cultural competence for libraries and librarians in health care institutions

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This article was downloaded by: [University of Auckland Library] On: 30 November 2014, At: 17:30 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Hospital Librarianship Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/whos20 Cultural Competence for Libraries and Librarians in Health Care Institutions Misa Mi a a Children's Hospital of Michigan Medical Library , Detroit, MI, USA Published online: 08 Sep 2008. To cite this article: Misa Mi (2005) Cultural Competence for Libraries and Librarians in Health Care Institutions, Journal of Hospital Librarianship, 5:2, 15-31, DOI: 10.1300/ J186v05n02_02 To link to this article: http://dx.doi.org/10.1300/J186v05n02_02 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

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Page 1: Cultural Competence for Libraries and Librarians in Health Care Institutions

This article was downloaded by: [University of Auckland Library]On: 30 November 2014, At: 17:30Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Journal of HospitalLibrarianshipPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/whos20

Cultural Competence forLibraries and Librarians inHealth Care InstitutionsMisa Mi aa Children's Hospital of Michigan Medical Library ,Detroit, MI, USAPublished online: 08 Sep 2008.

To cite this article: Misa Mi (2005) Cultural Competence for Libraries and Librarians inHealth Care Institutions, Journal of Hospital Librarianship, 5:2, 15-31, DOI: 10.1300/J186v05n02_02

To link to this article: http://dx.doi.org/10.1300/J186v05n02_02

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

Page 2: Cultural Competence for Libraries and Librarians in Health Care Institutions

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

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Cultural Competencefor Libraries and Librariansin Health Care Institutions

Misa Mi

ABSTRACT. Libraries in health care institutions play a leading role inknowledge-based information management. In response to the multicul-tural trends in society and to the challenge presented to libraries in thechanging health care environment, librarians need to develop culturalcompetent skills to work in a multicultural environment. This article ex-plores the concept and importance of cultural competence in librariesand librarians in relation to health care systems. The author argues that itis important for libraries and librarians to become culturally competentin order to provide services responsive and relevant to the changing in-formation needs of health care professionals and health care institutions.The article is focused on how cultural awareness or sensitivity can be ap-plied to many services or functions in libraries. It also includes methodsto implement cultural competent services, strategies for individual librari-ans to apply to develop cultural awareness and sensitivity, and research ar-eas worthy of investigation. [Article copies available for a fee from TheHaworth Document Delivery Service: 1-800-HAWORTH. E-mail address:<[email protected]> Website: <http://www.HaworthPress.com>© 2005 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Cultural competence, culture, health care, library ser-vices, information services

Misa Mi is Librarian, Children’s Hospital of Michigan Medical Library, Detroit, MI(E-mail: [email protected]).

Journal of Hospital Librarianship, Vol. 5(2) 2005Available online at http://www.haworthpress.com/web/JHSPL

2005 by The Haworth Press, Inc. All rights reserved.Digital Object Identifier: 10.1300/J186v05n02_02 15

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INTRODUCTION

In this new millennium, population diversity continues to be a trendin many countries around the world. The United States is a multiculturalsociety. Immigrants and their descendants constitute most of its popula-tion. Most Americans who are not immigrants themselves have ances-tors coming from elsewhere. According to the U.S. Census, more than30% of the total population is composed of various ethnic minoritiesother than non-Hispanic whites. It is estimated that this minority popu-lation will grow consistently to comprise almost 50% of the whole pop-ulation by 2050 (1). In a society as culturally diverse as the UnitedStates, the importance of cultural sensitivity is in critical need of atten-tion (2). Dreher and MacNaughton state that a standard of cultural com-petence in all human services is wholesome, desirable, and consistentwith the democratic principles on which this nation was founded (3).Cultural competence has been highlighted as a required characteristic ininteractions with ethnically diverse populations, such as relationshipsbetween physician and patient, teacher and student, and social workerand care recipient (4). In health care settings, being a culturally compe-tent health care professional has become a necessary and demandingprerequisite (4). Evidently, the ability to provide quality care is depend-ent on the skills of providers to communicate with patients from differ-ent cultures.

Librarians in health care institutions interact with a wide range of us-ers with culturally and linguistically diverse backgrounds. To provideservices and resources to enhance the provision of culturally effectivehealth care, it is critical for librarians to develop cultural compe-tence–awareness of diversity, cultural knowledge, cross-cultural com-munication skills, and proper attitudes.

