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Tools for Providers

The following compilation of tools, websites and resources has been developed to assist you and your office staff with providing culturally and linguistically sensitive services to racial and ethnic populations.  
This document provides links to other web sites. We make these links available for the sole purpose of providing general educational information on health care related issues. We cannot guarantee the quality, accuracy, truthfulness, or reliability of information presented on these web sites. These links do not constitute or imply endorsement by us of such web site or of any views or opinions expressed in the web site.  
Data Collection and Assessment Tools
Communication Tools
Links to Other Resources for Cultural and Linguistic Programs


Articles and Reports


Movies and Videos


Data Collection and Assessment Tools
Cultural competency in health care requires doctors and their office staff to be able to recognize and integrate culturally diverse health practices and beliefs about disease causation and prevention into the delivery of health care services. It allows you to take into account information about culturally specific disease incidence and prevalence data.  
Assess the following:  
Cultural values
Health beliefs
Preferred methods of learning
Communication (verbal vs. nonverbal)
Language spoken
Literacy level
The following tools for assessment may assist you in evaluating your populations and your practice:  
An Organizational Cultural Competence Assessment Profile
A Toolkit for Collecting Race, Ethnicity, and Primary Language Information from Patients
National Center for Cultural Competence, Georgetown University – Self-Assessment Tools
University of Michigan, Organizational, and individual assessment tools
Bibliography of cultural competence assessment tools
Communication Tools
Experts agree communication is the key to improving an individual’s understanding of health information and instructions, which in turn may help bridge the gap in health disparities. Here is a short list of communications principles to assist you in communicating with individuals:  
Use words and phrases used by the population. Avoid professional or technical jargon.
Use printed material at about 6th to 8th grade reading level so it is easy to understand. (See the resources in the Education Tools section.)
Use pictures, posters, drawings, or visual materials for people with limited reading ability.
Allow time for the education to occur.
Encourage and initiate conversation with the individual.
To assess understanding of the information you provided, ask the individual to repeat back what your instructions were.
The following resources can also assist you in your communications efforts:  
Speaking of Health: Assessing Health Communication Strategies for Diverse Populations, a report that examines the challenges of effective communication. Created by: Committee on Communication for Behavior Change in the 21st Century: Improving the Health of Diverse Populations, Board on Neuroscience and Behavioral Health, Institute of Medicine
Toward a More Perfect Union in an Age of Diversity: Working on Common Cross-Cultural Communication Challenges by ME DuPraw & M Axner
"Language Access and the Law" and "Viewpoints", two culturally and linguistically targeted e-learning courses which provide AMA Category 1 CME credits at no cost to providers and help clinicians to better serve more diverse patient populations. "Language Access and the Law" reviews the business, medical, and legal basis for the language access mandate in health care, and "Viewpoints" assists physicians in treating common infectious diseases that originate from outside the U.S. The link will take you to a "Quick Start Guide" to assist you in registering for the courses.
Health Literacy
AskMe3 Brochures, an approach using three questions geared to improve clear health communication between patient and provider. Available in English and Spanish for patients, health care professionals, and health care organizations. Other resources, such as fact sheets, white papers, and provider manuals are available on the website. Created by: Partnership for Clear Health Communication
Checklists for Your Next Checkup, two separate checklists for men and women to use during their next checkup with their doctor. These checklists are available in English and Spanish. Developed by: Agency for Healthcare Research and Quality (AHRQ) (English - Men) (Spanish - Men) (English - Women) (Spanish - Women)

