Cultural Competence in Telehealth: Strategies for Inclusive Care

Vol. 1, No. 17 | July 12, 2024 | By Dave Larsen, Väsentlig Consulting LLC

As a home-based solo mental health practitioner using telehealth as your primary method of interacting with clients, providing culturally competent care is essential for creating an inclusive and effective therapeutic environment (Sue et al., 2019). Cultural competence refers to the ability to understand, appreciate, and interact effectively with people from diverse cultural backgrounds, taking into account factors such as race, ethnicity, language, religion, socioeconomic status, gender identity, and sexual orientation (Chu et al., 2016).

In the context of telehealth, cultural competence is particularly important, as virtual communication can sometimes make it more challenging to pick up on subtle cultural cues or to establish trust and rapport with clients from different backgrounds (Hilty et al., 2018). In this post, we'll explore key strategies and best practices for providing culturally competent care in a telehealth setting, drawing on research and professional guidelines in the field.

The Importance of Cultural Competence in Telehealth

Cultural competence is a critical component of effective mental health care, regardless of the mode of delivery (Sue et al., 2019). Research has shown that culturally competent care is associated with a range of positive outcomes, including:

Improved Therapeutic Alliance: When practitioners demonstrate cultural competence, clients are more likely to feel understood, respected, and valued, leading to a stronger therapeutic alliance and better treatment engagement (Chu et al., 2016).
Enhanced Treatment Adherence: Culturally competent care can help to reduce misunderstandings or miscommunications that may lead to treatment non-adherence or dropout (Hilty et al., 2018).
Reduced Health Disparities: By addressing cultural barriers to care and providing culturally sensitive interventions, practitioners can help to reduce health disparities and improve outcomes for underserved populations (Sue et al., 2019).
Increased Client Satisfaction: When clients feel that their cultural identities and experiences are acknowledged and respected, they are more likely to report high levels of satisfaction with their care (Chu et al., 2016).

In the context of telehealth, cultural competence is especially important, as virtual communication can sometimes make it more difficult to establish trust and rapport with clients from diverse backgrounds (Hilty et al., 2018). By prioritizing cultural competence in their telehealth practice, practitioners can create a more inclusive and effective therapeutic environment that meets the needs of all clients.

Key Strategies for Cultural Competence in Telehealth

To provide culturally competent care in a telehealth setting, practitioners can employ several key strategies, including:

Self-Reflection and Cultural Humility: Cultural competence begins with self-reflection and cultural humility, or the ability to recognize one's own cultural biases and limitations and to approach clients with openness and respect (Chu et al., 2016). Practitioners should take time to examine their own cultural backgrounds, values, and assumptions, and to consider how these may impact their interactions with clients from different backgrounds (Sue et al., 2019).
Cultural Knowledge and Awareness: Practitioners should seek to acquire knowledge and awareness of the cultural backgrounds and experiences of their clients, including factors such as historical trauma, immigration experiences, and cultural beliefs and practices related to mental health (Hilty et al., 2018). This may involve reading relevant literature, attending cultural competence trainings, or consulting with cultural experts or community members.
Language and Communication: Language and communication are critical aspects of culturally competent care, particularly in a telehealth setting where non-verbal cues may be more difficult to interpret (Chu et al., 2016). Practitioners should ensure that they are using clear, jargon-free language and that they are taking steps to overcome any language barriers, such as using interpreters or translated materials when necessary (Sue et al., 2019).
Culturally Adapted Interventions: Practitioners should consider adapting their therapeutic interventions to be more culturally relevant and responsive to the needs and experiences of their clients (Hilty et al., 2018). This may involve incorporating cultural practices or beliefs into treatment, using culturally specific assessment tools or outcome measures, or collaborating with traditional healers or community leaders (Chu et al., 2016).
Flexibility and Responsiveness: Culturally competent care requires flexibility and responsiveness to the unique needs and preferences of each client (Sue et al., 2019). Practitioners should be willing to adjust their communication style, therapeutic approach, or treatment goals based on client feedback and cultural considerations, and to be open to learning from their clients about their cultural experiences and perspectives (Hilty et al., 2018).

By employing these strategies, telehealth practitioners can create a more inclusive and culturally responsive therapeutic environment that meets the needs of diverse clients (Chu et al., 2016).

