Cultural Competence and

Community Studies Concepts and Practices for

Cultural Competence

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Defining Cultural Competence

“Culture” refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious and social groups.

(Howard et al 2001)

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“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”.

(Howard, Cheryl, Sally Andrade, and Theresa Byrd, “The

ethical dimension of cultural competence in border health care settings? Family and Community Health, Jan 2001 v23,i4)

Defining Cultural Competence

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Defining Cultural Competence Cultural Competence is a set of academic

and interpersonal skills that allow individuals

to increase their understandings and

appreciation of

cultural differences and

similarities within,

among and between

groups.

(Howard, C. et al, ibid:38)

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Defining Cultural Competence

This requires a willingness and ability to draw on community-based values, traditions and customs, and to work with knowledgeable persons of and from the community in developing focused interventions, communications and other support.

(Howard, C. et al, ibid:38)

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Skill Components of Cultural

Competence

Cultural Reflexivity: continuously assessing one’s attitudes, beliefs, biases and prejudices toward distinct cultural groups; assessing how your interaction styles are conditioned by your academic training or other personal influences.

Cultural Knowledge: seeking and achieving a sound educational foundation regarding a variety of cultural races and world views (Smith, L. 1998)

Skill Components of Cultural

Competence

Cultural Skill: understanding diverse cultural perceptions, beliefs, practices and values on health and illness; requiring skills development that is focused, systematic and evaluative in areas of problem-solving and communication (Smith, L. 1998) .

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Skill Components of Cultural

Competence

Cultural Desire;

The motivation of the

practitioner to want to engage in the process of becoming culturally-aware, skilled, knowledgeable. Desire involves the concept of caring, passion to be open and flexible with others, “cultural humility” (Campinha-Bacote 2008).

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Cultural Competence/Humility and

Research Ethics with Diverse

Communities

In developing understandings of “culture”, know that it is historically-informed and also dynamic.

When working with culturally-diverse communities, discuss each other’s goals up-front, make sure to be transparent and ensure that your goals have community benefits.

Note the importance of two-way exchanges

in inter-cultural settings while working with

knowledge, resources, and other terms of

interactions.

Understand the importance of “context” (ask

health professionals about culturally-

sensitive practices; understand socio-

economic, geographic, spiritual and cultural

dynamics of communities) before working

with a diverse cultural group or community.

Examine power differentials (distribution

of resources, socio-economic status and

living conditions, decision-making

processes, skills and expertise,

communication styles, preferences

imposed (foods, meeting spaces,

conceptual models, writing methods,

etc…..)

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Review previous studies in the field

that you are working in and learn

strengths and weaknesses from that

work.

Learn about “cultures of origin” as

well as immigrant experiences.

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Explore cultural rituals, rights of

passage, ceremonies, mythology,

storytelling, traditional healing

practices as these are often ways of

transmitting and producing knowledge

in transcultural settings.

Cultural Competence/Humility

As with most communities, in culturally-

diverse communities

- be flexible by setting realistic timeframes,

- understanding the multiple burdens on the

community

- what types of training and skills development

are needed, negotiating multiple interests,

etc.

Understand roles of gender, age and

other social factors to ensure respect

with diverse cultural/other groups.

Understand that you may need to

transfer power (project decision-

making, skills/capacities, funding) in

these research practices as part of

building equity with underserved

communities.

Language and Communication

Language and communication” in

transcultural and subcultural contexts need

attention in terms of academic languages

vs. community languages; languages can

have dominating effects so it is important

to be conscious of how language reflects

dynamics of power.

Avoid intimidating or aggressive

communication styles (i.e. expert

languages, demeaning community

understandings).

With many diverse cultural groups, the need

to hire interpreters is critical to gaining

needed information from patients/subjects.

• Many linguistically-diverse groups have

histories of colonization, genocide, slavery

and worker exploitation between the

dominant nation-state and its diverse ethnic

and indigenous groups.

