Satisfaction with and Perceived Cultural Competency of Healthcare Providers: Findings
Findings
Minority community members are not satisfied with their healthcare. This hypothesis is not supported by our data. Only nine respondents (11.3%) reported dissatisfaction, six with care provided by the physician and four the nurse. One of the nine was dissatisfied with both the physician and nurse (Tables 5 and 6). The overwhelming majority of our respondents were satisfied with care they received. When these same respondents were asked if they would go to the same healthcare provider the next time they became ill, 66 or 83% said yes. Only seven respondents said they would want to see a different provider (Table 7). Although nine respondents were dissatisfied with doctor and/or nursing care, only seven said they would not go to the same provider again. All of the ethnic and racial groups were represented in the dissatisfaction with provider except for the Vietnamese and white group. And yet of the white group, two would go to a different provider the next time; and of the Vietnamese group, one would seek a different provider.
Table 5. Rate care received from doctor with race
| Race No Response |
Unsatisfactory |
Below Adequate |
Adequate |
Good |
Excellent Total |
| #(%) |
#(%) |
#(%) |
#(%) |
#(%) |
# (%) # (%) |
| 1 (1.3) |
0 |
0 |
0 |
0 |
0 1 (1.3) |
| African-American 1 (1.3) |
0 |
0 |
5 (6.3) |
4 (5.0) |
1 (1.3) 11 (13.8) |
| Hispanic-American 1 (1.3) |
1 (1.3) |
0 |
3 (3.8) |
6 (7.5) |
9 (11.3) 20 (25.0) |
| Native-American 0 |
0 |
1 (1.3) |
3 (3.8) |
4 (5.0) |
5(6.3) 13(16.3) |
| Sudanese 2 (2.5) |
2 (2.5) |
1 (1.3) |
0 |
4 (5.0) |
8 (10.0) 17 (21.3) |
| Vietnamese 0 |
0 |
0 |
0 |
7 (8.8) |
3(3.8) 10(12.5) |
| White 0 |
0 |
1 (1.3) |
1 (1.3) |
2 (2.5) |
4(5.0) 8(10.0) |
| Total 5 (6.3) |
3 (3.8) |
3 (3.8) |
12(15.0) |
27 (33.8) |
30(37.5) 80 (100) |
Table 6. Rate care received from nurses with race
| Race No | Response |
Unsatisfactory |
Below Adequate |
Adequate |
Good |
Excellent |
Total |
| #(%) |
#(%) |
#(%) |
#(%) |
#(%) |
#(%) |
#(%) |
|
| 1 (1.3) |
0 |
0 |
0 |
0 |
0 |
1 (1.3) |
|
| African-American | 0 |
0 |
1 (1.3) |
4 (5.0) |
5 (6.3) |
1 (1.3) |
11 (13.8) |
| Hispanic-American | 0 |
1 (1.3) |
0 |
4 (5.0) |
9 (11.3) |
6 (7.5) |
20 (25.0) |
| Native-American | 0 |
0 |
0 |
3 (3.8) |
5 (6.3) |
5 (6.3) |
13 (16.3) |
| Sudanese | 1 (1.3) |
2 (2.5) |
0 |
1 (1.3) |
3 (3.8) |
10 (12.5) |
17 (21.3) |
| Vietnamese | 0 |
0 |
0 |
3 (3.8) |
4 (5.0) |
3 (3.8) |
10 (12.5) |
| White | 0 |
0 |
0 |
0 |
4 (5.0) |
4 (5.0) |
8 (10.0) |
| Total | 2 (2.5) |
3 (3.8) |
1 (1.3) |
15 (18.8) |
30 (37.5) |
29 (36.3) |
80 (100) |
Reasons for dissatisfaction among the participants include the following:
Three Native Americans:
- Doctor said there was nothing wrong with her but she was still hurting.
- Doctor said she didn’t have an infection but she did.
- Patient was not satisfied that care received was professionally adequate.
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Three Sudanese:
- Rated both doctor and nurse as unsatisfactory but gave no comment
- Doctor didn’t treat her well; he told her he didn’t understand her problem.
- Patient said she had to wait long and saw too many different doctors.
Two Hispanics:
- Doctor treated her badly because she didn’t speak the language.
- Doctor had a bad attitude and was misinformed.
