1.
Cross-cultural misunderstandings between providers and patients can lead to mistrust and frustration but are unlikely to have an impact on objectively measured clinical outcomes.
Correct Answer
B. False
Explanation
(False: Low levels of cultural competence can impede the process of making an accurate diagnosis, cause the provider to order contraindicated medication, and reduce patient adherence to recommended treatment.)
2.
When the patient and provider come from different cultural backgrounds, the medical history obtained may not be accurate.
Correct Answer
A. True
Explanation
(True: Because of language and cultural barriers, the patient may not understand the questions or may be reluctant to report symptoms; in turn, the provider may misunderstand the patient’s description of symptoms.)
3.
Patients are more likely to understand and follow a medical regimen when their healthcare provider has confidence in their comprehension and adherence, as opposed to when doubts exist.
Correct Answer
A. True
Explanation
(True: This is an adaptation of the “Pygmalion theory” which has proven that students generally live up—or down—to the expectations of their teachers. (Rosenthal and Jacobson 1968).
4.
A really conscientious health provider can eliminate his or her own prejudices or negative assumptions about certain types of patients.
Correct Answer
B. False
Explanation
(False: Most of us harbor some assumptions about patients, based on race, ethnicity, culture, age, social and language skills, educational and economic status, gender, sexual orientation, disability/ability, and a host of other characteristics. These assumptions are often unconscious and so deeply rooted that even when an individual patient behaves contrary to the assumptions, the provider views this as the exception to the rule. A conscientious provider will not allow prejudices to interfere with making an accurate diagnosis and designing an appropriate treatment plan.)
5.
When taking a medical history from a patient with a limited ability to speak English, which of the following is LEAST useful?
Correct Answer
B. Encouraging the patient to give a description of her/his medical situation, and beliefs about health and illness.
Explanation
While this option may be valuable in certain contexts, it may not be as immediately helpful as the other options listed, especially when dealing with language barriers. Asking questions that require a simple "yes" or "no" answer, offering interpreter services, and asking specific questions about symptoms and changes in condition are more practical approaches in such situations.
6.
During a medical interview with a patient from a different cultural background, which is the LEAST useful technique?
Correct Answer
B. Gently explaining which beliefs about the illness are not correct.
Explanation
(Answer: B). Although the provider may be tempted to correct the patient’s different beliefs about illness, this may lead the patient to simply withhold his/her thoughts in the future and interfere with building a trusting relationship. It is more effective to be nonjudgmental about differences in beliefs. The provider should keep in mind two goals: 1) the patient should reveal her/his medical history and symptoms to help the provider make an accurate diagnosis, and 2) the patient should develop trust in the provider’s medical advice and be willing and able to adhere to that advice. To accomplish these goals, it is essential to treat the patient with respect, openly discussing differences in health beliefs without specifying “correctness” or “incorrectness.”
7.
When a patient is not adhering to a prescribed treatment after several visits, which of the following approaches is NOT likely to lead to adherence?
Correct Answer
B. Repeating the instructions very loudly and several times to empHasize the importance of the treatment.
Explanation
(Answer: b. Non-adherence can be the result of many different factors that may require a variety of interventions. Simply repeating the instructions may not address the real issues that are keeping the patient from adhering to the regimen. In fact, repetition of instructions may be inappropriate and quite offensive if the patient has a communication disability. Family members can provide valuable support. It may also be necessary to set small, realistic goals in order to achieve long-term behavioral change. Finally, an understanding of the patient's beliefs about other remedies may offer valuable clues to her/his reluctance to adhere to treatment.)
8.
Which of the following is NOT a key aspect of providing culturally competent healthcare?
Correct Answer
C. Treating all patients the same way, regardless of their cultural background.
Explanation
Culturally competent healthcare requires recognizing and respecting the diverse beliefs, values, and practices that patients from different cultural backgrounds bring to the healthcare setting. It involves tailoring communication, treatment plans, and overall care to be sensitive to these individual needs and preferences, rather than adopting a one-size-fits-all approach.
9.
Which of the following are the correct ways to communicate with a patient through an interpreter?
Correct Answer
D. None of the above.
Explanation
(Answer: d. Although it may seem natural to look at the interpreter when you are speaking, you want the patient to feel that you are speaking to her/him, so you should look directly at her/him, just as you would if you were able to speak her/his language. It is best to speak in a normal tone of voice, at a normal pace, rather than pausing between words. Because of differences in grammar and syntax, the interpreter may have to wait until the end of your sentence before beginning to interpret. Do pause after one or two sentences to allow the interpreter to speak. When you need further information or need to clarify what the patient has said, clearly tell the interpreter what you want to be asked of the patient. Although you may ask the interpreter to add his or her opinion of what the patient really meant, try to get as close as possible to the patient’s actual words and intent.
10.
If a family member speaks English as well as the patient’s native language and is willing to act as interpreter, this is the best possible solution to the problem of interpreting.
Correct Answer
B. False
Explanation
(False: This is an inappropriate responsibility for families to take on and may actually place the provider in violation of the Civil Rights Act of 1964 and the August 30, 2000 Office for Civil Rights (OCR) Policy Guidance. The rationale for using professional interpreters is clear. Professional interpreters have been trained to provide accurate, sensitive two-way communication and uncover areas of uncertainty or discomfort. Family members are often too emotionally involved to tell the patient’s story fully and objectively, or lack the technical knowledge to convey the provider’s message accurately.)
11.
Which of the following statements is TRUE?
Correct Answer
C. Cultural background, diet, religious, and health practices, as well as language, can differ widely within a given country or part of a nation.
