Cultural competence and the patient-clinician relationship

Background. Cross-cultural education of clinicians has been identified as one strategy to reduce racial healthcare disparities; however, there is limited empirical research to support this recommendation.;Objective. To determine the association of primary care provider (PCP) cultural competence (CC) with provider characteristics, the CC characteristics of the clinics where they work, the quality of the patient-provider relationship and patient involvement-in-care.;Design. PCP and patient survey data were analyzed using regression. A measure of cultural competence was developed by adapting items, categorized as attitudes, behaviors and knowledge, from existing measures.;Sample. The sample consisted of 49 PCPs from 23 clinics located primarily in Baltimore. The association of CC with the quality of the patient-provider relationship and patient involvement-in-care was evaluated in a subsample of 24 PCPs and 123 of their African American and white patients.;Findings. Female, liberal and family practice providers and providers with greater confidence in caring for the disadvantaged had more culturally competent power/assimilation attitudes. PCPs who were older, international medical graduates and more confident in caring for minorities were less knowledgeable about the epidemiology relevant to disparities. PCPs practicing in clinics with characteristics indicative of CC were more motivated to learn about cultures within their practice and society, and reported a greater frequency of culturally competent behaviors. Patients of PCPs who were more motivated had a higher quality relationship with their PCPs (more satisfied, and perceived greater provider respect, friendliness and warmth) and were more involved in their care (greater provider facilitation, patient information sharing and seeking, and patient activation). Patients of PCPs with more culturally competent power/assimilation attitudes perceived greater provider friendliness/warmth toward them, provider performance of facilitation behaviors, and information sharing and seeking with the provider during the medical visit. Greater reported frequency of culturally competent behaviors was associated with greater patient satisfaction, and information seeking and sharing.;Conclusions. PCPs reporting that their clinics had adopted recommendations to improve services to minority patients were more likely to have culturally competent attitudes and greater frequency of self-reported behaviors. Multifaceted CC training is a promising strategy to enhance patient experiences in their relationship with providers.