




This checklist is intended to heighten the awareness and sensitivity of personnel to the importance of cultural and linguistic competence in provider office settings.

Directions: Mark items with A = Frequently B = Sometimes or occasionally C = Rarely or never
“C” responses present opportunities for improvement.


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____ Our office setting, (including artwork, décor, and magazines), reflects the diversity of our client population.

____ Printed information, videos, or other media resources for health education, treatment, or other interventions reflect the culture and ethnic background of those served by our office.

____ Printed information disseminated by the office takes into account the average literacy of the office patient base.

____ There are clear, multi-lingual signs about linguistic services available in the office posted in the front desk area.

____ Signs, bulletin boards and other displays are language-appropriate for the clientele and are presented in large print.

____ Examination rooms and other service areas are equipped to handle telephonic interpreter services (by cell or standard phone).

____ Waiting areas, exam rooms, and restrooms are disabled-accessible for the clientele and are present in large print.

____ A TDD/TTY machine or posted instructions on accessing the Relay Services for the deaf is available.

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____ I understand that a limitation in English proficiency is not a reflection of level of intellectual capacity or ability to communicate in the patient’s primary language.

____ I keep in mind that verbal ability is not a refection of the patient’s ability to read and write in either English or their own language.

____ I understand that a heavy accent is not a reflection of a person’s education or the ability to speak or read English.

____ I understand the legal requirements related to use of bilingual staff when providing medical interpretation for treatment, interventions, or other associated meetings.

____ I attempt to learn and use key words in the most common language(s) spoken by the office patient base to improve communication during assessment, treatment or other interventions.

____ I know which documents are legally required to be translated for non-English speaking patients.

____ When possible, I insure that all notices and instructions are written in the most common language(s) read by the office patient base, or that they know how to get the information translated.

____ I am careful to avoid using idioms, acronyms, and jargon in both written and verbal communication.

____ I am careful in the use of body language and am aware of what is acceptable among the various people I work with.

____ I understand that for some, oral transmission of information may have a deep tradition and verbal exchange may be preferred as the primary method of communication.

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____ I understand that perceptions of health and illness vary greatly and I try to understand how different people think about health.

____ I recognize that the meaning or value of medical treatment, screening for prevention & early diagnosis, & health education will vary and are impacted by culture and previous experience

____ I recognize and accept that individuals from culturally diverse backgrounds may have, and/or desire, varying degrees of acculturation into the mainstream culture.

____ I try to be aware of when I might be passing judgment or imposing my own values on those who hold different beliefs from my own.

____ I understand and accept that family composition and dynamics are defined differently by various cultures (e.g. the definition and expected roles of extended family members, fictive kin, and godparents).

____ I accept and accommodate the fact that male-female roles may vary significantly among different cultures and ethnic groups (e.g. who makes major decisions for the family).

____ I understand and try to accommodate age and life cycle factors that must be considered in interactions with individuals and families ( e.g. high value placed on the decision of elders, the role of eldest male or female in families, or roles and expectations of children within the family).

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____ I seek information on acceptable behaviors, courtesies, customs, and expectations that are unique to the communities I work with.

____ I am aware of the socio-economic, major health, and environmental risk factors that contribute to the major health problems of the communities I work with.

____ I screen books, pamphlets, videos, and other media resources for negative cultural, ethnic, or racial stereotypes before sharing them with individuals and families served by my office.

____ I intervene in an appropriate manner when I observe other staff or clients within my office engaging in behaviors that show cultural insensitivity, racial biases or prejudice.

____ I seek professional development and training to enhance my knowledge and skills in the provision of services and supports to culturally, ethnically, racially and linguistically diverse groups

____ I recognize and accept that folk and religious beliefs may influence an individual’s or family’s reaction and approach to a child born with a disability, or later diagnosed with a disability, genetic disorder, or special health care needs.

____ I understand and try to accommodate some of the ways that grief and bereavement affect people.

____ Even though my professional or moral viewpoints may differ, I accept and accommodate individuals and families as the ultimate decision-makers for services and supports impacting their lives. ____ I seek information from individuals, families or other key community informants that will help me respond appropriately to the needs and preferences of the diverse groups served by my office.

____ I accept that religion and other beliefs may influence how individuals and families respond to illnesses, disease, and death. ____I advocate for the review of my program’s or agency's mission statement, goals, policies, and procedures to insure that they incorporate principles and practices that promote cultural and linguistic competence.

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____ I do not use the patient’s family members to interpret medical information or questions.

____ I ask my patients whether they would like adult family members or other people important to them present when discussing their diagnosis and treatment.

____ I take extra time to ensure that patients, who are not fluent in the language I use, understand the expected effects and side effects of the medication prescribed for them.

____ I ask patients, who are not fluent in the language I use, to paraphrase what I said in order to check the accuracy of their understanding.

____ I use indirect or open-ended questions with people to help those who have difficulty with direct questioning.

____ I understand which language needs, religious affiliations, and other cultural information, need to be entered into the medical chart.

____ I inquire about the patient’s use of alternative medical systems or cultural healers (e.g., curanderos, herbalists) and try to accommodate that treatment, when it is appropriate.

____ I am aware of the underground "pharmacies" and illegal "medical" services that are active in my community and can discuss them with patients as needed.

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