CULTURAL COMPETENCE IN HEALTH CARE

Culture shapes responses to illness and treatment outcome (5).Kagawa-Singer and Kassim-Lakha reported that cultural perceptions ofillness affect health-seeking behaviors, patient-physician communica-tion, and health outcome (6). From an anthropological point of view, theperception and experience of sickness by individuals are fundamentallyshaped by their cultural setting. As individuals grow up in society, theyare taught how to label their sickness experiences; they learn the cul-tural explanations of these conditions, the standard treatments, and the

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appropriate responses to others with the same conditions. It is the pa-tient’s experiences and life goals that define the distinction of normaland abnormal functions (7). Research has shown that a lack of sensitiv-ity and responsiveness to the linguistic needs and health beliefs of dif-ferent cultures impacts quality, safety, patient satisfaction, and thecourse of treatment.

It is important that health care professionals and health care organiza-tions develop cultural and linguistic competence–an ability to under-stand and respond to the cultural and linguistic needs brought bypatients to the health care encounter (8). The health care services pro-vided should be respectful, appropriate, and responsive to an individ-ual’s language, culture, health beliefs, and practices (9). Cross et al.adequately described cultural and linguistic competence as:

. . . a set of congruent behaviors, attitudes, and policies that cometogether in a system, agency, or among professionals that enableseffective work in cross-cultural situations. ‘Cultural’ refers to inte-grated patterns of human behavior that include the language,thoughts, communications, actions, customs, beliefs, values, andinstitutions of racial, ethnic religious, or social groups. ‘Compe-tence’ implies having the capacity to function effectively as an in-dividual and an organization within the context of the culturalbeliefs, behaviors, and needs presented by consumers and theircommunities. (10)

The Joint Commission on Accreditation on Healthcare Organiza-tions (JCAHO) views the delivery of services in a culturally and lin-guistically appropriate manner as an important health care safety andquality issue and encourages health care organizations to provide equi-table care, treatment, and services across diverse populations (9). InJanuary 2004, JCAHO, in cooperation with the California Endowment,launched a 30-month project–Hospitals, Language, and Culture: ASnapshot of the Nation. The organization is interested in raising theawareness of health care organizations to the need to deliver culturallyand linguistically appropriate services, and recognizing that the deliv-ery of these services is more than simply a patient’s right but an impor-tant factor in the safety and quality of patient care (9). The project,ending in June 2006, will gather baseline data on a sample of approxi-mately 60 hospitals in the nation to assess their capacity to address theissues of language and culture that impact the quality and safety of pa-

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tient care. JCAHO aims to use the results of the project as a foundationfor setting realistic expectations for hospitals to meet the cultural andlinguistic needs of the diverse population they serve.

Delivering quality health care services to the ethnically and culturallydiverse population is a growing challenge for health care administratorsand professionals. Kalnins pointed out, “Without understanding the cul-tural context on which the client builds his/her understandings of infor-mation, the managed care process will not succeed” (11). An evengreater challenge is finding the information, resources, and technical as-sistance to design and implement linguistically and culturally appropri-ate health care programs, services, and policies (12).

LIBRARIES IN HEALTH CARE SETTINGS

The library in the health care environment is positioned to play akey role in its parent institution. It serves as the primary department re-sponsible for developing systems and services to meet knowledge-based information (KBI) needs of the organization (13). The MedicalLibrary Association has developed “Standards for Hospital Libraries2002” as a guide for hospital administrators, librarians, and accredit-ing bodies to ensure that hospitals have the resources and services toeffectively meet their knowledge-based information needs. The stan-dards clearly define the roles of librarians in health care organizationsand the connection between knowledge-based information and manyfunctions such as:

• patient care–providing information to support patient care deci-sion, integrating KBI resources into point-of-care systems

• performance improvement and patient safety–providing informa-tion to support performance improvement and patient safety deci-sions

• lifelong learning and professional competence of hospital andmedical staff–identifying and providing print and electronic re-sources in support of planning and preparing organization and in-dividual educational activities

• patient and family education–consulting with the health care teamconcerning selection, creation, and quality filtering of sources forpatient education materials; providing, or facilitating access to pa-tient education materials for health care providers.

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The Standards require that all the functions be performed to complywith applicable federal, state, and local laws and regulations and guide-lines.

