How professional socialization and practice characteristics shape culturally competent care
Matteliano, Mary A.
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For this research, I used a sociological framework that draws on theoretical and empirical works that seek to understand health disparities and the social organization of health care. My purpose is to understand the factors that shape the delivery of more and less culturally competent health care to underserved groups in three community-based neighborhood health care sites in Buffalo, NY, understood from the perspective of frontline health care professionals. Data are from intensive interviews and observations over two years at three field sites; the qualitative data analysis used a grounded theory approach. I examined personal, professional, and organizational characteristics of health care service providers and their staff, to assess their capacity to meet the unique needs of underserved individuals who live in the surrounding community. My major findings show that: health care providers choose to work with underserved communities based on their personal characteristics and professional socialization experiences; professionals' socialization experiences often lead to effective teamwork in the health care setting, but at times constrain the process of efficient delivery of care; and the enactment of culturally competent care has both personal and professional components. Cultural and social factors influence patients' access to health care and their follow-through with healthy lifestyles; consequently, the providers I studied and the organizations where they work use a range of organizational strategies to try to make provisions to meet the cultural and social needs of the community. Shared values and a common mission to provide culturally competent care are necessary, but not sufficient components among health care teams that may lead to culturally competent care. For culturally competent care to be sustained and effective, the practice site must also support the health care team's mission by streamlining the process of entry for the patient, from the receptionist to the health care professional encounter, to follow-up services. Finally, the macro organizations, overseeing institutions and state and federal regulatory bodies play important roles by supporting the value of culturally competent primary health care to diverse groups through investment. When culturally competent health care is provided in neighborhood settings, it has the potential to provide health care interactions between professionals and patients that may prevent long-term functional disabilities and decrease the high cost associated with multiple and advanced chronic conditions in cultural minority patient populations.