For healthcare providers, gaining knowledge about cultural competency has been shown to improve patient satisfaction. In some circumstances, patients whose providers completed cultural competency training report higher opinions of their clinicians or participate longer in mental health counseling than patients whose providers did not (UW, 2025).
2.1 Cultural Competence
Cultural competence is a lifelong process. It encourages providers to integrate knowledge into standards, policies, practices, and attitudes. A provider who views cultural competence as a lifelong process recognizes that their own biases evolve over time. They can demonstrate cultural competence by moving beyond passive reading to active, structured self-critique.
Rather than memorizing a list of beliefs for specific ethnic or religious groups, a provider should recognize that culture is fluid and intersectional. To regularly review your own cultural competence:
- Complete an implicit bias test and a cultural self-assessment that identifies personal blind spots regarding patients from low-income backgrounds.
- Partner with medical interpreters to improve your comfort with these medical encounters.
- Attend community-led health forums and listen to local feedback.
- Audit documentation to ensure language is objective, person-first, and respectful.
- Mentor incoming clinical staff on cultural humility.
- Review clinical policies to ensure health equity standards are met at a structural level.
2.2 Diversity
Diversity is the inclusion of varied attributes or characteristics. Diversity education encourages providers to understand their position of power and privilege in society and recognize their own implicit biases and those of the institutions and systems in which they work (Togioka et al., 2024).
Diversity training encourages providers to consider the uniqueness of each individual patient and to remember that a situation may be experienced differently by different patients. It helps providers employ an attitude of curiosity about how each patient’s experiences and culture shape their views and behaviors (Togioka et al., 2024).
There are five key principles associated with diversity training (Ogrin et al., 2020):
- Understanding unconscious bias and prejudice, self-identifying biases.
- Focusing on similarities between people rather than differences.
- Ensuring access and equity in policy and practice.
- Uncovering individual characteristics that promote participation.
- Acknowledging the intersectionality of people’s various characteristics.
Gender diversity is one key part of improving cultural competence. In nursing, the male advantage has been described as a “glass escalator,” in which men are put on a fast track and pushed to achieve positions that include greater responsibility, higher salary, and more organizational benefits. While diversity is necessary and important, equity is also needed to decrease disparities and mitigate the impact of discrimination (Togioka et al., 2024).
2.2.1 Case: Jae
Background: Jae is an 18-year-old patient who identifies as a transgender male (assigned female at birth). He presents with severe, chronic pelvic pain. Jae is accompanied by his mother, who is a devout Muslim and insists on speaking for him.
Staff members are unsure how to proceed. One nurse suggests, “In their culture and religion, women and girls defer to their elders, so we should just let the mother lead the conversation.” Another nurse counters, “But the patient is trans and needs an autonomous, affirming space away from a religious parent.”
The team is viewing the family through two conflicting, flat stereotypes: a monolithic view of Muslim family structures vs. a Western-centric view of gender advocacy. They are missing the intersectionality of Jae’s lived experience.
Discussion: Start by mapping the intersections: look at how age, gender identity, family dynamics, and religious frameworks are colliding. Use the LEARN model (Listen, Explain, Acknowledge, Recommend, Negotiate) to give Jae individual autonomy without disrespecting the family unit.
The nurse says: “To provide the best care for our adult and young adult patients, our clinic policy is to spend part of the exam speaking with the patient privately. We will review the physical symptoms and then bring in the family to discuss the treatment plan. Let’s start with that.” By framing this as a universal clinic policy, the mother feels respected as a crucial part of the care team. The mother nods in agreement.
Outcome: Once the mother steps out, the nurse shifts her focus to the patient, ensuring a psychologically safe and affirming environment. She uses the private time to clarify the patient’s identity, preferred pronouns, and clinical history without family pressure.
Now that trust has been established, Jae provides an accurate, detailed history of his chronic pelvic pain. He discloses that he has been practicing chest-binding and has missed several periods. The clinician performs a physical examination, explaining every step beforehand and ensuring the patient remains in control of the pace.
The nurse invites Jae’s mother back into the room to discuss the treatment plan. Keeping Jae’s preferences in mind, she focuses entirely on the clinical management of the pain, avoiding gender-specific pronouns, and honoring the mother’s role as a supportive caregiver.
The nurse did not assume the mother would be hostile, nor did she assume the transgender patient wanted an ideological battle. By structuring the interview to include private time, the nurse obtained crucial diagnostic information that might have been withheld if the mother had remained in the room.
2.3 Regulatory Issues
The Oregon Health Authority (OHA) has established regulations against discrimination in any of its programs in relation to protected classes as defined by State of Oregon law and federal law. Protected classes include but are not limited to:
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Nondiscrimination policies and procedures are posted within the Oregon Administrative Rules, which outlines, along with other policies, that the Oregon Health Authority shall not, either directly or through another entity, discriminate against any individual, or harass, exclude from participation, or deny the benefit of programs, services or activities because the individual belongs to a protected class (Oregon Secretary of State, 2026).
The full text of Oregon’s nondiscrimination policy is available here.
2.3.1 Patient Rights and Responsibilities
Oregon Administrative Rules (OAR 333-700-0115) establish patient rights and responsibilities for healthcare facilities. These rules require that healthcare facilities establish and maintain policies and procedures related to patient care. Among other rules, patients must be informed of their rights and responsibilities, be allowed to participate in the planning of their medical care, be treated with consideration and respect, and be informed of the facility’s grievance process (Oregon Laws, 2025).