“Hospitals are characterized by change. They are affirming and de-fining mirrors of the culture in which we live . . . ” (14). It is a fact of lifethat libraries in health care institutions are in a state of change, which re-flects the evolutionary change taking place in the health care environ-ment as a whole. As libraries play a crucial role in enabling health careprofessionals to provide effective, evidence-based patient care (15), li-brarians must be aware of the driving forces which have brought evolu-tionary changes in the health care environment. With that awarenessand knowledge librarians can position themselves to be “responsivemembers of the health care team” (16).

CULTURAL COMPETENCE IN LIBRARIES

In response to the diversity trend in society and the health care envi-ronment, cultural competence should be required of librarians. Compe-tency will enable librarians to interact effectively with users fromdiverse cultures and to provide information services responsive and rel-evant to their informational needs and requests. Keller asserted that:

. . . by developing their cultural awareness, community relationsexpertise and marketing skills, libraries and librarians can main-tain and enhance their value in almost every aspect of library ser-vice, including access, collection development, staff developmentand recruitment, programs and services, awareness, funding, andevaluation. The future role of libraries and librarians depends ontheir ability to connect with their communities, develop their mar-keting savvy, and adapt to the changing information needs of theircommunities. (17)

The above statement succinctly recapitulated the important compe-tencies required of libraries and librarians and their correlation with dif-ferent aspects of library information services. It is crucial for librariansto develop the “ability” to know the community, promote themselves asinformation experts, and develop services and resources tailored to theinformation needs of a diverse user population. Librarians also need togain perspective on how cultural awareness or sensitivity can be applied

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to different areas of library performance improvement and library infor-mation services.

Training for Library Staff

To continue to be an integral part of the JCAHO quality processwithin health care institutions, librarians will continue to be challengedto match their library’s mission to that of their parent institution (15).It has become a necessity for librarians to constantly update theirknowledge and gain new skills to strengthen their leading role inknowledge-based information management. National, regional, andlocal professional organizations should take initiatives in promotingcultural competent skills for library staff, sponsoring or developing cul-tural competence programs and CE courses, and compiling a bibliogra-phy to meet the needs of libraries and librarians for information aboutproviding cultural competent services. Libraries and other departmentsin their parent institutions can collaborate in presenting programs totrain employees about cultural awareness and sensitivity. Speakers orrepresentatives from different ethnic communities can be invited topresent different perspectives of cultures, values, and beliefs. Librariansneed to engage in an ongoing learning process to become educatedabout cultural differences and to equip themselves with skills to workefficiently in a multicultural environment.

Needs Analysis

The standards for hospital libraries require that “the librarian provideevidence of an ongoing assessment of the knowledge-based informa-tion needs of the organization and the development and implementationof a plan to provide appropriate resources, services, and technology tomeet those identified needs” (13).

Information on the race, ethnicity, cultural and linguistic backgroundsof user population can help libraries anticipate information needs andknow the expectations and preferences of users in their parent institu-tions. Gruppen encourages librarians to become involved in “market re-search” to determine their clients’ needs, preferences, and use patterns(18). Doyle and Wellik pointed out, “Much of the information that isneeded is not recognized, and therefore not requested” (19). Librariesshould regularly conduct needs assessments to recognize unmet needsin their health care institutions and communities in order to plan and de-liver appropriate information services. A successful users’ needs as-

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sessment should reveal valuable information on types of health careprofessionals, cultural background, educational preparation, work as-signments and responsibilities, informational and educational needsand expectations, and library use patterns and preferences.

In the area of developing a consumer health information collection,Baker and Manbeck emphasized the importance of a greater under-standing of health care consumers and their perceived informationneeds (20). To meet the information needs of patients, families, andhealth care consumers and to get a good sense of the community, it is es-sential for librarians to conduct a needs assessment to develop in-depthknowledge and understanding of diverse populations. Librarians canget to know the community through interviews, focus group study, andtalking with the community leaders and gatekeepers in culturally di-verse communities.

Collection Development

Librarians must have a good understanding of the key factors beyondthe walls of their institutions which have an impact on collection deci-sions. Key factors include changing demographics of a community,new guidelines, and standards established by the American Medical As-sociation or JCAHO regarding culturally competent patient care. Li-braries can provide health care professionals with resources to increasetheir awareness of and sensitivity toward diverse patient populationsand to understand culturally influenced health behaviors. Users’ infor-mation needs are closely tied to books, journals, and other resourceswhich libraries purchase. The information elicited from the needs anal-ysis can be used to evaluate and develop the library collections to reflectthe users’ information needs, interests, and preferences.

