Developing cultural competence

Cultural Awareness

Being culturally aware of your own and others values is a step in becoming culturally competent. It is easy to be ethnocentric, using one’s own values and way of life as the standard for judging others. Becoming culturally competent means examining your biases and prejudices, developing cross-cultural skills, “having a willingness to recognize and accept that there are other legitimate ways of doing things, as well as a willingness to meet the needs of those who are different ” (Cartledge et al., 2002).

Cultural Sensitivity

"Part of being culturally competent is being culturally sensitive. Cultural sensitivity begins with recognition that there are differences between cultures. These differences are reflected in the ways that different groups communicate and relate to one another."

(Krapp & Cengage, 2002).

Cultural sensitivity involves having the ability to recognize cultural differences as well as similarities, without assigning values (ie better or worse, right or wrong) to those cultural differences. It includes being non-judgmental and having an enquiring attitude. It also involves not making assumptions based on appearance or generalised information, but to understand your client’s or patient’s cultural values and health beliefs as an individual eg enquiring about your client’s degree of acculturation or who makes the decision in the family for health care for the children. Making assumptions about cultural norms or behaviours can lead to stereotyping and less than optimal cross-cultural interactions. 

Cultural sensitivity also requires the qualities of openness and flexibility to adjust your behaviour to accommodate these differences for the best patient outcomes.

Cultural knowledge

“Cultural knowledge requires the familiarisation with selected cultural characteristics, history, values, belief systems and behaviours of the members of another ethnic group.”

(Adams, 1995).

Cultural competency is not about learning everything about a specific culture. It is better to learn about the values of collective cultures and to learn some of the more common cultural beliefs and practices of the groups you serve rather than to try to learn a list of practice ‘do’s and don’ts for caring for patients from some cultural groups. This latter approach can be reductionist and can lead to stereotyping and the oversimplification of your client and their culture.

By understanding the cultural dimensions of individualism and collectivism, power distance, uncertainty avoidance and masculinity and femininity from both our own and other cultural perspectives, we can identify potential areas of difference so that we can work with our clients effectively. Without understanding the client’s cultural expectations of health care and their health beliefs and practices, it is difficult to engage with families, maintain effective cross-cultural interactions and to achieve culturally and mutually acceptable care for children.

Cross-cultural skills

Cross-cultural skills refer to the ability to implement cultural awareness, sensitivity and knowledge in practice effectively in the cultural context of the child and their family, and the needs/issues they present with.

It involves, being competent with:

• Addressing language barriers in clinical encounters (knowing how to use interpreters is essential). You can learn how work with interpreters by undertaking the following training which is available on line: CALD 4: Working with Interpreters (Waitemata DHB, eCALD® Services, 2017d).
• The Cultural-Awareness – Assessment – Negotiation Technique (Campinha-Bacote, 2011), which involves:
  • Being aware of the ethno-medical beliefs of the clients/family/communities you serve.
  • Assessing the likelihood that a particular patient may act on these beliefs during a particular illness episode.
  • Negotiating between biomedical and ethno-medical belief systems.
  • Emphasizing common goals (eg helping your child to get better), while acknowledging differences.
  • If necessary or possible, incorporating non-harmful remedies in the treatment plan.
  • Not assuming that the family knows how to use the NZ Health system.
  • Referring to available culturally appropriate support services when required.