resources to to tribes and villiages (CDC-Comprehensive wellness).

Implementation Resources

US DHHS-Think cultural health - U.S. Department of Health & Human Services (US DHHS). Think cultural health.

US DHHS-Cultural competence - US Department of Health and Human Services (US DHHS). Health Resources and Services Administration (HRSA). Culture, language and health literacy.

Finding Answers-Responding to culture - Finding Answers: Disparities Research for Change. Responding to culture: Beyond cultural competence training.

CDC-Reproductive health - Centers for Disease Control and Prevention (CDC). Reproductive health: Successful culturally-adapted American Indian/Alaska Native interventions.

AHRQ HCIE-Yeung - Yeung AS. Culturally sensitive, multidisciplinary assessment, treatment, and support significantly increase treatment rates for depressed Chinese Americans in primary care. Rockville: AHRQ Health Care Innovations Exchange.

AHRQ HCIE-Ell - Ell K. Social worker-led, culturally tailored therapy and support improve treatment adherence, depression-related symptoms, and patient satisfaction in low-income Hispanics with diabetes. Rockville: AHRQ Health Care Innovations Exchange.

AHRQ HCIE-Trihn Shevrin - Trihn-Shevrin C. Community health workers offer culturally tailored interactive workshops and counseling to Filipino Americans, leading to improvements in medication adherence and cardiovascular risk factors. Rockville: AHRQ Health Care Innovations Exchange.

APHA-Translator - Public Health Newswire. APHA partnership offers medical translator for free.

RWJF-Menehan 2006 - Menehan K. Outreach program adapted to improve health care for Asian people in Philadelphia. Princeton: Robert Wood Johnson Foundation (RWJF); 2006.

CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). Tools for Cross-Cultural Communication and Language Access Can Help Organizations Address Health Literacy and Improve Communication Effectiveness.

Citations - Evidence

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Karliner 2007 - Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research. 2007;42(2):727-54.

Truong 2014 - Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research. 2014;14(1):99.

Chowdhary 2014 - Chowdhary N, Jotheeswaran AT, Nadkarni A, et al. The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: A systematic review. Psychological Medicine. 2014;44(6):1131-46.

Hodge 2010* - Hodge DR, Jackson KF, Vaughn MG. Culturally sensitive interventions and health and behavioral health youth outcomes: A meta-analytic review. Social Work in Health Care. 2010;49(5):401-23.

Cochrane-Bailey 2009* - Bailey E, Cates C, Kruske S, et al. Culture-specific programs for children and adults from minority groups who have asthma: Review. Cochrane Database of Systematic Reviews. 2009;(2):CD006580.

Kong 2014 - Kong A, Tussing-Humphreys L, Odoms-Young A, Stolley M, Fitzgibbon M. Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obesity Reviews. 2014;15(4):62-92.

Joo 2014* - Joo JY. Effectiveness of culturally tailored diabetes interventions for Asian immigrants to the United States: A systematic review. The Diabetes Educator. 2014;40(5):605-15.

Fuentes 2012 - Fuentes D, Aranda MP. Depression interventions among racial and ethnic minority older adults: A systematic review across 20 years. American Journal of Geriatric Psychiatry. 2012;20(11):915-931.

Benish 2011* - Benish SG, Quintana S, Wampold BE. Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology. 2011;58(3):279-89.

Pottie 2013* - Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30(9):1017-25.

Nierkens 2013 - Nierkens, V., Hartman, M. a, Nicolaou, M., et al. Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities: A systematic review. PloS One. 2013;8(10):e73373.

Hawthorne 2010 - Hawthorne K, Robles Y, Cannings-John R, Edwards AGK.  Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: A systematic and narrative review of randomized controlled trials. Diabetic Medicine. 2010;27:613-23.

Masi 2007 - Masi CM, Blackman DJ, Peek ME. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Medical Care Research and Review. 2009;64(5):195S-242S.

CWF-Cooper 2004 - Cooper LA, Powe NR. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. New York: The Commonwealth Fund (CWF); 2004.

Press 2012 - Press VG, Pappalardo AA, Conwell WD, et al. Interventions to improve outcomes for minority adults with asthma: A systematic review. Journal of General Internal Medicine. 2012;27(8):1001-15.

Cochrane-Attridge 2014* - Attridge M, Creamer J, Ramsden M, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus: Review. The Cochrane Database of Systematic Reviews. 2014;(9):CD006424.

Jacobs 2004 - Jacobs EA, Shepard DS, Suaya JA, Stone E. Overcoming language barriers in health care: Costs and benefits of interpreter services. Research and Practice. 2004;94(5):866-869.

Citations - Implementation Examples

* Journal subscription may be required for access.

Truong 2014 - Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research. 2014;14(1):99.

CDC-Comprehensive wellness - Centers for Disease Control and Prevention (CDC). A Comprehensive Approach to Good Health and Wellness in Indian Country.

Date Last Updated

Nov 19, 2015