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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