Closing the Gap: Cultural Competence for Equitable Student Healthcare

As healthcare professionals, we at The Learnery are committed to the well-being of every student in our nation’s schools. But cultural differences are often overlooked, but can significantly impact how students experience and understand health, and even how they interact with school nurses. Ignoring these differences can lead to miscommunication, missed diagnoses, and even exacerbate existing health disparities.

Imagine this: a young student comes to the nurse’s office complaining of stomach pain. The nurse, following standard protocol, asks a few questions and suggests a simple remedy. But the pain persists, and the student’s discomfort grows. What the nurse doesn’t realize is that this student comes from a culture where stomach ailments are often seen as a sign of a deeper spiritual imbalance, and her discomfort is made worse by being stressed and scared by this potential “metaphysical force.” By overlooking this cultural context, the nurse misses a crucial opportunity to connect with the student, understand their concerns, and potentially offer more meaningful support. This scenario, while hypothetical, highlights a critical reality in our schools: cultural differences matter when it comes to health.

Alarming Disparities: A Snapshot

Recent data from the CDC, the National Institute of Health, and various studies highlight stark differences in the health outcomes of K-12 students from different racial and ethnic backgrounds:

  • Asthma: In the US, the burden of asthma is disproportionately borne by racial and ethnic minority groups and the economically disadvantaged. Black and Hispanic children are more likely to have asthma and experience asthma-related emergency room visits than white children.
  • Obesity: Hispanic and American Indian/Alaska Native children have higher rates of obesity than white children.
  • Mental Health: Asian American and Pacific Islander students report higher rates of depression and anxiety than white students, but are less likely to seek help due to cultural stigma. Among females 15–24 years old, Asian Americans and Pacific Islanders (AAPIs) have the highest rate of suicide deaths (14.1%) compared to other racial/ethnic groups.

These statistics are just the tip of the iceberg. Cultural beliefs about health, illness, and the body can influence everything from a child’s diet and exercise habits to their willingness to seek medical care.

The Cultural Lens: Understanding the Nuances

Cultural differences can manifest in surprisingly subtle ways, influencing how students perceive health, interact with healthcare providers, and even respond to treatment. Let’s review some key areas where cultural nuances can have a significant impact in how a student is treated for health issues while at school:

  • Communication Styles: Some cultures value direct, assertive communication, while others prioritize indirectness and politeness. A student from a culture that avoids confrontation may hesitate to express pain or discomfort, leading to delayed diagnosis or inadequate treatment. Similarly, nonverbal cues like eye contact or physical touch can have different meanings across cultures, potentially leading to misunderstandings.
  • Beliefs about Illness: The way illness is understood varies greatly across cultures. Some may view it as a punishment for wrongdoing, an imbalance of energies, or the result of spiritual forces. These beliefs can influence a family’s willingness to seek Western medical care, their adherence to treatment plans, and even their understanding of the illness itself.
  • Family Dynamics: In many cultures, family plays a central role in healthcare decisions. Elders may be consulted, or parents may prioritize the family’s wishes over the individual child’s preferences. Understanding these dynamics is crucial for building trust and ensuring that treatment plans are aligned with the family’s values.
  • Dietary Practices: Religious or cultural beliefs often dictate specific dietary restrictions or preferences. These can range from avoiding certain foods to specific meal preparation methods. Ignoring these practices can lead to nutritional deficiencies or conflicts with school meal programs.
  • Gender Roles: In some cultures, there are distinct gender roles that influence who makes decisions about health and who is the primary caregiver. Recognizing these roles is essential for effective communication and collaboration with families.

Bridging the Gap: Practical Steps for Educators and School Nurses

By understanding these nuances, educators and school nurses can develop a more holistic approach to student health. This involves not just treating physical symptoms, but also addressing the cultural, social, and psychological factors that influence health behaviors and outcomes.

  1. Educate Yourself: Learn about the specific cultural backgrounds of your students in your educational facility. Learn a new language, read books, attend workshops, and talk to community leaders. The more you understand how certain students need to be communicated with and treated, the better health outcomes will be. 
  2. Build Relationships: Create a safe space for students and families to share their cultural beliefs and practices. Show genuine interest and respect. When possible, find common ground by sharing your own personal experiences (i.e. favorite foods when talking about nutrition). 
  3. Partner with Families: Involve families in healthcare decisions and respect their preferences whenever possible. After an influx of immigrant and refugee families into the area, one Midwestern school district needs assessment in 2017 revealed school nurses’ concern about the mistrust of the American healthcare system and fear of deportation if students visit the school nurse. This underlines the need for greater personal dialog with these families, building trust.
  4. Stifle Biases: Be aware of your own cultural biases and adapt your communication style to fit the needs of your students. This is easier to do when you proactively expose yourself to cultures other than your own. Partnerships with local community leaders and organizations can help build your cultural competence.
  5. Advocate for Resources: Work with your school district to provide culturally relevant health education materials and resources.

The Power of Cultural Competence

A 2018 study published in the Journal of School Nursing found that culturally competent school nurses were more likely to identify and address health disparities among their students. They have a great library of resources on the subject here: https://www.nasn.org/nasn-resources/resources-by-topic/cultural-responsiveness-equity 

By understanding and respecting cultural differences, we can build trust, improve health outcomes, and create a more inclusive learning environment for all.

# # #