EquiCare Toolkit

Abstract: This article reassesses and recontextualizes findings of an independent writing group commissioned in 2005 by what was then known as the Institute for Ethics of the American Medical Association (AMA). The authors were members of this group, which uncovered a paradigm case of structural racism that has perpetuated health inequity since the issue of admitting African Americans was first raised at the AMA’s national meetings immediately after the Civil War ended, in 1868. Upon publication of the writing group’s findings, the AMA publicly apologized for its social, cultural, and political roles in the racist history of organized medicine. Now, in 2021, the authors of this article seek to situate this aspect of the AMA’s history as it prepares itself for antiracist leadership in the health care sector.

Baker, R. & Wynia, M. K. (2021). Living histories of structural racism and organized medicine. AMA Journal of Ethics, 23(12), E995-E1003. https://doi.org/10.1001/amajethics.2021.995

Abstract – Objectives: To explore participants’ perceptions of cultural competence and cultural humility in mobile health clinic (MHC) service delivery, using the Cultural Competence Model (CCM) as an organizing framework. Methods: We conducted five focus groups with an ethnically diverse group of English- and Spanish-speaking men and women, ages 20-67, residing in five underserved neighborhoods in a Southeastern U.S. city. Data analysis followed a thematic approach and iterative qualitative content analysis. Results: Participants expressed a desire for well-trained and caring staff who practice cultural humility. Conclusions: By applying the CCM’s five-pronged constellation of cultural abilities, health care personnel could ultimately be more responsive to ethnically diverse clients. There is a need to reinforce compliance with Culturally Linguistic and Appropriate Service (CLAS) standards and to develop programs to increase providers’ cultural awareness, knowledge, and skills that ultimately would potentially reduce the amount of non-emergent Emergency Room visits and their associated costs.

Moore de Peralta, A., Gillispie, M., Mobley, C., & Gibson, L. M. (2019). It’s all about trust and respect: Cultural competence and cultural humility in mobile health clinic services for underserved minority populations. Journal of Health Care for the Poor and Underserved, 30(3), 1103-1118. https://doi.org/10.1353/hpu.2019.0076

Overview: This article emphasizes the need for healthcare systems and providers to be aware of and responsive to patients’ cultural perspectives and backgrounds. It discusses how cultural competence and patient-centered care intersect to improve healthcare delivery. 

Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49-51. https://doi.org/10.1176/appi.focus.20190041

Abstract: Diversity is being increasingly recognized as an area of emphasis in health care. The term cultural humility is used frequently but society’s understanding of the term is unclear. The aim of this article was to provide a concept analysis and a current definition for the term cultural humility. Cultural humility was used in a variety of contexts from individuals having ethnic and racial differences, to differences in sexual preference, social status, interprofessional roles, to health care provider/patient relationships. The attributes were openness, self-awareness, egoless, supportive interactions, and self-reflection and critique. The antecedents were diversity and power imbalance. The consequences were mutual empowerment, partnerships, respect, optimal care, and lifelong learning. Cultural humility was described as a lifelong process. With a firm understanding of the term, individuals and communities will be better equipped to understand and accomplish an inclusive environment with mutual benefit and optimal care.

Foronda, C., Baptise, D-L, Reinholdt, M. M., & Ousman, K., (2015). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3).      https://doi.org/10.1177/1043659615592677

Abstract: This paper describes results of a qualitative study that explored barriers to research participation among African American adults. A purposive sampling strategy was used to identify African American adults with and without previous research experience. A total of 11 focus groups were conducted. Groups ranged in size from 4-10 participants (N=70). Mistrust of the health care system emerged as a primary barrier to participation in medical research among participants in our study. Mistrust stems from historical events including the Tuskegee syphilis study and is reinforced by health system issues and discriminatory events that continue to this day. Mistrust was an important barrier expressed across all groups regardless of prior research participation or socioeconomic status. This study illustrates the multifaceted nature of mistrust and suggests that mistrust remains an important barrier to research participation. Researchers should incorporate strategies to reduce mistrust and thereby increase participation among African Americans.

Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: Understanding mistrust about research participation. Journal of Health Care for the Poor  and Underserved, 21(3), 879-897. https://doi.org/10.1353/hpu.0.0323

Abstract: Cultural humility is a process of self-reflection and discovery in order to build honest and trustworthy relationships. It offers promise for researchers to understand and eliminate health disparities, a continual and disturbing problem necessitating attention and action on many levels. This paper presents a discussion of the process of cultural humility and its important role in research to better understand the perspectives and context of the researcher and the research participant. We discern cultural humility from similar concepts, specifically cultural competence and reflexivity. We will also explore ways to cultivate cultural humility in the context of human subjects research. Mindfulness is one approach that can be helpful in enhancing awareness of self and others in this process. With a foundation in cultural humility, nurse researchers and other investigators can implement meaningful and ethical projects to better address health disparities.

Yeager, K. A., & Bauer-Wu, S. (2013). Cultural humility: Essential foundation for clinical researchers. Applied Nursing Research, 26(4), 251-256.     https://doi.org/10.1016/japnr.2013.06.008