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Main messages

Migrants in the UK have a diverse range of cultural, spiritual and religious beliefs and practices. Health beliefs and values vary between cultures and religions and between individuals within cultural and religious groups.

Cultural, spiritual and religious beliefs and practices can impact on health behaviours and practices, health outcomes, use of and access to healthcare, and decision-making regarding medical treatment.

Differences in cultural, spiritual and religious beliefs are not the only factors affecting whether patients accept and follow healthcare recommendations. Other factors can also limit the success of healthcare provision, such as language barriers, insecure immigration status and housing, discrimination, lack of trust between patients and healthcare professionals, and time and financial cost of attending appointments.

Healthcare professionals should:

• be aware of how cultural, spiritual and religious beliefs impact on an individual鈥檚 health and wellbeing
• be aware of how their own beliefs and biases influence how they interpret others鈥� health needs
• reflect on how they provide services to patients holding diverse cultural, spiritual and religious beliefs
• demonstrate cultural responsiveness and religious literacy by sensitively exploring the cultural, spiritual and religious factors that are unique to each individual鈥檚 circumstances
• seek opportunities to tailor services to individuals鈥� needs
• inform patients that they can request healthcare professionals and language interpreters of the same sex

Cross-cultural dynamics also affect how people communicate in healthcare settings. Consistently working with well-trained intercultural mediators (for example, bilingual advocacy programmes) can support effective cross-cultural communication between healthcare professionals and patients. Intercultural mediators can also help to explore relevant religious beliefs and practices.

Cultural, spiritual and religious influences on health

Migrants in the UK have a diverse range of cultural, spiritual and religious beliefs. Health beliefs and values vary between cultures and between individuals within cultural groups. Culture, spirituality and religion also mean different things to different people and is expressed in varied ways.

The cultural and religious beliefs and practices in a migrant鈥檚 country of birth or origin are unlikely to be the only influences that shape their understanding of health and wellbeing. Migrants鈥� destination country and other countries, that they have lived in and travelled through, will also shape their individual perspectives of health.

Cultural, spiritual and religious beliefs and practices can impact on:

• health behaviours
• health outcomes
• use of and access to healthcare services
• beliefs, rites and rituals around specific milestones like pregnancy and birth, 鈥榗oming of age鈥�, menstruation, marriage, and death
• acceptability of medical care, such as diagnostic procedures, medications and treatment programmes
• adherence to medication and treatment plans (for example, periods of religious fasting)
• use of alternative traditional medicine and healing practices

Differences in cultural, spiritual and religious beliefs are not the only factors affecting whether patients accept and follow healthcare recommendations. Other factors can also limit the success of healthcare provision, such as:

• lack of healthcare information in the patient鈥檚 preferred language
• insecure immigration status, housing, employment and finances, which can limit a patient鈥檚 ability to prioritise their health and interrupt treatment
• experiences of discrimination in healthcare settings
• lack of trust and relationship-building between patients and healthcare professionals
• time and financial cost of attending appointments (such as transport and childcare)

Individuals鈥� perspectives on health can also be influenced by factors like education, family values, gender, age and socio-economic position.

Cultural responsiveness and religious literacy

means:

• understanding that individuals have a right to high-quality healthcare regardless of their culture, ethnicity, religion, spiritual beliefs and languages spoken
• providing healthcare to individuals that is tailored to their needs and that takes into account the unique cultural, spiritual and religious factors that influence their health
• (PDF, 227KB)

It is also important to recognise culture, spirituality and religion intertwine and jointly shape beliefs and practices. Individuals sharing the same cultural background may hold different religious views affecting their approach to health and wellbeing. It is difficult to separate what beliefs are cultural, spiritual or religious. Cultural responsiveness therefore includes religious literacy. Religious literacy involves being open to the role that religion may play in an individuals鈥� understanding of their health needs. It does not require specific knowledge of religious traditions.

Healthcare professionals should:

• be aware of how cultural, spiritual and religious beliefs impact on an individual鈥檚 health and wellbeing
• be aware of how their own beliefs and biases influence how they interpret others鈥� health needs
• ask patients about their own understanding of their condition, and about what is important to them regarding their health issues, and why
• ask if there are any cultural, spiritual and religious considerations that the patient would like to take into account during treatment planning
• ask whether the patient is already engaged in another , including any traditional healing practices, and consider how this will affect treatment planning
• establish what is acceptable to patients in terms of diagnostic investigations, proposed treatments and medications
• create joint management plans with the patient
• be aware of that may be available and relevant for individuals of specific religious beliefs and traditions

The country profiles within the country pages of the migrant health guide can be used as a starting place for identifying cultural and religious information that may be relevant to specific countries of origin. Be aware that these generic facts are intended as background information only and will not reflect the complexities of each individual鈥檚 circumstances. Always sensitively explore the cultural, spiritual and religious factors that are unique to each individual鈥檚 circumstances.

Cross-cultural communication

. This can include:

• whether individuals disclose certain types of health information (for example, some health-related topics may be extremely sensitive for individuals of certain cultural and religious groups to discuss, such as disabilities and sexual and reproductive health matters
• how much information they disclose and to whom (for example, gender norms in certain cultures prevent women from discussing certain matters with men and vice versa)
• how they describe their health concerns (for example, discussing physical manifestations of underlying mental health issues)

Consistently working with well-trained (for example, bilingual advocacy programmes) can support effective cross-cultural communication between healthcare professionals and patients. Intercultural mediators can also help to explore relevant religious beliefs and practices.

Cultural, spiritual and religious considerations are also important when requesting language interpreters. In some situations, patients may wish to have an interpreter of the same religion, cultural background and sex. In other situations, patients may wish to request an interpreter that is not from their community (for example, to maintain confidentiality about sensitive topics in small religious and ethnic communities or due to fear of shame and stigma).

Inform patients that they can also request a medical or healthcare professional of the same sex.

Resources

Health Education England the Royal College of Midwives produced a for healthcare professionals in the NHS.

The Department of Health and Social Care produced .

The Royal College of Nursing created (PDF, 255KB).

The was created in Australia. Its overarching principles and recommendations for practice are applicable to the UK context.

Blackpool, Fylde and Wyre Hospitals NHS Trust developed (PDF, 390KB).

The NHS Chaplaincy Programme has published guidance on .

The Health Care Needs Assessment (HCNA) includes a chapter on (PDF, 843KB); Culture, Health and Illness, 4th edition. By Cecil G Helman. London, Arnold. 2000.