Cultural Competence: Do you have it?

Floyd B. Willis, M.D.

 
Racial and ethnic disparities exist in all facets of American society, but there is no more of a dramatic delineation than in the field of healthcare. This issue of Duval Medical Society journal will explore the issues of how people from diverse racial backgrounds suffer disproportionately from a number of debilitating diseases.

These health disparity problems run deep within the United States health care system and within the general fabric of our society. The problems arise from a set of very complex socioeconomic issues. The disparity statistics are alarming and often the problems seem insurmountable.

However, patients and physicians can empower themselves to work together to eliminate these disparities. In fact, given the increase in diversity of our nation, it will become imperative that more focused efforts be placed on resolving the disparity and finding ways for individual healthcare providers to play a role in solving this enormous problem.

Although we often view solving these kinds of large scale epidemiological problems as the responsibility of the government and large health care organizations, each of us has an important role to play in resolving this problem. That role begins with us being sure that we are providing care to those from muticultural backgrounds in a competent, culturally sensitive manner.

Cultural competence: what is it and do I need it?

Definition: Cultural Competence

The Office of Minority and Women's Health (OMWH) defines cultural and linguistic competency as a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals and enables those groups to work effectively in cross cultural situations.

Cultural Competency is a subject of great interest in the business and educational communities, but is particularly important in the health care arena. The importance of physicians and health care workers being well informed about cultural sensitivity is well recognized by the American Medical Association, which has formulated a Cultural Competence Compendium 2000 that is available in print and at the AMA website. Additionally, formal training on cultural competence is now required to be integrated in to most graduate medical training programs. The war on racial disparity in healthcare will likely not be won without widespread recognition of the virtues of cultural competence. All health care providers should be aware of the concept of cultural competence.

Assess and Improve your Cultural Competence!

Unfortunately many of our medical school curriculums have not traditionally prepared us to interact with and treat patients who are from backgrounds that are different from ours. Nevertheless, there are things that each of us can do in our own offices to improve our own ability to provide culturally sensitive care:

  1. Acknowledge and Value Patients Diversity: We must not merely tolerate populations from different cultures, but consider their differences as strengths. We must also be clear that cultural differences are not synonymous with cultural inferiority.1 2
  2. Assess yourself. On the following page is a simple self-assessment tool developed by Tawara D. Goode of the Georgetown University Child Development Center. It can provide physicians with insight in areas where they might improve lies receiving services.
  3. Learn about patient's culture. By being knowledgeable of your patient's culture and background you will be better able to account for the impact of emotional, social and psychological issues on the biomedical illnesses that you seek to treat.
  4. Optimize your care: Once you have familiarized yourself with culturally pertinent information, adapt and optimize your health care delivery to and acceptable cultural framework.

If we are to adequately address the racial and ethnic health care disparity problem in the United States, it will be important to understand not only patient and community barriers to care but also physician and healthcare institution barriers as well. By striving to better understand our differences and commonalties we not only work toward political correctness but also work toward what will be a better healthcare delivery system in general.

 

Promoting Cultural and Linguistic Competency

Self Assessment Checklist for Personnel providing Primary Health Care Services.

Directions: Please enter A, B or C for each item listed below:

  1. Things I do frequently

  2. Things I do occasionally

  3. Things I do rarely or never

 

Physical Environment, Materials & Resources

  1. ______ I display pictures, posters, artwork and other décor that reflect the cultures and ethnic back-grounds of clients served by my program or agency.
  2. ______ I ensure that magazines, brochures and other printed material in the reception area are of interest to and reflect the different cultures of individuals and families served by my practice, program, or agency.
  3. ______ When using videos, films or other media resources for health education, treatment or other interventions, I ensure that they reflect the cultures and ethnic background of individuals and families served by my practice, program, or agency.
  4. ______ I ensure that printed information disseminated by my practice ,agency or program takes into account the average literacy levels of individuals and families receiving services.

Communication Styles

  1. When interacting with individuals and families who have limited English proficiency, I always keep in mind that:

______ Limitations in English proficiency are in no way a reflection of their level of intellectual functioning.

______ Their limited ability to speak the language of the dominant culture has no bearing on their ability to communicate effectively in their language of origin.

