A Conversation of Culture, Connection & Community in Healthcare for National Hispanic Heritage Month

Connection, understanding and building trust are the foundation of helping Crossover Health members live their best health. These values are meaningful across cultures, but are especially important drivers of health for the Hispanic community. These qualities resonated throughout a recent discussion among several of our Hispanic providers during a conversation of culture and care for National Hispanic Heritage Month. Through regular dialogue with Crossover providers and our members, we facilitate tailored, personalized care for improved health and well-being, continuously striving to understand how different communities may experience their healthcare in unique ways due to cultural factors, language barriers, and access challenges. Our providers share insights from their own lives and personal experiences of caring for members and engaging in medical best practices that address barriers to care in this Q&A. 

Q: Throughout your years of working as a clinician, what do you find most meaningful about being Hispanic and caring for a Hispanic population?  

Joshua Pizarro, LVN, Licensed Vocational Nurse: The most meaningful aspect of being a part of this community is the beauty in our diversity. It is seen in our language, food, beliefs, and traditions. Being a spokesperson for the health of our community is a privilege that I do not take lightly. It’s an opportunity to bridge the gap between our rich culture and embrace healthy life choices that can positively impact our community and future.

Q: Does the number of Hispanic healthcare providers in the U.S have an impact on the overall health of the Hispanic population, and how?

Carlos Ventura, MD, Market Physician Manager: There are about 1 million physicians in the U.S., and only about 3 to 5% of them are Hispanic. This can contribute to access issues for Hispanics – who make up almost 19% of the population – because often people prefer to see a physician of their own ethnicity. Unfortunately, access challenges tend to compound complications of chronic diseases. I frequently hear “If I’m not feeling poorly, then it’s impossible for me to be sick,” yet hypertension and diabetes  – two notorious “silent killers” – are diseases highly prevalent in the Hispanic community. To help members manage these conditions and sustain good health, I focus on building relationships with my patients through acknowledging and honoring their heritage. This empowers our relationships and helps them understand my commitment to keeping them healthy.

Q: From your experience, how do you think healthcare providers can work to close gaps in care for the Hispanic population?

Alberto Luis Ibarra, PsyD, Psychologist: Building and maintaining trusted relationships is critical, especially within mental health care. I’ve seen statistics that only about 5% of psychologists identify as Hispanic, which is definitely a huge barrier to care access. In my experience, when the Hispanic population seeks mental health care, about 80% will go through their primary care provider, but the follow-through on actually getting care can be very low if they’re not guided through the process. The relationships our care navigators build with members can really help alleviate that falloff. Also, building a supportive community by encouraging word of mouth can help. When we prompt members to share their positive experience with their communities, gaps in care start to close.

Q: What kinds of best practices can be applied to break down communication barriers between clinicians and Hispanic patients so they feel heard?

Pizarro: That’s a great question. Trust is so important and central to our community. We need to trust you in order for us to share what is sacred to us: our families, our health, our lives. So there has to be that trust between the clinician and member, which includes incorporating cultural traditions into care. Growing up, when you’re sick, there are all these remedies that our parents would give us, like drinking a certain tea or eating a particular herb. When patients come in and say they’ve been following a regimen, it’s important we don’t brush it off, and instead, really listen. These traditions have been passed down from generation to generation, so acknowledging them is an important way to validate family and beliefs. If I take the time to understand where they’re coming from, this really helps deepen my relationship to build trust and even improve adherence with medications I may prescribe. “Okay, you may be using this regimen, but what if we try using this medication or diet change, as well, and incorporate it into what you’re already doing?” It’s a simple way to respect the culture and build trust through solid communication.

Graicee Cifuentes, RN, Access Practice Manager: From my personal experience, communicating effectively means getting to know your patients, and identifying what’s important to them. It’s vital to spend time during the visit to really understand their social determinants of health and get to know them as individuals. With every population, each member is unique so there are no black and white answers. No patient is the same. Recognizing that and becoming acquainted with each patient definitely helps improve relationships and trust, across cultures.

Q: Can you share lessons learned about moving populations from reactive care to preventive care?

Dr. Ventura: This is an important part of improving outcomes, and relies heavily on trying to find that anchor that’s going to resonate with the patient. Studies reinforce that if people receive care in their own language, the results improve. Also, having a provider who “looks like me” is paramount to building trust and helping to create change. Regarding advice, I try to look in the mirror. For example, I’m from El Salvador: if you know something about El Salvador, we have pupusas. If you haven’t tried one, you’re missing out, please do, they’re delicious. You’re not going to tell somebody from El Salvador with diabetes, “You can no longer eat pupusas for the rest of your life.” Instead, I would work with the patient to effectively make a change by cutting back and making them a once-in-a-while food.

Q: Are there stigmas in healthcare within the Hispanic community that lead to underutilization of services, and how do you address them?

Cifuentes: I would definitely say this is true with mental health. Even just myself growing up, if someone had depression or anxiety, people could assign a label of “crazy.” And so there’s a stigma in the community that’s built around seeking mental health services. We need to work to break that, and I think that’s what we’re really here for. I advocate a lot for mental health. I tell everybody, hey, sometimes it’s nice to just talk to somebody and just tell them how your day was. And if it’s a professional person, by all means, right? 

Dr. Ibarra: The biggest thing when we’re looking at stigma is that we’re talking about something that folks don’t want to talk about in public. And so holding spaces like this, it’s important that there’s visibility that there are Hispanic providers, because we don’t often get to talk about what mental health, for example, looks like for Hispanics. You can’t just generalize and say that all Hispanics are going to be the same. You also have to look at generations, the differences between Gen X vs. Gen Z, for instance. When it comes to mental health, or talking about [gender] pronouns, or talking about depression, or anxiety, it will differ by generation. So the way we have these conversations with one another has to change, and we need to recognize that we need to meet everyone where they’re at. We need to be holding hands, doing community outreach, and connecting through relationships.

Q: Can you comment on diversity in the Hispanic community and how adaption of your approach to care can account for key differences?

Dr. Ibarra: There’s so much diversity within the Hispanic community that there isn’t one healthcare solution that’s going to resonate with the population. There are a lot of conversations in healthcare, especially with tech right now, based on this idea of, what’s this one thing that we can do that’s going to improve access? There isn’t one thing. We can’t think that way.

Pizarro: It’s important to recognize that there are so many countries and regional cultures that make up this population. I’ll use myself as an example. My family’s from Chihuahua, that’s north of Mexico, which is completely different from central Mexico like Durango, or south of Mexico, Chiapas, or Heroica Veracruz [on the Gulf]. It’s important for us to understand that even people from the same country may not be observing or even practicing health care the same way and that will impact how we relate to members. It all comes back to that individual connection, understanding and building those trusted relationships.