The U.S. Has a Serious Problem Providing Culturally Competent Care
When the Affordable Care Act became law, the intent was to protect the rights of American healthcare consumers and expand affordable, quality healthcare to millions of uninsured individuals. While the number of Americans with access to healthcare coverage (not necessarily care) has risen in the ensuing years, the American healthcare system as a whole still struggles to provide effective care to marginalized groups including minorities, elderly, mentally ill and lower income healthcare consumers. Why is culturally competent care so challenging to achieve?
Insurance Does Not Eliminate Disparities
While expanded Medicaid and subsidized health insurance has improved access to healthcare coverage, a Kaiser Family Foundation issue brief from earlier this month notes that both African Americans and Hispanics with private insurance are less likely to have a regular provider. At the same time, they also have more doubts in their ability to afford preventative or major medical costs. The KFF brief notes that “While these differences may, in part, reflect the fact that Black and Hispanic privately insured adults have lower incomes than their White counterparts, the findings also suggest that other factors beyond cost are a substantial barrier to care.” What else needs to be addressed?
One barrier was highlighted rather spectacularly when the Spanish-language version of Healthcare.gov went live. Technical problems notwithstanding, the site also featured translation errors that made the enrollment process more challenging, compounded by a shortage of live, Spanish-speaking customer service representatives to keep up with calls for help. This isn’t a unique issue.
Language barriers challenge hospitals and other care providers in any region that is home to a significant population of individuals for whom English is a second language. According to the 2011 Census, more than 60 million people speak a language other than English at home—381 different languages, in fact, that fall into four larger language categories: Spanish, Indo-European, Asian and Pacific Island and other. And a lack of English proficiency makes individuals even less likely to seek care, even when insured.
Vulnerable populations also suffer from higher rates of health conditions and worse health outcomes. People of color—Black, Hispanic, Native American—have a higher prevalence of diabetes and obesity. Sexual and gender minorities are also vulnerable. Another recent KFF issue brief on the LGBT population notes that LGBT individuals suffer disproportionately from chronic conditions and experience earlier onset of disabilities than the general population including HIV/AIDs, mental illness, substance abuse and sexual and physical violence.
Building Culturally Competent Care into Healthcare Delivery
An organization in New York is using an integrated approach to deliver care to marginalized patients. Boom!Health combines harm reduction services with preventive and primary care, as well as behavioral health services. The organization also partners with other organizations to break down the barriers to care—a pharmacy that assists with medication management, counselors to aid with affordable housing for the homeless, food and nutrition and legal aid. The organization works with a local hospital, a federally-qualified health center and other community resources, and is proving effective in its efforts. As the number of ACOs grows, the potential for building out care networks that address healthcare disparities increases.
Understanding Patient Motivations with Psychographic Segmentation
We already know that certain populations face barriers to accessing affordable, quality healthcare, but developing a plan based on the shared features of these populations will not connect with every member of the population. A one-size-fits-all approach based on a shared language, gender, race or diagnosis does not take into account the unique motivations and beliefs that also influence how individuals interact with healthcare providers or engage in their own wellness. Psychographic segmentation groups healthcare consumers according to lifestyles, personalities and motivations, regardless of demographic or socioeconomic background. c2b solutions has identified five distinct psychographic segments according to consumers’ approach to health and wellness. Each segment prioritizes health in a different way, and has its own unique communication preferences. The 2015 c2b Consumer Diagnostic looked at the distribution of these five segments across populations (all respondents ages 18+; consistent with U.S. Census):
Note: Each segment has a letter a-e associated with it. A percentage with a letter underneath it indicates that the percentage is statistically different (95% confidence) than the segment denoted by that corresponding letter.
Blacks and Hispanics are overdeveloped relative to Whites among the Self Achiever segment, while Hispanics and Asian Americans are overdeveloped among the Willful Endurer segment. Interestingly, Self Achievers are the most proactive, wellness-oriented of the five segments, and Willful Endurers are the most reactive or disengaged regarding health and wellness.
In the next table we see that Willful Endurers and Direction Takers tend to be less educated, while Self Achievers and Priority Jugglers tend toward higher levels of education.
Income seems to follow education, as those with higher income tend toward Self Achievers and Priority Jugglers.
Older healthcare consumers are overdeveloped among Self Achievers and Direction Takers, while younger healthcare consumers are overdeveloped among Willful Endurers and Balance Seekers
While there is some skewing toward segments among these demographic and socioeconomic populations, it is important to note that all five segments can be found among them. To reiterate, each segment has its own motivations and communication preferences.
With psychographic segmentation, you can begin to understand these differences so that as you develop a more culturally competent care program, you also recognize the disparate needs of individuals within the larger population and craft solutions that connect more effectively. How could deeper insights into the attitudes of these vulnerable patients improve your delivery of care?