Cultural Competency - Basic Concepts & Definitions
Familiarizing one’s self with these basic concepts and definitions is critical before delving into additional concepts, tools, and resources. Knowing what cultural competency is, where one is at on the cultural competence continuum, and having an understanding of basic terminology will be helpful in developing awareness, knowledge, and skill in providing culturally competent care.
- What is Cultural Competence
- Cultural Competence Continuum
- Thought Process: Working Towards Cultural Competency
- Platinum Rule
- Generalizations vs. Stereotypes
- Sociocultural Barriers to U.S. Healthcare
- Terms and Concepts for Cross-Cultural Competence
What is Cultural Competence?
1. Awareness of self and one's own value system
- How do I react when a patient does not speak English?
- What are my beliefs toward folk remedies?
2. An Understanding of the concept of culture and its role as a factor in health and health care.
- Is there anything about your cultural beliefs that I should be aware of when providing you healthcare?
3. A sensitivity to cultural issues for each patient.
- In order to provide a more effective medical treatment, it is vital to inquire about a patient's:
- native language
- influence of religion/spirituality
- family relationships
- communication style
- health practices
- illness beliefs
- relationship with health care provider
4. An understanding and ability to use specific methods to deal effectively with cultural issues in interacting with individual patients, their families, members of the health care team, and the wider community.
- Several questions, such as the following, may be
asked to learn more about the patient's cultural beliefs:
- What do you think may be the reason you have these symptoms?
- What do friends, family, others say about these symptoms?
- Do you know anyone else who has had or has this kind of problem?
Source:
Adapted from Association of American Medical Colleges,
Contemporary Issues in Medical Education, Feb 1998. 1(5)
by Tulin DiversiTeam Associates: Wyncote, PA.
Cultural Competence Continuum
Cultural competence at the organizational and individual level is an ongoing developmental process. The following chart is designed to highlight selected characteristics that organizations may demonstrate along two stages of the cultural competence continuum.
Moving Towards Cultural Competence
- Cultural destructiveness acknowledges only one way of being and purposefully denies or outlaws any other cultural approaches.
- Cultural incapacity supports the concept of separate but equal; marked by an inability to deal personally with multiple approaches but a willingness to accept their existence elsewhere.
- Cultural blindness fosters an assumption that people are all basically alike, so what works with members of one culture should work within all other cultures.
- Cultural pre-competence encourages learning and understanding of new ideas and solutions to improve performance or services.
- Cultural competence involves actively seeking advice and consultation and a commitment to incorporating new knowledge and experiences into a wider range of practice.
- Cultural proficiency involves holding cultural differences and diversity in the highest esteem, pro-activity regarding cultural differences, and promotion of improved cultural relations among diverse groups.
Definitions source:
Adapted by T. Goode (2004) from: Cross, T., Bazron, B., Dennis,
K., & Isaacs, M. (1989). Towards a Culturally Competent
System of Care, Volume 1. Washington, DC: CASSP Technical
Assistance Center, Center for Child Health and Mental Health
Policy, Georgetown University Child Development Center. Available at: http://gucchd.georgetown.edu/nccc/sidsdvd/
continuum.pdf (accessed 11/05). Available at:http://www.nccccurricula.info/
documents/TheContinuumRevised.doc Accessed 7/28/06).
Graph Source:
Goode, T.D. and Harrison S. (2004). Cultural Competence Continuum.
Policy Brief 3, 5, Washington, D.C.:National Center for Cultural
Competence-Bureau of Primary Health Care Component, Georgetown
University Child Development Center.
http://www.nccccurricula.info/assessment/B3.html (accessed 11/05)
These characteristics have been
adapted and expanded from original work of Cross, et al.,
in several ways: (1) to ensure their relevance for primary
health care organizations; (2) to incorporate salient items
from the NCCCOs Policy Brief 1 checklist (Cohen & Goode,
1999); and (3) to emphasize the role of primary health care
organizations in research.
Thought Process: Working Towards Cultural Competency
- A.S.K.E.D: A thought process of cultural competence in the delivery
of healthcare services.
- Exploring one's background and becomingawareof one's own cultural biases.
- Seeking and obtaining knowledge of various cultural
beliefs. - Gaining the skills to conduct a cultural assessment.
- Engaging in an abundance of cultural encounters.
- Having the desire of "wanting",
not "having", to deliver
culturally competent care.
- A.S.K.E.D. Questions to assist with informally assessing one's level
of cultural competence.
- Am I aware of my biases and prejudices towards other cultural groups, as well as racism in healthcare?
