This Is AuburnElectronic Theses and Dissertations

An Examination of Cultural and Linguistic Competence in Health Care




Whitman, Marilyn

Type of Degree



Political Science


The increasing number of foreign-born persons in the United States is creating significant cultural and linguistic challenges for health care providers. The Department of Health and Human Services, Office of Minority Health (OMH) has issued standards for hospitals to meet in order to provide culturally and linguistically appropriate care to all patients. This research used a combination of mail and Internet surveys to examine whether Alabama’s 101 general medical and surgical hospitals are meeting these standards. The surveys were directed to Chief Executive Officers, Human Resource Directors, and Registered Nurses. The findings indicate that health care providers do believe that the increasing foreign-born population will pose future cultural and linguistic challenges for their hospitals and the overwhelming majority has witnessed an increase in the number of patients that speak a language other than English. While some of the OMH standards are being met, many are not. And policies and procedures described by Chief Executive Officers are often contrary to the perceptions of policies and procedures held by the RNs, suggesting miscommunication. Human Resource Directors indicated that their hospitals are actively recruiting persons from diverse cultural, religious, and linguistic backgrounds, yet the distribution of their hospitals’ workforce by race indicates that hospitals are having difficulty finding qualified candidates from races other than White, non-Hispanic and Black or African American. A greater percentage of Chief Executive Officers and registered nurses indicated that their hospitals do have trained interpreters on staff; however, an overwhelming majority of registered nurses indicated that they have not been trained on how to effectively use interpreters and interpreters are not available on all shifts. Hospitals are having difficulty finding trained interpreters in their area and often rely on non-English speaking patients bringing a family member or friends to help translate, a practice discouraged by OMH and most research on competent care. In addition, a greater percentage of registered nurses agreed that they prefer to care for a patient that is of the same culture and speak the same language because it is easier. Overall, Alabama general medical and surgical hospitals appear to be taking the initial steps to prepare for the diversifying patient population. All respondents indicate a willingness to become more culturally and linguistically competent, but a great deal needs to be accomplished before Alabama hospitals meet the OMH standards.