Cultural diversity in health care

Culture and ethnicity are two concepts often used synonymously (1). Within this paper, culture refers to the inherited ways of life in which a person is socialized, including value systems, beliefs and norm systems that different groups of people deal with (2–4) or the phenomena that provide them with means of interpreting the world (5). Language plays an important role in communication and interpretation of a culture (6). Ethnicity is a matter of group affinity and a collective sense of identity (7). As a system that constructs meaning, people’s ethnicity is meaningful to them only in contrast to that of other groups (8). Ethnicity is seen as a broader concept that also includes culture. Working with culturally diverse populations requires sensitivity to cultural beliefs and needs, as well as specific knowledge, skills and awareness of a person’s world. To have knowledge about which language and symbols an individual uses informs the caregivers of specific communication patterns. Nursing science theories that focus on raising cultural awareness will constitute the starting point from a theoretical sense. A review of literature within this field shows that there are a broad range of approaches to the question of transcultural care (cf. 2, 9–11), It is now common knowledge, for example, that the values and beliefs that different cultures uphold as ‘true’ can provide us with insight into the potential culture shock that may occur when care providers and receivers do not share the same cultural point of departure. Transcultural care is a humanistic and scientific area of research and practice that focuses on similarities and differences that exist among people from various cultural backgrounds. Transcultural knowledge is used to provide cultural specific or culturally congruent care to people based on their cultural values, beliefs and practices in relation to health and illness issues. Almost 50 years ago, Leininger commenced research in the USA on transcultural knowledge (12). The goal was to develop a body of humanistic and scientific knowledge with the overall aim to provide cultural specific care (13). Leininger launched the ‘Culture Care Diversity and Universality Theory’ (2). Through the formulation of her ‘Sunrise Model’, she paved the way for other culturally interested caring scientists. The goal of Leininger′s theory is to help nurses to identify and to explain cultural factors concerning similarities and differences that may have an influence on people (13). However, her work has been criticized by virtue of its relative disregard of other sources of value and belief formulations besides culture (14). Followed by Leininger′s theory, subsequent models have been constructed and developed, mostly from North America (15, 16). Transcultural care knowledge base has also been developed in Europe and has a slightly different approach compared with North American studies. Studies from the USA focuses on ‘cultural groups’, and European research studies on ‘ethnic groups’ (17, 18). To provide transcultural care, the knowledge needs to be cultural specific as well as generic. Culturally specific knowledge is regarding a specific ethnic group whilst generic knowledge refers to a general culturally based knowledge that is universally accepted (18). According to Gerrish & Papadopoulos (18), in order to provide transcultural care, nurses need to be aware of how historical, political, social and economical factors influence ethnic minority groups. In Sweden, researchers have focused on ethnic groups such as Finnish (19, 20) Iranian (21, 22) and Turkish (23), as well as broader research on cultural differences (24). Many transcultural studies are ‘single case’ studies that have been conducted on minority groups or among professional health care providers (21, 22, 25–27). A few studies have focused on the educational aspects of the development of transcultural knowledge within health care-related programmes (18, 28, 29). Findings from such studies reveal that patients’ perceptions of their disease differs from the health carers’ perceptions and this leads to difficulties in adhering to health care recommendations and medical treatments (21, 23, 25). Many findings also show that health care services have failed to deliver satisfactory and effective health care to patients. Research further demonstrates the fact that patients from ethnic minority groups feel exposed when meeting with health care professionals and experience insufficient communication and social interaction during these meetings (25). However, there is a lack of knowledge about how transcultural care should be understood and implemented in the health care system (21, 23–25). Health care services need to be adjusted to the needs of the culturally diverse patients instead of the other way around. Information that is provided according to the patients’ understanding and values will contribute to an increase of successful health outcomes for the patients that will in turn be economically beneficial. In order to provide culturally sensitive and appropriate care, we need to develop educational programmes that provide nurses with adequate knowledge and skills in transcultural care. In today’s multicultural and multiethnic societies, diversity is a noticeable phenomenon among patients, as well as health care providers. Having knowledge of transcultural care, contributes to the opportunity for caregivers, teachers and students to receive the knowledge and skills that are necessary for providing culturally sensitive care.