Understanding the BESAFE Framework

The BESAFE framework is based on research conducted by Campinha-Bacote that uses culturally pluralistic content & perspectives based on the following 6 core elements to guide providers in caring for patients of all races.

Barriers to Care address real and perceived gaps to providing quality care and the impact of race and ethnicity on each of them. Barriers to Care include:

  • Mistrust of medical systems, HIV programs
  • Lack of access, no insurance
  • Stigmas, lack of awareness about HIV transmission
  • Lack of support systems; poverty, crime, violence
  • Drug abuse; risk behaviors
  • Clinician bias, lack of objectivity
  • Stereotyping, racism, homophobia

Ethics addresses the morality of beliefs, values, and behavior. Providers must give priority to professional duty; valuing of different cultures; and issues relevant to honesty, confidentiality, research, death and dying as they relate to HIV/AIDS. Ethics, such as

  • Morality, values
  • Belief systems
  • Behaviors driven by individual experiences and social influences
  • Professionals ethic is "to do no harm"
  • Truth telling; honoring patient's perspective and autonomy
  • Confidentiality

Sensitivity of the Provider addresses the need for providers to examine their own prejudices and biases toward other cultures and determine where they are along a continuum that ranges from unconscious to conscious competence. It is important that they conduct an in-depth exploration of their own cultural background and work to avoid engaging in the phenomena of cultural imposition - the tendency to impose their values on another culture (Leninger 1978). Sensitivity to...

  • Examine ones own biases and prejudices: race, ethnicity, sexual orientation, language, gender, etc.
  • Explore/know ones cultures
  • Avoid cultural imposition
  • Create shared understandings and shared context

Assessment addresses the need to be able to collect relevant data regarding patient's health history and problems in the context of the patient's cultural background and understanding that patients have a right to have their specific cultural beliefs, values, and practices. (Campinha-Bacote 1998). Assessment that...

  • Collects relevant patient information
  • Uses systemic appraisal approach
  • Presents to the patient in the context of the patients own cultural background

Facts address the fact that full assessment requires the understanding of physiology, behavior, and the patient's perception or his/her illness. Providers must seek to master biologic variations based on ethnicity, worldviews, and culture-specific behavioral patterns for each patient and design treatment regiments based on that knowledge. Facts, such as:

  • Biologic variations based on ethnicity, worldviews (metaphorical explanations), and culturally specific behavioral patterns; variations in virologic and immunologic interpretations
  • HIV sub types
  • Variations in drug interactions and efficacy
  • Influence of spirituality, discrimination and stigmas, support systems

Encounters address the fact that the providers have a duty to achieve effective encounters with all of their patients. Factors such as: language, cultural norms, the role of spirituality and concepts of personal space should be discussed during patients' first visit when unsure how best to proceed. Encounters characterized by...

  • Face to face, personal space, eye to eye contact, touch
  • Norms, language