One African American:
- Doctor failed to diagnose her asthma because the doctor rushed through the exam.
- Minority community members have difficulty communicating with healthcare providers.
Table 7. Would you want to see the same or different healthcare provider?
| Race |
No Response # (%) |
Different # (%) |
Same # (%) |
Total # (%) |
| Missing data |
1 (1.3) |
0 |
0 |
1 (1.3) |
| African-American |
0 |
1 (1.3) |
10 (12.5) |
11 (13.8) |
| Hispanic-American |
3 (3.8) |
1 (1.3) |
16 (20.0) |
20 (25.0) |
| Native-American |
0 |
2 (2.5) |
11 (13.8) |
13 (16.3) |
| Sudanese |
3 (3.8) |
0 |
14 (17.5) |
17 (21.3) |
| Vietnamese |
0 |
1 (1.3) |
9 (11.3) |
10 (12.5) |
| White |
0 |
2 (2.5) |
6 (7.5) |
8 (10.0) |
| Total |
7 (8.8) |
7 (8.8) |
66 (82.5) |
80 (100) |
Table 8. Able to complete papers/forms and race
| Race | No Response |
No |
Yes |
Yes Help |
Total |
|
#(%) |
#(%) |
#(%) |
HELP # (%) |
#(%) | |
| Missing data |
1 (1.3) |
0 |
0 |
0 |
1 (1.30 |
| African-American |
2 (2.5) |
2 (2.5) |
7 (8.8) |
0 |
11 (13.8) |
| Hispanic-American | 8 (10.0) |
2 (2.5) |
10 (12.5) |
0 |
20 (25.0) |
| Native-American |
2 (2.5) |
0 |
10 (12.5) |
1 (1.3) |
13 (16.3) |
| Sudanese |
4 (5.0) |
7 (8.8) |
6 (7.5) |
0 |
17 (21.3) |
| Vietnamese |
1 (1.3) |
2 (2.5) |
7 (8.8) |
0 |
10 (12.5) |
| White |
1 (1.3) |
0 |
7 (8.8) |
0 |
8 (10.0) |
| Total | 19 (23.8) |
13 (16.3) |
47 (58.8) |
1 (1.3) |
80 (100) |
Though the majority of the respondents were satisfied with the care they received, our results suggest that there is room for improvement in doctor/ patient interaction and communication. The data support the hypothesis that for some minorities, a language barrier creates problems when seeking healthcare services. Communication, whether written or spoken, has some effect on the care. More than 70% of the respondents were asked to complete forms at their last visit to a healthcare provider, but only 59% were able to do so without help. Whites were the only group that did not need assistance in completing the form (Table 8). Fifteen respondents said they needed an interpreter at their last visit, seven used a relative. When asked if the interpreter did an adequate job, here are the findings: one Sudanese and two Vietnamese said no (Table 9). This may have contributed to the dissatisfaction with healthcare for the Sudanese, but the Vietnamese did not express dissatisfaction with healthcare received. lexapro medication
Table 9. The interpreter did an adequate job
| Race | No Response # (%) |
No # (%) |
Yes # (%) |
Total # (%) |
| Missing data | 1 (1.3) |
0 |
0 |
1 (1.3) |
| African-American | 11 (13.8) |
0 |
0 |
11 (13.8) |
| Hispanic-American | 11 (13.8) |
0 |
9 (11.3) |
20 (25.0) |
| Native-American | 12 (15.0) |
0 |
1 (1.3) |
13 (16.3) |
| Sudanese | 9 (11.3) |
1 (1.3) |
7 (8.8) |
17 (21.3) |
| Vietnamese | 7 (8.8) |
2 (2.5) |
1 (1.3) |
10 (12..5) |
| White | 8 (10.0) |
0 |
0 |
8 (10.0) |
| Total | 59 (73.8) |
3 (3.8) |
18 (22.5) |
80 (100) |
Table 10. Healthcare provider familiar with cultural background
| Race No | Response # (%) |
Don’t Know # (%) |
No # (%) |
Yes # (%) |
Total # (%) |
| Missing data | 1 (1.3) |
0 |
0 |
0 |
1 (1.3) |
| African-American | 0 |
4 (5.0) |
1 (1.3) |
6 (7,5) |
11 (13.8) |
| Hispanic-American | 0 |
1 (1.3) |
О |
19 (23.8) |
20 (25.0) |
| Native-American | 0 |
0 |
4 ( 5.0) |
9 (11.3) |
13 (16.3) |
| Sudanese | 1 (1.3) |
3 (3.8) |
12 (15.0) |
1 (1.3) |
17 (21.3) |
| Vietnamese | 0 |
0 |
6 (7.5) |
4 (5.0) |
10 (12.5) |
| White | 0 |
0 |
0 |
8 (10.0) |
8(10.) |
| Total | 2 (2.5) |
8 (10.0) |
23 (28.8) |
47 (58.8) |
80 (100) |
Minority community members find that healthcare providers are not adequately knowledgeable about their ethnic group and culture.
