Culturally adapted health care

There is strong evidence that culturally adapted health care improves health outcomes (Lambert 2021, Cochrane-McCallum 2017, Shommu 2016, Cochrane-Attridge 2014, Benish 2011, Pottie 2013, Hodge 2010), mental health (Healey 2017, Benish 2011, Chowdhary 2014, Fuentes 2012, Kalibatseva 2014, Pearson 2019), health-related knowledge (Lambert 2021, Cochrane-McCallum 2017, Cochrane-Attridge 2014, Pottie 2013, Hawthorne 2010, Howie-Esquivel 2014), and chronic disease management (Cochrane-McCallum 2017, Benish 2011, Cochrane-Attridge 2014, Masi 2007, Press 2012, Shommu 2016), and increases cancer screening (Healey 2017, Shommu 2016, Masi 2007) for culturally and linguistically diverse (CALD) patients.

There are many types of culturally adapted care, with approaches such as culturally appropriate health education programs (Lambert 2021, Cochrane-McCallum 2017, Cochrane-Attridge 2014), culturally tailored lifestyle interventions (Nierkens 2013, Pottie 2013), and culturally trained or bilingual health workers (Truong 2014, Pottie 2013) appearing especially effective. Evidence of improved outcomes is strongest for chronic diseases (Lambert 2021, Shommu 2016) such as asthma (Cochrane-McCallum 2017) and diabetes (Cochrane-Attridge 2014), mental health (Benish 2011), and improvements in health behaviors, including increased cancer screening (Shommu 2016, Masi 2007) and smoking cessation (Nierkens 2013).

Chronic disease management. Culturally adapted health education interventions for chronic conditions improve health outcomes such as BMI, cholesterol, blood glucose, HbA1C, and depression, and increase health-related knowledge, particularly when offered by bilingual health care providers (Lambert 2021). Culturally adapted health education appears to be more effective at increasing knowledge when delivered by health care professionals, although lay providers may be particularly effective at providing lifestyle advice for diabetics (Lambert 2021).

Culturally adapted diabetes care improves glycemic control and diabetes knowledge more than usual care (Cochrane-Attridge 2014, Pottie 2013, Hawthorne 2010), especially when interventions include flexible implementation; local health worker support; affordable, culturally acceptable food choices; less intense patient time requirements (Pottie 2013); and culturally adapted health education and appropriately adapted education materials (Lambert 2021, Pottie 2013). Including incentives such as cash, glucose monitors, or healthy snacks can also improve patient retention and short-term glycemic control (Pottie 2013). Effects appear strongest in communities with limited access to diabetes education and services (Pottie 2013, Joo 2014).

For asthmatic adults, culturally adapted care improves self-reported quality of life (Cochrane-McCallum 2017) and disease management (Press 2012). Culturally adapted care for children with asthma improves caregiver and patient understanding of asthma more than usual care. It can also lead to improvements in symptom control and reductions in hospitalization and emergency room visits (Cochrane-McCallum 2017).

Mental Health. Psychotherapy adapted to a patient’s cultural understanding of illness improves psychological functioning more than standard psychotherapy (Benish 2011). Treatment built on patient understanding may improve patient satisfaction (Benish 2011, Healey 2017), expectations, adherence to treatment, and willingness to consider alternate illness explanations (Benish 2011). Addressing values, customs, language, and culturally relevant metaphors can also improve mental health among patients with depression (Chowdhary 2014, Fuentes 2012, Kalibatseva 2014). A rural Washington-based study of Native American women exposed to trauma found that culturally adapted Cognitive Processing Therapy reduced symptoms of post-traumatic stress disorder (PTSD), risky sexual behavior, and frequency of alcohol consumption (Pearson 2019).

Health behaviors. Adapting care to patient linguistic and cultural needs can improve breast cancer screening rates and knowledge more than usual care, especially among women with lower incomes; addressing financial and transportation barriers, language, and literacy skills can yield stronger effects (Masi 2007). For example, offering vouchers for the cost of service may increase the number of Latina women with low incomes receiving mammograms (Skaer 1996). Community outreach efforts and use of culturally matched staff linking pregnant women to maternity care can increase the use of pre- and post-natal care in some circumstances; efforts should ensure that other health care providers within the broader continuum of care are also providing culturally appropriate services (Jones 2017a, Coast 2016).

