According to the Care Quality Commission (CQC), culturally appropriate care means being sensitive to people’s cultural identity or heritage when providing care. Such cultural identity might be based on ethnicity, nationality, or religion. Culturally appropriate care might also relate to a person’s sexuality or gender identity.
Unfortunately, the current narrative of social care often neglects to mention the specific needs of the ethnic minority community and how the lack of culturally appropriate care leads to a poorer quality of care for them. For example, Alzheimer’s Society found that advanced dementia can cause some people to lose their English language skills and revert to their native language. It then becomes difficult to connect them with a care worker who can communicate with them in their preferred language. This will inevitably lead to feelings of loneliness in the person being cared for.
In addition, healthcare studies have found that the language barrier between people and providers prevents people from accurately describing their symptoms and causes problems for providers when fully explaining diagnoses, leading to adverse health effects. In fact, healthcare environments that show an awareness of and respect for differences create more satisfying experiences for patients. The Plos One review found that black men rated providers’ behaviors and attitudes significantly higher after the clinic gave its providers cultural competence training.
Identifying people’s needs
There are many ways we can ensure that people receiving care are getting the culturally appropriate support they require. Firstly, identify what people need from you beyond their care needs and, specifically, how their cultural needs might impact their day-to-day requirements.
Arguably the most vital part of considering culture in care is to ask the person you support and/or their representatives what they prefer and then meet their preferences wherever possible. You should try to understand a person’s history by talking to them and their family and asking questions if you are unsure about something. This all forms a part of understanding what is important to them to help them live their fullest life.
As a starting point, during your initial assessments, include a questionnaire regarding the person’s cultural needs; it goes without saying that while planning their care, you should incorporate these needs into their care plan. Such needs may include religious and spiritual practice; for example, people who follow some religions like Islam may wish to get up early to pray. They might also need to eat at different times during religious festivals, such as Ramadan.
Other cultural needs might include food and drink. If someone follows a Kosher or Halal diet, you may need to prepare their food differently to avoid cross-contamination. In addition, if someone is vegetarian and from a South Asian or African culture, only having English vegetarian dishes might be boring for them.
Healthcare is another important need to take into consideration when providing culturally appropriate care. If someone lacks the mental capacity to consent to a decision about a particular care or treatment option, it’s important to apply the Mental Capacity Act. When assessing if someone lacks mental capacity or when giving information to support someone to make a decision, you should ensure you take cultural factors into account. These are just a few examples of the needs that you should take into consideration if you hope to provide the people you support with culturally appropriate care. Other examples of such needs include clothes and personal presentation, personal and shared space, and shared activities.
Moving beyond barriers
Sadly, there are some possible barriers to providing culturally appropriate care. For example, there may be limited resources in terms of time and money, both of which are necessary for developing the infrastructure to provide culturally appropriate care. You may also face pushback from some staff who consider themselves culturally competent already.
In such cases, you can implement educational programs that broaden the definitions of cultural competence.
The best place to start looking into this is the Care Quality Commission website. The CQC has written up a report on culturally appropriate care and has provided resources on how care providers can start providing culturally appropriate care within their services. You could also provide care workers with cultural competence training (CCT). This has been proposed as a strategy that facilitates the provision of culturally appropriate care. There are many free and paid resources available for providers that will give them the tools and provisions needed to provide culturally appropriate care, some of which are listed below: Health Education England and the Royal College of Midwives produced a cultural competence e-learning program for healthcare professionals in the NHS.
The Department of Health and Social Care produced ‘Religion or belief: A practical guide for the NHS’.
The Royal College of Nursing created ‘A guide to cultural and spiritual awareness. ‘The Competency Standards Framework for the culturally responsive clinical practice: Working with people from migrant and refugee backgrounds’ was created in Australia. Its overarching principles and recommendations for practice are applicable to the UK context. Blackpool, Fylde, and Wyre Hospitals NHS Trust developed guidelines on religious and cultural beliefs.
The NHS Chaplaincy Programme has published guidance on ‘Promoting Excellence in Pastoral, Spiritual and Religious Care.
The Health Care Needs Assessment (HCNA) includes a chapter on Black and minority ethnic groups: ‘Culture, Health and Illness, 4th edition. By Cecil G Helman. London, Arnold. 2000.
First response training. Its health and social care range includes person-centered care, dignity in care, the duty of care, equality, diversity, and inclusion.
It might also be helpful to match staff with people from the same culture. However, it’s important you give the person you support a choice and do not assume it’s what they want. You should discuss it both with them and the staff member(s) with whom you might look to match them.
You can also make use of skills your staff have that are not strictly part of their job.
For example, a member of staff who shares a language with someone using the service could teach their colleagues a few useful phrases. Again, it’s important to ask them first if they’re happy to do things like this.
Organizing events in your service that recognize the cultural backgrounds of your staff, as well as people using the service, can really help people to understand each other better and show that you are dedicated to supporting people’s cultural traditions. It’s also important to take racism and other forms of discrimination into consideration. Having an open culture can help with this; so, staff can raise any issues with managers to work out solutions. You need to provide a safe environment not only for the people you support but also for your staff members – especially those from a Black, Asian and Minority Ethnic (BAME) background
– by shielding them from discrimination and harassment over characteristics protected by the Equality Act.
You might find benefits in building teams with care workers who reflect the diversity of the populations they serve. Diverse teams have a wider cultural knowledge base that they can share with one another, which makes them more likely to respond with empathy to the unique cultural needs of the people they support. There’s also a greater likelihood that a person will be able to be matched with a care worker who can affirm their cultural needs when providing care.
Although we’ve seen a significant increase in the number of providers attempting to provide culturally appropriate care, it’s worth noting that we still have a long way to go in accomplishing this on a wider scale across the UK. There are consistent reports of health inequalities, disparities in the quality of care, lower rates of satisfaction and a convincing perception of culturally inadequate healthcare provision for members of minority groups.
This clearly demonstrates that the UK healthcare system is struggling to meet the needs of culturally diverse populations. However, we can still turn this around and ensure that culturally appropriate care is being provided on a wider scale. We can start by emphasizing the importance of culturally appropriate care among all providers and local authorities because it can make such a positive difference in the lives of people who are receiving care.
The results of a recent Care Matched client satisfaction survey found that there were significant increases in engagement between care workers and care receivers. The survey results also found that there was a significant improvement in the mood of the care receiver as a result of their newfound sense of belonging after being matched with a culturally appropriate care worker.
It’s clear that providing culturally appropriate care can change the way adult social care is perceived by the public. People would be happier to use care services if the option of receiving culturally appropriate care was more readily available. We must keep pushing for the need for culturally appropriate care and raise awareness on this topic across all platforms. This will help to ensure that more people are receiving the culturally appropriate care they need and rightly deserve.