Addressing Cultural Barriers to Telehealth

While telehealth has the potential to increase access to mental health care for underserved populations, it can also present unique cultural barriers that practitioners must be aware of and address (Hilty et al., 2018). Some common cultural barriers to telehealth include:

Digital Divide: The digital divide, or the gap in access to technology and internet services based on factors such as income, education, and geographic location, can limit the ability of some clients to participate in telehealth (Chu et al., 2016). Practitioners should be aware of these disparities and take steps to address them, such as providing technology assistance or referrals to community resources.
Cultural Beliefs and Attitudes: Some cultural groups may have beliefs or attitudes that make them less likely to seek mental health care or to feel comfortable with telehealth (Sue et al., 2019). For example, some cultures may view mental illness as a sign of weakness or may prefer to seek help from family or community members rather than from professionals. Practitioners should be sensitive to these beliefs and work to build trust and rapport with clients.
Language and Communication: Language and communication barriers can be particularly challenging in a telehealth setting, where non-verbal cues may be more difficult to interpret (Hilty et al., 2018). Practitioners should ensure that they are using clear, jargon-free language and that they are taking steps to overcome any language barriers, such as using interpreters or translated materials when necessary.
Privacy and Confidentiality: Some cultural groups may have concerns about the privacy and confidentiality of telehealth, particularly if they live in shared or multi-generational households (Chu et al., 2016). Practitioners should be aware of these concerns and take steps to ensure that clients have a private and secure space for their sessions, such as using headphones or finding a quiet room.

By addressing these cultural barriers, telehealth practitioners can create a more inclusive and accessible therapeutic environment that meets the needs of diverse clients (Sue et al., 2019).

Best Practices for Cultural Competence in Telehealth

To ensure that they are providing culturally competent care in a telehealth setting, practitioners can follow several best practices, including:

Seek Cultural Competence Training: Practitioners should seek out cultural competence training opportunities, such as workshops, webinars, or continuing education courses, to enhance their knowledge and skills in working with diverse populations (Chu et al., 2016).
Collaborate with Cultural Experts: Practitioners should consider collaborating with cultural experts or community leaders to gain insights into the cultural experiences and needs of their clients and to develop culturally responsive interventions (Sue et al., 2019).
Use Culturally Sensitive Assessment Tools: Practitioners should use culturally sensitive assessment tools and outcome measures that have been validated for use with diverse populations, such as the Cultural Formulation Interview (CFI) or the Multicultural Mental Health Awareness Scale (MMHAS) (Hilty et al., 2018).
Engage in Ongoing Self-Reflection: Practitioners should engage in ongoing self-reflection and cultural humility, examining their own biases and assumptions and seeking feedback from clients and colleagues on their cultural competence (Chu et al., 2016).
Provide Culturally Responsive Resources: Practitioners should provide culturally responsive resources and referrals to their clients, such as community organizations, support groups, or traditional healers that are specific to their cultural backgrounds and needs (Sue et al., 2019).

By following these best practices, telehealth practitioners can ensure that they are providing high-quality, culturally competent care to all of their clients (Hilty et al., 2018).

Conclusion

Cultural competence is a critical component of effective mental health care, particularly in the context of telehealth where virtual communication can sometimes make it more challenging to establish trust and rapport with clients from diverse backgrounds. By prioritizing self-reflection, cultural knowledge and awareness, language and communication, culturally adapted interventions, and flexibility and responsiveness, telehealth practitioners can create a more inclusive and effective therapeutic environment that meets the needs of all clients.

Addressing cultural barriers to telehealth, such as the digital divide, cultural beliefs and attitudes, language and communication, and privacy and confidentiality, is also essential for ensuring that all clients have access to high-quality mental health care. By following best practices for cultural competence, such as seeking cultural competence training, collaborating with cultural experts, using culturally sensitive assessment tools, engaging in ongoing self-reflection, and providing culturally responsive resources, telehealth practitioners can demonstrate their commitment to providing culturally competent care to all of their clients.

As the field of telehealth continues to grow and evolve, it is essential that practitioners prioritize cultural competence as a key component of their practice. By doing so, they can help to reduce health disparities, improve treatment outcomes, and create a more equitable and inclusive mental health care system for all.

References

Chu, J., Leino, A., Pflum, S., & Sue, S. (2016). A model for the theoretical basis of cultural competency to guide psychotherapy. Professional Psychology: Research and Practice, 47(1), 18-29. https://doi.org/10.1037/pro0000055

Hilty, D. M., Gentry, M. T., McKean, A. J., Cowan, K. E., Lim, R. F., & Lu, F. G. (2018). The effectiveness of tele-mental health (TMH): A 2018 revision of 2013 systematic review to include clinical and research developments and culturally diverse populations. Journal of Technology in Behavioral Science, 3(3), 128-156. https://doi.org/10.1007/s41347-018-0056-4

Sue, D. W., Sue, D., Neville, H. A., & Smith, L. (2019). Counseling the culturally diverse: Theory and practice (8th ed.). Wiley.