C. Cultural Sensitivity and Communication

      Another aspect of accessibility is cultural sensitivity.  Studies show that “racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment.” As discussed previously, while studies show that physicians of color generally provide care to people of color, they are underrepresented in the health care profession, and their numbers are insufficient to meet the health care needs of people of color. Access difficulties are compounded by the fact that prospective patients may also refuse to visit health care providers who are racially or ethnically different from them. Establishing a trusting and productive provider-patient relationship between persons who share different values, beliefs, and languages is difficult. Studies show that Native Americans are hesitant to use non-Native American providers. In fact, Native Americans living in urban areas will often travel back to their reservations for health care treatment. Additionally, Hispanic Americans who value family and holistic and personal health care may be less apt to go to bureaucratic providers that treat patients as objects.

      Language barriers may also affect access to health care.  Communication between patients and physicians is more problematic for Hispanics (33%), Asian Americans (27%), and African Americans (23%) than for Caucasians (16%).   For Asians and Hispanics, an inability to speak English coupled with a scarcity of multi-lingual health care providers poses a significant hardship on patients.   An inability to communicate can be a complete barrier to care, or it may cause misdiagnosis and inappropriate treatment of the patient's symptoms.   A recent survey revealed the following communication problems among minority patients: “(1) the doctor did not listen to everything that the [patient] said, (2) the patient did not fully understand the doctor, or (3) the patient had questions during the visit but did not ask them.”

      Another barrier to receipt of health care is the patient's lack of awareness that care is needed.  Oftentimes, formal educational resources do not portray people of color as patients.  Thus, people of color may not perceive themselves as persons needing treatment and may not seek preventative or appropriate care.   This is especially problematic, because studies show that patient education materials improve patients' knowledge about clinical encounters and their participation in health care decisions.