Many social inequities result from a lack of

translation and a respect for linguistic

diversity.

In reviewing some new ethical approaches to

language translation and mediation,

researchers and scholars recommend the

building of hybrid models of language and

discourse.

Hybrid models will allow the expression of

cultural identities and distinct cultural

meanings and terms within the predominant

language.

One form of hybrid language is a language

that carries a universal meaning (as with

English) but will incorporate the unique

experience of the immigrant or culturally-

diverse groups.

Advice for Language and Discourse

Engaging cultural representatives for

material designs, methods, outreach.

Gathering information on family

binational and cultural contexts.

Working side by side with cultural reps

in developing and reviewing materials

Evaluating the effectiveness of

culturally-based materials and

discourse.

Avoid Homogenizing Cultural

Groups

Do not assume a homogeneity of one

culture in a community. In many

Southeast Asian, Hispanic and Native

American communities,

- the diversities of groups may be great;

i.e. Southeast Asians – Khmer Rouge,

Vietnamese, Laotian; or Hispanics –

Puerto Ricans, Cubans, Haitian, etc.

Upholding distinct cultural identities in

the universalizing markets that

homogenize distinct cultures.

A community’s awareness of and pride

in its own unmistakable features, a

sense of belonging by birth, language,

common territory all need to be

maintained in contact with other

cultures.

Specific cultural groups within one

community will require understandings

of not only those groups, but

relationships between and among

different groups (Hispanic, Southeast

Asian and others within the

community).

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It is critically-important to assess the

research history of a racial/cultural

group in a community. There may have

been past research harms of

exploitation, stigmatization, or fears of

being “guinea pigs” for researchers.

Community leaders should be

approached before research on a

racial/cultural group is proposed.

Critical Consciousness

Cultural competence is not static or

achieved with a set of cognitive skills, it

requires a critical self-consciousness

about racism, sexism, ethnocentric

privilege, stereotypes, and other

oppressive behaviors for members of

other cultures.

In critical consciousness, a practitioner will need to be self-reflective about power and privilege, one’s own assumptions, beliefs, biases and values in encountering settings and groups with social justice inequities.

Role-plays, case studies, oral histories, community stories all can allow the practitioner to evaluate their responses and attitudes in engaging cultural groups.

Promoting Training in Cultural

Competence/Humility

.

Small group mentoring as part of regular

course work in medicine, community health,

environmental studies andother fields.

Theories, case studies, applied articles

Films on human rights issues

Creative writing about reflexive responses to

culture.

References:

Campinha-Bacote, J 2002. The Process of Cultural Competence in the

Delivery of Healthcare Services: A Model of Care. Journal of Transcultural

Nursing, Vol. 13, No. 3, July 2002

Foster,J. “Cultural Humility and the Importance of Long-Term Relationships

in International Partnerships,” JOGNN 38 (2009), 100-107.

• Genao, I, Bussey-Jones, J. et al. “Building the Case for Cultural

Competence”, The American Journal of the Medical Sciences, Sept. 2003,

v. 326 #3 Samanta, A., MRD Johnson, F. Guo, A. Adebajo. (2009). Snails in

Bottles and Language . Rheumatology; 48: 299-303

Howard, Cheryl et al. “The Ethical Dimensions of Cultural Competence in

Border Health Care Settings”. Family and Community Health, Jan 2001 v.

23, i4

Kumagai, AK, Lipson, ML Beyond Cultural Competence: Critical

Consciousness, Social Justice, Multicultural Education. Academic Medicine,

v.84. no.6, 2009

Smith, L. “Concept Analysis: Cultural Competence,” Journal of

Cultural Diversity 5 (1998), 4-10.

Snell-Hornby, Mary. (1999). Communicating in the Global Village:

On Language, Translation and Cultural Identity. Current Issues in

Language and Society, 6:2, 103-120

Sze, Julie. (2004). Asian American Activism for Environmental

Justice. Peace Review 16: 2, June: 149-156