Telephone-based cessation counseling adapted to patients’ linguistic and cultural needs increases smoking cessation more than standard telephone counseling; additional counselor contacts and addressing familial influences can yield stronger effects than less intense interventions (Nierkens 2013). Culturally and gender-sensitive programs show promise for treating alcohol and substance use in Latino men (Valdez 2018); for example, culturally adapted motivational interviewing can reduce the number of heavy drinking days and physical harm related to alcohol use for Latinos (Lee 2013b). A New Haven, Connecticut-based study of Spanish-speaking individuals found that culturally adapted web-based cognitive behavior therapy (CBT) reduced drug and alcohol use and increased completion of substance use disorder treatment (Paris 2018).

Culturally adapted obesity interventions can improve diet and weight status for women who are Black, especially when patients are involved in the planning and recruitment phases of these interventions (Kong 2014), although additional evidence is needed to determine if they outperform usual care (Nierkens 2013). A small study suggests a culturally adapted CBT-based guided program may reduce the frequency of binge eating and may improve mental health among Latinas (Cachelin 2019).

Culturally congruent counseling programs for HIV-positive women and men who are Black may increase long-term adherence to HIV treatment (Bogart 2017).

Medical interpretation. For patients with limited English proficiency (LEP), professionally trained medical interpreters improve patient-provider communication and are associated with improved quality of care (Campbell-Wollscheid 2015, Flores 2005). Culturally appropriate, individualized education for Spanish-speaking heart failure patients improved self-care and heart failure knowledge more than usual care (Howie-Esquivel 2014).

Costs. The cost of culturally adapted care varies by intervention and condition; additional research is needed to determine the cost-effectiveness of culture-specific programs (Cochrane-McCallum 2017).

Culturally adapted health care has the potential to decrease disparities in health outcomes and quality of care for patients from diverse racialized minorities and those for whom English is not their first language (Joo 2021). However, culturally adapted health care programs alone cannot overcome health inequities brought about by poverty and racial discrimination (Truong 2014).

Available evidence shows that compared to usual care, culturally adapted health care programs improve numerous health outcomes, particularly for chronic diseases such as asthma (Cochrane-McCallum 2017, Cochrane-Bailey 2009, Press 2012) and diabetes (Cochrane-Attridge 2014, Pottie 2013, Hawthorne 2010), when provided to the patient groups it is designed for (Lambert 2021, Cochrane-McCallum 2017, Cochrane-Attridge 2014, Pottie 2013, Press 2012, Hawthorne 2010). Additional research is needed to determine if impacts are large enough to decrease disparities (Joo 2021).

Patients from culturally and linguistically diverse (CALD) populations have significant health disparities and higher rates of chronic diseases than non-minoritized patients and are less likely to use or have access to care (Lambert 2021, Joo 2021). Culturally adapted health care may improve health outcomes by increasing use of preventive care, screenings, and follow-up (Lambert 2021).

Most culturally adapted health care has been designed to reach patients who are from racially minoritized groups, primarily populations that are Black or Hispanic, and those who do not speak English as a first language. Further research is needed to adapt care for patients who are sexual and gender minorities (SGM), have disabilities, or are from Indigenous populations.

Culturally adapted care emerged in the 1980s as a way to improve health care accessibility, acknowledging that differences in culture and language between patients and health care providers could be barriers to quality care (Truong 2014). A range of models and frameworks followed, most incorporating different knowledge, attitudes, and skills, moving from interpersonal interactions to organizational and systemic cultural competency (Truong 2014).

