Culture influences our behaviors in every aspect of our lives, contributing to dental hygienists’ decisions about habits, desires, and needs. Culture also heavily influences decision-making in health care ‒ a major reason why cultural competency classes are required to renew dental hygiene licenses in many states.
In order to serve a vast demographic of patients and be able to cater to their individual needs, cultural competency is a necessary skill for all health care providers, including dental hygienists. Health is variable among individuals and population groups which means providers must be aware of how to best reach these groups.1 Some basic topics to be familiar with include the definition of culture and how it informs a person’s health care decisions, social determinants of health, and biases that can further restrict access to care in certain communities.
The Reach of Culture in Dentistry
Culture is defined as what makes a person’s environment meaningful; how languages, customs, beliefs, rules, arts, knowledge, and collective identities and memories affect their identity.2 This framework guides an individual or community on what health decisions they will make and what behaviors they may adopt to survive and thrive.
While culture includes race and ethnicity, it encompasses much more than that. Regardless of our own personal culture or race, we should all receive training on how to competently communicate and provide excellent health care to all individuals.
Since all behavior is culturally informed, even the systems created by health care professionals are influenced by their own culture, potentially prioritizing people of that same culture while also marginalizing people of different cultures. The roles of these individuals (doctors, nurses, teachers, government officials, etc.) have been codified by their own culture, inclining them towards those specific values, beliefs, and norms.3 The multifaceted nature of culture predisposes individuals or communities toward a distinct course of action or thought in health care, health-related decisions, and health behaviors.
By understanding how vast culture is in an individual’s life, hygienists can be more delicate when approaching methodologies relating to home care, diet/nutrition, referral recommendations, and more. We can start to understand that what we’re recommending is not only because of our education, it is based on the foundation of our own culture, the cultures of our instructors, and the cultures of people who run the university, public health departments in the area, and government leaders in the state.
Understanding Social Determinants
Understanding social determinants of health and how they factor into a community is also imperative. Social determinants of health are the social and physical factors of the environment within which individuals are born, live, learn, play, and work that impact their health.4 These can include wealth, education level, access to healthy foods, discrimination, poverty, geographic location, public transportation, and more.4
Without a foundational understanding of how these factors and conditions contribute to a person’s ability to be healthy, access to care, or how they think about health care, we cannot adequately provide oral health services.
Health Care Bias
It is also crucial to understand how our biases contribute to the care we are able to provide or how the health care system has been created and informed. This bias contributes to health disparities and increased health risks (including increased decay, periodontitis, and other oral diseases) among certain demographics.5
As health care providers, we want to provide the best care to anyone regardless of any factor. However, it is a very common issue in healthcare today that many minorities find themselves on the receiving end of these biases.
The most common biases we should be aware of and analyze in ourselves are conscious and unconscious biases. Conscious bias is the prejudiced views we are aware of having towards a group. Unconscious bias, or implicit bias, is the biased views in operation outside of your awareness.6
In a dental appointment, this could look like several different scenarios. Maybe when explaining a procedure, you give the short and sweet version instead of the full, comprehensive version. Maybe you don’t talk about procedures because you don’t think someone would be able to financially afford the most ideal treatment.
Most of our behavior is performed based on implicit bias without us even realizing it. Our actions occur without having conscious thoughts, meaning our implicit biases may more accurately depict actions than our established, conscious values.7
These are two important concepts dental professionals must be aware of in order to provide excellent care to everyone. Just learning about these concepts can help professionals be more in tune with the blind spots they are unaware of in themselves. It provides the framework for each individual to look at their lives for each of these potential biases and work towards correcting that behavior.
What Can We Do
It should be a mission for each dental hygiene professional to “increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persistent disparities, and to promote health and mental health equity.”8
This goal will help each provider promote health equity to ensure each patient is receiving care specifically designed for that individual. There are several actionable steps we can take to reach this goal:
- Have open communications with all patients. Ask your patients if they need anything or if you could accommodate them in a better way.
- Do your own research about different cultures in your state/area. You can look up different demographic statistics about your area on local public health, county, or government websites and go from there.
- Take a variety of cultural competency CE classes. Learn from online, in-person discussions, and lectures.
- Have access to interpreters when needed. Ask ahead of time if the patient needs an interpreter. There are companies to hire someone from or online resources that remain HIPAA compliant.
- Have an open mind. Evaluate if your personal beliefs or culture could be creating bias or blind spots in your care.
- Travel to get experience with other cultures, demographics, populations, and communities.
- Be knowledgeable of different cultural norms that affect oral health. For example, in parts of Latin America, floss is only used for extracting teeth at home. In parts of Africa, a diet may be high in carbohydrates, affecting caries development. In parts of Asia, individuals chew betel nut as an important cultural practice.
Health care professionals must be self-motivated to educate and enact new information. We must all strive to always be learning and be receptive when someone shares that learning. Only when we have educated ourselves on how to do this will we be able to provide culturally competent health care for all people, everywhere.
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References
- Appuhamy, R. (2017, June 25). Social Determinants of Health – An Introduction. [Video]. YouTube. https://www.youtube.com/watch?v=8PH4JYfF4Ns
- Introsocsite: Introduction to Sociology Glossary. (2008). American Sociological Association. https://www.asanet.org/sites/default/files/savvy/introtosociology/Documents/Glossary.html
- Singer, M.K., Dressler, W., George, S., et al. Culture: The missing link in health research. Social Science & Medicine. 2016; 170: (237-246). https://doi.org/10.1016/j.socscimed.2016.07.015
- Determinants of Health. (2022, February 6). Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
- Artiga, S., Garfield, R., Orgera, K. (2020, April 20). Communities of Color at Higher Risk for Health and Economic Challenges due to COVID-19. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/
- Lesson 6: Conscious and Unconscious Bias. (2022, February 18). School of the Art Institute of Chicago. https://libraryguides.saic.edu/learn_unlearn/foundations6
- Implicit Bias. (n.d.). Perception Institute. https://perception.org/research/implicit-bias/
- National Center for Cultural Competence at Georgetown University. (2020, June). Our Commitment to Racial Justice. https://nccc.georgetown.edu
