PDF(Pubmed)
Abstract：
The delivery of culturally competent health care is recognized as critical to providing quality, equitable care for marginalized groups. This includes immigrant patients and families who experience significant barriers to health care and poor health outcomes. However, operationalization of cultural competence challenges health care delivery. Complementary concepts have also emerged such as cultural humility, cultural safety, and structural competence, recognizing the need for multi-level approaches involving patients, families, clinicians, health care organizations, the larger community, and policymakers. In this review, we define cultural competency and related frameworks and their applicability to immigrant patients and families. The evolution in terminology reflects an increasingly more comprehensive approach to understanding culture as multidimensional and shaped by social and structural factors. We then highlight strategies at each level, focusing on clinicians and organizations to leverage loci of control most directly within clinicians\' reach. Community-level strategies include community engagement (ie, vis-à-vis community health workers or community advisory boards) for clinical and research practice. Organization-level strategies include \"immigrant-friendly,\" or \"immigration-informed\" policies aimed at reducing immigration-related stressors, like limiting cooperation with immigration enforcement agencies or developing medical-legal partnerships to assist with patients\' legal needs. Lastly, policy-level strategies seek to change local and federal policies to address needs beyond health care (eg, education, housing, other social services), taking a \"Health in All\" policies approach that articulates health considerations into policymaking across sectors. Finally, we conclude with suggestions for future directions that center the experiences of immigrants, with the ultimate goal of sustainably meeting the complex needs of immigrant patients and families.
摘要：
提供具有文化能力的医疗保健被认为是提供高质量、公平照顾边缘化群体。这包括移民患者和家庭，他们在医疗保健和不良健康结果方面遇到重大障碍。然而,文化能力的可操作性挑战了医疗保健的提供。互补的概念也出现了，如文化谦逊，文化安全,和结构能力，认识到需要涉及患者的多层次方法，家庭,临床医生,卫生保健组织,更大的社区，和政策制定者。在这次审查中,我们定义了文化能力和相关框架及其对移民患者和家庭的适用性.术语的演变反映了一种越来越全面的方法来理解文化是多维的，并由社会和结构因素塑造。然后我们突出每个级别的策略，专注于临床医生和组织，以便在临床医生的接触范围内最直接地利用控制位点。社区层面的战略包括社区参与(即，相对于社区卫生工作者或社区咨询委员会），用于临床和研究实践。组织层面的战略包括“对移民友好，“或”移民知情“旨在减少与移民相关的压力源的政策，例如限制与移民执法机构的合作或发展医疗法律伙伴关系以协助患者的法律需求。最后,政策层面的战略寻求改变地方和联邦政策，以解决医疗保健以外的需求(例如，教育,住房,其他社会服务)，采取“全民健康”政策方法，将健康考虑因素纳入各部门的决策。最后,最后，我们提出了以移民经验为中心的未来方向的建议，最终目标是可持续地满足移民患者和家庭的复杂需求。
