Cultural Considerations for Psychologists in Primary Care
Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients’ health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers’ cultural sensitivity, patient–provider cultural congruency, and patients’ health literacy) can be applied in primary care using the Five A’s Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity.
KeywordsCultural sensitivity Cultural congruency Health literacy Behavioral health Health disparities
Jessica Jackson acknowledges the New Mexico State University RISE program (NIH NIGMS Grant R25GM061222) which supported her contribution to this manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors Adeya Richmond and Jessica Jackson declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human participants or animals performed by any of the authors.
- Abe-Kim, J. S., & Takeuchi, D. T. (1996). Cultural competence and quality of care: Issues for mental health service delivery in managed care. Clinical Psychology: Science and Practice, 3, 273–295.Google Scholar
- American Psychological Association. (2015). Competencies for psychological practice in primary care. Retrieved December 15, 2016 from http://www.apa.org/ed/resources/compentencies-practice.pdf.
- Bailey, R., Sharpe, D., Kwiatkowski, T., Watson, S., Dexter Samuels, A., & Hall, J. (2017). Mental health care disparities now and in the future. Journal of Racial and Ethnic Health Disparities, 15, 1–6.Google Scholar
- Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The evidence base for cultural and linguistic competency in health care. Washington, D.C.: The Commonwealth Fund.Google Scholar
- Gwynn, K. B., Winter, M. R., Cabral, H. J., Wolf, M. S., Hanchate, A. D., Henault, L., … Paasche-Orlow, M. K. (2016). Racial disparities in patient activation: Evaluating the mediating role of health literacy with path analysis. Patient Education and Counseling, 99, 1033–1037.CrossRefPubMedPubMedCentralGoogle Scholar
- Hoge, M. A., Morris, J. A., Laraia, M., Pomerantz, A., & Farley, T. (2014). Core competencies for integrated behavioral health and primary care. Washington, D.C.: SAMHSA-HRSA Center for Integrated Health Solutions.Google Scholar
- Institute of Medicine. (2004). Health literacy: A prescription to end confusion. Washington, D.C.: The National Academies Press. https://doi.org/10.17226/10883.
- Institute of Medicine (U.S.), Adams, K., & Corrigan, J. (2003). Priority areas for national action: Transforming health care quality. Washington, D.C.: National Academies Press.Google Scholar
- Office of Minority Health. (2013). National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice. Office of Minority Health (OMH), U.S. Department of Health and Human Services, April, 2013. Retrieved January 5, 2017 from https://www.thinkculturalhealth.hhs.gov/pdfs/EnhancedCLASStandardsBlueprint.pdf.
- Palmer, N. R. A., Kent, E. E., Forsythe, L. P., Arora, N. K., Rowland, J. H., Aziz, N. M., Blanch-Hartigan, D., … Weaver, K. E. (2014). Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. Journal of Clinical Oncology, 32, 4087–4096.CrossRefPubMedPubMedCentralGoogle Scholar
- Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et sEq. (2010).Google Scholar
- Sanchez, K., Chapa, T., Ybarra, R., & Martienez, O. N. Jr. (2012). Eliminating disparities through the integration of behavioral health and primary care services for racial and ethnic minority populations, including individuals with limited English proficiency: A literature report. U.S. Department of Health and Human Services Office of Minority Health and Hogg Foundation for Mental Health.Google Scholar
- Sanchez, K., Chapa, T., Ybarra, R., & Martinez, O. N. Jr. (2014). Eliminating health disparities through culturally and linguistically centered integrated health care: Consensus statements, recommendations, and key strategies from the field. Journal of Health Care for the Poor and Underserved, 25, 469–477.CrossRefPubMedGoogle Scholar
- The Joint Commission. (2007). “What did the doctor say?”: Improving health literacy to protect patient safety. Oakbrook Terrace, IL: Author.Google Scholar
- U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity- a supplement to mental health: A report of the Surgeon General (SM-01-3612). Rockville, MD: Author.Google Scholar
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities.