Assessing levels of patient-centered cultural sensitivity in rural and urban healthcare sites

Patients in rural communities experience greater barriers to healthcare than patients in urban communities. In particular, rural patients often have less financial resources, limited transportation, and less choices in healthcare providers. Research has called for increased levels of cultural sensitivity training in the healthcare field. This is particularly true in rural communities, given their specialized needs. The present study examines perceived levels of cultural sensitivity of healthcare providers, office staff, and clinic environment/policies as rated by patients in either rural or urban communities. National healthcare sites such as hospitals, health departments, community healthcare centers, and private clinics were recruited. Participants were adult patients, healthcare providers, and office staff members who completed questionnaires that included a perceived cultural sensitivity measure, the Tucker-Culturally Sensitive Health Care inventory (T-CSHC), and demographic information. The T-CSHC inventory is unique in that it was developed from focus group data in which patients identified characteristics of their healthcare experiences which made them feel comfortable, trusting, and respected. Thus, patients rather than experts defined the construct of cultural sensitivity. The T-CSHC inventory consists of three sub-scales: Provider, Office Staff, and Clinic Environment/Policies. Participants were asked to rate the level of perceived cultural sensitivity for interactions with each group on the respective sub-scales. A total of 1,426 participants completed questionnaires. Of these, 397 were from rural healthcare sites and 1,029 were from urban healthcare sites. A one-way analysis of variance was conducted on perceived cultural sensitivity and city classification, and was found to be significant for providers, F(1, 600) = 12.39, p < .00, for office staff, F(1, 875) = 24,35, p < .00, and clinic environment/policies, F(1, 784) = 28.20, p < .00. Participants from rural sites experienced higher levels of perceived cultural sensitivity from their healthcare providers (Rural M = 3.44, Urban M = 3.29), office staff (Rural M = 3.36, Urban M = 3.16), and clinic environment/policies (Rural M = 3.28, Urban M = 3.07), as compared to participants from urban sites. The results suggest that patients in rural healthcare sites experience higher levels of cultural sensitivity from their healthcare providers, office staff, and clinic environment/policies than those who utilize urban healthcare sites. Future research is needed to examine how specific characteristics of rural healthcare sites contribute to improved cultural sensitivity, given the dire need for increased cultural sensitivity and cultural competence training in the healthcare field.