Similarly, it is important to know the cultures of ethnic communitieswhen consumer health librarians make collection decisions. Baker andManback stated eloquently, “The collection must contain not only ma-terial that librarians feel is necessary for healthcare consumers, butmore importantly, material that these consumers believe they need tocope with their disease” (20).

Health Literacy

Cross-cultural communication also features the growing field ofhealth literacy. Health literacy problems affect people from all back-

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grounds. Older people, non-whites, immigrants, and those with low in-comes are disproportionately more likely to have trouble reading andunderstanding health-related information (21). The National Library ofMedicine defines health literacy as the degree to which people can ob-tain, process, and understand the basic health information and servicesthat they need to make appropriate health decisions. Healthy People2010 views health literacy as “the degree to which individuals have thecapacity to obtain, process, and understand basic health information andservices needed to make appropriate health decisions” (22). The Ameri-can Medical Association recognizes that limited patient literacy is a bar-rier to effective medical diagnosis and treatment (23). In response to thechallenges faced by health information and literacy professionals, theMedical Library Association has formed the Health Information TaskForce to support health information literacy, advocating the active rolelibrarians can play in empowering people to read, understand, and act.The Task Force encourages consumer health information training anddelivery of patient education information services.

“Health care” has shifted to “self-care.” Time constraints are forcinghealth care practitioners to spend less time with patients. Patients whohave limited literacy skills find it difficult to carry out doctor’s ordersand to adhere to medical treatment. Librarians can play an active role inidentifying, selecting, and organizing educational materials for patientsand families of low literacy and facilitating access to print and elec-tronic resources for both health care professionals and patients. It is ad-visable that librarians working with patients and families learn about thecultures, religions, and health beliefs of the ethnic groups residing in thecommunity. Understanding and knowledge help librarians select mate-rials used to improve health literacy.

Another area in which librarians can get involved in health literacyimprovement is creating Internet Web resource guides. More and moreconsumers go online to look for health information for themselves, theirfamily members, and friends. They want to get educated about a medi-cal condition or procedure, take better care of their health, get a secondopinion, and clarify or confirm what they have learned about a dis-ease/condition. It is critical for them to find appropriate informationfrom reliable sources. Increasingly, librarians play an important role asinformation “gatekeepers” in filtering and recommending reliable, mul-tilingual, and culturally sensitive resources to health care consumers ontheir library Web sites.

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Reference Interview Process

Librarians interact with a wide range of users in person, on phone, orby e-mail. The quality of library reference service has a direct impact onuser satisfaction. Published library literature abounds describing thereference interview process, the ideal interview setting, and interviewtechniques required for a thorough understanding of the requester’s in-formation-seeking needs and behavior. Nonetheless, the importance ofcultural competence and cross-cultural communication skills for librari-ans is overlooked in library training programs and librarians’ compe-tency requirements. When intercultural contacts and interaction takeplace and the communication process involves culturally diverse peo-ple, librarians’ cross-cultural communication skills and understandingof the verbal and non-verbal processes become very important in a ref-erence interview process. Several verbal and non-verbal communica-tion patterns of culture need to be described, as they are likely to affectthe reference interview process.

Language is one of the most important differences between cul-tures (24) and the primary means by which a culture expresses its be-liefs, values, norms, and world views (25). Language is also one of thegreatest barriers in a cross-cultural situation. In every culture, there arespecial forms of words, types of conversation, and forms of polite us-age, which are thought to be appropriate and manifest different culturalpatterns such as individualism vs. collectivism and high context cul-tures vs. low context cultures. The following examples are illustrativeof how language mirrors cultures:

• Americans prefer directness. Mexicans regard openness as a formof weakness or treachery and think one should not allow outsidepeople to penetrate their thoughts (24). Arabs make greater use ofsubtle, contextual clues in interpreting messages (26).

• In Asian countries, the word “no” is rarely used. Openly express-ing disagreement is avoided. Saying “no” would lead to loss offace by others, so indirect methods of conveying the message (e.g.,“perhaps”) may be used.

• Individuals from East Asian cultures exhibit modesty in identifyingtheir achievement and success. People from these cultures do notsay “thank you” verbally when hearing praise and complimentsabout them. Instead, they depreciate what they have achieved.

• Americans are very expressive and are often perceived as exces-sively talkative, elaborating the obvious and using redundancies.

