Moving towards cultural competence . . .

A fundamental aspect of enhancing cultural competence requires that one:

1. understand the meaning of culture and the social, behavioral and psychological implications;
    
2. apply these principals to understanding one’s own culture;
    
3. translate this knowledge to a better understanding of other cultures; and
    
4. develop skills and behaviors that are more responsive to patient needs.

The quality of care can be enhanced if providers focus on understanding both their own perspective on the illness as well as their patient’s.^[3]

To better understand one’s own cultural beliefs, it is important to consider questions such as:

What types of health beliefs did I learn from my family? Do I still hold these beliefs today?

What important influences shaped my values and beliefs?

How have my values and beliefs changed and why?

How has becoming a health professional influenced my beliefs?

How do I integrate my family beliefs with those of the medical profession?

How does my work environment influence my beliefs? How does diversity?

How does understanding my own beliefs contribute to my effectiveness at work?^[14]

For more information on cultural self-assessment, consult:

American Academy of Family Physicians

American Speech-Language-Hearing Association’s Cultural Competence Checklist

Understanding your patients’ culture . . .  

There are many factors that influence behavior and communication. It is important to consider both the overall cultural differences between different populations as well as the patient’s individual characteristics. This includes having an awareness of generalizations that may apply to patients given their cultural backgrounds (see the dimensions of culture outlined above) as well as their level of acculturation (based on age, gender, socio-economic status, literacy, language, income, etc.).^[16]

Determining Acculturation . . . 

Acculturation is the process that occurs when two or more groups have ongoing interaction that results in subsequent changes in one or more of the groups[16]. Overall cultural and individual level characteristics will influence where a patient falls on the following continuum depicted below. Although in the present context, we are emphasizing acculturation of immigrant populations, the principles and issues we cover also apply to transitions experienced when one shifts between urban and rural settings, geographic regions, or any significant shift in environment:

Individuals who are newly arrived to the U.S. may fall into the “separation” and “marginalization” segments of the cultural continuum. Thus, when working with patients who seem to have limited English proficiency or who indicate they are new to the U.S., pay particular attention to communication (verbal or non-verbal), health beliefs, decision-making methods, and other dimensions of culture. Additional issues that can complicate the clinical encounter are language barriers, unfamiliarity with the U.S. medical system, lack of knowledge of community resources available to them, and being uninsured or underinsured.^[17] Health care providers who work with immigrants and/or patients with limited English proficiency should become familiar with languages services offered by their organization, including interpreter services, availability of written materials in other languages, and availability of bilingual staff members.^[17]

In the next section, “Special Populations,” we will look at special considerations for specific population groups – African American/Black, American Indian / Alaska Native, East and Southeast Asians, and Hispanics/Latinos. This represents only a small sample of the multitude of cultures present in the U.S. and the world. These samples are presented as illustrations of the topics we have covered thus far.

Please heed a note of caution . . .

The information presented herein and, in particular, in the “Special Populations” section of this website should be read and used only as generalizations and not as stereotypes. The distinction between these two possibilities is the intent of the use. Generalizations are guidelines used as a starting point for understanding a person’s behavior. More information is desired and necessary to fully understand the behavior(s). With stereotypes, no additional information is desired or sought. This is often the grounds for a cultural misunderstanding.^[3] Remember, the most important information in the clinical encounter process is what you learn from discourse with the patient and from following models, such as LEARN, to illicit the appropriate cultural information for developing a treatment plan.

Acculturation is the process that occurs when two or more groups have ongoing interaction that results in subsequent changes in one or more of the groups. ^[16]

Generalizations are guidelines used as a starting point for understanding a person’s behavior. More information is desired and necessary to fully understand the behavior(s).^[3]

Continue to Special Populations