______ They may or may not be literate in their language of origin or English.

  1. ______ I use bilingual-bicultural staff and/or personnel and volunteers skilled or certified in the provision of medical interpretation during treatment, interventions, meetings or other events for individuals and families who need or prefer this skill or assistance.
  2. ______ For Individuals and families who speak languages or dialects other than English, I attempt to learn and use key words in their language so that I am better able to communicate with them during assessment, treatment or other interventions.
  3. ______ I attempt to determine any familial colloquialisms used by individuals or families that may impact on assessment, treatment or other interventions.
  4. ______When possible, I ensure that all notice and communiqués to individuals and families are written in their language of origin.
  5. ______ I understand that it may be necessary to use alternatives to written communications for some individuals and families, as word of mouth may be a preferred method of receiving information.

Values & Attitudes

  1. ______ I avoid imposing values that may conflict or be inconsistent with those of cultures or ethnic groups other than my own.
  2. ______ I screen books, movies and other media resources for negative cultural, ethnic or racial stereotypes before sharing them with individuals and families served by my practice program or agency.
  3. ______ I intervene in an appropriate manner when I observe other staff or clients within my practice,program or agency engaging in behaviors that show cultural insensitivity, racial biases and prejudice.
  4. ______ I recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture.
  5. ______ I understand and accept that family is defined differently by different cultures (e.g., extended family members, godparents).
  6. ______ I accept and respect that male-female roles may vary significantly among different cultures and ethnic groups (e.g.,who makes major decisions for the family).
  7. ______ I understand that age and life-cycle factors must be considered in interactions with individuals and families (e.g., high value placed on the decision of elders, the role of eldest male or female in families, or roles and expectation of children within the family).
  8. ______ Even though my professional or moral viewpoints may differ, I accept individuals and families as the ultimate decision makers for services and supports impacting their lives.
  9. ______ I recognize that the meaning or value of medical treatment and health education may vary greatly among cultures.
  10. ______ I accept that religion and other beliefs may influence how individuals and families respond to illnesses, disease and death.
  11. _____ I understand that the perception of health, wellness and preventive health services have different meanings to different cultural or ethnic groups.
  12. _____ I recognize and accept that folk and religious beliefs may influence an individual's or family's reaction and approach to a child born with a disability, or later diagnosed with a disability, genetic disorder or special health care needs.
  13. _____ I understand that grief and bereavement are influenced by culture.
  14. _____ I seek information from individuals, families or other key community informants that will assist in service adaptation to respond to the needs and preferences of culturally and ethnically diverse groups served by my program or agency.
  15. _____ Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs and expectations that are unique to the culturally and ethnically diverse groups served by my program or agency.
  16. _____ I keep abreast of the major health concerns and issues for ethnically and racially diverse client populations residing in the geographic locale served by my program or agency.
  17. _____ I am aware of the socioeconomic and environmental risk factors that contribute to the major health problems of culturally, ethnically and racially diverse populations served by my program or agency.
  18. _____ I am well versed in the most current and proven practices, treatments and interventions for major health problems among ethnically and racially diverse groups within the geographic locale served by my agency or program.
  19. _____ I avail myself to professional development and training to enhance my knowledge and skills in the provision of services and supports to culturally, ethnically, racially and linguistically diverse groups.
  20. ____ I advocate for the review of my practice, program or agency's goals, policies and procedures to ensure that they incorporate principles and practices that promote cultural and linguistic competence.

How to use the checklist

This checklist is intended to heighten the awareness and sensitivity of personnel to the importance of cultural and linguistic competence in health and human service settings. It provides concrete examples of the kinds of beliefs, attitudes, values and practices that foster cultural and linguistic competence at the individual or practitioner level. There is no answer key with correct responses. However, if you frequently responded "C", you may not necessarily demonstrate beliefs, attitudes, values and practices that promote cultural and linguistic competence within health care delivery programs.3

 
References
  1. Cross TL, Bazron BJ, Dennis KW, Isaacs MR, Towards a Culturally Competent System of Care: Vol 1. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Child Development Center; 1989.
  2. ISCOPS (interdisciplinary studies of community-oriented preventive enhancement services). Can be found at http://gwunc.edu/iscopes/execumm.html
  3. Self-assessment developed by Tawara D. Goode, Georgetown University Child Development Center-UAP, Adapted with permission from Promoting Cultural Competence and Cultural Diversity in Early Intervention and Early Childhood Settings and Promoting Cultural Competence and Cultural Diversity for Personnel Providing Services and Supports to Children with Special Health Care Needs and Their Families (June 1989, latest revision July 2000).

January 2001 / Jacksonville Medicine

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