Cultural competence is the level of knowledge-based skills required to provide effective clinical care to patients from a particular ethnic or racial group.
- A set of congruent behaviors, attitudes and policies that come together as a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations.
- Cultural competence requires that organizations have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally.
- Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum.
Cultural incompetence in the business community can damage an individual's self-esteem and career, but the unobservable psychological impact on the victims can go largely unnoticed until the threat of a class action suit brings them to light.
Notice that some definitions emphasize the knowledge and skills needed to interact with people of different cultures, while others focus on attitudes. A few definitions attribute cultural competence or a lack thereof to policies and organizations. It's easy to see how working with terms that vary in definition can be tricky.
In an attempt to offer solutions for developing cultural competence, Diversity Training University International (DTUI) isolated four cognitive components: (a) Awareness, (b) Attitude, (c) Knowledge, and (d) Skills.
- Awareness. Awareness is consciousness of one's personal reactions to people who are different. A police officer who recognizes that he profiles people who look like they are from Mexico as "illegal aliens" has cultural awareness of his reactions to this group of people.
- Attitude. Paul Pedersen's multicultural competence model emphasized three components: awareness, knowledge and skills. DTUI added the attitude component in order to emphasize the difference between training that increases awareness of cultural bias and beliefs in general and training that has participants carefully examine their own beliefs and values about cultural differences.
- Knowledge. Social science research indicates that our values and beliefs about equality may be inconsistent with our behaviors, and we ironically may be unaware of it. Social psychologist Patricia Devine and her colleagues, for example, showed in their research that many people who score low on a prejudice test tend to do things in cross cultural encounters that exemplify prejudice (e.g., using out-dated labels such as "illegal aliens" or "colored".). This makes the Knowledge component an important part of cultural competence development.
Regardless of whether our attitude towards cultural differences matches our behaviors, we can all benefit by improving our cross-cultural effectiveness. One common goal of diversity professionals, such as Dr.Hicks from URI, is to create inclusive systems that allow members to work at maximum productivity levels.
- Skills. The Skills component focuses on practicing cultural competence to perfection. Communication is the fundamental tool by which people interact in organizations. This includes gestures and other non-verbal communication that tend to vary from culture to culture.
Notice that the set of four components of our cultural competence definition—awareness, attitude, knowledge, and skills— represents the key features of each of the popular definitions. The utility of the definition goes beyond the simple integration of previous definitions, however. It is the diagnostic and intervention development benefits that make the approach most appealing.
Cultural competence is becoming increasingly necessary for work, home, community social lives.
History in American ethnic studies
The United States in its earliest history had a culture influenced heavily by its Northern European population, primarily from the British Isles, who originally settled in the original British Colonies. While the indigenous peoples, known as Indians, were the largest population of North America, they were slowly pushed away from the Eastern Seaboard into the interior of North America during the 17th century, 18th century, and 19th century (see Indian Removal Act describing specific actions during early 19th century). During this period, people from the British Isles (England and Scotland primarily) brought the culture and religion of the British Isles with them to the United States and became the dominant political and cultural group along the Eastern Seaboard of North America.
Both voluntary immigration from other regions as well as the results of the Atlantic slave trade, brought a mix of people to the Americas, including Europeans, Africans, and, to a lesser extent until the 20th century, Asians. Thus began the process of diversifying the population of the Western Hemisphere. While the majority of the U.S. population were white immigrants from northern and western Europe and their descendants, they maintained most of the power, social and economic, of the nation.
In the U.S. context, immigration from the 1840s onward diversified the ethnic composition of the nation. During the early part of the 20th century, southern and eastern European immigrants and their descendants became a larger percentage of the population, but as recent immigrants concentrated in urban areas were also very often poor and lacking in basic healthy living and working conditions. Descendants of African slaves and immigrants faced a much more difficult challenge due to their skin color and discrimination enforced by legal systems, such as the Jim Crow laws in the United States. Since the 1960s, African Americans as well as other minority groups such as Mexican Americans have gained greater social and economic status and power.
Nonetheless, the dominant models of education and social services retained models developed by northern and western European intellectuals, even such well-meaning and important reformers as Jane Addams and Jacob Riis. After the Civil Rights movement of the 1950s and 1960s, though, social workers, activists, and even healthcare providers began to examine their practices to see if they were as effective in African American, Latino, and even Asian American communities in the U.S. The arrival of more than half a million Southeast Asian refugees, from 1975 to 1992, for example, tested the ability of medical and social workers to continue effective practice among speakers of other languages and among those coming from very different understandings of everything from mental health to charity.
Education in the United States
With the larger population of minorities and racial integration during the 1960s and 1970s, the public school system of the United States had to grapple with issues of cultural sensitivity as most teachers in public school system came from white, middle class backgrounds. Most of these teachers were educated, primarily English speaking, and primarily from the Western European cultures. They often had trouble trying to communicate with speakers of limited English proficiency, let alone people of vastly different value systems and normative behaviors from that of Anglo-European culture. The purpose of training educators and others in the area of cultural competence is to provide new teachers the background and skills to work effectively with children of all backgrounds and social classes.
