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Health promotion programs in global health systems need to incorporate culturally competent care and provide linguistic access. This article describes the challenges in one country, the United States, and reports on research studies, which articulate the current gaps in meeting the above goals. Health care providers are bound by both legal and ethical standards to provide such care. Legal standards are cited. Regardless of legal standards, health care providers are also bound ethically to provide such care. An analysis of basic ethical concepts of principalism is described for the importance of these aspects of care.

The premise of this article is that one cannot have a successful health system without inclusion of culturally competent health promotion programs. And, one cannot have such health promotion programs without an understanding of the role that cultural and linguistic competence plays in the provision of clinically competent and cost-effective services. Not only is there a need for culturally competent care that is legally mandated in some countries, such care is ethically necessary. The first part of this paper will address the need for culturally and linguistically appropriate care and applicable laws and standards. The latter part of the paper will provide an ethical analysis. However, before doing that, one global perspective of health care concerns for underserved populations will be presented as well as a discussion of the importance of the use of ethical frameworks.

It is again suggested that people from black and minority ethnic (BME) communities comprise a disproportionately high percentage of mental health inpatients. Furthermore, the Commission for Racial Equality (CRE) concluded the Department of Health (DH) did not have ‘due regard’ to the Race Equality Duty, retaining major concerns regarding the ability of the DH to ensure future compliance (CRE, 2007). In light of these ongoing problems the DH published a five‐year action plan, Delivering Race Equality (DRE) in Mental Health Care to develop race equality and cultural competence training for mental health practitioners (DH, 2005).A focused review of literature was undertaken, structured around three questions.1. How is cultural competence in mental health care defined?2. How is cultural competence in mental health care delivered?3. How is the delivery of cultural competence in mental health care evaluated?Consensus is lacking on definition of cultural competence and on the sequence of when the components should be acquired, some terms being used interchangeably. It is unclear how cultural competence in mental health care can be delivered. No attempts have been adequately evaluated, particularly by service users (Bhui et al, 2007). More innovative research is needed to develop a consensual definition of cultural competence and to facilitate the delivery and evaluation of such, in ways acceptable to service users and service providers.

The purpose of this paper is to analyze the study results conducted at a four-year university in Hawaii investigating the impact of providing nursing students with an educational intervention session aimed at improving cultural competence.

A descriptive-correlational research method was used to examine the correlations between a control group and experimental group using pre-and post-tests. The t-test for equality of means and Levene’s test for equality of variances were conducted for statistical analysis on pre-and post-test scores. In addition, a power analysis was conducted due to the small sample size.

The control group receiving no intervention scored lower on the post-test in overall competency by five points, while the experimental group increased their post-score by five points after receiving the intervention; however, this increase did not change the overall cultural competence score. The results indicate that the educational intervention of a two-hour didactic, discussion and presentation did not provide as robust as what was needed to increase domain scores for the experimental group. Further, the domains of awareness, skill, knowledge, encounter and desire cannot be taught by instruction alone and should be reinforced over time.

The study was a convenience sample and limited by the small sample size. The sample may not be representative of all senior nursing students. The study is limited to one school of nursing in Hawaii; the results may not be generalized to other populations.

This research provides a foundation for future curriculum development and the evaluation of nursing programs. For instance, incorporating a value-added instructional project on cultural competence into each nursing class would increase cultural competence awareness and knowledge.

This study also emphasizes the necessity of education in cultural competence for all health professionals, which has implications for improving quality, patient satisfaction and increased health outcomes.

This research is unique to examining and applying an educational intervention on cultural competence for nursing students in Hawaii. This research sheds light on studying the importance of culture competence for nursing students and other health professionals. This is not a skill that can be taught in one class or only even a single immersion experience and should be acquired over time where continuing education and encounters are necessary in order to become culturally competent; this will enable health professionals to provide meaningful and appropriate care to patients.

According to the Census, racial/ethnic minority populations are growing at such a fast rate that by 2050 more than 50% of the population will belong to a minority group (US Census, 2001). The increasing diversity of the U.S. population is one of the many changes that health care delivery organizations need to proactively address in order to better serve their community and improve their performance. In this paper, we argue that cultural competency not only is important from a societal perspective, i.e., reducing health disparities, but can also be a strategy for health care organizations to improve quality, lower cost, and attract customers. We provide detailed recommendations for health care leaders and managers to adopt in order to successfully serve a diverse patient population.

Purpose – This chapter will explore the link between health disparities and cultural competence and demonstrate the importance of helping providers to understand how their personal biases can result in care that is inequitable and unsafe.