In 2000, the Office of Minority Health in the U.S. Department of Health and Human Services issued the 14 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care (Georgetown-Ihara 2004). Later expanded to 15 action steps, CLAS serves as a blueprint for health care organizations, providers, and individuals who provide culturally adapted care (US DHHS-OMH-CLAS standards). CLAS is intended to improve the quality of care offered to all individuals while being inclusive of all cultures, thereby reducing disparities and inequities within health services systems, particularly those felt by minoritized racial, ethnic, and linguistic populations (Georgetown-Ihara 2004, US DHHS-OMH-CLAS standards).

Racism and structural inequalities may have a greater negative effect on health disparities than cultural differences (Truong 2014). Systemic racism contributes to under-resourced health care facilities, inequitable policies, and disparities in access to care (Spencer 2023). A substantial portion of health care infrastructure in the U.S. was built prior to the Civil Rights era, prioritizing access to the majority population in power at the time (white patients) and primarily staffed by white, middle-class male clinicians which further institutionalized discrimination against people of color by limiting access and quality of care (Saha 2010).

• Who might benefit from culturally adapted care in your community? Which groups have difficulty accessing care due to cultural or language barriers?
• How can care be adapted to reach other minoritized groups, such as patients from sexual and gender minorities (SGM), with disabilities, or from Indigenous populations?
• Are partnerships in place, such as between health care systems, academic institutions, non-profits, and community-based organizations to sustain and evolve culturally adapted care based on community needs?

There are many different interventions and models for implementing culturally appropriate care, which will vary based on community needs. The American Hospital Association (AHA) features guidance on how health care organizations can become culturally competent, including recommendations for culturally adapting patient care (AHA-Cultural competency 2013), while the National Research Center on Hispanic Children & Families offers cultural competency resources including guidelines, fact sheets, and a webinar for community-based service organizations (Hispanic Research Center, Lopez 2017).

In the 2024-2029 grant cycle, the Centers for Disease Control and Prevention’s (CDC) Good Health and Wellness in Indian Country (GHWIC) provides $20.7 million a year across 29 awards for American Indian and Alaska Native communities to implement culturally adapted care initiatives in support of healthy living and chronic disease prevention. GHWIC reaches over 115 federally recognized tribes and Urban Indian Organizations through direct funding and indirect funding via tribal organizations (CDC-GHWIC-Recipients, CDC-GHWIC). The CDC also offers guidance and tools on cross-cultural communication and health literacy for organizations to use (CDC-Cross-cultural tools).

The World Health Organization (WHO) also provides guidance on culturally tailoring health care to support health behavior change (WHO-BCI-Tailoring).

‡ Resources with a focus on equity.

CDC-CC evaluation - Centers for Disease Control and Prevention (CDC). Practical strategies for culturally competent evaluation.

CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). (2024, October 16). Culture and Language: Tools for cross-cultural communication and language access can help organizations address health literacy and improve communication effectiveness.

US DHHS-OMH-CLAS standards^‡ - U.S. Department of Health and Human Services (U.S. DHHS), Office of Minority Health (OMH). (n.d.). Think cultural health: National CLAS Standards. Retrieved July 23, 2025.

* Journal subscription may be required for access.

AHA-Cultural competency 2013 - Health Research & Educational Trust. (2013, June). Becoming a culturally competent health care organization. American Hospital Association (AHA).

Benish 2011* - Benish SG, Quintana S, Wampold BE. Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology. 2011;58(3):279-89.

Bogart 2017 - Bogart LM, Mutchler MG, Wagner GJ. A randomized controlled trial of Rise, a community-based culturally congruent adherence intervention for Black Americans living with HIV. Annals of Behavioral Medicine. 2017;51(6):868-878.

Cachelin 2019* - Cachelin, F. M., Gil-Rivas, V., Palmer, B., Vela, A., Phimphasone, P., De Hernandez, B. U., & Tapp, H. (2019). Randomized controlled trial of a culturally-adapted program for Latinas with binge eating. Psychological Services, 16(3), 504–512.

Campbell-Wollscheid 2015 - Wollscheid S, Munthe-Kaas HM, Hammerstrøm KT, Noonan E. Effect of interventions to facilitate communication between families or single young people with minority language background and public services: A systematic review. Campbell Systematic Reviews. 2015:7.

CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). (2024, October 16). Culture and Language: Tools for cross-cultural communication and language access can help organizations address health literacy and improve communication effectiveness.

CDC-GHWIC - Centers for Disease Control and Prevention (CDC). (2024, September 5). Good Health and Wellness in Indian Country (GHWIC). Retrieved July 22, 2025.

CDC-GHWIC-Recipients - Centers for Disease Control and Prevention (CDC). (2024, November 19). Good Health and Wellness in Indian Country (GHWIC): Recipients and funding. Retrieved July 22, 2025.

Chowdhary 2014 - Chowdhary N, Jotheeswaran AT, Nadkarni A, et al. The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: A systematic review. Psychological Medicine. 2014;44(6):1131-46.

Coast 2016* - Coast E, Jones E, Lattof SR, Portela A. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: A systematic review. Health Policy and Planning. 2016;31(10):1479-1491.

Cochrane-Attridge 2014* - Attridge M, Creamer J, Ramsden M, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus: Review. The Cochrane Database of Systematic Reviews. 2014;(9):CD006424.

Cochrane-Bailey 2009* - Bailey E, Cates C, Kruske S, et al. Culture-specific programs for children and adults from minority groups who have asthma: Review. Cochrane Database of Systematic Reviews. 2009;(2):CD006580.

Cochrane-McCallum 2017* - McCallum G, Morris P, Brown N, Chang A. Culture‐specific programs for children and adults from minority groups who have asthma. Cochrane Database of Systematic Reviews. 2017;(8):CD006580.

Flores 2005* - Flores G. The impact of medical interpreter services on the quality of care: A systematic review. Medical Care Research and Review. 2005;62(3):255-299.

Fuentes 2012 - Fuentes D, Aranda MP. Depression interventions among racial and ethnic minority older adults: A systematic review across 20 years. American Journal of Geriatric Psychiatry. 2012;20(11):915-931.

Georgetown-Ihara 2004 - Ihara, E. (2004). Cultural competence in health care: Is it important for people with chronic conditions? [Issue brief series: Challenges for the 21st Century: Chronic and Disabling Conditions]. McCourt School of Public Policy, Georgetown University.

Hawthorne 2010 - Hawthorne K, Robles Y, Cannings-John R, Edwards AGK. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: A systematic and narrative review of randomized controlled trials. Diabetic Medicine. 2010;27:613-23.

Healey 2017 - Healey P, Stager ML, Woodmass K, et al. Cultural adaptations to augment health and mental health services: A systematic review. BMC Health Services Research. 2017;17(1):1-26.

Hispanic Research Center - National Research Center on Hispanic Children & Families. Research to help programs and policies better serve Hispanic children and families with low incomes.

Hodge 2010* - Hodge DR, Jackson KF, Vaughn MG. Culturally sensitive interventions and health and behavioral health youth outcomes: A meta-analytic review. Social Work in Health Care. 2010;49(5):401-23.

Howie-Esquivel 2014 - Howie-Esquivel J, Bibbins-Domingo K, Clark R, Evangelista L, Dracup K. Appropriate educational intervention can improve self-care in Hispanic patients with heart failure: A pilot randomized controlled trial. Cardiology Research. 2014;5:91-100.

Jones 2017a - Jones E, Lattof SR, Coast E. Interventions to provide culturally-appropriate maternity care services: Factors affecting implementation. BMC Pregnancy and Childbirth. 2017;17(267):1-10.

Joo 2014* - Joo JY. Effectiveness of culturally tailored diabetes interventions for Asian immigrants to the United States: A systematic review. The Diabetes Educator. 2014;40(5):605-15.

Joo 2021 - Joo, J. Y., & Liu, M. F. (2021). Culturally tailored interventions for ethnic minorities: A scoping review. Nursing Open, 8(5), 2078–2090.

Kalibatseva 2014 - Kalibatseva Z, Leong FTL. A critical review of culturally sensitive treatments for depression: Recommendations for intervention and research. Psychological Services. 2014;11(4):433-450.

