Cultural Barriers in Healthcare & Communication Techniques to Explore Them

Culture shapes almost every aspect of our lives, including our beliefs, customs, and daily interactions with the world and people around us. However, we often oversimplify “culture” by reducing it to mean ethnic or national identity alone. This may particularly be the case among individuals from a historic majority culture when viewing immigrant or minority groups. This is an important consideration as we explore the issue of cultural barriers in healthcare.

Recognizing that we all have culture, and that culture is often hidden from view, there is a good chance of experiencing a “cultural barrier” with almost any patient. Take, for example, the issue of mistrust. Although mistrust may be higher among certain groups that have historically been mistreated by the U.S. medical institution, only 35% of Americans report having “great trust” in medical leaders. Other cultural barriers to care include health beliefs that differ from the biomedical disease model and religious customs or practices that conflict with standard medical practice.

Language barriers may be one of the most dramatic and recognizable barriers to care, given that clear communication is the gateway to understanding our patients, and making ourselves understood by them in turn. In absence of effective interpreter services, it will be nearly impossible to ensure high-quality care to a patient with limited English proficiency. If you are interested in ensuring high-quality care for patients with Limited English Proficiency, take our LEP course.

Cultural barriers that present an immediate obstacle to the healthcare experience can generally be overcome when they are understood and dealt with directly. In healthcare, as in many other fields, the key to understanding (and eventually overcoming barriers) is communication. In some cases, the barrier to be navigated may be obvious—for example, a patient who is a Jehovah’s Witness may be reluctant to undergo surgery because of concerns surrounding blood transfusion.

In many other cases, however, cultural barriers to care are not so apparent. Uncovering these less recognizable barriers takes awareness, and savvy communication skills. Here are a few examples of ways to uncover and respond to cultural barriers to care. 

Exploring culturally based health beliefs

When you suspect a patient may not be on the same page with you, it can help to explore their perspectives. For example, if a patient seems hesitant to agree with your diagnosis or plan, you may open a conversation like this:

“I’ve given you a lot of information about this condition, but I’d also like to hear your thoughts about it. People usually know their bodies pretty well and sometimes they have different perspectives about what may be going on than we do. What do you think about the health issues you’ve been having?”

Giving patients an opening like this to tell you about their deeper thoughts and ideas about their condition can be extremely useful at uncovering hidden concerns, fears, beliefs, and perspectives, regardless of if they seem to be culturally based.

You may learn that the patient was concerned they had cancer because a family member died of something similar. Or they may tell you that they read something on the internet and have been treating themselves with an herbal supplement for the past few months. They may even believe that a spiritual aspect is at play. But these ideas usually won’t come out unless the right questions are asked in the right ways.

Exploring culturally based customs and practices

Cultural and religious practices can have a significant impact on healthcare. We discussed the refusal of blood transfusions earlier. Other examples include the first-born son being designated as the healthcare decision-maker for the family, various customs related to the care of women just after giving birth and what to do with the placenta, and fasting or avoiding certain types of food.

While it can be helpful to be familiar with common customs of the cultural groups that you work with most often, it’s best not to assume that patients will follow these. Additionally, it would be impossible to know every custom or practice across all individuals in our care. For these reasons, open communication techniques, like the following, are universally applicable: “Are there any customs or practices that you or your family follow that have to do with your health and healthcare that would be helpful for me to know about?”

You can get more specific to the situation at hand and incorporate that into your question as well. For example, “Do you have any customs or practices around childbirth that I should know about?”

Opening statements that normalize the issue being discussed can also help put the patient at ease and prompt a more open response. For example: “A lot of the patients I see have customs that they tell me about so I can take better care of them. Do you…”

These are just a few examples of how effective communication can help overcome cultural barriers that could prevent patients from getting the best possible healthcare. While these and other related communication skills are particularly effective with patients from cultural backgrounds that are unfamiliar, the beauty of them lies in the fact that they are useful with all patients, because we all have culture.

If you are interested in learning more about the topic, read our blog on culturally sensitive ways to approach mental health.