The commitment to providing cultural competent services is a commendable intention to respect and respond to the unique characteristics of vulnerable and underserved communities. These efforts are critical components of building accessible and appropriate services for all patients. Nevertheless, how does health center staff appropriately develop cultural sensitivity skills while recognizing that not one correct formula exists for understanding a patient’s culture? Cultural competency cannot be reduced to learning a prescribed set of skills, traits, or beliefs. Instead, it is an ongoing part of development by health centers and their staff. In this article, we explore a more flexible and open approach for addressing cultural competency, as well as propose some specific techniques to try yourself and within your organization.
What is Cultural Competence?
According to The Office of Minority Health, “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.” However, the idea of cultural competency can create a false sense of understanding. In other words, cultural competency runs the risk of being viewed as an endpoint that can be demonstrated by mastering a set of skills or traits; rather, it should be seen as a process individuals continually learn about with patients, communities, colleagues, and themselves.1
What is Cultural Humility?
Individuals and organizations alike need to recognize cultural competence as an ongoing process that takes time, effort, active awareness, and practice. Framing cultural competency as a broader, ongoing process that stretches beyond static definitions of culture is referred to as cultural humility. Linda Hunt, professor of Anthropology at Michigan State University, explains cultural humility as:
“… not requiring mastery of lists of ‘different’ or peculiar beliefs and behaviors supposedly pertaining to certain groups of patients. Rather, the provider [or outreach worker] is encouraged to develop a respectful partnership with each patient through patient-focused interviewing, exploring similarities and differences between his own and each patient’s priorities, goals, and capacities.”2
In the cultural humility framework, when exploring cultural issues, the emphasis begins with recognizing cultural difference. Identifying differences involves putting the staff person’s and the patient’s perspectives side-by-side. Practicing cultural humility requires less emphasis on knowledge and a greater focus on fostering self-awareness, interpersonal sensitivity, an attitude of openness, and learning from differences.
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Essential Concepts of Culture and Health Care When addressing culture in health care settings, take into account the following essential concepts: 4
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Practicing Cultural Humility
Cultural humility can be practiced in a variety of ways. Instead of assuming that culture may interfere with effective utilization of services, assume patients want care and may have problems accessing it. Once staff understands the concerns of patients, they can decide what changes to make and how to make them.5
To begin practicing cultural humility, individuals should be aware of their personal values, attitudes, and experiences. This will help avoid the identification of one’s culture and personal values, attitudes and experiences as the “norm.” Routinely reflect and ask the following questions:
- What are my cultural beliefs?
- What are my family’s beliefs and values?
- What is my personal culture and identity (ethnicity, age, experience, education, socio-economic status, gender, sexual orientation, religion)?
- Am I aware of my personal biases and assumptions about people with different values than my own?
- Do I consider my values to be representative of the population at large?
Also, reflect on why you have certain personal values, attitudes, and experiences. Through this self-examination and reflection process, cultural variations and differences become more apparent and easier to appreciate and accept.
Cultural humility can be practiced on the organizational level. To begin, staff can listen to patients express their experiences with the health center. Focus groups or patient interviews can involve a open-ended questions about patient experience accessing health services. A few activities to help your organization begin practicing cultural humility include:
- Host small group conversations with outreach program staff in which each staff member recounts an event that suddenly made them aware they were different from others in the situation. Explore similar themes across groups (common ones might be feelings of fear, vulnerability, anger, confusion). Lastly, have staff draw analogies to their professional role at your organization.6
Practice patient-focused interviewing techniques. Patient-focused interviewing uses a less controlling, less authoritative style that signals to patient that the practitioner values the patient’s agenda and perspectives, both medical and nonmedical. Role-play patient-focused interviewing techniques, such as Motivational Interviewing.7 For more information on Motivational Interviewing, visit www.motivationalinterview.org
- Organize a panel presentation in which panelists describe their beliefs or values and the effect on health care decision-making. Have volunteers present their own experience, and then facilitate a brief question and answer period. These volunteers can be patients or health center staff. Staff could speak to their own experience in discovering a difference they had with a patient encounter or two.
These reflection questions and activities are merely an introduction to an ongoing practice that honors our diverse cultural backgrounds as well as those of our patients.
For more on cultural humility, visit our Innovative Outreach Practices and Outreach Connection Portals. Read more about cultural humility and practices demonstrating cultural humility in the following:
- Cultural Humility Considerations in Health Outreach to Address Obesity and Overweight
- Medically Trained Cultural Liaison Model: Using a Cultural Lens to Deliver Health Services
1, 7 Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in refining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved. May 1998; 9, 2; page 117.
2 Hunt, Linda. Beyond cultural competence, The Park Ridge Center for Health, Faith, and Ethics Bulletin. Issue 24. December 2001. Also available electronically: http://www.parkridgecenter.org/Page 1882.html
3 Anderson Juarez J, Marvel K et. al. Bridging the gap: a curriculum to teach residents cultural humility. Family Medicine. February 2006; 38, 2; page 97.
4, 6 O’Connor, Bonnie B. Promoting cultural competence in HIV/AIDS care. Journal of the Association of Nursers in AIDS Care. Vol. 7, Suppl. 1, 1996.
5 Correspondence with Dr. Linda Hunt, Associate Professor of Anthropology, Michigan State University. January 11, 2008.