With the growing diversity of the student body in U.S. public school, it is increasingly imperative that teachers have and continually develop a cultural competence that enables them to connect with, respond to, and interact effectively with their pupils. The achievement gap between cultural minority and majority students suggests a communication disconnect often occurs in minority classrooms because cultural mismatch between teachers and students is common and should not prevent positive, productive for both parties, provided the educator is a culturally competent communicator. Over the last few decades, scholars have increasingly shown interest in the relationship between learning, reading, schema, and culture. People's schema depends on their social location, which, as Anderson (1984) explains, includes a reader's age, sex, race, religion, nationality, and occupation, amongst other factors. Considering schemata determine how people understand, interpret, and analyze everything in their world, it is clear that background and experience really do affect the learning and teaching processes, and how each should be approached in context. "In short," Anderson (1984) says, "the schema that will be brought to bear on a text depends upon the reader's culture" (p. 374-375). More simply, Anderson (1984) describes a person's schema as their "organized knowledge about the world" (p. 372). In considering the role of schema, one of the educator's principal functions in teaching, particularly with literacy, is to "‘bridge the gap between what the learner already knows and what he needs to know before he can successfully learn the task at hand'" (Anderson, 1984, p. 382). This is important because Staton (1989) explains that student learning—i.e. successful communication between instructor and pupil—occurs when teachers and students come to "shared understandings" (p. 364). Thus, teachers must remember that they are "cultural workers, not neutral professionals using skills on a culturally-detached playing field" (Blanchett, Mumford & Beachum, 2005, p. 306).
Teachers and administrators in the public school systems of the United States come in contact with a wide variety of sub-cultures and are at the forefront of the challenge of bringing diverse groups together within a larger American society. Issues confronting teachers and administrators on a daily basis include student learning disabilities, student behavioral problems, child abuse, drug addiction, mental health, and poverty, most of which are handled differently within different cultures and communities.
Examples of cultural conflicts often seen by teachers in the public school system include:
- role of women in the family and the decisions they can make
- practices among cultural groups (e.g. fire cupping)
- symbol systems among cultural groups (see semiotics)
Examples of sub-groups within the United States: African American, Asian American, Indian American, Irish American, Jewish American, Mexican American, Native Americans or American Indians and refugees.
The provision of culturally tailored health care can reduce disparities among patient populations and reduce problems associated with linguistic barriers. In 2005, California passed Assembly Bill 1195 that requires patient-related continuing medical education courses to incorporate cultural and linguistic competence training in order to qualify for certification credits. In 2011, HealthPartners Institute for Education and Research implemented the EBAN Experience™ program to reduce health disparities among minority populations, most notably East African immigrants.
Hispanic versus Latin American
The term “Hispanic” is problematic. It is impossible to refer to “a Hispanic-American perspective” or to “a single Latino culture.”(1)(2) The label “Hispanic” is controversial because it was coined by the Federal Government to describe a heterogeneous ethnic population whose ancestors come from a Spanish speaking country. Although these American citizens have Latin American roots, the term “Latino” to characterize them is more correct since it is more inclusive of non-Spanish-speaking Latinos. However, the term "Latino" does not include individuals from Spanish speaking countries outside of Latin America (e.g., Spain).
There is also a lack of adequate research into how race and ethnicity affects members of a group.(3)(4)(5) There are few life histories and phenomenological studies of illness as experienced by people outside the American white, urban, middle class, especially of immigrant and native populations. Race has been used to explain the absence of research. Racial classifications are based on outmoded concepts and dubious assumptions regarding genetic differences. In fact, outside of skin color, race is poorly correlated with biological or cultural phenomena, which sharply diminishes its validity in biomedical or social research. Yet, unlike race or national origin, ethnicity is a sociological construct highly correlated with behavioral and cultural phenomena, particularly language, dress, adornment, food preference, religion, social interaction, marriage and family customs.
Further research is needed to determine whether race and ethnicity among Latinos are rather driven by mechanisms of discrimination and macrosocial factors or social status. Fortunately, not too long ago, the National Institutes of Health took an important step by insisting that any NIH- supported clinical investigation include, where appropriate, minority populations, women and the aged.(6) However, we must guard against what has been called a new “tokenism," that is, having a large aggregate of “non-whites”, and a few African Americans and Hispanics included. This aggregate will never produce a proper sample. Rigorous attention to sample size, composition and sampling strategies is required to research basic psychosocial processes and clinical responses of minority populations. Accordingly, the heterogeneity of the Hispanic community has to be taken into account. The Hispanic's country of origin, cultural history, migration history, language, family, traditions, religion, educational level, socio-economic status, gender, sexual orientation, age and generation--- all need to be explored.
