Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.
The term cultural competence was first used by Terry L. Cross and colleagues in 1989, but it was not until almost a decade later that health care professionals began to be formally educated and trained in cultural competence. In 2002, cultural competence in health care emerged as a field and has been increasingly embedded into medical education curricula and taught in health settings around the world since then.
Definitions Cultural competence is a practice of values and attitudes that aims to optimize the healthcare experience of patients with cross cultural backgrounds."Cultural Competency | Human Services Education". www.humanservicesedu.org. Retrieved 2019-12-03. Essential elements that enable organizations to become culturally competent include valuing diversity, having the capacity for cultural self-assessment, being conscious of the dynamics inherent when cultures interact, having institutionalized cultural knowledge, and having developed adaptations to service delivery reflecting an understanding of cultural diversity. By definition, diversity includes differences in race, ethnicity, age, gender, size, religion, sexual orientation, and physical and mental ability.The American Heritage® New Dictionary of Cultural Literacy. (2005). Third Edition. Boston: Houghton Mifflin Company. Accordingly, organizations should include these considerations in all aspects of policy making, administration, practice, and service delivery.
Cultural competence involves more than having sensitivity or awareness of cultures. It necessitates an active process of learning and developing skills to engage effectively in cross-cultural situations and re-evaluating these skills over time.Office of Minority Health. (2002). Teaching cultural competence in health care: A review of current concepts, policies and practices. Washington D.C.: U. S. Department of Health and Human Services. Contract Number: 282 - 98 - 0029. Cultural competence is often used interchangeably with the term cultural competency. Multicultural competency is a more encompassing term that includes the ability to function effectively in cross-cultural interactions with a wide range of different cultural groups. Acquiring cultural competence is a continuous process.
Other terms relating to cultural competence include cultural responsiveness, cultural humility, cultural intelligence, and cultural safety. Cultural responsiveness involves recognizing the unique cultural identity of each client and exploring the differences as well as being open to valuing clients’ knowledge and expertise. Cultural humility is the process by which providers participate in the process of self-reflection and self-critique devoted to being life-long learners or practitioners to further address power differences between professionals and clients and a commitment to respect the clients’ values. Cultural intelligence relies on cultural metacognition (knowledge of your own attitudes and values) and encompasses the ability to interact effectively with culturally different clients. Cultural safety relates to the assumptions of power held by health providers of particular groups of people that have been historically marginalized. Providers must recognize their own beliefs, attitudes, and culture to foster a safe, trusting, and respectful experience for their clients to encourage trust and empowerment.
Awareness The awareness aspect of cultural competence relates to the consciousness of one's personal reactions to people who look or exhibit different practices from cultural norms. According to the American Sociological Association, culture itself is understood as the languages, customs, beliefs, rules, arts, knowledge, collective identities, and memories shared by members of a social group that form the foundations of motives or actions. In measuring cultural competence in health care, one must recognize their own implicit biases toward patients or employees. Lack of awareness causes cultural discrimination during patient care. An analysis by researchers at UC San Francisco, UC Berkeley, and Stanford University found that almost one in five patients with chronic conditions over the age of 54 reported feeling discrimination within health care in a national survey that took place between 2008 and 2014.
Attitude Paul Pedersen, a pioneer in multicultural competence, theorized a framework of culturally competence practices that consisted of three factors: awareness, knowledge, and skills. The Diversity Training University International (DTUI) included an attitude component that is delineated from the other factors increasing the analysis of general biases and beliefs as a scheme in one's daily life. This differs from an exercise that forces students to examine their own values and beliefs of cultural differences.
Knowledge The problem of cultural incompetency lies in the lack of familiarity of the cultural and social experiences of the patient. Social psychologist Patricia Devine and her colleges conducted research that found that low-scorers on a cultural familiarity test tended to exemplify more discriminatory actions or speech in cross-cultural interactions. When awareness, attitudes, and knowledge are given prominence in these encounters, ethnocentrism, racism, and inequitable relations are no longer present.