Linguistic competency is not the only way to measure communication problems. Cultural competency was assessed from the patient-client perspective. The majority of the respondents think that the last healthcare provider that they visited was familiar enough with their cultural background to treat someone of their ethnic or racial group. However, 29% or 23 of our respondents disagreed: four Native Americans, 12 Sudanese, six Vietnamese and one African-American (Table 10). Only one Hispanic said he did not know, and three Hispanics said they were not comfortable with the healthcare provider’s medical knowledge of their illness (Table 11).
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Table 11. Comfortable with healthcare provider’s medical knowledge of illness
| Race No Response # (%) |
Don’t Know # (%) |
No # (%) |
Yes # (%) |
Total # (%) | |
| Missing data | 1 (1.3) |
0 |
0 |
0 |
1 (1.3) |
| African-American | 1 (1.3) |
2 (2.5) |
1 (1.3) |
7 (8.8) |
11 (13.8) |
| Hispanic-American | 2 (2.5) |
0 |
3 (3.8) |
15 (18.8) |
20 (25.0) |
| Native-American | 0 |
0 |
2 (2.5) |
11 (13.8) |
13 (16.3) |
| Sudanese | 1 (1.3) |
3 (3.8) |
1 (1.3) |
12 (15.0) |
17 (21.3) |
| Vietnamese | 0 |
1 (1.3) |
1 (1.3) |
8 (10.0) |
10 (12.5) |
| White | 0 |
0 |
1 (.13) |
7 (8.8) |
8 (10.0) |
| Total | 5 (6.3) |
6 (7.5) |
9 (11.3) |
60 (75.0) |
80 (100) |
Table 12. Certain illness can be better treated by someone of the same ethnic/racial cultural group
| Race No Response # (%) |
Don’t Know # (%) |
NA # (%) |
No # (%) |
Yes # (%) |
Total # (%) |
| Missing data 1 (1.3) |
0 |
0 |
0 |
0 |
1 (1.3) |
| African-American 0 |
6 (7.5) |
1 (1.3) |
1 (1.3) |
3 (3.8) |
11 (13.8) |
| Hispanic-American 1 (1.3) |
1 (1.3) |
0 |
12 (15.0) |
6 (7.5) |
20 (25.0) |
| Native-American 0 |
3 (3.8) |
0 |
4 (5.0) |
6 (7.5) |
13 (16.3) |
| Sudanese 1 (1.3) |
3 (3.8) |
0 |
5 (6.3) |
8 (10.0) |
17 (21.3) |
| Vietnamese 1 (1.3) |
1 (1.3) |
0 |
4 (5.0) |
4 (5.0) |
10 (12.5) |
| White 1 (1.3) |
0 |
0 |
5 (6.3) |
2 (2.5) |
8 (10.0) |
| Total 5 (6.3) |
14 (17.5) |
1 (1.3) |
31 (38.8) |
29 (36.3) |
80 (100) |
Lack of cultural understanding and sensitivity by providers also contributes to problems of communication, establishment of trust and satisfaction. Only 51% of the respondents said that the doctor asked them what they thought caused their illness. Thirty-one said the doctor did not ask. And only 25 said that the doctor asked what treatment they thought they should receive. In addition, 22 of our respondents said the doctor made no attempt to communicate with them through language and/or gestures. Thirty-seven said no visual aids were used. Six felt that the healthcare provider “spoke down to them.” Four said the doctor used “too many big words.” Eighteen said they were not able to talk to the nurse, and 14 said they had difficulty talking to the doctor. Even though the majority of our respondents say they are satisfied with healthcare, there are problems with doctor-patient interaction and/or communication. Perhaps more respondents require the services of an interpreter than are willing to admit, and lack of patient input with diagnosis may be contributing to dissatisfaction with healthcare received. Thorn et al. found encouraging questions and providing answers associated with trust and satisfaction. There may be more respondents who were less than satisfied with healthcare received but were reluctant to say so on paper. This may be the reason three respondents said they were satisfied with care but would seek a different provider next time. Silence or unexpressed dissatisfaction may have manifested itself in responses to questions testing the fourth hypothesis.
