Cultural Competency Can Make Practice More Effective

Attention to the nuances of ethnic differences may improve communication with patients.

By Agustin L. Gonzalez, OD

Successful practices know that patient management involves many pieces, including good doctor-to-patient communication, in order to achieve the patient’s trust in recommended treatment plans. As such, health care providers are increasingly becoming knowledgeable and conscious about cultural diversity in their patient populations and developing the cultural competence skills necessary to achieve optimal patient management.

Many factors contribute to the increased diversity we see now in our patient populations. Global trade and communications, immigration related to education and technology opportunities, and easy access to travel have all facilitated increasing population diversity. In the United States, Hispanics with roots stemming from countries throughout North, Central, and South America make up 12.5% of the US population. The next largest US nonwhite ethnic group is African Americans at 12.4%, followed by Asian Americans at 3.6% of the population.1

In light of this increasing diversity in the population, more and more health care practitioners, including surgical and clinical eye care providers, are understanding that success in managing these diverse populations requires many factors to be in place. From promoting a diverse office culture to being more aware of and sensitive to the topic of cultural competency, subtle changes in one’s practice environment can be rewarding by increasing the practice’s marketing reach to these diverse ethnic populations.


There is no doubt that all patients must be treated equally with respect and dignity no matter what their beliefs and practices are. Yet there is also no doubt that, because of the nature of our work, we encounter various culture-based perspectives in our patients. These differences observed by a certain race or ethnicity can shape their perceptions about eye care and therefore affect their interactions with us.

A recent survey conducted by Harris Interactive gauged individuals’ perceptions of vision care in the United States.2 According to the responses, among the three largest nonwhite ethnic groups in the United States (Hispanics, African Americans, and Asian Americans), Hispanics are the most concerned about their vision. Interestingly, however, they survey suggests they are also the least likely to see an eye doctor, as only 17% of respondents said they have their eyes checked on a frequent schedule.

When asked whether they seek ethnic-specific professional relationships with eye care providers, Hispanics were in the middle among the three groups because only 19% of respondents said they would prefer an eye doctor who is of the same or similar ethnic background. These statistics may be linked to the strong cultural practices of Hispanics, who often refer to an illness as something mystic in origin that is either natural or brought about by supernatural causes.

Based on survey responses, African Americans are the most compliant among the three groups, willing to undergo an eye exam even if their vision is fine, as indicated by 59% of survey respondents. Only 14% of African American respondents said they would choose an eye care professional who is also African American. These two findings could be attributed to a strong belief and fear among African Americans that they might become blind at a later stage in their lives.

Asian Americans were the most likely (50%) to say that they would seek an eye care practitioner that is “like them.” Asian Americans ranked second among the three cultures in complying with routine eye exams (31%). However, once scheduled for an appointment with their eye doctor, Asian Americans are the most compliant in attending. These results may be associated with Asians having strong family ties and placing importance on honoring what has been agreed upon with the health care provider.


Hispanics are strongly grounded in traditional and natural methods of treating eye problems. Asian Americans tend to endure the eye signs and symptoms they are experiencing until the symptoms become unbearable. African-Americans tend to have more problems with insurance use and coverage, leading to compliance with eye exam attendance but often not with subsequent treatments prescribed.2

Given the survey data, it can be inferred that different cultures have distinct traits and that each has strong values and belief systems. Before, during, and after an eye care consultation, these beliefs may affect patients’ behaviors. Thus, understanding these subtle variations in perceptions due to cultural origin can make the difference in improving eye health and ensuring compliance with treatment. Knowledge of these distinctions can be used by the keen ophthalmologist or optometrist to help improve acceptance among patients belonging to a certain community.

Being aware of these subtle cultural differences, practices can create strategies for communicating and delivering care that can go a long way in creating stronger doctor-patient relationships. For example, with Hispanic patients it may be best to provide more medical advice and, if possible, accept home remedies as part of the treatment plan. Hispanics are most likely to believe in natural remedies and traditional treatment options, rather that instructions and treatments coming from an eye consultation. For African Americans, it might be a good idea to provide more information on the importance of improving compliance to treatments, not merely complying with eye exams without following up with the recommended treatments. Finally, Asian American might become more comfortable and willing to comply with eye exams and eye treatments if someone in the clinic can speak their language and if they are provided with materials in their own language.3


Myriad factors affect compliance and eye care delivery for all patients. One important aspect that can contribute to better understanding is being sensitive to the varying cultural views of patients about eye care—even the mystical qualities of vision itself—and how cultural beliefs might shape patients’ opinions about treatment.

A culturally sensitive eye care practice can be developed by acknowledging ethnic differences, training staff, and cultivating a culturally competent and diverse eye care team. These efforts can go a long way toward improving acceptance among diverse populations.

Successful physicians know that the best patient management involves many pieces, including good communication and patients’ trust in their prescribed treatment plans. Being sensitive to and knowledgeable about cultural beliefs is one very effective tool for achieving trust in the physician and his or her treatments.

There is no doubt that we want to improve acceptance of recommended therapies and compliance with eye treatments among our patients. Crafting culturally sensitive messages and delivering care by embracing and addressing potential cultural barriers are great first steps toward achieving trust and building patient compliance to treatment plans. n

1. US Census Bureau. Profiles of general demographic characteristics 2000: 2000 census of population and housing: United States. Washington, DC: U.S. Department of Commerce. May 2001. Accessed April 29, 2016.

2. Harris Interactive. Americans’ Attitudes and Perceptions about Vision Care. VisionCare.pdf. Accessed March 25, 2016.

3. Galanti GA. Basic concepts. In: Caring for patients from different cultures. 3d ed. Philadelphia: University of Pennsylvania Press; 2004:1-19.

Agustin L. Gonzalez, OD
• Optometric glaucoma specialist and therapeutic optometrist in practice at Eye & Vision in Richardson, Texas