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Cultural Background

Category: Multi-Cultural Resources

Everyone approaches illness as a result of their own experiences, including education, social conditions, economic factors, cultural background, and spiritual traditions, among others. In our increasingly diverse society, patients may experience illness in ways that are different from their health professional’s experience. Sensitivity to a patient’s view of the world enhances the ability to seek and reach mutually desirable outcomes. If these differences are ignored, unintended outcomes could result, such as misunderstanding instructions and poor compliance.

The following tools are intended to help you review and consider important factors that may have an impact on health care. Always remember that even within a specific tradition, local and personal variations in belief and behavior exist. Unconscious stereotyping and untested generalizations can lead to disparities in access to service and quality of care. The bottom line is: if you don’t know your patient well, ask respectful questions. Most people will appreciate your openness and respond in kind.

The following materials are available in this section:

Information on Special Topics


Substance Abuse

Physical Abuse

Communicating with the Elderly

Let’s Talk About Sex

Consider the following strategies when navigating the cultural issues. Surrounding the collection of sexual health histories

Gender roles 

Sexual health and patient cultural background 


Confidentiality preferences 


 *NOTE: Avoid using family members as interpreters. Minors are prohibited to be used as interpreters. Find an interpreter with a health care background. Make sure the request for or refusal of an interpreter is documented in the patient’s medical chart.


Pain Management Across Cultures

Your ability to provide adequate pain management to some patients can be improved with a better understanding of the differences in the way people deal with pain. Here is some important information about the cultural variations you may encounter when you treat patients for pain management.

These tips are generalizations only. It is important to remember that each patient should be treated as an individual.

Reaction to pain and expression of pain 

Spiritual and religious beliefs about using pain medication 

Beliefs about drug addiction 

Use of alternative pain relief treatment 

Methods needed to assess pain 

* NOTE: Avoid using family members as interpreters. Minors are prohibited from being used as interpreters. Find an interpreter with a health care background. Document in the patient’s medical chart the request for or refusal of an interpreter.

Promoting Cultural & Linguistic Competency 

A Self-Assessment Checklist for Personnel Providing Primary Health Care Services

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.

Physical Environment Communication Styles

____ 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. 

____ 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 reflection 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.

Values and Attitudes

____ 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).

____ 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.

Medical Encounter 

____ 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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