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Cultural Considerations for Behavioral Health Providers in Primary Care

Posted By Matthew P. Martin, Monday, March 12, 2018

Healthy People 2020 is a multi-year, multi-stakeholder effort by the US government to address social determinants of health and disparities. This vision for a healthier country includes specific actions that the United States must take to achieve better health by the year 2020.

Some of the goals include:

  • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
  • Achieve health equity, eliminate disparities, and improve the health of all groups.
  • Create social and physical environments that promote good health for all.
  • Promote quality of life, healthy development, and healthy behaviors across all life stages.

To address disparities in health and healthcare, behavioral health providers must apply their knowledge and skill in ways that meet the high demands for care. Specifically, they must apply a cultural lens to utilize knowledge about patients’ cultural background, values, and experiences when delivering services.

One recent article on this very topic appeared in the recent issue of Journal of Clinical Psychology in Medical Settings. I reached out to the authors Jessica Jackson and Adeya Richmond for answers to some questions and received the following responses. 

1. How can a culture-centered paradigm help address health equity? 


Patient engagement and subsequent compliance with treatment are one pathway to improving health equity. A culture-centered paradigm is a more comprehensive way of assessing patient needs and addressing barriers to care. In order for patients to make health decisions that are in their best interest they need the opportunity to receive and interpret basic health information in a way that resonates with their cultural frame of reference.  Patients are more likely to engage in and successfully complete treatment when they believe that the intervention aligns with their values and beliefs. Culturally sensitive providers who provide culturally competent care have the potential to increase patients treatment engagement.


2. What are the Five A’s Organizational Construct?


The Five A’s is an evidence-based assessment and intervention format for behavior change. (Hunter, Goodie, Oordt & Dobmeyer, 2009; Whitlock, Orleans, Pender, & Allan, 2002). It encompasses 5 phases that are patient-centered and collaborative: Assess, Advise, Agree, Assist & Arrange. This format equips providers with a tool to help thoroughly identify and address concerns that may be a barrier to optimal functioning and has been found to be especially effective in primary care settings.


3. What is the model of cultural competence you describe in your article and how can it help behavioral health providers?


The model of cultural competence described in our article is one put forth by Josepha Campinha-Bacote (2002): The Process of Cultural Competence in the Delivery of Healthcare Services. This model emphasizes cultural competence as a dynamic process that clinicians engage in as they work to understand and provide services within the cultural context of patients. This model encourages clinicians to develop (1) cultural awareness, (2) cultural knowledge, and (3) cultural skill which will influence their (4) cultural encounters and increase (5) cultural desire. This model can help behavioral health providers integrate their assessment of patient concerns with sociocultural factors that influence patient behaviors. Patients often understand and address their behavioral health and medical needs through the lens of their cultural beliefs (Andrulis & Brach, 2007) and providers need to be cognizant of how these beliefs are influencing behaviors and decision-making. Behavioral health providers who seek to understand these beliefs may be able to more accurately address patient needs and concerns.


4. How can behavioral health providers help other providers (physicians, nurses, and students) to develop a culture-centered paradigm?


Behavioral health providers often work in interdisciplinary settings and have the unique opportunity to help other providers understand how the cultures of multiple systems (medical culture, culture of the practice, the different personal cultures of the providers etc. interact and together and influence healthcare/behavioral health service delivery. Another way that behavioral health providers can help other providers develop a culture-centered paradigm is by assessing (formally or informally) the level of cultural sensitivity in the practice/clinic/classroom that they work in. This may include assessing for an understanding of the concerns of the specific community being served or ensuring that patients can receive health information in their native language or other community relevant concerns


  Matt Martin, PhD, LMFT is Clinical Assistant Professor at Arizona State University Doctor of Behavioral Health Program. He serves as CFHA blog editor. 

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