Improving access to dementia care for persons with an ethnic minority background by strengthening nurses’ cultural competence.

Persons with dementia with an ethnic minority background face significant barriers in accessing healthcare. Limited awareness of dementia within their communities, misconceptions that symptoms are part of normal ageing, and a lack of culturally responsive healthcare contribute to reduced access to services. This thesis examined how strengthening the cultural competence of healthcare professionals can improve access to appropriate healthcare. The central research question was: To what degree can access to appropriate healthcare for persons with dementia and their informal caregivers with an ethnic minority background be improved by strengthening cultural competence of healthcare professionals? Using the healthcare access framework of Levesque et al. (2013) and the Process of Cultural Competence model of Campinha-Bacote (2002), four studies were conducted. The first study was a scoping review exploring barriers and facilitators to healthcare access. On the demand side, limited health literacy, cultural health beliefs, and low trust in formal services affected the ability of persons with dementia with an ethnic minority background and their informal caregivers to recognize dementia and seek healthcare. Misconceptions about dementia contributed to stigma and delayed help-seeking. On the supply side of healthcare access, language barriers, limited knowledge of culturally appropriated resources, and stereotypical thinking among healthcare professionals hindered the approachability, acceptability, and appropriateness of healthcare. The findings highlighted a mismatch between the needs of persons with an ethnic minority background and the healthcare services available to them. The second study used qualitative interviews with nurses and informal caregivers, complemented by focus group discussions with healthcare professionals. Informal caregivers reported a need for more information an support, while nurses described difficulties in outreach and communication. Nurses also expressed uncertainty when discussing cultural and religious topics and feared being perceived as discriminatory. Both nurses with and without an ethnic minority background emphasized the need for greater cultural knowledge and communication skills. The findings demonstrated the importance of asking open questions rather than relying on assumptions about cultural preferences or care needs. The third study applied a Design Thinking approach to develop a practical tool. This process resulted in the Good Conversation Method, a tool designed to support nurses in delivering culturally competent dementia care. The method helps healthcare professionals explore family structures, identify formal and informal care networks, and discuss cultural and religious identities in a structured way. The development process demonstrated the importance of involving stakeholders throughout all stages of design and implementation. In the fourth study, a small-scale mixed methods pilot among healthcare professionals from three organizations evaluated the usability and relevance of the Good Conversation Method. Nurses found the conversation cads supportive and used them during conversations, in preparation for consultations, and to stimulate reflection in multidisciplinary meetings. The tool helped clarify care networks and roles, while encouraging reflection on assumptions and potential blind spots. The findings of this thesis demonstrate that cultural competence is an essential component of accessible and person-centered dementia care. Cultural competence involves not only knowledge, but also skills, attitudes, self-reflection, and practical tools. Improving access to healthcare for people with dementia and their informal caregivers with an ethnic minority backgrounds requires addressing barriers on both the demand and supply sides of healthcare. The Good Conversation Method provides a practical approach to strengthening cultural competence among healthcare professionals. However, reducing inequalities in healthcare access will also require continued efforts in research, policy, and healthcare organizations to support culturally responsive and person-centered care.