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Building Cultural Competence in Caring for African American Patients with Diabetes

Understanding how the social and cultural backgrounds of your patients may influence aspects of diabetes management can help you and your patients craft a self-care plan that is more likely to succeed and get patients to their treatment goals. Cultural competence in health care has been defined as the capacity to provide effective medical care to persons of varied backgrounds through the use of appropriate knowledge, skills, attitudes, and behaviors.1,2 Cultural competence among healthcare providers can help strengthen lines of communication between the clinician and the patient, allowing patient preferences to be heard, respected, and incorporated into the plan of care through shared decision-making.

Certain cultural practices or beliefs may conflict with what patients are being asked to do to manage diabetes. For example, the types of foods that are recommended for controlling blood glucose may be different from what patients traditionally eat, and patients may find it difficult to incorporate certain dietary changes into their lives. Historical mistrust in the healthcare system, perceptions about a diagnosis or its impact on lifestyle, and belief in the effectiveness of treatment can also influence adherence to self-care plans.1 

Multiple medical, social, and cultural influences can add to the complexity of identifying and treating diabetes in African American patients. While not all people from a certain culture will respond the same way to a diagnosis of diabetes or the requirements of diabetes self-care, there are a few common themes that have been reported in the literature that relate African American culture to self-care behaviors:

  • Recognize that spirituality is deeply embedded in the African American culture
  • Understand that spirituality is intertwined with perceptions of health and illness3
  • Present self-management of diabetes within a sociocultural and family context
  • Encourage and support community-, family-, and church-based approaches to diabetes care and education4

A recent survey of Nurse Practitioners found that they directly contribute to cultural competence in patient care by establishing partnerships with their patients that account for cultural factors and adjusting care to meet individual patient needs in a cultural context.5

The ability to conduct a cultural assessment is an essential skill that can help you and your patients develop a culturally relevant treatment plan. There are several frameworks that have been developed to help nurses conduct a cultural assessment.6 In one model, the nurse first invites the patient to explain their perceptions—physiological, psychological, spiritual, and/or cultural—about diabetes or a certain aspect of its treatment and then the nurse shares his or her perception of the same topic. The next step involves identifying any cultural differences and then finding any similarities that treatment can be built on. Treatment recommendations are then negotiated, incorporating selected aspects of the patient’s culture into the diabetes self-care plan.

A cultural assessment can be integrated into a larger discussion about diabetes treatment, using the Patient Interview Guide.

You can find more information about providing culturally competent diabetes care to your patients at the National Diabetes Education Program website.

References

  1. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports. 2003;118(4):293-302.
  2. Clarke ME, DeGannes CN. Cultural competency in healthcare: a clinical review and video vignettes from the National Medical Association. http://www.medscape.com/viewprogram/12540. Accessed September 30, 2015.
  3. Polzer R, Miles MS. Spirituality and self-management of diabetes in African Americans. J Holist Nurs. 2005;23(2):230-250.
  4. Samuel-Hodge CD, Headen SW, Skelly AH, et al. Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors. Diabetes Care. 2000;23(7):928-933.
  5. Matteliano MA, Street D. Nurse practitioners' contributions to cultural competence in primary care settings. J Am Acad Nurse Pract. 2012;24(7):425-435.
  6. Campinha-Bacote J. Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online J Issues Nurs. 2011;16(2):5.