- Do I have the skill of conducting a cultural assessment?
- Am I knowledgeable about the worldviews of different cultural and ethnic groups, as well as knowledge in the field of biocultural ecology?
- Do I seek out face-to-face, and other types of encounters with individuals who are different from myself?
- Do I really "want to", desire to, become culturally competent?
Source:
Campinha-Bacote (1998). The Process of Cultural Competence
in the Delivery of Healthcare Services: A Culturally Competent
Model of Care (3rd ed). Cincinnati, OH, Transcultural
C.A.R.E. Associates.
Platinum Rule:
Do unto others as they would have done unto them.
Generalization= a starting point.
When generalizing, one begins with an assumption about a group but then seeks further information about whether the assumption fits that individual.Stereotype = an ending
point.
When stereotyping, one makes an assumption about a person
based on group membership without learning whether or not
that individual fits the assumption.
Sociocultural Barriers to US Healthcare
People of diverse racial and ethnic minority groups face substantial barriers to care such as language and communication barriers, medical practices that differ from their own beliefs and traditions, fear and mistrust of health care institutions, and a lack of knowledge about how to navigate the system.
These sociocultural barriers can lead to difficulty in scheduling an appointment, misunderstandings between clinicians and patients, misdiagnoses, and poor follow through on the patient's behalf. Sociocultural barriers to health care are created by differences between patients and providers in areas such as:
- Language and nonverbal communication
- Health practices and beliefs
- The role of family members in health care decision-making
- Patient knowledge and expectations of the health care system
- The culture and complexity of the health care system
Source:
Social Cultural Barriers to US Healthcare. (Online). Opening
Doors. National Program Office.
(1/5/01).
Redirected to: http://www.rwjf.org/reports/npreports/opendoorse.htm
Terms and Concepts for Cross-Cultural Competence
Acculturation:
The process that takes place when contact between two societies
is so prolonged that one or both cultures change substantially.
In regards to immigrant groups, acculturation is the process
or incorporating values, beliefs, and behaviors from the host
culture into the immigrants' cultural worldview.
Cultural Competence:
A set of practice skills, knowledge and attitudes that must
encompass five elements:
- awareness and acceptance of difference
- awareness of one's own cultural values
- understanding of the dynamics of difference
- development of cultural knowledge
- ability to adapt practice skills to fit the cultural context of the client
Judging and interpreting the behavior and belief of others in terms of their traditions and experiences.
Cultural Self-Awareness:
Understanding the assumptions and values upon which one's
own behavior and worldview rests. The appreciation and acceptance
of differences.
Culture:
The learned and shared knowledge, beliefs and rules that people
use to interpret experience and to generate social behavior.
The guiding force behind the behaviors and material products
associated with a group of people.
Culture Shock:
A form of anxiety that results from an inability to predict
the behavior of others, or act appropriately in a cross-cultural
situation.
Ethnicity:
A group identity based on culture, language, religion, or
a common attachment to a place or kin ties. Ethnicity is a
relational concept.
Ethnocentrism:
The interpretation of the beliefs and behavior of others in
terms of one's own cultural values and traditions with the
assumption that one's own culture is superior.
Power:
The ability to produce intended effects on oneself, on other
people, and on things or situations.
Race:
A biological term classifying people who have the same physical
characteristics.
Racism:
The belief that some human population groups are inherently
superior or inferior to others because of genetically transmitted
characteristics.
Social Stratification:
The division of members of a society into strata (or levels)
with an unequal access to wealth, prestige, power, opportunity,
and other valued resources.
Socio-Structural Factors:
The manner in which social ideologies influence individual
access to services and opportunities provided by particular
institutional systems, e.g. political, legal, education, health
care, housing and economic systems.
Spirituality:
One's orientation or total response to oneself, others, and
the universe. It reflects the human capacity to see, to feel,
to act in terms of a transcendent dimension, to perceive meaning
that is more than merely mundane. (Smith in Wulff 1991, p.4)
There are three aspects of spirituality:
- Orientation to the Self may include: accord with self-definition; lasting self-verification; goal clarity and sense of purpose to pursue valued goals; conviction.
- Orientation to Others may include: connectedness with community (others, nature, other forms of life); meaningful world order and purpose; shared values with a group that in turn affirms one's own identity; belonging.
- Orientation to the Universe/Transcendent in connectedness to an "otherwise incomprehensible
realm beyond oneself"
(Wulff, 1991, p.635).
Source:
Adapted from PROJECT ADEPT, Brown University. (Online) (Disabled link) Retrieved on (1/5/01).
