#SystemsofCare: What is cultural competence, and how can we use it to battle health inequality?

By Brett Mayfield

Health disparities in the United States continue to be an area of focus for many nonprofits. In 2021, NNSI Founder and Director Michelle Shumate focused on this area herself, partnering with leading researchers from renowned medical institutions, namely NNSI’s neighbor organization Northwestern Medicine. Following research1-3 that found that Hispanic medical patients “receive disproportionately fewer living donor kidney transplants (LDKTs) than non-Hispanic Whites” (Gordon et al., 2021), these researchers wanted to explore why this problem occurs and how it could be solved. 

A living donor kidney transplantation (LDKT) is just what its name implies: a patient in need of a new kidney receives a new one from a living donor—a life-saving procedure for those with end-stage kidney disease. This procedure not only allows a patient to survive longer, but it also shortens waiting times and is associated with better quality of life compared to kidney transplants from deceased donors. While an effective procedure, it does not serve everyone equally, so researchers designed the Northwestern Medicine Hispanic Kidney Transplant Program (HKTP) so Hispanic patients could have more access to these LDKTs. By intervening at the patient- , provider- , and system-levels, Shumate and her team hoped to set a foundation by which other healthcare providers could begin to battle health disparities themselves. 

The HKTP worked to reduce Hispanic health disparities through culturally targeted interventions, or “a set of values, principles, behaviors, attitudes, policies, and structures that enable organizations and individuals to work effectively in cross-cultural situations.”4 In short, researchers wanted to help patients and their families better understand the procedure and its policies through culturally targeted messaging. They attempted to intervene in a mixed-methods study with 2063 LDKT recipients at two intervention sites, assessing interventions as they occurred. 

The research team’s hypothesis proved successful: LDKT in Hispanic patients significantly increased at one of the intervention sites by 47 percent. Shumate and her colleagues found great impact in their interventions by including patient family members and friends in transplant education sessions, health evaluations, and donor inquiries, as this inclusion helped motivate decision-making by patients to choose the LDKT. Furthermore, interventions by bilingual and bicultural transplant teams helped encourage clear communication, likely helping patients to better complete transplant evaluations. In the end, taking the steps to cater to Hispanic patients’ cultural understandings of healthcare proved to be supportive to reducing the health disparity associated with LDKTs.

This research team made strides to reduce disparities in the Hispanic population, and with a successful study, it seems that there is hope to do so. After all, the Hispanic population is one of the fastest-growing minority groups in the United States—currently 18.4 percent of the population.5 Addressing this population’s battles with kidney disease is a step toward equitable healthcare and longer, better lives enjoyed by Hispanic people in the United States. What’s more, the research team determined that the financial impact of the HKTP on intervention transplant centers was small and recoverable. With financial feasibility, equity can be pursued by many other healthcare providers, including those without large funding sources. 

As nonprofits and their networks continue to make efforts toward healthcare equity, their leaders can look to this study to imitate and implement culturally competent systems of care to make a lasting impact—all without large financial setbacks. While this study may seem limited to its intervention centers, it can still inform healthcare providers of the importance of culturally sensitive, patient-centered networks of care. With efforts toward this care, healthcare providers and other organizations can make similar strides toward a more equitable healthcare system.


Want to learn more?


You can read more about the foundations of this research in sources included in the full article (below), five of which are included in this post:


  1. Purnell TS, Hall YN,Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis. 2012;19(4):244-251.
  2. Desai N, Lora CM, Lash JP, Ricardo AC. CKD and ESRD in US Hispanics. Am J Kidney Dis. 2019;73(1):102-111. https://doi.org/10.1053/j.ajkd.2018.02.354
  3. Organ Procurement Transplant Network/United Network for Organ Sharing Transplants by donor type. U.S. Transplants Performed. January 1, 1988-March 31, 2021. Data as of May 4, 2021. Accessed May 5, 2021. 
  4. U.S. Department of Health and Human Services, Office of Minority Health. National Standards for culturally and linguistically appropriate Services in Health Care Final Report. Office of Minority Health U.S. Department of Health and Human Services; 2001. https://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf


Check out the full research article here: 

Gordon EJ, Uriarte JJ, Lee J, et al. Effectiveness of a culturally competent care intervention in reducing disparities in Hispanic live donor kidney transplantation: A hybrid trial. Am J Transplant. 2021;00:1-15. doi:10.1111/ajt.16857


Read more from other thought leaders here:

Braveman, P. A., Arkin, E., Proctor, D., Kauh, T., & Holm, N. (2022). Systemic and structural racism: Definitions, examples, health damages, and approaches to dismantling: study examines definitions, examples, health damages, and dismantling systemic and structural racism. Health Affairs, 41(2), 171–178. https://doi.org/10.1377/hlthaff.2021.01394
January 2024 research round-up | siren. (n.d.). https://sirenetwork.ucsf.edu/newsroom/news/january-2024-research-round