What is cultural competency?
Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, 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.
And why is it important?
Cultural competency is one of the main ingredients in closing the disparities gap in health care. It’s the way patients and doctors can come together and talk about health concerns without cultural differences hindering the conversation, but enhancing it. Quite simply, health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes.
Culture and language may influence…
Health, healing, and wellness belief systems; how illness, disease, and their causes are perceived; both by the patient/consumer and the behaviors of patients/consumers who are seeking health care and their attitudes toward health care providers; as well as the delivery of services by the provider who looks at the world through his or her own limited set of values, which can compromise access for patients from other cultures.
The increasing population growth of racial and ethnic communities and linguistic groups, each with its own cultural traits and health profiles, presents a challenge to the health care delivery service industry in this country. The provider and the patient each bring their individual learned patterns of language and culture to the health care experience which must be transcended to achieve equal access and quality health care.
Culture can influence treatment plans
The effect the patient’s culture will have on their acceptance and adherence to the treatment plan should also be considered. Common influences are:
- Values – things they hold important and therefore affect their behavior
- Religion and their theory about reality
- The individual vs. the family
- Independence vs. dependence
- Privacy vs. Openness
- Health & Fitness – what is their definition of healthy
- Physical appearance – what is their definition of beauty
- Modesty
- Self-control vs. expressiveness
- Present vs. Past vs. Future time orientation
- Social structure – democratic vs. hierarchical
- Gender roles – men, women, children
- Gender and taboos
- Food
- Alternative medicine and health care providers
Effective communication is key
The challenges to caring for patients of multiple cultures can often be overcome simply through effective communication. The appropriate use of professional interpreters cannot be overemphasized. Family members, friends and “informal” interpreters are more likely to modify what the patient has actually stated, whereas professional interpreters are trained to convey messages without interjecting their own opinions, beliefs or prejudices. Laws and regulations guarantee non-English speaking patients “meaningful access” to health and social services that receive any form of federal funding.
As a health care professional you must become acquainted with the policies, procedures and resources at the facility you are assigned when it comes to accessing services of a professional interpreter. When the health care professional is able to converse with the patient from another culture the primary way to convey empathy, interest and concern is through effective communication.
- Activities that can contribute to effective communication include:
- Asking non-judgmental questions to help understand the patient’s perspective
- Attentive listening – listening for clues on the patient’s comprehension of the situation and course of treatment
- Working with the patient (and family – when appropriate and desired by the patient) to set goals and to understand their ability to adhere to the recommended treatment plan
- Involve the patient and family (when appropriate/desired) in the decision making and treatment planning process
Culture differences come with non-verbal methods of communicating
Observation and appreciation for nonverbal communication by the patient as well as the health care professional’s own nonverbal communication include paying attention to:
- Facial expressions
- Touching
- Hand and arm gestures
- Eye contact
- Head movements
- Posture
- Physical space
Body language
Body language is a term for communication using body movements or gestures instead of, or in addition to, sounds, verbal language or other communication. It forms part of the category of paralanguage, which describes all forms of human communication that are not verbal language. This includes the most subtle of movements that many people are not aware of, including winking and slight movement of the eyebrows. In addition, body language can also incorporate the use of facial expressions.
Although they are generally not aware of it, many people send and receive non-verbal signals all the time. The technique of ‘reading’ people is used frequently. For example, the idea of mirroring body language to put people at ease is commonly used in interviews. It sets the person being interviewed at ease. Mirroring the body language of someone else indicates that they are understood.
U.S. Department of Health & Human Services: The Office of Minority Health
The mission of the Office of Minority Health (OMH) is to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities. OMH was established in 1986 by the U.S. Department of Health and Human Services (HHS). It advises the Secretary and the Office of Public Health and Science (OPHS) on public health program activities affecting American Indians and Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians, and other Pacific Islanders.
Did you know?
- Providers may order fewer diagnostic tests for patients of different cultural backgrounds because they may not understand or believe the patient’s description of symptoms. Alternatively, providers may order more diagnostic tests to compensate for not understanding what their patients are saying.
- Patients may not adhere to medical advice because they do not understand or do not trust the provider.
- African-Americans may be less likely to be referred for cardiac catheterization than Caucasians, even when presenting with the same symptoms.
- Although Hispanics have a lower incidence of breast, oral cavity, colorectal, and urinary bladder cancers, their mortality from these is similar to that of the majority population.
- Newly arrived immigrants and refugees from several parts of the world should be tested for tuberculosis, hepatitis, intestinal parasites, malaria, and post-traumatic stress disorder.
- Please keep in mind that while culture is an essential mediator in people’s health status, culture is not the only factor that shapes us. Other factors including environment, economics, genetics, previous and current health status, and psycho-social factors exert considerable influence on our well-being.
In conclusion, cultural competence by the healthcare professional is an ongoing process. Cultural sensitivity, cultural diversity and cultural awareness are an inevitable part of the healthcare profession.
This is simply an overview of some of the concepts the healthcare professional must consider. All healthcare professionals must continue their cultural awareness training on a daily basis as they communicate and interact with their patients.