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Cultural Competence & Reflection

Definitions

  • "a set of congruent behaviours, attitudes and policies that come together in a system, agency, or among professionals and enable effective work in cross-cultural situations" (Cross et al., 1989, p. 7)

  • “the ability of individuals to establish effective interpersonal and working relationships that supersede cultural differences” (Cooper & Roter, 2002, p. 554) 

Figure 6
Black and gray stethoscope

Image by Hush Naidoo Jade Photography

Note. From Black and gray stethoscope, by Hush Naidoo Jade Photography, 2017, Unsplash 
(https://unsplash.com/photos/black-and-gray-stethoscope-yo01Z-9HQAw). Unsplash License.   

Cultural Competence in Healthcare

The Process of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 1998)

In 1998, Campinha-Bacote proposed a model for the delivery of culturally competent healthcare. This model was proposed on the background of the changing demographics and economics of the growing multicultural world and the health disparities associated with coming from diverse cultural and ethnic backgrounds. 

 

Foundational Assumptions of the Model:

  1. Cultural competence is an ongoing process.

  2. Cultural competence consists of five constructs: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.

  3. Intra-ethic variation is larger than inter-ethnic variation: there is more variation within cultural groups than between them. 

  4. The level of cultural competence of healthcare providers is correlated to their ability to provide culturally responsive healthcare.

  5. Cultural competence is essential if wishing to provide effective and culturally responsive services to diverse clients.

5 Constructs of Cultural Competence
(Campinha-Bacote, 1998)

Cultural Awareness

  • self-examination and exploration of one’s own cultural and professional background (Campinha-Bacote, 2002). 

  • the frame of reference through which we see the world (DiAngelo, 2012)

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Campinha-Bacote (2002), DiAngelo (2012) and The National Centre for Cultural Competence: The University of Sydney (personal communication, 2023) suggest that understanding one's own frame of reference, enables individuals to gain perspective on biases, prejudices, and assumptions they have about people who are different. 

Without awareness of the influence of one’s own cultural or professional values, healthcare providers risk engaging in cultural imposition; the tendency of an individual to impose their beliefs, values, and patterns of behaviour on another culture (Leininger, 1978).

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In short, understanding your own culture is the first step towards cultural competence. 

Cultural Knowledge

  • the process of educating one's self about diverse cultural and ethnic groups.

 

In obtaining this knowledge base, therapists should focus on three specific factors (Lavizzo-Mourey, 1996):

  1. Health-related beliefs and cultural values
    - understanding another's worldview to help explain a patient's interpretation of illness and their health-related decisions.

  2. Disease incidence and prevalence
    - biocultural ecology: i.e., how and why incidence varies between different cultural groups.
    - utilising this knowledge to tailor treatment, education and screening for best possible outcomes.

  3. Treatment efficacy 
    - e.g., ethnic pharmacology: how drug metabolism may vary among different ethnic groups.

 

When collecting cultural knowledge, it is crucial to remember that no-one is a stereotype of one’s culture of origin; they are a unique blend of the diversity found within each culture, their life experiences, and the process of acculturation to other cultures.

Healthcare providers MUST develop the ability to conduct a cultural assessment with each client. 

Cultural Skill

The ability to:

1. Collect relevant cultural data regarding the client’s presenting problem. ​

  • ​Cultural assessment: “systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values, and practices to determine explicit needs and intervention practices within the context of the people being served” (Leininger, 1978, p. 85-86).

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2. Accurately performing a culturally based physical assessment.​

  • Developing knowledge on how a client’s physical, biological, and physiological variations influence the ability to conduct an accurate and appropriate physical evaluation. This may include differences in body structure, physical characteristics, skin colour, and laboratory variances.

Cultural Encounters

  • the process of healthcare providers directly engaging in cross-cultural interactions.

  • Aim: to refine or change one’s existing beliefs about a cultural group to help prevent stereotyping.  


Note, an awareness of intra-ethic differences is paramount. Interacting with a handful of members of a specific cultural group, does not make one an expert; it is possible that these individuals may not fully represent the beliefs, values, or practices of all within that group. Thus, the importance of a cultural assessment is paramount with each unique patient. 


Communication:

  • Differing linguistic and communication needs also fall into the bracket of cultural encounters.

  • From a language perspective, utilising professional interpreters is the recommended method for communicating with those speaking a language other than the therapists' own. This is because, untrained interpreters, friends or family may lack knowledge regarding medical and disease terminology, potentially leading to incorrect or inaccurate data collection. 

Cultural Desire

  • "the motivation of the healthcare provider to want to, rather than have to, engage in the process of becoming culturally aware, culturally knowledgeable, culturally skilful, and familiar with cultural encounters." (Campinha-Bacote, 2002, p. 182). 

 

A key component of cultural desire is caring. It has been suggested that people don’t care how much you know, until they first know how much you care (Campinha-Bacote, 1999).

 

DON'Ts:

  • just say you respect a client’s values, beliefs, and practices.

  • go through the motions of providing an intervention because evidence suggests it is effective for a particular cultural group.

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DOs:

  • be motivated and passionate to learn more about cultures other than your own.

  • be open and flexible to others.

  • accept differences and build on similarities.

  • be willing to learn from others as cultural informants.

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This type of learning is a lifelong process that has been referred to as 'cultural humility' (Tervalon & Murray-Garcia,1998)

Where to from here?

(National Centre for Cultural Competence: The University of Sydney, personal communication, 2023)

 

Cultural competence is a lifelong journey. We can spend our lives getting to know ourselves and the world around us. We are constantly invited to reflect and respond to all the experiences and interactions we have.

 

But where to from here:

  • keep reflecting and being curious about yourself and those around you.

  • remember to listen before acting and create space and respect for diverse knowledges, voices, and experiences.

  • understand that knowing about other cultures does not make you culturally competent; you also need to know about yourself and how you are positioned in the world.​

  • actively seek out opportunities that may expose you to different cultures; consider taking part in a student exchange (like Learn.On)!

©2023 by Alexandra Moore. Proudly created with Wix.com

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