Improving Cultural Competency Among HCPs
Dr. Lisa Sumlin, Ph.D., APRN, ACNS-BC, is an advanced practice nurse who works with people with diabetes. Her work in research and clinical care has allowed her to learn what matters most to her patients, including from a cultural-competency standpoint. In the interview below, Dr. Sumlin talks about how health care professionals can improve their cultural competency skills when working with African-Americans and people of color with diabetes.
What do you think are the most pressing issues Black/African-Americans with diabetes face?
The most pressing issue regarding Blacks/African-Americans with diabetes is the increase in complications due to uncontrolled diabetes which continues to be due to the racial disparities in health care. Socioeconomic factors (i.e. class in society, financial, social, etc) play a role in accessing care, however, the quality of care, once they get access, remains substandard for African Americans. We have to continue to educate and confront the systems in place that reduce the quality of care African-Americans receive. Otherwise, they will continue to die from preventable diabetes complications.
Talk to us about inclusivity within your field. Do you encounter many researchers/clinical nurses who are Black/African-American? Why is diversity among healthcare professionals important?
Inclusivity is improving in both nursing higher education for professors, as well as the student population, and as a healthcare provider as an Advanced Practice Nurse (APRN) yet there is still much progress to be made. There aren’t enough African-Americans that are professors and student nurses at the university level as well as practicing APRNs in health care. Diversity among healthcare professionals is one of the keys to improving the quality of care to African-Americans with chronic diseases such as diabetes. People, in general, relate better to someone who looks like them.
Barriers that may exist for Black students are financial, the fact that nursing is extremely competitive, as well as the lack of knowledge regarding the nursing role. The role of a nurse can be very diverse: from creating diagnoses for patients to the ability to work in different arenas—from hospital settings to serving as consultants, to serving specific populations with specific disease processes.
What are some of the biggest challenges you face within your field as a healthcare professional who works with people with diabetes?
Diabetes self-management is challenging because there are multiple behavior changes that need to be addressed to improve health outcomes. However, the options can be overwhelming and decrease patient follow-through. Choosing which option is best for an individual patient’s improvement requires patient trust and by-in.
When your Black/African-American diabetes patients meet you for the first time, do you get the sense they feel like they’re in a safer environment and their health concerns will be taken more seriously because you’re also a POC?
Absolutely, when patients with diabetes see me for the first time I can see the sense of relief, literally, go throughout their entire body just during our introductions. It is as if a load is lifted and they begin to immediately relax because they are looking at someone who will listen, understand and partner with them in their health care.
I have had the pleasure of helping many patients achieve diabetes control. I recall one patient who had an elevated A1c in addition to other co-morbid diseases. He was not exercising, not eating to benefit his health and would occasionally take his medication. He would show up to his appointments and on time. Diabetes management requires a lot of different areas to manage. One day I asked what area of diabetes management he would like to work on to help control his diabetes.
He chose medications. After spending time explaining how the medications work in his body and how they help with diabetes control he was very open to taking his medications consistently. After he mastered his medications, we moved on to the other areas of diabetes management until he was finally able to get his diabetes under control. Spending time building trust and partnering with the patient helped move him towards greater diabetes control
In regards to misdiagnosis within the African-American community, are there any surprises about the chances of being misdiagnosed with Type 2?
It’s less surprising that some people have type 1 diabetes (T1D) because many already believe that if a person is on insulin they have T1D. So, we do have to continue to educate and explain the differences between the two diagnoses. From a healthcare perspective, most people with diabetes will be type 2 diabetes (T2D). Statistically, 90 percent of the diabetes community has T2D so I try not to fault those who jump to the conclusion that African-Americans automatically have type 2 diabetes and not type1.
Do you think the rate of Type 2 misdiagnosis is higher than we know? Why or why not?
I don’t believe that the misdiagnosis within our community is statistically significant. Most of the diabetes mellitus patients are going to be T2D and hopefully if there is a misdiagnosis, it is picked up quickly based on the effectiveness of diabetes treatment.
What improvements would you like to see within your field? What research do you think is needed to help Black/African-Americans with diabetes?
Until we see a decline in the number of deaths of Black/African Americans due to diabetes complications the need for improvements will continue. Access to quality care is subpar for Black/African Americans. To this day, there is very little research with African-Americans with diabetes. Continued research is needed to identify successful behavior modifications and treatment modalities in order to improve the overall health of the community into the future.
What I’d like to see is more research on the effectiveness of support groups and resources that are culturally effective. For instance, what type of support group fosters long term accountability partners for improved diabetes control? What resources targeted towards African-Americans can be statistically proven to improve diabetes control? The answers to these topics are needed in the patient community now.
How can healthcare providers improve their day-to-day treatment of POC patients with diabetes? What are some things health care professionals (HCPs) should keep in mind when working with African-Americans?
Improvement of day-to-day patient treatment benefits greatly when we have culturally-competent health care providers. Providers have to understand that there are things that patients will not do if it doesn’t line up with them culturally. For African-Americans, culture is a strong part of our identity so understanding the culture and incorporating culturally appropriate health initiatives is necessary to gain buy-in into improving their own health care outcomes.
What are some practical steps HCPs can take to improve cultural competency?
Cultural competence with HCPs has been on the rise over the last several years. There are numerous training opportunities in cultural competencies from professional conferences and webinars, to continuing education courses. The key is not only being trained in this skill but also being effective in implementing in the patient community. Practice makes perfect!
What empowers you to maintain excellence as a healthcare provider?
First of all, I would not be doing this unless God had put this passion in me to help those with diabetes. But what moves me daily is to educate and empower people, especially people of color, and watch how they really start to understand things as I explain to them how to properly manage their diabetes. When I see the expressions on their face—the light bulb goes off to indicate “oh, I got it.” This is one of the internal drivers that motivate me to strive for excellence in my field.