Improving access to care by determining key elements of culturally and linguistically appropriate healthcare interventions for Hispanic populations in Texas using a Delphi technique

Cultural competence, mandated by Federal law since 1964, has not been appropriately addressed due to its lack of specifics and the lack of specifics within subsequent mandates. This study was designed to determine specific key elements of cultural and linguistic appropriateness which would "operationalize" cultural competence in the provision of healthcare services. Knowing the elements of cultural and linguistic appropriateness will assist non-Hispanic healthcare providers to remove personal barriers of cultural and linguistic differences for Texas' Hispanic population. The problem of cultural competence gained national focus during the Civil Rights movement of the '60s. Current research revealed that Hispanics continue to have the worst healthcare outcomes of any minority population. Census data reflecting that Hispanics are the fastest growing segment of the population, with Texas having the nation's second largest Hispanic population, make it imperative for healthcare providers to determine methods to improve healthcare for Texas' Hispanic population. A Delphi Technique was used to extract expert opinions from 26 highly qualified, Texas Hispanic healthcare providers regarding the key elements of cultural and linguistic appropriateness for Texas' Hispanic population. The ultimate goal of the research was to determine essential information which would assist non-Hispanic healthcare providers in removing personal barriers of cultural and linguistic appropriateness to the delivery of healthcare services for Texas' Hispanics. Through the approximately 16-month process of the Delphi Technique, the Panel produced 249 distinct elements in 11 groups of cultural appropriateness and 8 groups of linguistic appropriateness. Members of the Panel ranked the groups for importance, indicated the level of agreement/disagreement with each element, and rated each element for its individual importance. This study is important because it is the first time an expert panel of solely Hispanic healthcare providers has spoken collectively about what constitutes cultural and linguistic appropriateness. This research can provide a framework for professional practices, grant providing organizations, or evaluation teams to assess professionals and programs to determine their degree of cultural and linguistic appropriateness. The work can also form the basis for curricula to be used in Texas' healthcare professions preparatory schools or continuing education for practicing healthcare professionals.