Recommendations for providers
There has always been a thin line between the influence of religious activity and cultural boundaries. For the majority of religious patients and population groups, healthcare services can be deemed culturally competent when they are able to understand and provide catered and care. Mandated training is often given at many institutions to try and achieve this status, but this effort at exposing providers to this abundance of religions and cultures runs the risk of stereotyping and stigmatizing patient groups. Additionally, many providers have noted many aspects of their training that could be managed or enhanced to improve cross-cultural healthcare.
The first step: identify the religion and/or culture of patients and familiarize these to staff.
- A practical method could be producing or updating a directory of common R/S practices in the U.S. This can start small with specific concerns in different cultures and religions. These could be religious beliefs with health implications like Ramadan/Yom Kippur fasting for pregnant women, underutilization of R/S resources and community to help people with mental illness, and individuals not being treated through R/S strategies and communities. Local resources can help propagate the recommendations above.
Second: While studies on how R/S can have a positive impact on an individual’s life has been conducted, the topic often stops there, with no great effort of applying that knowledge in actual clinical settings. In order to ensure better patient experience providers must be aware of the main components of multi-cultural openness: cultural safety, cultural humility, cultural intelligence, and cultural competence.
- Cultural safety is the idea of protecting the culture of minority groups and balancing power and correcting biases within institutions.
- Cultural humility is the act of encouraging non-judgmental viewpoints while allowing the patient to express how their own culture impacts their life and clinical experience.
- Cultural intelligence also focuses on the individual’s ability to identify and respond to many different cultural situations that are different from their own.
- Cultural competence—often used as a buzzword—is the idea that is a framework that works on an institution’s internal and external ability to improve physician attitudes, cultural communication, diversity, and patient experience.
Third: Physicians must learn how to adopt such mindsets in order to improve health outcomes and experiences for the variety of patients that they encounter. However, quickly learning about these concepts may result in homogenizing many religions as well as certain stereotypes, therefore, education must be done carefully and over a long-term period.
The article above emphasizes objectives should be to focus on improving “cross-cultural communication, enhanc[ing] responsiveness to the health care needs of diverse patients, and reduc[ing] health care disparities” (Shepard, 2019). The field of healthcare has often failed to follow organized, directed, and integrated manners diving into R/S issues. Efforts have especially been lacking in physician training. As seen in the article above, practitioners considered diversity of staff, interpreter services, and cultural education/training to be the best ways to improve cultural competence. It was also found that healthcare workers would have found it helpful to have training and discussions with different ethnic backgrounds in order to “learn about their cultures/norms and how health care providers would be most effective in helping those clients”. This strategy may prove to increase the effectiveness of treatment of patients because this takes into account intersectionality of religion and healthcare as well.
Please reference the Working with Individuals Page to see more resources available!
Some examples of possible questions to ask you patients will be addressed below. These are formal assessments to aid in describing the spiritual needs of patients with open-ended questions to gain information about the patient’s views and faith.
The HOPE Questions for a Formal Spiritual Assessment in a Medical Interview
H: Sources of hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality and practices
E: Effects on medical care and end-of-life issues
SPIRIT5
Spiritual Belief System
Personal Spirituality
Integration and Involvement in a Spiritual Community
Ritualized Practices and Restrictions
Implications for Medical Care
Terminal Events Planning (advance directives)
FICA Spiritual History Tool6
F – Faith and Belief
Do you consider yourself spiritual or religious?” or “Do you have spiritual beliefs that help you
cope with stress?” If the patient responds “No,” the health care provider might ask, “What gives
your life meaning?” Sometimes patients respond with answers such as family, career, or nature.
I – Importance
“What importance does your faith or belief have in our life? Have your beliefs influenced how
you take care of yourself in this illness? What role do your beliefs play in regaining your
health?”
C – Community
“Are you part of a spiritual or religious community? Is this of support to you and how? Is there
a group of people you really love or who are important to you?” Communities such as churches,
temples, and mosques, or a group of like-minded friends can serve as strong support systems for
some patients.
A – Address in Care
“How would you like me, your healthcare provider, to address these issues in your healthcare?”
https://www.aamc.org/media/24831/download
Recommendations in the community
Public health officials must also be aware that the R/S communities engage in a multitude of practices and beliefs and be open to adjusting treatments for these cases.
The first step to aid in catering towards R/S in the community is to assess the practices already in place. In his book Why Religion and Spirituality Matter for Public Health (available on the “Working with Individuals” page), Dr. Doug Oman gives an example of improving cultural competence in the community through nutritional efforts. He gives three points: policy makers must be aware that communities engage in a mixture of practices and not just one dietary plan.
Second, when seeking to address chronic issues in the community, one will find that building upon church-based interventions may help. In other words, utilizing the existing programs and resources that the community already trusts is a great way for policy makers to impact the people.
Third, preventative measures based on R/S strategies may and have shown to be effective for more mental or emotional illnesses. With this information, we can incorporate R/S efforts into primary prevention measures as the combination of spiritual aspects and the acknowledgement of beliefs for patients may reduce future risks of disease and disorders.
Although integrating R/S into a community measure may seem relatively easy to do, secularization of medicine makes it easy to develop ethical concerns or conflicts of interest. These include ethical concerns of omission–which would be not offering holistic care, and commission–”coercion and overstepping one’s competence in offering spiritual care” (Polzer Casarez, 2012). The conditions under which health officials decide to integrate spirituality into policies also differ and depend on the situation at hand. Strategies they use to integrate spirituality may cause some people to wonder the reason behind it and question the benefits of R/S in decision making.
Because of these concerns, public health officials must tread carefully when coming up with community initiatives or policy changes. Keeping the three steps above in mind will help them avoid these issues and officials may find it helpful to actually go to places of worship or health organizations to truly understand the community at hand.
Polzer Casarez, R.L. and Engebretson, J.C. (2012), Ethical issues of incorporating spiritual care into clinical practice. Journal of Clinical Nursing, 21: 2099-2107. https://doi-org.ezproxy.neu.edu/10.1111/j.1365-2702.2012.04168.x1
Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019, February 26). The challenge of cultural competence in the workplace: Perspectives of Healthcare Providers – BMC Health Services Research. BioMed Central. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-3959-72