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They like to ask questions and get others to talk to fill interpersonalsilences (27). Silence is not valued and may be considered sociallyundesirable in the U.S. society (28). Native Americans and EastAsians do not value verbal communication the same way as Amer-icans do and, therefore, they may be perceived as reticent and mys-terious. In Japanese society, silence is generally considered to bemeaningful and is socially and culturally accepted to a muchhigher degree (28).

When librarians have an encounter with a user who speaks English asa second language and comes from a different culture, certain non-ver-bal processes come into play in the cross-cultural interaction and lack ofknowledge or recognition can easily produce mistrust, misinterpreta-tions, and misunderstanding. For example, touch as a form of communi-cation is a product of culture. The Germans, both women and men,shake hands at the outset of every social encounter; in the United States,women are less likely to shake hands. Vietnamese men do not shakehands with women or elders unless the woman or the elder offers thehand first (25). Another illustrative example is eye contact. In theUnited States, children are taught to maintain direct eye contact whenthey talk to people. This non-verbal behavior is also suggested as one ofgood communication skills for library reference interview (19). How-ever, in China, Japan, and other Asian countries, eye contact is unim-portant and avoided in a face-to-face interaction with individuals ofopposite sex, old age, high rank, or seniority. Another example of non-verbal messages is the use and organization of space. People of differentcultures have different ways in which they relate to each other spatially.For example, Arabs and Latinos tend to interact physically closer to-gether than do the Americans (25).

Library Instruction

The need to provide education and training to library users is growingsince the advent of the Internet. Librarians take on the role of instructorsto teach health care professionals to improve their skills in informationretrieval and management in health care settings (19). With the prolifer-ation of new media, health information has become voluminous. Manylibrarians have developed training classes as a community outreach pro-gram to teach health care consumers how to navigate through a wealthof Web resources and how to find reliable health information on theInternet.

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Just as the concept of cultural sensitivity and awareness is applicableto many aspects of library information services, it is equally importantwithin the realm of library instruction design and teaching. In a trainingsetting, learners can include those with different cultural and linguisticbackground. They bring to a learning environment culturally-basedlearning styles, cognitive styles, motivation for learning, expectations,value systems, and educational needs. Learning styles are one com-ponent of cultural behavioral styles, habits, values predispositions,and references that develop during a child’s cultural socializationprocess (29). For example, some cultures have different time orienta-tion. Hispanics and Native Americans are very much involved in thepresent time rather than the future. Ideas of punctuality or planning forthe future may be unimportant. The teacher-student relationship is cul-turally mandated (30). In China, as in other Asian countries, teachersare revered individuals and regarded as the authority of the class-room. The whole learning-teaching process is very formal and struc-tured. Most teachers lecture with little interaction with students inclass. Students rarely ask questions in class to avoid challenging theteaching authority. It is important for library educators to identify thediversity in learners and design programs responsive to the needs of dif-ferent learners.

BUILDING CULTURAL COMPETENCE

Michael Hash made an excellent point on quality health care for cul-turally diverse population:

Culturally and linguistically appropriate services means providinginformation that people need and want in ways that they can un-derstand and use. It’s of course not just about language, it’s aboutattitudes, it’s about behaviors, it’s about skills, it’s about policiesthat need to be in place . . . When we succeed, of course, we pro-mote access, we reduce disparities and, most importantly, we im-prove the outcomes of our beneficiaries who need health careservices. (31)

Mr. Hash presented a precise definition of culturally and linguisti-cally appropriate services. What it takes to provide quality health care isequally applicable to library settings. To assist health care providers indeveloping cultural competent skills and to support the delivery of qual-

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ity patient care, it is critical for libraries to implement continuous ser-vice improvement plans and adapt library services to meet the changinginformation needs of health care professionals and health care institu-tions. The following are different ways which libraries can undertake tomaintain their leading role in knowledge-based information manage-ment:

• designing a cultural competence self-assessment tool to evaluatelibrary staff’s skills and their ability to work in a multicultural en-vironment

• designing cultural competence training programs for all librarystaff

• developing culturally appropriate services and policies in areas ofreference, education, collection development, marketing, and pro-motion

• taking outreach initiatives into ethnic communities to help reduceracial and ethnic health care disparities

• integrating cultural competence skills into library position descrip-tions

• collecting and disseminating information on cultural competenceeducational programs, practices, conferences, and workshops toassist health care professionals and institutions in developing cul-tural competence and cultural competent care

• providing books, tools, and other resources to assess individual ororganization cultural competencies

• assisting with the development and integration of cultural compe-tence course modules or courses for health care professions’ cur-ricula

• collecting or developing cultural profiles and resource materialsfor health professionals, especially on topics related to the needs ofthe local ethnic communities or new immigrants

• using information technology to make the wealth of informationabout various communities available to health care providers.

