Cultural Competence

Question 1

What is race?

Answer 1

People with shared physical attributes or traits, or skin colour, e.g. Black or white

Question 2

What is ethnicity?

Answer 2

Long shared cultural experiences, religious practices, traditions, ancestry, language, dialect or national origins, e.g. African-Caribbean, Travellers, etc

Question 3

What does BME/BAME stand for?

Answer 3

Black
Asian and
Minority
Ethnic groups

Question 4

Which areas have attracted a high proportion of BAME, leading to more ethnically diverse communities?
(2)

Answer 4

London
Other metropolitan cities

Question 5

What can the changing demographic within the UK be due to?
(3)

Answer 5

Increased levels of migration,e.g. for education, family, work, etc

More refugees and displaced people entering due to conflicts or natural disasters

More people with parents from other countries are being born in the UK

Question 6

How does an increase in diversity in the UK impact healthcare professionals?

Answer 6

They have to make sure that the services they provide can suit the needs of the whole population. So they have to regularly reassess and adapt services to meet the cultural needs of the population

Question 7

What specific law sets out the responsibilities that the NHS should operate under?

Answer 7

The NHS Constitution (2013)

Question 8

What does the NHS Constitution say?
(3)

Answer 8

Every individual matters

There should be equal access of healthcare to everyone regardless of gender, race, disability, age, sexual orientation or belief

There’s now a duty to promote equality- specific alt to promote better health for disadvantaged groups and those who has less favourable health outcomes than the rest of the population

Question 9

What are some policies and acts that aim to reduce inequalities at a local and national level?
(6)

Answer 9

Equality Act 2010

9 protected characteristics

Human Rights Act 1998

Mental Capacity Act 2005

The Care Act 2014

The Health and Care Act 2022

Question 10

What is the Equality Act 2010?

Answer 10

The legislation that surrounds the topics of equality and diversity. It covers all areas of society,including health and social care. It works off the structure of the 9 protected characteristics

Question 11

What are the 9 protected characteristics?

Answer 11

Age
Disability
Marriage and civil partnership
Pregnancy and maternity
Race
Religion and belief
Sex
Gender reassignment
Sexual orientation

Question 12

What is the Human Rights Act 1998?

Answer 12

The principles of basic human rights and equality. It has 5 main principles

Question 13

What are the 5 main principles of the Human Rights Act 1998?

Answer 13

Fairness
Respect
Equality
Dignity
Autonomy

Question 14

What is the Mental Capacity Act 2005?

Answer 14

It helps people who are unable to maintain their independence, dignity and the right to freedom (vulnerable people) the ability to maintain their right to dignity and equality

Question 15

What is the Care Act 2014?

Answer 15

It underpins all help with vulnerable adults. This includes ensuring that adults give consent for support that is tailored to them and chosen by them

Question 16

What is the Health and Care Act 2022?

Answer 16

The act that contains a description of all the powers that different NHS bodies have to collect, analyse and publish information about inequalities between people and their ability to access health services. Also about inequalities between people relating to the outcomes of their time in health services

Question 17

Why is it important to adapt to change?
(2)

Answer 17

It prevents differential outcomes and experiences between cultural groups

It allows everyone to have a good experience within the healthcare system relating to access to care, choice and quality of care. E.g. in areas with higher levels of poverty, often seen in Black, Asian and ethnic minority communities, it’s reported that they experience poorer clinical outcomes, inequalities in health and lower life expectancy, which has a negative impact on patient satisfaction

Question 18

What are the variations in health services between communities more likely to be a sign of?

Answer 18

Differences in service performance towards a certain social or cultural group, leading to unwarranted variation

Question 19

Are unwarranted variations always intentional?

Answer 19

No

Question 20

What do unwarranted variations show?

Answer 20

That the way we plan and deliver services needs to be changed to give people an equal chance of good outcomes and experiences of care

Question 21

What can the differences in the health and care outcomes of ethnic minority groups be due to?

Answer 21

Cultural blindness

Question 22

What is cultural blindness?

Answer 22

Claiming not to see differences in race, culture or ethnicity, causing you to treat everyone the same with a one size fits all approach (which doesn’t represent person-centred care or an equal chance for all)

Question 23

What do we need to do to create inclusive care?

Answer 23

We need to be able to construct a new dialogues with our patients, their families and our local communities, so they can see themselves as experts in their own lives

Question 24

What does creating inclusive care help to improve?

Answer 24

Our services to align to patients’ cultural values, individual beliefs and expectations, so we don’t risk minimising the real differences and cultural contexts that people have- as this has an important role in promoting health and wellbeing

Question 25

What is culture?

