Cultural Competence in Health Care:
Culture can be defined as, ‘that complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society’. 1 Cultural competences (ability to successfully do something) in Health Care is a process where in the system considers the individual cultural, social and linguistic needs of the patient in order to provide quality treatment with effective cross-cultural communication with the provider.2
About twenty-one percent of the population in the United states of America speaks another language at home and about nine percent has limited English Proficiency.3Cultural Competence is important in order to understand and accordingly respond to the cultural needs of the patient or receiver.4 Becoming a culturally competent health care provider has become a prerequisite in this multicultural society.5 The ultimate goal is that a healthcare system can provide the highest quality of services to every patient regardless of their color, culture, race or ethical background.6
Definitions: Cultural competency is defined as the set of congruent behaviors, attitudes and policies that come together in a continuum to enable a health care system, agency, or individual practitioner to function effectively in cross-cultural interactions.6 Cultural Competence in Health Care can be defined as the ability of the systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patient’s social, cultural, and linguistic needs.7 Cultural Competence can also be defined as the process in which the healthcare professional continually strives to achieve the ability and availability of effectively word within the cultural context of the client, family, individual, or community.8
Cultural competence can be a viewed a goal which the health care professionals and the system can achieve in order to become a culturally competent society. It is a developmental process and ranges from cultural destructiveness to cultural proficiency. There are six stages, the first one being cultural destructiveness. Attitudes or practices that are destructive to other cultures and dehumanizing of other people of assuming superiority. Second stage is cultural incapacity, which is unintentional cultural destructiveness. Third stage is cultural blindness, involves the philosophy of being unbiased and belief that class, cultural etc makes no difference. Fourth stage is cultural pre-competence, there is a realization that there is cultural incompetency and that efforts are lacking so there is a desire for inclusion, commitment to civil rights. Basic Cultural competence, acceptance and respect for differences, expanding knowledge about other cultures and making efforts to hire staff of different cultures. Sixth stage is advanced cultural competence, cultural competence is advocated well with all systems and organizations and there is constant development of new knowledge and approaches to interaction.6
The ability of a health care system to become culturally competent system requires five essential elements. It is important to acknowledge the influence of culture and value diversity. The system or the health care professional should be capable enough for cultural self-assessment. Capacity to recognize when cultures interact there are inherent dynamics. System or the individual should be able to expand cultural knowledge and incorporate into everyday practice. The last element is that the system or individual should have developed adaptions to diversity.6
Cultural competency is about obtaining cultural knowledge and then applying that knowledge and so it a process and not an event.8 So health care providers must make attempts to acquire knowledge of different cultures and also the ability to understand and communicate with patients/ clients of different cultures and backgrounds in order to provide quality treatment.
There are certain barriers or challenges to cultural competence. Some individuals have limited English proficiency or other challenges like low literacy or disabilities like hearing loss etc are responsible for lack of communication. Lack of communication between the health care providers and patients/ clients of different racial, cultural or ethical backgrounds. It is important to hire professionals from all races and cultural backgrounds and the leaders or heads in Health Care Systems are not from all races and cultures so that’s another barrier. The system is poorly designed and so does not meet the needs of the multicultural society.7
The National Culturally and Linguistically Appropriate Services ( CLAS) Standards in Health and Health Care developed by the Office of Minority Health intend to advance equality, eliminate the different racial or ethnic disparities and also improve the quality of services provided. They have a framework for organizations to serve diverse populations. The CLAS standards include Governance, Leadership, communication and language assistance, continuous improvement ad accountability. This is an excellent resource for health care systems and organizations to become culturally and linguistically competent in order to provide the highest quality of health care services.9
Cultural competency helps eliminate the different racial or ethnic disparities in health care and also improve the quality of services provided.7