Culturally adapted health care

There is strong evidence that culturally adapted health care improves health outcomes^{1, 2, 4, 6, 7, 8}, mental health^{3, 8, 9, 10, 11, 12}, health-related knowledge^{1, 4, 6, 13, 14}, and chronic disease management^{4, 6, 7, 8, 15, 16}, and increases cancer screening^{7, 9, 15} for culturally and linguistically diverse (CALD) patients. There are many types of culturally adapted care, with approaches such as culturally appropriate health education programs^{4, 6}, culturally tailored life style interventions^{1, 17}, and culturally trained or bilingual health workers^{1, 18} appearing especially effective.

Evidence of improved outcomes is strongest for asthma, mental health, and diabetes treatment, cancer screening, and smoking cessation^{4, 6, 7, 8, 15, 17}. 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 visits⁶. For asthmatic adults, culturally adapted care improves self-reported quality of life⁶ and disease management¹⁶.

Psychotherapy adapted to a patient’s cultural understanding of illness improves psychological functioning more than standard psychotherapy⁸. Treatment built on patient understanding may improve patient satisfaction^{8, 9}, expectations, adherence to treatment, and willingness to consider alternate illness explanations⁸. Addressing values, customs, language, and culturally relevant metaphors can also improve mental health among patients with depression^{3, 10, 11}. A rural Washington-based study of Native American women exposed to trauma found that culturally-adapted Cognitive Processing Therapy reduced symptoms of post-traumatic stress disorder (PTSD), risky sexual behavior, and frequency of alcohol consumption¹².

For patients with limited English proficiency (LEP), professionally trained medical interpreters improve patient-provider communication and are associated with improved quality of care^{19, 20}. Culturally appropriate, individualized education for Spanish-speaking heart failure patients improved self-care and heart failure knowledge more than usual care¹⁴. Culturally and gender-sensitive programs show promise for treating alcohol and substance abuse in Latino men²¹. A New Haven, CT-based study of Spanish-speaking individuals found that culturally adapted web-based cognitive behavior therapy (CBT) reduced drug and alcohol use and increased completion of substance use disorder treatment²². Culturally-adapted motivational interviewing can reduce the number of heavy drinking days and physical harm related to alcohol use for Latinos⁹.

Telephone-based cessation counseling adapted to patients’ linguistic and cultural needs increases smoking cessation more than standard telephone counseling¹⁷. Interventions that include more counselor contacts and address familial influences can yield stronger effects than less intense interventions¹⁷.

Culturally adapted diabetes care improves glycemic control and diabetes knowledge more than usual care^{1, 4, 13}, especially when interventions include: appropriately adapted education materials; flexible implementation; local health worker support; affordable, culturally acceptable food choices; and less intense patient time requirements¹. Incentives such as cash, glucose monitors, or healthy snacks can also improve patient retention and short-term glycemic control¹. Effects appear strongest in communities with limited access to diabetes education and services^{1, 23}.

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 interventions⁵. However, additional evidence is needed to determine whether such interventions outperform usual care¹⁷. A culturally congruent counseling program for HIV-positive black women and men was shown to increased long-term adherence to HIV treatment²⁴.

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 effects¹⁵; offering vouchers for the cost of service can increase the number of low income Latina women receiving mammograms⁹. Coordinating culturally-appropriate maternity care within the broader continuum of care can increase the use of skilled maternity care^{25, 26}.

The cost of culturally adapted care varies by intervention and condition; additional research is needed to determine the cost-effectiveness of culture-specific programs⁶. 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 quality adjusted life years (QALYs) saved^{4, 13}.

In 2019, the Centers for Disease Control and Prevention (CDC) expanded their $98 million program, Good Health and Wellness in Indian Country, to fund 27 awards over five years for American Indian and Alaska Native communities to implement culturally adapted care initiatives in support of healthy living and chronic disease prevention²⁷. The CDC also offers guidance and tools on cross-cultural communication and health literacy for organizations to use²⁸.

The U.S. Department of Health and Human Services’ Office of Population Affairs provides numerous resources on cultural competence principles and how to apply them in specific settings²⁹. The National Research Center on Hispanic Children & Families offers cultural competency resources including guidelines, fact sheets, and a webinar for community-based service organizations^{30, 31}.

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

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

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

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.

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.

CDC-CC evaluation - Centers for Disease Control and Prevention (CDC). Practical strategies for culturally competent evaluation.

US DHHS-OPA CC - U.S. Department of Health and Human Services (U.S. DHHS), Office of Population Affairs (OPA). Cultural competence.