The full list of patient rights and responsibilities for Oregon healthcare facilities can be accessed here.
2.3.2 Civil Rights Laws and Regulations
Healthcare organizations and their employees are required by state and Federal law to implement nondiscrimination policies including Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, Oregon Revised Statute Chapter 659A, and Section 1557 of the Affordable Care Act.
Civil Rights Act of 1964 states:
“No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”
Title VI of the act prevents discrimination by programs and activities that receive federal funds, including hospitals and other healthcare facilities.
The Americans with Disabilities Act of 1990 provides equal opportunities for people with disabilities as well as a comprehensive national mandate for the elimination of discrimination against individuals with disabilities (ADA.gov, 2023).
Section 504 of the Rehabilitation Act of 1973 states: “no otherwise qualified individual with a disability in the United States, as defined in section 705 (20) of this title, shall, solely by reason of his or her disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under, any program or activity receiving federal financial assistance.”
Oregon Revised Statute Chapter 659A covers unlawful discrimination in labor and employment. It prohibits discrimination based on race, color, religion; sex, sexual orientation; national origin; marital status; or age.
Section 1557 of the Affordable Care Act (ACA) prohibits discrimination based on race, color, national origin, sex, age, or disability in certain health programs and activities.
OR Senate Bill 567 establishes the right to be free from unlawful discrimination and bias in the healthcare system. SB 567 clarifies that it is unlawful for a licensed or certified health professional to discriminate on the basis of a protected class by:
- denying medical treatment to the patient that is likely to benefit the person based on an individualized assessment of the patient using objective medical evidence; or
- limiting or restricting in any manner the allocation of medical resources to the patient (DRO, 2026).
2.3.3 Joint Commission Standards
Effective January 1, 2023, new and revised requirements to reduce healthcare disparities apply to organizations in the Joint Commission’s ambulatory healthcare, behavioral healthcare and human services, critical access hospital, and hospital accreditation programs. Based on the idea that healthcare disparities are “quality of care” issues, the Joint Commission requires healthcare organization to examine and understand the root causes of health disparities and address them with targeted interventions.
2.4 Oregon Resources
2.4.1 OR Equity Advancement Plan
The Oregon Health Authority (OHA) is a state government agency with an overarching strategic goal: eliminate health inequities in Oregon by 2030. The equity advancement plan primarily focuses on communities experiencing health inequities and the healthcare system that has failed to serve them. Guided by its Affirmative Action Plan, the OHA uses a variety of proactive efforts to advance workforce equity and inclusion (OHA, 2023).
The OHA has established the Office of Equity, Health Disparities, and Cultural Competence to addresses the needs of diverse populations. This office is responsible for developing, implementing, and evaluating health equity initiatives that reduce health disparities among vulnerable populations.
2.4.2 Developing Equity Leadership through Training and Action
Developing Equity Leadership through Training & Action (DELTA) is a leadership program in Oregon that includes training, capacity building, and networking for health, community, and policy leaders. The purpose of this program is to promote equity and diversity within Oregon’s public health systems (DELTA, 2026).
DELTA includes 40 hours of classroom training and facilitates opportunities for cross sector partnership. Each participant submits a project proposal that drives and institutionalizes best practices in their organization that promote health equity and inclusion (DELTA, 2026).
2.4.3 Oregon Health Care Interpreter Program (HCI)
Health Care Interpreters (HCIs) are bilingual individuals who help people in their communities by providing high-quality healthcare interpretation at in-person medical appointments or over the phone. The purpose of the Health Care Interpreter (HCI) programs is to help HCIs in Oregon become trained and qualified or certified to meet current requirements, diversify the healthcare workforce in Oregon, provide high-quality healthcare interpretation to Oregon's growing diverse populations, and promote health equity (OHA, 2026).
2.4.5 Additional Oregon Programs
Additional initiatives and programs aimed at improving cultural competence in Oregon’s healthcare systems include:
- Oregon Equity and Inclusion Division—carries out more than 16 distinct functions for the state, providing expertise and technical assistance on equity, inclusion, anti-racism, anti-oppression, universal accessibility, and social justice topics.
- Oregon Health Equity Alliance—a statewide coalition of organizations, agencies, and individuals working to advance health equity and reduce health disparities.
- Health Equity Network—a coalition of community health clinics that provides technical assistance to the OHA and other stakeholders on health equity issues.
2.5 Health Disparities and Social Determinants of Health
Social determinants of health (SDOH) are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a range of health, functioning, and quality-of-life outcomes and risks.” They are not abstract concepts—they are our life circumstances (Healthy People 2030).
Social determinants of health are grouped into five domains (Healthy People 2030):
- Healthcare access and quality
- Neighborhood and the built environment
- Social and community context
- Economic stability
- Education access and quality
Did You Know. . .
Income, education, employment, and housing contribute to 50% of the variability in the length and quality of life and are largely responsible for many observed disparities in health (Towe et al., 2021).
Most Americans are unaware of these health gaps, do not understand what causes them, and do not necessarily find them to be unfair. Many Americans placed the responsibility for these outcomes on individual behaviors such as smoking, diet, and exercise, as well as access to clinical care as the primary drivers, and less so on social determinants of health (Towe et al., 2021).