Exploring the Implications of Culture in Integrated Primary Care: Perspectives of Behavioral Health Consultants

Cultural adaptations to Integrated Primary Care (IPC) models have impacted behavioral health outcomes in Black, Indigenous, and People of Color (BIPOC), with varying results. However, researchers have yet to determine which culturally sensitive approaches in IPC have the greatest impact. Furthermore, no study has explored culture in the context of IPC or how cultural context shapes behavioral health processes for BIPOC patients, who are overrepresented in behavioral health diagnoses and underrepresented in services in the United States. This phenomenological study used semi-structured interviews to explore Behavioral Health Consultants (BHCs) definition of culture and how culture shaped screening, assessment, and treatment of behavioral health conditions in BIPOC patients in IPC settings. Thematic analysis revealed endorsement of White male cisgender heteronormative and use of White authoritarianism in medicine, both of which reportedly contributed to poor conceptualization of BIPOC patients’ symptoms. Use of culturally sensitive and responsive frameworks in IPC, tailored to contextual factors that shape behavioral health outcomes in BIPOC patients were encouraged. Themes support an ongoing need to identify how culturally-sensitive and responsive frameworks are defined in IPC settings and the efficacy of these frameworks in reducing structural barriers across all levels of health systems. In doing so, cultural adaptations to existing models and interventions can be made to improve behavioral health outcomes for BIPOC patients