Provider Tips for Promoting Health Equity

Provider Tips for Promoting Health Equity

Darius B. Dawson, Ph.D.

Darius B. Dawson, Ph.D.

Dr. Dawson is a Core Investigator with the South Central Mental Illness Research, Education, and Clinical Center and the Houston Center of Innovation for Quality, Effectiveness, and Safety at the Michael E. DeBakey Veterans Affairs Medical Center and Instructor in the Department of Medicine at Baylor College of Medicine in Houston, TX. His research promotes health equity in mental health treatment among minoritized populations. Specifically, his work aims to increase access and initiation of tobacco cessation treatment for African American Veterans. He also examines cultural factors associated with engagement of anxiety, tobacco cessation, behavioral health treatments in primary care settings among minoritized individuals.

Provider Tips for Promoting Health Equity

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Provider Tips for Promoting Health Equity

Various strategies are important to consider when working with minoritized populations. Minoritized groups are those that do not have equal access to or have been limited in attaining equal levels of wealth, resources, or power compared to a majority group. Often, health inequities can impact minoritized individuals’ access to treatment, how they interact with the health care system and providers, and their overall treatment outcomes. Addressing health inequity requires a collaborative effort between many levels of the health care system (i.e., patient, community, provider, hospital, government). However, behavioral health providers and researchers can implement strategies that promote health equity at their level of care.

Assessing Personal Biases and Background Culture

Relating to patient needs is difficult if you have not assessed your own personal biases or examined your own cultural background. Everyone is a diverse being with a variety of cultural experiences that have shaped their worldview perspectives. Providers’ perspectives may result in implicit or explicit biases that can knowingly or unknowingly impact interactions with patients. Acknowledgement of a bias towards a group of people does not mean you are an unethical or discriminatory provider. However, lack of acknowledgement and awareness of biases means that you have the potential to practice unethically or discriminate towards patients that are different from you. Once you have assessed your cultural experiences and how they have facilitated biases, then you can evaluate and reform interactions with patients. 

Research supports that patients of minoritized backgrounds are more likely to be subjected to microaggressions, neglect, and discrimination from providers, often resulting in lower initiation and retention of treatment. Due to this barrier, these patients may delay treatment, exhibit more chronic symptoms, and display higher levels of severity. 

Leveraging Patients’ Cultural Strengths 

One of the principles of Community-Based Participatory Research framework is identifying strengths of communities that are minoritized. Typically, important cultural aspects of these communities are framed as barriers in accessing treatment. For example, the importance of religion among African American communities has been associated with limited engagement in mental health treatment services. However, religion is a protective factor in developing negative mental health outcomes and may be a vital component for many African American individuals. Therefore, religion is a strength rather than a barrier for this community and should be integrated into mental health treatment. 

Researchers can identify essential cultural factors to develop equitable outreach strategies to increase engagement of services. Long-term community partnerships are essential in this process and require researchers to become collaborative partners with minoritized populations. Community members and leaders inform researchers about cultural factors, or cultural strengths, that are important to them, while also granting researchers exposure to their culture and lifestyles. Once strengths are identified, researchers work collaboratively and continuously with the community to implement strategies or interventions to increase engagement of services to leverage identified strengths. For example, strategies may include religious or spiritual leaders as liaisons between the community and mental health providers. Or, providing telehealth equipment to a local community center for patients to connect privately and conveniently with mental health providers.  

Integrating Cultural Strengths into Treatment

Within the clinical setting, it is important to ensure accurate diagnosis of patients’ presenting problems. However, accurate diagnosis includes examining patients’ cultural backgrounds and how their culture may be impacting their presenting symptoms. Patients from minoritized populations may present with anxiety and depression due to ongoing discrimination or minority stress. For example, a lesbian woman may report experiencing panic attacks while driving or before presentations at work, limiting her functioning. Through further assessment, you may find that she is experiencing workplace discrimination, which results in panic attacks while driving on her way to work and throughout her workday. Her discrimination experiences should be considered in her treatment plan and may require a shift from traditional therapy approaches. 

Integrating cultural strengths may be the key to positive therapeutic outcomes for patients. However, it is important to note that culture is a piece of the “mental health” puzzle for some patients and the full, completed puzzle for others. When opening the conversation about patients’ culture, their backgrounds, and important values, allow them the intellectual space and psychological safety to explore the degree that these factors play a role in their lives and their symptoms. They can be collaborative partners in their treatment plan to ensure adequate integration of cultural strengths. 

Darius B. Dawson, Ph.D.

Darius B. Dawson, Ph.D.

Dr. Dawson is a Core Investigator with the South Central Mental Illness Research, Education, and Clinical Center and the Houston Center of Innovation for Quality, Effectiveness, and Safety at the Michael E. DeBakey Veterans Affairs Medical Center and Instructor in the Department of Medicine at Baylor College of Medicine in Houston, TX. His research promotes health equity in mental health treatment among minoritized populations. Specifically, his work aims to increase access and initiation of tobacco cessation treatment for African American Veterans. He also examines cultural factors associated with engagement of anxiety, tobacco cessation, behavioral health treatments in primary care settings among minoritized individuals.

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