Health Literacy: A Prescription for Confusion, an Institute of Medicine (IOM) report summarizing the financial and health care impact of health literacy on the health care system. Created by: Committee on Health Literacy, Board on Neuroscience and Behavioral Health, Institute of Medicine of the National Academy of Sciences April 2004
Health Literacy Fact Sheets, a series of nine fact sheets defining health literacy and its impact on creating and evaluating patient education materials for consumers with low health literacy skills. Authored by: Linda Potter, DrPH, Family Health Research and Constance Martin, MHA, Center for Health Care Strategies, Inc. (CHCS) August 2005
Practical Solutions to the Problems of Low Health Literacy, an executive summary for the fourth annual national health communication conference to address solutions and highlight programs that address low health literacy. Created by: American College of Physicians Foundation (ACP Foundation) and the Institute of Medicine (IOM) November 2005
Language Proficiency
For individuals with language barriers, an interpreter may enhance the doctor-patient encounter. The goal of the use of interpreters is to help improve compliance with prevention and treatment regimens. Some tips for selecting and using an interpreter include:  
When possible, choose an interpreter whose age, sex, background, etc. are similar to that of the individual.
Brief the interpreter in private before the appointment. Provide him/her with relevant information about the individual.
Verify the interpreter understands what message you are trying to convey. Encourage the interpreter to ask questions or clarify a message whenever necessary.
Address the individual directly. Avoid directing all comments to the interpreter.
Talk in short sentences. Discuss one concept at a time.
Avoid using medical jargon when possible. It may be difficult for the interpreter and individual to understand.
Be patient. Careful interpretation may require the interpreter to use long phrases. It can take more words or time to describe a concept in another language.
Come back to an issue if there is a problem or a negative response from the individual.
Be aware of non-verbal cues from the individual. They may indicate how much information is understood. (such as nodding of head, smile, body position, etc.)
The following resources may assist you in understanding when and how to best utilize interpreters and other language specific communications in your practice:  
Using medical interpreters. – Curbside Consultation Jun 1, 2004
The Access Project & the National Health Law Program Language Services Action Kit: Interpreter Services in Health Care Settings for People with Limited English Proficiency. Language Svcs Action Kit

Kit in English

Kit in Spanish

Universal Symbols in Health Care: Best Practices for Sign Systems, a workbook, written for health care executives, designers, and facility managers, recommends the use of universal symbols as an alternative to the challenges and expense of signs in different languages. Created by: Hablamos Juntos and the Society for Environmental Graphic Design (SEGD) 2005
Getting the Most From Language Interpreters, an article providing guidelines for clinicians on how to best work with interpreters both on-site and via telephone. Authored by: Emily Herndon, MD and Linda Joyce 2004
Language Services Issue Brief – Affordable Language Services: Implications for Health Care Organizations, an issue brief highlighting the impact of language barriers on patient safety and quality care and the challenges health care organizations must overcome to effectively address this issue. The issue brief provides recommendations for reducing language barriers. Created by: Hablamos Juntos September 2005.
Limited English Proficiency Manual, a manual geared for health care providers and community health centers to ensure Asians, Native Hawaiians and other Pacific Islanders (NHOPIs), have access to health care services. Created by: Asian Pacific Health Care Venture, Inc. and the Association of Asian and Pacific Community Health Organizations (AAPCHO) 2002
Patient Handout for Requesting an Interpreter, an educational resource to assist patients in requesting an interpreter. Spanish with English translation. Developed by: Javier F. Sevilla M├ítir, MD, and Deanna R. Willis, MD, MBA July–August 2004
Other Resources for Cultural and Linguistic Programs
American Academy of Family Physicians (AAFP)
Cultural Proficiency Guidelines
American College of Emergency Physicians Board of Directors.

Recommended Core Curriculum Guidelines on Culturally Sensitive and Competent Care. Like, R, Steiner, P, & Rubel, A. Family Medicine, Vol. 28 (4)3.2001

