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Cultural Competencies

What is cultural competence?

Cultural competence is a set of attitudes, skills behaviors and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices and communications patterns of clients and their families to improve services and close the gaps in health status among diverse population groups.

Cultural competence also focuses its attention on population-specific issues including:

  • Health-related beliefs and cultural values (the socioeconomic perspective)
  • Disease prevalence (the epidemiological perspective)
  • Treatment efficacy (the outcome perspective)

 

What is linguistic competence?

Linguistic competence is the capacity of an organization and its personnel to communicate effectively and convey information in a manner that is easily understood by diverse audiences including persons with limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic competency requires organizational and provider capacity to respond effectively to the health literacy needs of populations served. The organization must have policy, structures, practices, procedures and dedicated resources to support this capacity.

Glossary of related terms

The collective set of culturally and linguistically appropriate services (CLAS) mandates guidelines and recommendations issued by the U.S. Department of Health and Human Services Office of Minority Health intended to inform, guide and facilitate required and recommended practices related to culturally and linguistically appropriate health services.

National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, OMH, 2001.

Culture: The thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups

Culture defines:

  • How health care information is received
  • How rights and protections are exercised
  • What is considered to be a health problem
  • How symptoms and concerns about the problem are expressed
  • Who should provide treatment for the problem
  • What type of treatment should be given

In sum, because health care is a cultural construct, arising from beliefs about the nature of disease and the human body, cultural issues are actually central in the delivery of health services treatment and preventive interventions. By understanding, valuing and incorporating the cultural differences of America’s diverse population and examining one’s own health-related values and beliefs, health care organizations, practitioners and others can support a health care system that responds appropriately to, and directly serves, the unique needs of populations whose cultures may be different from the prevailing culture.

Katz, Michael. Personal communication, November 1998.

Cultural and linguistic competence in health: A set of congruent behaviors, at agency or among professionals, that enables effective work in cross-cultural situations

Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.

Based on Cross, T., Bazron, B., Dennis K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care Volume I. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.

Culturally and linguistically appropriate services: Health care services that are respectful of and responsive to cultural and linguistic needs

National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, OMH, 2001.

Limited-English proficiency: Persons who have difficulty speaking, reading, writing or understanding the English language because they are individuals who:

  • Were not born in the United States or whose native language is a language other than English
  • Come from environments where a language other than English is dominant
  • Are American Indian and Alaskan Natives and who come from environments where a language other than English has had a significant impact on their level of English language proficiency
  • By reason, thereof, are denied the opportunity to learn successfully in classrooms where the language of instruction is English or to participate fully in our society

Adapted from A Study of Programs and Demographics for Students of Limited English Proficiency in Delaware Schools 1995-1996 School Year, Delaware Department of Education, 1996.

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Cultural competence pointers for clinicians

Robert C. Like, M.D., M.S., Director of the Center for Healthy Families and Cultural Diversity, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, reminds us:

  1. As clinicians, we need to “check our own pulse” and become aware of personal attitudes, beliefs, biases and behaviors that may influence (consciously or unconsciously) our care of patients as well as our interactions with professional colleagues and staff from diverse racial, ethnic, and sociocultural backgrounds.
  2. Every clinical encounter is cross-cultural. Developing partnerships with our patients and maintaining “cultural humility” can help us to learn occupational and environmental contexts in which our patients live.
  3. It should be understood that there is no “one” way to treat any racial and ethnic group, given the great sociocultural diversity within these broad classifications. We need instead to have a framework of interventions that can be individualized and applied in a patient- and family-centered fashion.
  4. Clinical and preventive care needs to be evidence-based, flexible, authentic and ethical. We need to appropriately tailor our interventions to patients, families and communities.
  5. Cookbook approaches about working with patients from diverse sociocultural backgrounds are not useful and instead risk potentially dangerous stereotyping and overgeneralization. Important intergenerational differences exist, and diversity is often greater within groups than between them.
  6. We need to challenge and confront racism, sexism, classism, and other forms of prejudice and discrimination that occur in clinical encounters as well as in the society-at-large.

Through collaboration and achieving a better understanding and appreciation of our commonalties and differences, patients and physicians can become empowered to work together with others to help eliminate racial and ethnic disparities in health care.

Betancourt and Like, 2000.