Librarians contribute to the success of all library functions. It is im-portant for librarians to be open-minded and flexible, and to developskills and ability to work effectively with customers from cultures otherthan their own. Apply the following seven strategies to become more ef-fective in serving culturally diverse customers and communities and inworking with people coming from different cultural background.

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1. Identifying Potential Language Barriers

Pay attention to verbal and non-verbal differences in users from di-verse cultures. Avoid equating one’s language fluency with his/her intel-ligence. Adjust your communication styles to promote understanding.Non-verbal communication or body language conveys subtle meaningsand plays an essential role when people are exchanging information(32). For example, direct eye contact is considered rude in Asian cul-tures whereas making direct contact when speaking to African-Ameri-can or Latino patients implies strength and inspires confidence.

2. Double-Checking Comprehension

Recognize that, in some cultures, nodding and affirmative responsesdo not necessarily guarantee understanding has been achieved. Con-versely, lack of response from a user during a cross-cultural interactiondoes not necessarily indicate communication failure. To facilitate com-prehension, apply some useful techniques: listen patiently, speak clearlyin a pleasant tone, repeat a response, and avoid using library jargon,American idioms, and slang. Having printed handouts of instruction,user guides, and glossaries ready may enhance comprehension for userswhose native language is not English.

3. Identifying Barriers to Health Information Access

Barriers to health care cause health care disparities. Similarly, thereare barriers for patients and health care consumers to access health in-formation. Many of them face the problem of low health literacy. Otherbarriers they face may include but are not limited to lacking transporta-tion vehicles, being unaware of the availability of library patient educa-tion resources and services, and lacking Internet access at home forsearching online health information. Identifying these barriers to healthinformation can help librarians design information and training servicestailored to the needs of patients and health care consumers.

4. Being Aware of Cultural or Ethnic Differences

Culture is like water for the fish: we are in it and are part of it but weare not aware of it. Making culture explicit will help us understand our-selves better in contrast to others (33). Librarians need to take the initia-tive to learn about other cultures, values, and beliefs. Cultures canchange slowly or very quickly. Make sure your knowledge of other cul-

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tures is up-to-date. The knowledge will help you develop cultural sensi-tivity and look beyond your own view of the world. Be cautious not tomake assumptions that people from one culture or geographic area holdthe same belief or value. As with cultures, there are many within-groupdifferences, and different degrees of assimilation and acculturation.

5. Letting Go of Your Old Way of Thinking

The way we think affects how we interact with people. It is importantfor librarians to be aware of the existence of cultural perspectives, prej-udice, and biases. Those who deny them are most afflicted. Stereotypesand prejudicial attitudes toward others are the stumbling blocks in suc-cessful cross-cultural communication. Sebert et al. contended that “la-beling and generalizing those who are different, based on global andignorant stereotypes are, to a great extent, contributing to the problem ofbeing culturally uneducated” (2). We are all different, but understand-ing the differences in culture may allow us to appreciate them, and, con-sequently, to be able to improve communication with others.

6. Showing a Genuine Interest in People Different from You

Multiculturalism in this country is evident in many areas such as thevocabulary, science, cuisine, music, clothing, art, and architecture. It isthe result of taking what works from many cultures and leaving the restbehind. In Halvorson’s words (34), “This selective and enlightened bor-rowing of the best features from other cultures creates a synergy whichdraws people from all the over the world to the United States.” Takingan interest in others different from yourself can enrich your life and ex-perience.

7. Being Empathetic and Open-Minded as Health/MedicalInformation Providers

Many immigrants came to this country to seek religious and politicalfreedom, better educational and economic opportunities. Their life wasfraught with difficulties–going from an “old” to a “new” way of life,learning a new language and social system, and adapting to a new cli-mate, new foods, and a new culture (35). Life for them was very hardand lonely. The newcomers may experience high anxiety, and mentaland physical stress in an intercultural situation. The effect of stress cancause cultural shock which may trigger illness. Being unfamiliar with

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the health care system makes it harder for them to take good care of theirhealth. It takes patience, compassion, and empathy to understand andmeet their specific information needs.

