Ask a Librarian! addresses questions that clinicians commonly ask medical librarians, with the goals of providing information about the various resources offered by medical libraries and of promoting collaboration between PAs and medical librarians. Do you have a question for a medical librarian? Send your question to ask.a.librarian.jaapa@gmail.com.

Question: I am looking for resources that can provide context for improving my skills in working with diverse populations. I know that there is great diversity within cultures, and am looking for tools beyond the potentially stereotyping “cultural pearls.”

Answer: As societies around the world become increasingly diverse, knowing where to locate culturally responsive information becomes ever more important for health care providers and the patients they serve. Informed communication and an understanding of cultural differences are crucial elements for quality care. These sites are excellent starting points for that valuable information:

EthnoMed From the University of Washington, EthnoMed offers guides to cultural beliefs and practices, as well as translated patient education materials for immigrant groups, many of whom are refugees from war and conflict. In addition to addressing specific cultural or linguistic groups, EthnoMed provides information on many issues related to refugees in general, such as immigration/naturalization and working with survivors of torture. You can browse by culture or medical topic and find some interesting entries, such as translated instructions on preparing for common medical procedures. 

Consumer Health Information in Many Languages Resources Compiled by National Network of Libraries of Medicine consumer outreach librarians, this site serves as a gateway to many resources in a variety of languages from around the world. Some resources specialize in a single language, and others offer information in multiple languages. Topics covered cross the spectrum of medicine, including public health, nutrition, and even non-English guides on how to search PubMed.

NSW Multicultural Health Communication Service/Publications and Resources From New South Wales, Australia, this is a compilation of resources in many languages, including some European ones. As with the sites listed earlier, you can browse by either topic or language. Topics tend to be broad categories, such as Allergy or Family Planning, under which you'll find more narrowly focused patient information in many languages. This site also contains some audio and video resources. 

SPIRAL (Selected Patient Information Resources in Asian Languages) Maintained by the Tufts University Hirsh Health Sciences Library, SPIRAL is another gateway site, sending users out to reputable sources for Asian language patient information. Many of the entries in SPIRAL are also in English, as a basis for comparison. Again, SPIRAL provides links to additional useful sites for information on cultural effectiveness.

Take advantage of these sites to help bridge the gaps of language and culture when working with patients from diverse backgrounds. 

Question: I'm still not sure I understand what people mean by cultural competency. Is it an achievable goal, and what tools are there to help me better understand and integrate this topic into my care of patients?

Answer: Our favorite compendium of top-notch resources about this topic comes from the US Department of Health and Human Services' HRSA (Health Resources and Services Administration) Web site, Cultural Competency and Health Literacy Resources for Health Care Providers. This site stresses that “cultural competence” is not a destination but rather a process and then goes on to provide valuable background and understanding into this complex issue. We also are big fans of how the HRSA “definition of culture” helps to frame this issue. It reads in part as follows:

Culture can be thought of as an integrated pattern of learned beliefs and behaviors that are shared among a group of people. Beliefs and behaviors include styles of communication, ways of interacting, views on roles and relationships, values, practices, and customs. Culture shapes how we explain and value our world; it is the lens through which we give our world meaning. 

Many people may think of culture primarily in terms of their culture of origin/the environment and belief systems within which they were raised. Beyond cultures of origin, people are influenced by the many group cultures to which they belong. These can include kinship networks; ethnic, gender, or sexual orientation identity groups; religious affiliations; social classes; geographic regions; occupation; and disability. These variables influence us in many ways and are reflected in what we think about health care and the people who provide it.

A related piece, also helpful in framing a way to view cultural competence, comes from the AAPA Committee on Diversity web page. This piece by member Dave Coleman is titled A Comment on the Myth of Cultural Competence. JAAPA

Jim Anderson is a physician assistant in the Department of Neurological Surgery at Harborview Medical Center in Seattle. He is a former chair of the AAPA's Committee on Diversity and a member of the JAAPA editorial board. Susan Klawansky is a medical librarian at Seattle Children's Hospital.