Knowledge of culture also includes awareness of the structural, social, and environmental barriers that give meaning to certain actions in patients' lives. In the Cross-cultural Counseling Inventory, practitioners are examined by their understanding of "the current socio-political system and its impact on the client". In 2017, there was an estimated 20.5 million Black, Hispanic, and Native Americans living below the poverty line. Without taking aspects like socioeconomic status, immigrant status, and environment into consideration, physicians often resort to stereotyping or biases in their behavior.
Skills The skills aspect of cultural competence involves implementing the practices of cultural knowledge, sensitivity, and awareness into daily experiences with patients. One aspect of developing skills is learning respectful and effective communication strategies whether within an organization or between individuals. Learning communication practices includes examining communication through body language and other non-verbal cue as some gestures may have extreme variations and meanings from one culture to another. Developing skills is an active process that requires reexamining one's own internal belief system.
Cultural competence in various settings
Healthcare system A healthcare system, sometimes referred to as health system, is the organization of people, institutions, and resources that deliver healthcare services to meet the health needs of target populations. A culturally competent health system not only recognizes and accepts the importance of cultural diversity at every level but also assesses the cross-cultural relations, stays vigilant towards any changes and developments resulting from cultural diversity, broadens cultural knowledge, and adapts services to meet the needs that are culturally-unique.
As more and more immigrants are coming to America, healthcare professionals with good cultural competence can use the knowledge and sensitivity that they obtain in order to provide holistic care for clients from other countries, who speak foreign languages. The challenges for American healthcare systems to meet the health needs of the increasing number of diverse patients are becoming very obvious. The challenges include but are not limited to the following: Sociocultural barriers Poor cross-cultural communication Language barriers Attitudes toward healthcare Beliefs in diagnosis and treatment Lack of cultural competence in the design of the system
Leadership and workforce In response to a rapid growth of the population of minority groups in the United States, healthcare organizations have responded by providing new services and undergoing health reforms in terms of diversity in leadership and workforce. Despite improvements and progress seen in some areas, minorities are still underrepresented within both healthcare leadership and workforce.
Clinical practice To provide culturally sensitive patient-centered care, physicians should treat each patient as an individual, recognizing and respecting his or her beliefs, values and care seeking behaviors. However, many physicians lack the awareness of or training in cultural competence. With the constantly changing demographics, their patients are increasingly getting diverse as well. It is utterly important to educate physicians to be culturally competent so that they can effectively treat patients of different cultural and ethnic backgrounds.
Ignorance of these cultural differences could manifest in discomfort for the patient, subpar healthcare, incorrect diagnosis, and even racism, all which lower patients’ access to quality healthcare. Studies stress culturally sensitive training and education programs in healthcare settings that will impart to physicians how culture can affect healthcare treatment. Additionally, when interacting with patients of different cultures, specifically East Asian culture, it is important to “bridge the health care system with more traditional Eastern medical care… entail[ing] education for health professionals as part of a broader curriculum on providing culturally competent care.” Within western healthcare, there are also large amounts of inaccuracies and misperceptions of health risks for different minority groups, which could be addressed through further linguistically and culturally appropriate health education.
Implicit bias aimed towards certain races or ethnicities is frequent in the healthcare field, specifically in the United States, commonly with Black Americans, Hispanic Americans, and American Indians. Subconscious discrimination occurs regardless of the advancement of disease prevention in the United States, as shown by the significantly high mortality rates of the groups mentioned earlier in the paragraph. This discrimination is shaped by attitudes of healthcare professionals, who often differ in effort and type of treatment based on the race and physical appearance of a patient. Carrying over to the diagnosis and treatment of minority patients, the disparities in quality of healthcare increase the likelihood of developing diseases such as asthma, HIV/AIDs and other life-threatening diseases. For example, a study that focused on the treatment and diagnosis differences between black women and white women in regards to breast cancer indicated this discrimination against minorities and its effects. Furthermore, the study indicated that "white women are more likely to be diagnosed with breast cancer, [and] Black women are more likely to die from it."