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Table 13. Have you ever been asked to participate in a healthcare study?
| Race | No Response # (%) |
No # (%) |
Yes # (%) |
Total # (%) |
| Missing data | 1 (1.3) |
0 |
0 |
1 (1.3) |
| African-American | 0 |
11 (13.8) |
0 |
11 ) 13/8) |
| Hispanic-American | 2 (2.5) |
16 (20.0) |
2 (2.5) |
20 (25.0) |
| Native-American | 0 |
12 (15/0) |
1 (1.3) |
13 (16/3) |
| Sudanese | 1 (1.3) |
15 (18.8) |
1 (1.3) |
17 (21.3) |
| Vietnamese | 0 |
10 (12.5) |
0 |
10 (12.5) |
| White | 0 |
5 (6.3) |
3 (3.8) |
8 (10.0) |
| Total | 4 (5.0) |
69 (86.3) |
7 (8.8) |
80 (100) |
Table 14. If you were asked, would you participate in a healthcare study with race?
| Race No Response # (%) |
Don’t Know # (%) |
No # (%) |
Yes # (%) |
Total # (%) | |
| Missing data | 1 (1.3) |
0 |
0 |
0 |
1 (1.3) |
| African-American | 0 |
5 (6.3) |
1 (1.3) |
5 (6.3) |
11 (13.8) |
| Hispanic-American | 1 (1.3) |
2 (2.5) |
3 (3.8) |
14 (17.5) |
20 (25.0) |
| Native-American | 0 |
1 (1.3) |
3 (3.8) |
9 (11.3) |
13 (16.3) |
| Sudanese | 1 (1.3) |
1 (1.3) |
2 (2.5) |
13 (16.3) |
17 (21.3) |
| Vietnamese | 0 |
0 |
3 (3.8) |
7 (8.8) |
10 (12.5) |
| White | 0 |
0 |
0 |
8 (10.0) |
8 (10.0) |
| Total | 3 (3.8) |
9 (11.3) |
12 (15.0) |
56 (70.0) |
80 (100) |
Minority community members prefer healthcare providers who are of the same ethnic, racial and/or cultural background. The data support a preference for healthcare providers of the same racial and/or ethnic group. When respondents were asked if there were certain illnesses that were better treated by someone of the same ethnic or racial background, 36% or 29 respondents said yes (Table 12). Many respondents thought diabetes was a disease that could be better treated by someone of the same ethnic or racial group because the healthcare provider would be familiar with that racial/ ethnic group’s diet.
Minority community members do not participate in healthcare research. Minority community members do not want to participate in healthcare research. The data support the first of these two hypotheses. Only seven respondents had ever been asked to participate in a healthcare study (Table 13). These seven participated in an osteoporosis, breast cancer, smoking and homelessness study. This result clearly indicates that a lack of willingness does not account for the low participation in clinical studies. When probed for their reason for participation, they said to improve healthcare and to help others. Furthermore, 70% of respondents said if they were asked, they would participate in a study (Table 14). Their reason for participation was similar to those who had, and included “to learn more about the disease”, “to get treatment”, “to teach providers about their culture”, and “money.”
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Approximately 25% of our sample said they did not know if they would participate in a healthcare study if asked or said, no, they would not participate if asked. This percentage exceeds the 11.3% that were dissatisfied with healthcare. A disproportionate number unwilling to participate were African Americans. All of the whites said they would participate. Reasons for not participating in a healthcare study included: “it might hurt me”, “meds not approved by the FDA” and “scared of the unknown.”
Category: Health
Tags: community, cultural competency, health disparities, minority population, researchers, satisfaction, trust