Perceptions of cultural competency among elderly African Americans

We conducted a qualitative study of 23 subjects to determine how African Americans perceive culturally competent care by physicians. Our objectives were to understand patients' perceptions of: 1) high-quality health care by physicians; 2) the role of culture and ethnicity in the doctor-patient relationship; and 3) patients' expectations of doctors. We developed a discussion guide and a questionnaire to capture the perception of competent (desirable or high-quality) health care in the context of cultural beliefs and attitudes. We found that African Americans are concerned with traditional performance aspects of care. In addition to professional demeanor and appropriate diagnosis and treatment, communication and respect were critical aspects of the process of care. Most participants thought that physicians should know something about African American culture but only in the context of healthcare issues. For these individuals, a culturally competent doctor is one who provides effective treatment while showing respect and using effective communication methods, regardless of the ethnicity and sex of the doctor. Future research on cultural competence in the doctor-patient relationship must elicit the full range of patient values--technical performance, general (culture-nonspecific) process of care, and cultural-specific preferences.