Kong 2014 - Kong A, Tussing-Humphreys LM, Odoms-Young AM, Stolley MR, Fitzgibbon ML. Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obesity Reviews. 2014;15(S4):62-92.

Lambert 2021* - Lambert, S., Schaffler, J. L., Ould Brahim, L., Belzile, E., Laizner, A. M., Folch, N., Rosenberg, E., Maheu, C., Ciofani, L., Dubois, S., Gélinas-Phaneuf, E., Drouin, S., Leung, K., Tremblay, S., Clayberg, K., & Ciampi, A. (2021). The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. Patient Education and Counseling, 104(7), 1608–1635.

Lee 2013b - Lee, C. S., López, S. R., Colby, S. M., Rohsenow, D., Hernández, L., Borrelli, B., & Caetano, R. (2013). Culturally adapted motivational interviewing for Latino heavy drinkers: Results from a randomized clinical trial. Journal of Ethnicity in Substance Abuse, 12(4), 356–373.

Lopez 2017 - López M, Hofer K, Bumgarner E, Taylor D. Developing culturally responsive approaches to serving diverse populations: A resource guide for community-based organizations. National Research Center on Hispanic Children & Families; 2017.

Masi 2007* - Masi CM, Blackman DJ, Peek ME. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Medical Care Research and Review. 2009;64(5):195S-242S.

Nierkens 2013 - Nierkens V, Hartman MA, Nicolaou M, et al. Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities: A systematic review. PLOS One. 2013;8(10):e73373.

Paris 2018* - Paris M, Silva M, Añez-Nava L, et al. Culturally adapted, web-based cognitive behavioral therapy for Spanish-speaking individuals with substance use disorders: A randomized clinical trial. American Journal of Public Health. 2018;108(11):1535-1542.

Pearson 2019 - Pearson CR, Kaysen D, Huh D, Bedard-Gilligan M. Randomized control trial of culturally adapted cognitive processing therapy for PTSD substance misuse and HIV sexual risk behavior for Native American women. AIDS and Behavior. 2019;23(3):695-706.

Pottie 2013* - Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30(9):1017-25.

Press 2012 - Press VG, Pappalardo AA, Conwell WD, et al. Interventions to improve outcomes for minority adults with asthma: A systematic review. Journal of General Internal Medicine. 2012;27(8):1001-15.

Saha 2010 - Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient Centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275–1285.

Shommu 2016 - Shommu NS, Ahmed S, Rumana N, et al. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. International Journal for Equity in Health. 2016;15(6).

Skaer 1996 - Skaer, T. L., Robison, L. M., Sclar, D. A., & Harding, G. H. (1996). Financial incentive and the use of mammography among Hispanic migrants to the United States. Health Care for Women International, 17(4), 281–291.

Spencer 2023 - Spencer, J. C., Kim, J. J., Tiro, J. A., Feldman, S. J., Kobrin, S. C., Skinner, C. S., Wang, L., McCarthy, A. M., Atlas, S. J., Pruitt, S. L., Silver, M. I., & Haas, J. S. (2023). Racial and ethnic disparities in cervical cancer screening from three U.S. healthcare settings. American Journal of Preventive Medicine, 65(4), 667–677.

Truong 2014 - Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research. 2014;14(1):99.

US DHHS-OMH-CLAS standards - U.S. Department of Health and Human Services (U.S. DHHS), Office of Minority Health (OMH). (n.d.). Think cultural health: National CLAS Standards. Retrieved July 23, 2025.

Valdez 2018* - Valdez LA, Flores M, Ruiz J, et al. Gender and cultural adaptations for diversity: A systematic review of alcohol and substance abuse interventions for Latino males. Substance Use and Misuse. 2018;53(10):1608-1623.

WHO-BCI-Tailoring - World Health Organization (WHO), Behavioural and Cultural Insights (BCI). (2023, April 20). A guide to tailoring health programmes: Using behavioural and cultural insights to tailor health policies, services and communications to the needs and circumstances of people and communities.