Nápoles-Springer Anna M, Santoyo Jasmine, Houston Kathryn, Pérez-Stable Eliseo J, Stewart Anita L
Medical Effectiveness Research Center for Diverse Populations and the Center on Aging in Diverse Communities, University of California San Francisco (UCSF), San Francisco, CA 94118-1944,
Health Expect. 2005 Mar;8(1):4-17. doi: 10.1111/j.1369-7625.2004.00298.x.
The aim of this study was to identify key domains of cultural competence from the perspective of ethnically and linguistically diverse patients.
The study involved one-time focus groups in community settings with 61 African-Americans, 45 Latinos and 55 non-Latino Whites. Participants' mean age was 48 years, 45% were women, and 47% had less than a high school education. Participants in 19 groups were asked the meaning of 'culture' and what cultural factors influenced the quality of their medical encounters. Each text unit (TU or identifiable continuous verbal utterance) of focus group transcripts was content analysed to identify key dimensions using inductive and deductive methods. The proportion of TUs was calculated for each dimension by ethnic group.
Definitions of culture common to all three ethnic groups included value systems (25% of TUs), customs (17%), self-identified ethnicity (15%), nationality (11%) and stereotypes (4%). Factors influencing the quality of medical encounters common to all ethnic groups included sensitivity to complementary/alternative medicine (17%), health insurance-based discrimination (12%), social class-based discrimination (9%), ethnic concordance of physician and patient (8%), and age-based discrimination (4%). Physicians' acceptance of the role of spirtuality (2%) and of family (2%), and ethnicity-based discrimination (11%) were cultural factors specific to non-Whites. Language issues (21%) and immigration status (5%) were Latino-specific factors.
Providing quality health care to ethnically diverse patients requires cultural flexibility to elicit and respond to cultural factors in medical encounters. Interventions to reduce disparities in health and health care in the USA need to address cultural factors that affect the quality of medical encounters.
本研究旨在从种族和语言背景各异的患者角度确定文化能力的关键领域。
该研究在社区环境中进行了一次性焦点小组访谈，参与者包括61名非裔美国人、45名拉丁裔和55名非拉丁裔白人。参与者的平均年龄为48岁，45%为女性，47%的人受教育程度低于高中。19个小组的参与者被问及“文化”的含义以及哪些文化因素影响了他们就医体验的质量。使用归纳和演绎方法对焦点小组访谈记录的每个文本单元（TU或可识别的连续言语表达）进行内容分析，以确定关键维度。按种族计算每个维度的TU比例。
所有三个种族共有的文化定义包括价值体系（占TU的25%）、习俗（17%）、自我认同的种族（15%）、国籍（11%）和刻板印象（4%）。所有种族共有的影响就医体验质量的因素包括对补充/替代医学的敏感度（17%）、基于医疗保险的歧视（12%）、基于社会阶层的歧视（9%）、医患种族一致性（8%）和基于年龄的歧视（4%）。医生对精神信仰作用（2%）和家庭作用（2%）的接受度，以及基于种族的歧视（11%）是非白人特有的文化因素。语言问题（21%）和移民身份（5%）是拉丁裔特有的因素。
为种族各异的患者提供高质量医疗服务需要文化灵活性，以便在就医过程中引出并应对文化因素。美国减少健康和医疗保健差距的干预措施需要解决影响就医体验质量的文化因素。
