Cultural Competency

• Cultural competency training is seen as a way to reduce or prevent racial inequalities, & promote culturally appropriate services in health & social care
• Evidence shows the influence of culture, diversity & equality on the availability, accessibility, acceptability & quality of healthcare service provision (Napier, et al, 2014)
• UK healthcare services claim to ensure equity & the responsiveness of healthcare services to diverse needs
• The aim is to be culturally inclusive
• However, evidence shows that there are health inequalities, & disparities in health provision for members of minority groups
• This shows that the UK health system does not adequately meet the needs of culturally diverse populations (Gallagher, 2015)
• Cultural competency training is supposed help professionals to meet the needs of patients
• Definition of ‘cultural competency’: “A set of congruent behaviours, attitudes and policies, that come together in a system, agency or among professionals, and enables that system, agency, or those professionals to work effectively in cross-cultural situations.” (Cross, et al, 1989)

In practice, ‘cultural competence’ is vaguely defined

• Evidence shows that current ‘cultural competency training’ does not do enough to prepare professionals to meet the needs of culturally diverse communities (Turner, et al, 2014)
• This seems to be, in part, because the concept of ‘cultural competence’ is not clearly defined
• The most common definitions are North American, & little work has been done to see if they fit well in UK contexts

The idea of ‘diversity’ covers a range of groups in society, identified by a range of characteristics

‘Cultural competency training’ appears to focus mainly on issues of ‘race’ and ‘ethnicity’, as opposed to other characteristics and related differences – this seems very limiting; policy is thus often    too simplistic (lumps people together re: ‘culture’)

Diversity actually covers a range of differences: “working in partnership with service users, carers, families & colleagues to provide care & interventions that not only make a positive difference but do so in ways that respect & value diversity in age, race, culture, disability, gender, spirituality, & sexuality” (Hope, 2004, p.3)

An alternative

‘Cultural humility’ rather than ‘cultural competence’

Definition of Cultural Humility:

“Incorporates a life-long commitment to self-evaluation & self- critique, addressing power imbalances in the provider-client relationship and to the development of mutually beneficial and dynamic partnerships.” (Tervalon & Murray-Garcia, 1998)

Is this a better approach to ‘cultural competence’?

Humility

What does it mean to be ‘humble’? Understanding humility as a virtue:

• Requires self-knowledge
• Requires genuine gratitude towards others
• Requires working in collaboration with the community

What can this mean in practice for health & social care professionals?

What is the difference between ‘competence’ & ‘humility’?

Cultural Humility

• Cultural humility sees the professional as a ‘guest’
• The ‘guest’ must be invited into the community, and must not force their way in
• The professional must not demand that the community adheres to pre-defined bio-medical definitions
• Try to develop co-participation & attitudes of serving the needs of the community
• How does this approach compare to ‘cultural competence’?

References

Cross, et al (1989), Towards a Culturally Competent System of Care, Washington

Gallagher, (2015), Napier, et al (2014)

Tervalon & Murray-Garcia (1998), Cultural Humility versus Cultural Competence, Journal of Health Care for the Poor and Undeserved, p. 117-125

Turner, et al (2014)