- Cultural Health
- Cross-cultural communication
- Cultural behavior
- Immigration to the United States
- Intercultural communication principles
- Intercultural competence
- Intercultural relations
- Social constructionism
- Josepha Campinha-Bacote (2002). "The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care". Journal of Transcultural Nursing.
- "THE IMPORTANCE OF CULTURAL COMPETENCE IN HEALTHCARE". Cultural Candor Inc. Retrieved 25 November 2015.
- "State Legislation Requires Inclusion of Cultural and Linguistic Competence in Continuing Medical Education, Increasing Acceptance of Their Importance by Educational Programs and Clinicians". Agency for Healthcare Research and Quality. 2013-09-25. Retrieved 2013-09-25.
- "Clinics Offer Culturally Tailored Diabetes Education and Culturally Appropriate Care to Ethiopian Patients, Leading to More Engagement, Better Outcomes, and Reduction of Health Disparities". Agency for Healthcare Research and Quality. 2014-01-29. Retrieved 2014-01-29.
- 1. Stavans, I. (1995) The Hispanic Condition: Reflections on Culture and Identity in America. Harper Collins
- 2. Sea, M.C., et al. (1994) Latino Cultural Values: Their Role in Adjustment to Disability. Psychological Perspectives on Disability. Select Press CA
- 3. Anderson, M. Moscou, S. (1998) Racism and Ethnicity in Research on Infant Mortality, Methodological Issues in Minority Health Research. Family Practice, Vol. 30#3,224-227
- 4. Krieger, n. et al. (1993) Racism, Sexism, and Social Class: Implications for Studies in Health, Disease, and Well-being. American Journal of Preventive Medicine. Supp. to Vol. 9#4,82-122
- 5. Macaulay, A.C., el. al. (1999) Responsible Research with Communities: Participatory Research in Primary Care. North America Primary Care Research Group Policy Statement.
- 6. Hayunga, E.G., Pinn, V.W. (1999) NIH Policy on the Inclusion of Women and Minorities as Subjects in Clinical Research. 5-17-99*Mercedes Martin & Billy E. Vaughn (2007). Strategic Diversity & Inclusion Management magazine, pp. 31–36. DTUI Publications Division: San Francisco, CA.
- Nine-Curt, Carmen Judith. (1984) Non-verbal Communication in Puerto Rico. Cambridge, Massachusetts.
- Anderson, R. C. (1984). Role of the reader's schema in comprehension, learning, and memory. In Learning to read in American schools: Basal readers and content texts (pp. 373–383). Laurence Earlbaum Associates.
- Blanchett, W. J., Mumford, V., & Beachum, F. (2005). Urban School Failure and Disproportionality in a Post-Brown Era. Remedial and Special Education, 26(2), 70-81.
- Chamberlain, S. P. (2005). Recognizing and responding to cultural differences in the education of culturally and linguistically diverse learners. Intervention in School & Clinic, 40(4), 195-211.
- Moule, Jean (2012). Cultural Competence: A primer for educators. Wadsworth/Cengage, Belmont, California.
- Staton, A. Q. (1989). The interface of communication and instruction: Conceptual considerations and programmatic manifestations. Communication education, 38(4), 364-372.
- http://www.adph.org/ALPHTN/Default.asp?DeptId=143&TemplateId=3780&TemplateNbr=3 (video) Building Cross-Cultural Partnerships in Public Health, Alabama Department of Public Health
- http://gucchd.georgetown.edu/nccc/ National Center for Cultural Competence at Georgetown University
- http://www.nasponline.org/culturalcompetence/ National Association of School Psychologists
- http://www.gov.bc.ca/bvprd/bc/search.do?navId=NAV_ID_-8379&action=searchresult&qp=&nh=10&ministry_search=0&ministry_search=1&qt=competency%20assessment%20tool Competency Assessment Tool From Ministry for Children & Families, Government of British Columbia
- http://www.aoa.gov/prof/adddiv/cultural/CC-guidebook.pdf Achieving Cultural Competence guidebook from Administration on Aging, Department of Health and Human Services, United States
- http://www.med.umich.edu/multicultural/ccp/tools.htm University of Michigan Program For Multicultural Health
- http://www.xculture.org Cross Cultural Health Care Program
- http://www.centre4activeliving.ca/publications/wellspring/2006/oct/oct06.pdf Diversity in Practice: Becoming Culturally Competent
- http://www.thinkculturalhealth.org Bridging the Health Care Gap through Cultural Competency Continuing Education Programs
- http://sherwoodfleming.com/the-intercultural-cost-of-silence/ What is the Cost of Intercultural Silence?
- Stuart, R. B. (2004). Twelve Practical Suggestions for Achieving Multicultural Competence. Professional psychology: Research and practice, 35(1), 3.