Methodology/approach – This chapter provides a literature review as well as case studies to illustrate the association between culture competence and health disparities.

Findings – Research has shown that racial and ethnic minorities experience more negative health outcomes as compared to Caucasians. Many of these health disparities are associated with communication difficulties created by language, cultural barriers, and low health literacy. These barriers often result in ethnic and racial minority patients having longer hospital stays for common medical and surgical conditions and more adverse events with greater consequences than Caucasians; moreover, minorities are more likely to be readmitted to the hospital after discharge.

Practical implications – Empowering health care providers with skills and techniques in cultural competence can reduce health disparities. Intentionally using cultural competence as an intervention to address health disparities can lead to more effective, patient-centered care, with improved health care outcomes.

Originality/value – This chapter will provide practical knowledge to help health care providers deliver culturally competent and patient-centered care.

This chapter provides an overview of the importance of cultural competence and how it is developed in some careers by higher education institutions. Included in the discussion is a brief overview of some research and strategies used when attempting to develop cultural competence.

Despite contemporary concerns arising from high levels of serious mental illness in this group, there is no convincing evidence that the mental well‐being of black men is generally poor. The potential for general practice to influence mental well‐being derives from the totality of its services to patients. Black and minority ethnic (BME) users report lower levels of satisfaction with general practice services than the population as a whole. A review of evidence indicates poorer access to effective care in general practice by BME users. For general practice to become a service that is culturally competent for multicultural communities the setting of consultations and skills‐employed need to maximise patient enablement, and patient profile data, including self‐ascribed ethnicity, needs to be developed and utilised for routine race equality audit.

This chapter presents information related to models and frameworks from the perspective of cultural competence in healthcare settings, such as the Joint Commission on Accreditation of Healthcare Organizations, Department of Health and Human Services, specifically the Office of Minority Health and Healthy People 2020. National health-related organizations such as the American Physical Therapy Association and the American Association of Colleges of Nursing provide scaffolding for educating future health professionals regarding providing culturally competent care. Research on effectiveness of professional development and integrating cultural competence into the curriculum will be presented along with suggestions for faculty interested in incorporating these models and practices into their courses.

In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health care experiences in two policy contexts in the Washington, DC metropolitan area.

This qualitative study includes 40 in-depth interviews with first-generation, low-income immigrant Latin American and African mothers in DC and Northern Virginia.

The majority of families living in Virginia had child-only health insurance, whereas most of the families living in Washington, DC, had family health insurance. Regardless of these insurance differences, all mothers had access to free health care for prenatal care. Pregnancy, for most, was their entry into the U.S. health care system. Families’ ongoing health care experiences differed in relation to insurance access, and culture, including parents’ previous experiences with health care in their countries of origin.

Future research should consider the experiences of other immigrant groups, mental health experiences of immigrants, and fathers’ experiences with health care.

Future initiatives to address health care should focus on providing family health care to low-income immigrant families across the country, improving access to mental health services for immigrant families, and creating more culturally and linguistically appropriate health care services.

This study points to the importance of family health care for immigrant families, as well as care that is culturally and linguistically competent.

This study illustrates the need for public family health insurance for low-income immigrant families, and the importance of culturally competent health care for immigrants.

There is a recognition in Europe and in the western world of a demographic shift in the ageing population. While the overall ageing of the general population is growing, the numbers of immigrants getting old in their host countries is also increasing, thereby increasing the racial and ethnic proportion of older people in these countries. This changing landscape calls for understanding of issues related to health care provision, policy and research regarding ethnic minorities. Communication is seen as a key factor in understanding the needs of ethnic minority elders (EMEs). The purpose of this paper is to explore health care workers’ (HCWs) perceptions and experiences of communication with EMEs. In this paper the term HCW includes qualified nurses and health care assistants.

A descriptive qualitative study design using semi-structured interviews was employed. Ten HCWs, who had ethnic minorities in their care were individually interviewed to explore their perceptions and experiences of communication when caring for EMEs.

Analysis of data revealed that in common with all older people, EMEs experience stereotyped attitudes and difficulties in communication. However, EMEs face particular challenges, including cultural differences, different language and stereotyping of care based on misunderstood needs of EMEs. Facilitators of communication included appropriate training of HCWs and appropriate use of interpreters.

Only homes willing to take part in the study gave permission for their staff to be interviewed. In addition, the HCWs came from various settings. Therefore, views of staff in homes who did not give permission may not be represented.

The diversity of older people needing care in nursing homes and the community calls for training in culturally competent communication for effective provision care provision for EMEs.

Training of health care staff in culturally appropriate communication requires effective practice.