By Brett Mayfield
Health inequalities continue to pose a significant public health problem, so nonprofit leaders often must intervene with this challenge head-on. However, these interventions are usually not widely practiced or not delivered as initially planned, even though effective evidence-based interventions are available today. Unfortunately, ongoing inequalities continue in the public health sphere because organizations often face significant barriers to implementing these interventions. To confront these health disparities, Northwestern Medicine® launched its Hispanic Kidney Transplant Program (HKTP) in 2006. The HKTP is a culturally and linguistically competent intervention created to lessen inequalities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. Later, in 2016, Northwestern Medicine® introduced this program in two transplant programs to measure its success. In the end, nonprofit leaders hoped that the HKTP would reveal any barriers that organizations face when reducing healthcare disparities.
Researchers took this opportunity to examine obstacles during HKTP’s execution preparation. In a 2020 study, Gordon et al. (including NNSI’s founding director Michelle Shumate) took an ethnographic longitudinal approach to this opportunity. Through site visit interviews, group discussions, and learning collaborative discussions, the study assessed many participants involved in the program. These forty-four stakeholders, including transplant physicians, administrators, clinical staff involved in HKTP preparation and future implementation, and research staff, described their concerns in implementing the program.
From those discussions, Gordon et al. noted new factors unique to the implementation of culturally competent care. Specifically, the research team realized three facilitating factors and three barriers. Facilitating factors included:
- Equity. Stakeholders found the HKTP moral and equitable.
- Personal Motivation. Both Hispanic and non-Hispanic stakeholders expressed personal desire to implement a program to reduce health disparities.
- Characterization of Hispanics. Some stakeholders’ accounting of Hispanics as a cultural group reinforced their preparation for implementing the HKTP.
On the other hand, barriers to implementation included:
- Payment. Some expressed ‘reservations’ because they believed that increasing numbers of Hispanic patients might reduce reimbursement.
- Lack of Knowledge. Nearly all stakeholders were unaware of their centers’ patient volume and outcomes data by ethnic/racial background.
- Immorality. Stakeholders expressed concern for recipient/donor confidentiality and the possible resentment by other minority patients without similar programs to the HKTP.
Additionally, this research suggests that a portion of stakeholders were not fully knowledgeable of the meaning of culturally competent care, even after being informed. Many pictured the HKTP as offering the same care as before but in Spanish. This misunderstanding is potentially dangerous to the public health sphere, as it may perpetuate the disparities that many providers aim to reduce.
Overall, Gordon et al.’s study provides a novel analysis of health providers’ barriers and facilitators to intervention implementation during the preparation phase. Further, the study intervened beyond the patient-provider interaction in outreach, marketing, clinic education, scheduling processes, and more. Most importantly, the researchers advanced implementation research designed to increase health equity––the ongoing challenge health providers continue to tackle. By revealing implicit biases regarding providing care to cultural groups, this research has the opportunity to influence healthcare organizations to more effectively implement culturally competent care interventions such as the HKTP in the future as the journey to create equitable healthcare continues.
Gordon, E. J., Romo, E., Amórtegui, D., Rodas, A., Anderson, N., Uriarte, J., McNatt, G., Caicedo, J. C., Ladner, D. P., & Shumate, M. (2020). Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study. Health Expectations, 23(6), 1450–1465. https://doi.org/10.1111/hex.13124