Explanation
(Answer: c. The only assured similarity among people from around the world who come to you for care is the fact that they are your patients and they hope to be treated with respect and with concern for their individual health needs. As a health care practitioner, it is important to have a basic understanding of your patients’ cultures—and to recognize the similarities and differences among people from the same region of the world and the same country. Differences in cultures within a region can be pronounced. Each patient is the product of many cultural forces. People from the same continent, the same country, the same part of the country, and even the same city, may have major differences in cultural heritage, traditions, and language, as well as differences in socioeconomic status, education, religion, and sexual orientation. It is the combination of all of these factors that make up a person’s “culture.”)
12.
Which of the following statements is NOT TRUE?
Correct Answer
C. Most African people are either Christian or follow a traditional religion.
Explanation
(Answer: c. A large percentage of Africans are Muslims, most of them living in North and West Africa, but there are also many Muslims in East Africa.)
13.
Which of the following statements is NOT TRUE?
Correct Answer
B. Japanese men who migrate to the US retain their low susceptibility to coronary heart disease.
Explanation
(Answer: b. The longitudinal NI-HON-SAN study and Honolulu Heart Program showed that dietary changes contributed to a significant increase in coronary heart disease among Japanese men who migrated to Hawaii and California. It highlighted the role that environmental factors can play in counteracting predispositions to disease.)
14.
Because Hispanics have a lower incidence of certain cancers than the majority of the US population, their mortality rate from these diseases is correspondingly lower.
Correct Answer
B. False
Explanation
(False: Despite the lower rate of breast, oral cavity, colorectal, and urinary bladder cancers among Hispanics, their mortality rate from these cancers is just as high as that of the rest of the population.)
15.
Minority and immigrant patients in the US who go to traditional healers and use traditional medicines generally avoid conventional Western treatments.
Correct Answer
B. False
Explanation
(False: In the US, some individuals from minority and immigrant groups use traditional treatments before turning to conventional Western medicine, or use both concurrently.)
16.
Providers whose patients are mostly European-American, U.S.-born, and middle-class still need to know about health practices from different world cultures.
Correct Answer
A. True
Explanation
(True: A growing number of people from majority U.S. cultures are turning to traditional medicines as part of their health care strategies. Providers should be aware of any such practices that may affect their patients’ health.)
17.
Which of the following is good advice for a provider attempting to use and interpret non-verbal communication?
Correct Answer
A. The provider should recognize that a smile may express unhappiness or dissatisfaction in some cultures.
Explanation
(Answer: a. Although smiling is an expression of happiness in most cultures, it can also signify other emotions. Some Britishers, for example, may smile when they are discussing something sad or uncomfortable. The other pieces of advice are incorrect. The use and interpretation of body language depend entirely on the patient’s culture and personal preferences. What is appropriate in one culture may be embarrassing or offensive in another culture. Interpersonal greeting behaviors, for example, vary widely from one culture to another. Beliefs about touching are also highly variable, with some cultures placing a high value on physical contact, and others believing that physical contact of any kind is a sign of intimacy. Similarly, some cultures perceive direct eye contact as a sign of respect, while in other cultures, eye contact with elders and authority figures is to be avoided. Hand gestures in particular can lead to serious misunderstandings. For example, the “ok” sign, widely used in the US, is the symbol for coins or money in Japan. In several other cultures, the gesture represents a bodily orifice and is highly offensive.)
18.
Some symbols—a positive nod of the head, a pointing finger, a “thumbs-up” sign—are universal and can help bridge the language gap.
Correct Answer
B. False
Explanation
(False: Each of these symbols has a very different meaning in different cultures, and may be offensive.)
19.
Out of respect for a patient’s privacy, the provider should always begin a relationship by seeing an adult patient alone and drawing the family in as needed.
Correct Answer
A. True
Explanation
​​​​​​In healthcare, respecting patient privacy is essential. For adult patients, it is generally recommended to start the consultation alone, ensuring that the patient feels comfortable sharing personal health information without external influence. Family members can be invited to join later if the patient consents or if their involvement is necessary for support or decision-making. This approach helps maintain confidentiality and respects the patient’s autonomy.
20.
In some cultures, it may be appropriate for female relatives to ask the husband of a pregnant woman to sign consent forms or to explain to him the suggested treatment options if the patient agrees and this is legally permissible.
Correct Answer
A. True
Explanation
(True: In many cultures, men are not involved in the activities surrounding pregnancy or childbirth. Yet they maintain the responsibility for making decisions and giving permission for treatment, medication, and hospital stays. A female relative may have to intervene between the provider and the husband.
21.
Which of the following is NOT TRUE of an organization that values cultural competence:
Correct Answer
D. The organization assumes that professional medical staff does not need to be reminded to treat all patients with respect.
Explanation
(Answer: d. Even the most conscientious, committed staff who have been trained in cultural competence may need periodic reminders. In a busy practice, it is easy for providers to seek shortcuts, slipping into assumptions about the diverse populations they serve and failing to take the time needed to fully understand the health beliefs and values of each patient.)
22.
A female Muslim patient may avoid eye contact and/or physical contact because:
Correct Answer
C. Modesty is very important in Islamic tradition.
Explanation
(Answer: c. Modesty is a very important aspect of a Muslim's life. Handshakes between unrelated men and women are inappropriate according to Islamic norms. In addition, eye contact will often be avoided, especially in mixed-gender situations.)
23.
Which of the following statements is NOT TRUE:
Correct Answer
C. Arab people have not historically had an impact on the medical field.
Explanation
(Answer: c. Health and healing has been a part of Arab tradition since the earliest historical times. Not only has Arab medicine been in existence for over one thousand years, but Arab medical texts and practices were very influential in the development of Western medical tradition.)