6.1 Cultural Competence

Question 1

What is culture

Answer 1

• set of practices and behaviors defined by customs, habits, language and geography that groups of individuals share
• accumulated store of shared values, ideas, attitudes, beliefs, norms, understandings, and practices of a group of people

Question 2

Intercultural sensitivity

Answer 2

Level of awareness of other cultures
->as ones experiences with other culture increases, so does competence with intercultural relations

each stage of development represents a particular worldview… and certain attitudes and behaviors

Question 3

intercultural sensitivity continuum

Answer 3

In order of ethnocentrism to ethnorelativism
- Denial, defence, minimization, acceptance, adaptation, integration

Question 4

Denial

Answer 4

• limited contact with people and cultures unlike ourselves -> vague awareness of the “other”
• the other is not viewed as a threat to the dominant group - little overt hostility -> assumptions about superiority of dominant group largely unconscious and unchallenged

Question 5

Defense

Answer 5

• Awareness of the other -> seen as a threat, contact discouraged
• Stereotyping common with emphasis on negative aspects of the other culture
• tendency to assert superiority of own culture ->

Question 6

Minimization

Answer 6

• Cultural differences acknowledged but seen as irrelevant ->superficial differences (etiquette and customs) acknowledged but “deep down we are all the same” “we all have same needs”
• “tolerant society” -> there is an expectation of eventual assimilation into the dominant culture

Question 7

Acceptance

Answer 7

-aware of cultural complexity of others -> shift to ethnorelativism
- cultures seen as different but equal -> differences viewed as interesting, positive,

Question 8

Adaptation

Answer 8

• Consider the perspectives of another culture in assessing how to respond to a particular situation -> showing both empathy and cultural humility
• growing awareness of your cultural lens -> and appreciate how others may see you through their cultural lenses

Question 9

Integration

Answer 9

• Bicultural/Multicultural in ones worldview -> identity not moored to any one culture
• Able to move easily and intentionally between different cultural frames of reference

Question 10

Why greater cultural awareness in HC?

Answer 10

• Pt populations increasingly diverse
  —>can affect how person perceives & experiences illness, who is consulted and how the symptoms are reported ->
• Cultural differences in health seeking behaviours -> western bio-medical model of disease vs other HC traditions
• Professional and moral obligation to provide best care to Pt -> miscommunication and misunderstandings based on lack of awareness of cultural factors leads to sub-optimal care

Question 11

What is cultural competence in HC?

Answer 11

• to possess attitudes, knowledge and skills that support the acquisition and integration of the realities of different cultures into your practice

Question 12

Attitudes in cultural competence

Answer 12

• Positive attitude toward own cultural heritage as well as your Pt’s -> appreciate and respect differences b/w backgrounds
• Be aware of your personal and professional values and biases ->

Question 13

Knowledge in cultural competence

Answer 13

• increase understanding of other cultures -> seek out various worldviews and models of disease
• Increase understanding of how culture affects distribution of health disparities, communication, assuming roles
• Familiarize with cultural-specific resources -> that may be suitable for groups and individiual

Question 14

Skills in cultural competence

Answer 14

• Communicate respectfully -> verbal and non-verbal
• Examine and explain issue from Pt perspective
• Advocate for Pt based on their needs and preferences

Question 15

How to increase cultural competence

Answer 15

• Examine cultural background
• Assess level of cultural sensitivity
• Talk with Pt’s from diverse backgrounds in community
• Read about cultural specific diseases and evidence based interventions -> tailor practice to what works best for the people you serve
• Immerse yourself in the community
• Work with Pt or community groups -> ensure your efforts align with health goals of community
• Hold staff meetings or seminars focused on cultural competence topics -> increase knowledge of you and staff
• Seek out traditional cultural healers
• Reach out to religious leaders and org’s -> beliefs and observances may make it difficult for Pts to participate in treatments

Question 16

Cultural competence cautions

Answer 16

• Tendency to gloss over the heterogeneity and fluidity that exist within a culture -> static view of culture may reinforce stereotypes
• Concern with reducing cultural awareness to a series of tick boxes -> may be seen as separate from clinical competence
• Failure to reflect on the culture of health care professions, and the attitudes and assumptions it creates around roles, values and acceptable world views
• Need for greater cultural humility

Question 17

Cultural Humility

Answer 17

• Intrapersonal -> having an accurate view of onself culturally and understanding the limitations of our own perspective and ability to understand anothers background
• Interpersonal -> openness to other cultures characterized by respect and lack of superiority