Cultural Competence and Emergency Care

American Academy of Pediatrics
Cultural Effectiveness and Health Disparities Resources/links
American Nurses Association
Position Statements: Cultural Diversity in Nursing Practice.
American Public Health Association. Planner’s Guide available on-line
American Psychological Association
Guidelines for Culturally Diverse Populations: APA Guidelines Approved by the APA Council of Representatives in August.
For more information, write to 750 First Street, NE, Washington, DC 20002.Tel. 202-336-5500.
National Association of Social Workers (NASW)
Reports and Articles
Agency for Healthcare Research and Quality (AHRQ) by the Johns Hopkins University Evidence-based Practice Center, Baltimore, MD, under Contract No. 290-02-0018. The full report is available from the AHRQ Publications Clearinghouse. Printed copies may be obtained free of charge by calling 800-358-9295. Requesters should ask for Evidence Report/Technology Assessment No. 90, Strategies for Improving Minority Healthcare Quality.  
Report “What a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency” national findings from the Community Access Monitoring survey.
Cultural Competence in Health Care: Is it important for people with chronic conditions? Issue Brief Number 5, Feb 2004 Center on an Aging Society Institute for Health Care Research and Policy – Georgetown University
Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health care JR Betancourt, et al- Pub Health Repts, 2003 Jul-Aug 2003 V118#293
Joseph R. Betancourt, Alexander R. Green, J. Emilio Carrillo and Elyse R. Park. FROM THE FIELD Cultural Competence and Health Care Disparities: Key Perspectives And Trends. Health Affairs, Vol 24, Issue 2, 499-505, 2005
The Role of Culturally Competent Communication in Reducing Ethnic & Racial Healthcare Disparities SL.Taylor & N Lurie Sep 04, Special Issue SP001-4
Introduction & Key Findings Setting the Agenda for Research on Cultural Competence in Health Care
The Administration on Aging (AoA) has created the guidebook, “Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families.”  
The Office of Minority Health published the “Physician Toolkit and Curriculum: Resources to Implement Cross-Cultural Clinical Practice Guidelines For Medicaid Practitioners” to aid healthcare providers in the practical application of the Cross-Cultural Clinical Practice Guidelines.  
Administration on Aging. Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families A guidebook for Providers of Services for Older Americans and their families.
The National Alliance for Hispanic Health. A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics. For information, contact: The National Alliance for Hispanic Health at 1501 Sixteenth Street, NW, Washington, DC 20036. Tel. 202-387-5000.
Office of Minority Health (2004). PHYSICIAN TOOLKIT AND CURRICULUM Resources to Implement Cross-Cultural Clinical Practice Guidelines for Medicaid Practitioners
Intercultural Disposition and Communication Competence of Future Pharmacists
Movies and Videos
Alexander M. “Cinemeducation: An Innovative Approach to teaching Multi-Cultural Diversity in Medicine,” Annals of Behavioral Science and Medical Education 1995; 2(1): 23-28
The Bilingual Medical Interview I (1987), and The Bilingual Medical Interview II: The Geriatric Interview, Section of General Internal Medicine, Boston City Hospital, in collaboration with the Department of Interpreter Services and the Boston Area Health Education Center (Available from the BAHEC, 818 Harrison Ave., Boston, MA 02118; Phone (617)-534-5258
Other Resources
An Organizational Cultural Competence Assessment Profile - Resources developed by the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services for its centers of excellence hospitals.
Assuring Cultural Competence in Health Care: Recommendations for National Standards & an Outcomes-Focused Research Agenda Recommendations for National Standards & National Public Comment Process Final (2000)

CLAS in Health Care 14 Standards - Resources developed by the University of Michigan Health System’s Programs for Multicultural Health.
Crosswalk of Joint Commission and CLAS Standards – A tool developed by the Joint Commission that crosswalks Office of Minority Health National Culturally and Linguistically Appropriate Services (CLAS) Standards to the Joint Commission 2006 Standards for Hospitals, Ambulatory, Behavioral Health, Long Term Care, and Home Care.
Diversity Rx – Health policy on disparities conference materials and other information on how to meet the language and cultural needs of minorities, immigrants, refugees and other diverse populations seeking health care.
Hospitals, Language & Culture: A Snapshot of the Nation – Resources for hospitals developed by the Joint Commission.
This document provides links to other web sites not owned or controlled by care management program. We make these links available for the sole purpose of providing general educational information on health care related issues. We cannot guarantee the quality, accuracy, truthfulness, or reliability of information presented on these web sites. These links do not constitute or imply endorsement by us of such web site or any views or opinions expressed in the web site. While we do our best to ensure your privacy, we cannot be responsible for the privacy practices of other web sites. We encourage you to review the privacy practices of any web site you visit.  
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