Getting it Right Among Diverse Communities

An American friend works for an NGO that is building a health clinic in a remote area of South America.  The patients are older and many have chronic diseases such as diabetes, asthma, or heart disease.   The clinic is staffed by young physicians and healthcare providers who speak the local dialect.  Unfortunately, the adherence rate is much lower than anticipated and there has been no real improvement in patient outcomes.  What went wrong?

A key challenge in health promotion among diverse populations is honoring traditions and beliefs of the intended audience, while recognizing that some of those beliefs and practices may not be congruent with emerging knowledge of what supports healthy outcomes.

So what’s a health provider to do?

Here are some hints from Georgetown University’s National Center for Cultural Competence:

Culturally and linguistically competent health promotion should fall within a social, environmental and political context.  Traditionally, health promotion works to change health-related behaviors of individuals. Too often, however, there is no support within the community environment to do so.   These include:

  • Lack of local grocery stores stocked with healthy foods
  • Poor environment for exercise—e.g., no sidewalks, very poor air quality, lack of safety
  • Inadequate housing
  • Unachievable economic goals
  • Lack of community-based health supports such as smoking cessation programs, primary and maternal  and child health care, and substance abuse treatment
  • Lack of access to communication formats, information and venues needed for health promotion for individuals with disabilities

Culturally and linguistically competent health promotion recognizes the family and community as primary systems of support and intervention.

  • For many diverse populations, health values, beliefs and practices of the individual are inextricably linked with those of the family and community. Thus, the intended audience for health promotion efforts may need to be family or community rather than solely the individual.  Take care to define family and community in ways that are congruent with the culture of the recipients

Assure that your efforts exist in concert with natural and informal health care support systems.

Health promotion should tap into naturally occurring resources within the community of the intended audience. Both messages and methods for delivering them should acknowledge that community networks of natural healers are integral to the health belief system in many cultural groups. In many cultures, healing involves a holistic approach addressing mind, body and spirit.

It is vital to have substantive community involvement in planning and decision-making from the very beginning, in order to assure that health promotion efforts are effective and appropriate for the intended audience. An inclusive process can forge alliances and partnerships that have long-lasting benefits for the health of the community.

Community partners play several key roles including:

  • providing the cultural perspectives of the intended audience
  • providing credibility to the effort within the community
  • bringing expertise (e.g., knowledge of health beliefs and practices, language and preferred sources of information for the intended audience)
  • bringing community resources to support health promotion efforts (e.g., access to local media outlets or other dissemination points, local financial or in-kind support for activities)


And what happened to my friend?

After meeting with the village elders, it turns out that many people in this particular region of South America do not trust young healthcare providers. They also have great respect for uniforms and white coats. But to achieve an air of familiarity, the young staff eschewed lab coats. Both factors together fostered an atmosphere of mistrust among the locals. This was overcome when the staff put on their white coats and hired several local elders to escort people to and from their appointments. Had the NGO involved the key stakeholders from the community in their planning, this could likely have been avoided.

Do you have any lessons learned about cultural differences and patient outcomes?

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