Answer 25

It can be a way of life for people, or it could be linked to a person’s background or heritage.

Question 26

Is culture genetic?

Answer 26

No- it’s learned, shared and transmitted from one generation to the next

Question 27

What are some observations of culture?
(9)

Answer 27

Education
Worship and religion
Language
Diet
Art and music
Humour
Clothing
Child-rearing methods
Life experiences and upbringing

Question 28

What are the 2 aspects of culture?

Answer 28

Visible aspects

Non-visible aspects

Question 29

What are visible aspects of culture?

Answer 29

Obvious and observable characteristics of a group that we can see with our eyes, e.g. music, art, greetings, rituals, etc

Question 30

What are non-visible aspects of culture?

Answer 30

The more influential and unrecognised subconscious elements of a group. They include a culture’s core beliefs, values and thought patterns, e.g. what’s seen as right/desirable and what’s not

Question 31

What is acculturation?

Answer 31

The process that members of a cultural group adopt the cultural beliefs and behaviours of another group

Question 32

Why does acculturation happen?
(2)

Answer 32

Because of their environment

If the group felt rejected or excluded

Question 33

When is acculturation often seen?

Answer 33

When people move from one country to another. This can happen by necessity or by choice

Question 34

Why else would cultural information be required in healthcare?
(3)

Answer 34

Understanding the content of usual foods included in family meals to help give advice about medicines or the control of diabetes

Awareness of how LGBTQ+ sexuality is viewed or accepted within different cultural or religious groups, which may help to guide conversations around emotional wellbeing

Knowledge of religious observances during pregnancy or childbirth, which may impact on decisions about plans or person-centred care

Question 35

Why can cultural information be a barrier?

Answer 35

Because it can cause health and care services to make assumptions or broad generalisations based on race or ethnicity, rather than providing services based on the individual’s needs and preferences

Question 36

When is culturally specific information only useful?

Answer 36

If it’s relevant to the individual concerned

If it’s appropriate to the purpose for which it’s being asked

Question 37

What is the issue with simplifying ethnic minority to BAME?

Answer 37

It can cause a risk of individuals oversimplifying ethnic groups

Question 38

Are refugees and asylum seekers with an active application or appeal fully entitled to free NHS care?

Answer 38

Yes

Question 39

What are examples of where cultural beliefs could impact health and care needs?
(6)

Answer 39

Body language, e.g. making or avoiding eye contact can be seen as rude or polite

Healthcare system- people may be unaware of the system, so they could delay seeking help or following additional care for fear of the cost of care. So we must provide them with this information

Expressing physical and emotional pain- the way patient’s express it could be different based on their specific social and cultural norms. E.g. in some cultures, it could be considered honourable and desirable to be brave ad quiet when in immense pain, yet in other cultures it could be acceptable to openly express distress

Higher powers- some cultures may have a fatalist view due to a belief in a higher power, such as God, so they won’t reach out for help, e.g. it’s god’s will for them to be ill

Being in control- they may see only themselves as responsible for their own health, so they may not seek help from healthcare professionals

The human body- it may be seen as sacred, so they could avoid procedures such as blood transfusions or organ transplants

Question 40

What are some questions that patients may ask/say?
(5)

Answer 40

This is something that we have always done in my family for generations

This is normal where I come from, why are professionals challenging me on this?

What life will my children have? It’s important that I raise them in the same way we always have

What will my family and community think of me if I choose not to do what is culturally expected of me?

I won’t do that anymore; I didn’t realise it wasn’t good for my health

Question 41

What are some questions that we (health professionals) may ask/say?
(5)

Answer 41

I want to be respectful, but I don’t think this can be good for her health

I haven’t heard of his before, I wonder why people choose to undergo that practice?

I don’t want to be judgemental, but is this something that she and her family may wish to continue now they’re in the UK

I need to know more about this

I am unsure what to do, should I let other professionals know?

Question 42

What should we do if we need support or are concerned?

Answer 42

Speak to colleagues, line manager or supervisor

Question 43

How can we create positive interactions with the patients?
(4)

Answer 43

Ask them questions- gain information on their expectations and understanding of what you’ve told them

Language and behaviour- be non-judgemental and inclusive towards different cultures

Demonstrate willingness to understand people’s cultural context

Look at their body language- they could be uncomfortable or anxious

Power imbalances- this could affect the user-practitioner relationship in some cultures

Question 44

What should we do about the presentation of the information we give to the patient?
(2)

Answer 44

Ask them how they’d like to receive their health information, e.g. written, phone call, etc

Gestures differ in cultures,e.g. shaking head could mean no in one culture but mean yes in another culture. This could cause confusion if interpreted incorrectly