Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.
OBJECTIVE
Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care.


METHODS
The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers.


RESULTS
Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care.


CONCLUSIONS
Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.
Betancourt
Joseph R
JR
Institute for Health Policy, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, MA 02114, USA. jbetancourt@partners.org
Green
Alexander R
AR
Carrillo
J Emilio
JE
Ananeh-Firempong
Owusu
O
D001291:Attitude of Health Personnel / Q000208:ethnology; D001294:Attitude to Health / Q000208:ethnology; D003144:Communication Barriers; D018864:Cultural Diversity; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005006:Ethnicity; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007857:Leadership; D008913:Minority Groups; D011361:Professional Competence / Q000592:standards*; D011635:Public Health Administration / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration; D012959:Socioeconomic Factors; D014481:United States