How Can MS Care Providers Improve Cultural Competency in Daily Life and Healthcare Practice?

Social determinants account for as much as 80% of a person's health outcomes, reported social worker Alicia Sloan, MPH, MSW, LICSW, at the Tuesday CMSC session on improving cultural competence in healthcare. (Click on image to enlarge).ORLANDO, Fla. – People with multiple sclerosis (MS) often encounter bias and condescension in the course of receiving healthcare services. When the person is in a racially or culturally marginalized group, the feeling of being devalued can be greatly compounded. At the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting this week, multiple sessions were dedicated to helping MS clinicians recognize, address, and improve cultural competency in their MS practice.

Alicia Sloan, MPH, MSW, LICSW, Senior Social Worker at the Veteran’s Administration (VA) Puget Sound Health Care System in Seattle, has helped the VA design and implement cultural competency programs. For the CMSC audience, she started with some definitions. “Cultural competence in healthcare means delivering effective quality care to a diverse group of patients with diverse beliefs, values and behaviors,” Ms. Sloan explained. “It also includes meeting the needs of people with disabilities, those from diverse socioeconomic backgrounds and members of the LGBTQ community.”

As a person with self-discussed “white privilege,” Ms. Sloan described the process for growing more aware of how these privileges shape her life and how that experience is different for a person of color. People in these groups face everyday assaults, both direct and indirect, known as microaggressions, that gradually eat away at a person’s self-esteem, tolerance, and trust, she said. “Microaggressions include micro-insults—verbal or nonverbal snubs, whether intentional or unintentional—that communicate hostile, derogatory or negative messages.” Micro-insults are often unconscious, she said, such as remarks or actions that convey a message of insensitivity such as telling a joke based on a stereotype. Micro-invalidations are typically unconscious and include comments and behaviors such as denying the existence of discrimination.

What does a culturally competent pathway for healthcare delivery look like? According to Ms. Sloan, it is a patient-centered care model not unlike the one clinicians are already using in the care of MS patients. Some of the goals include:

• Better health for all patients
• Addressing communication differences between providers and their patients
• Reducing care disparities that people of racially and culturally diverse backgrounds often experience
• Improving understanding between patients and providers
• Enhancing the patient experience and satisfaction

“In communities of color, racism is a primary driver for the social determinants of health and sets the stage for all other social determinants,” Ms. Sloan said. A definition of racism proposed by a former president of the American Public Health Association reads, “Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (what we call ‘race’) that unfairly disadvantages some individuals and communities, unfairly advantages others, and saps the strength of the whole society through the waste of human resources.”

Ms. Sloan has worked with the VA, the largest healthcare system in the U.S., to help address racism, and reduce health inequities and disparities within its system. “We still have a lot of work to do, but we have reformed many communities at different levels of leadership to improve DEI [diversity, equity, and inclusion] experiences for both employees and veterans.” Many academic institutions and professional organizations and healthcare systems have launched their own anti-racism initiatives, she noted. She provided the CMSC audiences with multiple resources and links for tools they can apply in their own practices (see sidebar).

“In clinical care, cultural humility can serve as a guiding concept for us,” she concluded. “It focuses on empowering patients on their journey of healing, rather than making assumptions about the patient's experience or using an authoritative or ‘fixer’ communication style rather than a guiding and empowering style. We all have the ability to provide culturally competent care.”

 

Selected Cultural Competency Resources for MS Clinicians

• Antiracism Resources and the Impact of Racism Within VA Health Services Research & Development. Focus on Health Equity and Action. US Department of Veterans Affairs. 2021.
• Stubbe DE. Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Communication Commentary. Focus. Psychiatry Online. Jan 4, 2020.
• Thorne S Race, Culture, and Community While Living with Multiple Sclerosis. The MS Views and News Learning Channel. February 21, 2021.
• Jordan, S, et al. Focus on Health Equity and Action: Antiracism Resources and the Impact of Racism within VA. Health Services Research & Development. (Webinar). July 14, 2021.
• Kanter J, et al. Addressing microaggressions in racially charged patient-provider interactions: a pilot randomized trial. BMC Med Educ. 2020;20(1):88.