IDEAS Committee Update: Applying Cultural Congruence in Patient Care
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February 6, 2023
By Emma Nye, DAT, LAC, ATC
The increasing diversity of patient populations brings the necessity for health care providers to change the way we practice. In recent years, health care organizations have put improving outcomes and patient satisfaction at the forefront of their diversity, equity and inclusion efforts. One such mechanism to reduce health disparities, and ultimately improve outcomes for diverse patients, is to adapt how we provide care and to become more culturally congruent.
The concept of "culturally congruent practice" has been circulating among health care professionals for decades. Many definitions of culturally congruent practice, or culturally congruent care, exist in the health care space. One such definition used among the nursing profession is "the process through which providers and clients create an appropriate fit between professional practice and what patients and families need and want in the context of relevant cultural domains." The processes of culturally congruent care aim to push health care professions forward by recognizing that it is within a "dynamic interaction between clients and providers that care occurs, and that both client patient, family and provider attitudes, perceptions and behaviors influence outcomes."
The profession of athletic training has largely focused on "cultural competency" as a means to ensure practicing Athletic Trainers work to consider the patient's beliefs, values and preferences into care plans. Cultural competence, while it’s a clear advancement from simply culture awareness, can oftentimes come up short when it comes to making a clear connection to actual health care outcomes. Other health professions have used cultural competence to represent the process by which practitioners demonstrated culturally congruent care, rather than a standalone skill. Additionally, it is difficult to align cultural competence directly with improved health outcomes if we fail to include the patient, as we know that "care offered is not always equal to care received." The concepts of culturally congruent practice aim to close this gap.
One first step to becoming more culturally congruent in your health care practices is to ask the right questions that take into consideration the patient's values, needs and beliefs. Cultural assessment tools have been used as a means to best collect information from the patient's perspective, to ultimately address cross-cultural differences in health care planning and plan culturally appropriate interventions. Many cultural assessment tools may be used by health care providers, we have included a document with a good starting point here. The goal with these tools is to not only reflect that the provider is culturally competent but to take it one step further to involve the patient to compromise interventions through shared, culturally congruent, decision-making. In addition to exploring cultural assessment tools for implementation into their practice, providers can also seek out professional development to learn about culturally congruent care and ways to eliminate disparities and develop skills to become more self-aware of how to best respond to patients' cultural differences, and how to integrate them into care planning. As our profession continues to evolve with the needs of the patients within our care, so does the need to reevaluate the expectations of our current and future clinicians.
Schim, S. M., & Doorenbos, A. Z. (2010). A three-dimensional model of cultural congruence: Framework for intervention. Journal of social work in end-of-life & palliative care, 6(3-4), 256-270.
Marion, L., Douglas, M., Lavin, M. A., Barr, N., Gazaway, S., Thomas, E., & Bickford, C. (2016). Implementing the new ANA standard 8: Culturally congruent practice. Online Journal of Issues in Nursing, 22(1).
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About the Author
Emma is an active member of the BOC’s IDEAS Committee, and also recently served as Guest Editor LGBTQIA+ Special Issues for the Athletic Training Education Journal, is a Founding Member of the Alliance for Equitable Care in Sports Medicine, as well as being the District 5 Chair for the NATA LGBTQ+ Advisory Committee. In addition, Emma co-presented the following sessions at the NATA Annual Meeting, June 2022: The Athletic Trainers’ Role in Gender Affirming Health Care and Inclusive Athletic Participation for Transgender Athletes and Incorporating Intersectionality into LGBTQIA+ Patient Care.
Emma recently received the MAATA Denise Fandel Award for Advocacy and Diversity (2023), and has authored and co-authored several recent publications, including the following:
- Schulman E, Eberman LE, Crossway AK, Nye EA, Uriegas N, Connell S, Winkelmann ZK. Integration of Inclusive Healthcare Curriculum for Sexual Health and Gender Minorities. Athletic Training Education Journal. 2022;17(4): 251–261.
- Eberman LE, Winkelmann ZK, Crossway, AK, Lopez RM, Nye EA, Rogers SM, Walen DR, Olewinski LH. Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes. Clinical Journal of Sports Medicine. 2022;10-1097.
- Linsenmeyer W, Heiden-Rootes, K, Drallmeier T, Thomaure M, Nye EA. Nutrition and Exercise as a Source of Empowerment: A Narrative Inquiry of Transgender Men. Qualitative Research in Health. 2022;2,100128.
- Anderson, M. Nye EA. Nutritional Considerations for Transgender Patients. Clinical Practice in Athletic Training. 2022;5(1):8-11.
- Nye EA. The Past, Present, and Future of LGBTQ Health Care. Clinical Practice in Athletic Training Journal. 2021;4(3):1-4.