RESEARCH AREAS NEEDED FOR INVESTIGATION

There is limited research on cultural and linguistic competence inlibraries and librarians in health care settings. Librarians need to takeresearch initiatives toward generating evidence that links culturalcompetence with performance improvement, quality services, and usersatisfaction. Following are areas worthy to be investigated:

• investigating whether library school programs provide studentsadequate cultural competence training to prepare them to work inthe multicultural society

• designing a self-assessment tool to evaluate medical librarians’cultural and linguistic competence

• conducting users’ needs assessments to identify what culturallybased barriers they face

• examining how users’ social-cultural differences influence theirinformation-seeking behaviors and library use patterns

• studying how cultural competence training programs or CE classesincrease librarians’ cultural awareness and sensitivity

• conducting outcome research linking librarians’ cultural and lin-guistic competence with user satisfaction and service quality im-provement

• studying how differently, in a reference interview process, refer-ence librarians interact with users from different cultures (speak-ing with different accents and wearing traditional ethnic dress)

• investigating how a library’s collection reflects the diversity of itsusers and what resources/services a library provides to preparehealth care professionals to better care for their patients from di-verse ethnic communities

• examining how diverse the library workplace is.

CONCLUSION

In response to the rapidly changing trends in society and health caresystems, librarians need to establish the following goals: to become ad-

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ept in working with people from different races, ethnicities, and cul-tures; to create a library which promotes diversity; and to enhance therole of librarians in knowledge-based health care information manage-ment. By striving to accomplish cultural competence, librarians work aspartners to empower consumers and to satisfy information needs in amulticultural environment.

Received: September 10, 2004Accepted: October 31, 2004

REFERENCES

1. U.S. Department of Commerce. U.S. census 2000. http://census.gov. (21 Jun2004).

2. Seibert PS, Stridh-Igo P, Zimmerman CG. A checklist to facilitate culturalawareness and sensitivity. J Med Ethics 2002;28:143-6.

3. Dreher M, MacNaughton N. Cultural competence in nursing: foundation or fal-lacy? Nurs Outlook 2002;50:181-6.

4. Suh E. The model of cultural competence through an evolutionary concept anal-ysis. J Transcult Nurs 2004;15:93-102.

5. Amodeo M. Viewing alcohol and other drug use cross culturally: a culturalframework for clinical practice. Fam Society 1997;78:240-50.

6. Kagawa-Singer M, Kassim-Lakha S. A strategy to reduce cross-cultural mis-communication and increase the likelihood of improving health outcomes. Acad Med2003;78:577-87.

7. Hahn RA. Sickness and Healing: An Anthropological Perspective. New Havenand London: Yale University Press, 1995.

8. Office of Minority Health (2001). Assuring Cultural Competence in HealthCare: Developing National Standards and an Outcomes-Focused Research Agenda.http://www.omhrc.gov/clas/finalcultural1a.htm. (21 Jun 2004).

9. The Joint Commission on Accreditation on Healthcare Organizations. Hospi-tals, Language, and Culture. http://www.jcaho.org/about+us/hlc/index.htm. (25 Jun2004).

10. Cross TL, Bazron BJ, Dennis KW, Isaacs MR. Towards a culturally competentsystem of care. Washington, DC: National Technical Assistance Center for Children’sMental Health, Georgetown University Child Development Center; 1989.

11. Kalnins ZP. Cultural diversity and today’s managed health care. J Cult Divers2004;4:43.

12. Diversityrx (1997). Resources for Cross Cultural Health Care. http://www.diversityrx.org/HTML/WERCCH.htm. (18 Jun 2004).

13. Gluck J, Hassig RA, Balogh L, Bandy M, Doyle J. Standards for hospital librar-ies 2002. J Med Libr Assoc 2002;90:465-72.

14. Stevens R. In sickness and in wealth: American hospitals in the twentieth cen-tury. Baltimore: MD: Johns Hopkins University Press; 1999.

15. Holst R. Libraries in health care settings: an introduction. In: Holst R, PhillipsSA, editors. The Medical Library Association guide to managing health care libraries.New York: Neal-Schuman; 2000.

30 JOURNAL OF HOSPITAL LIBRARIANSHIP

Dow

nloa

ded

by [

Uni

vers

ity o

f A

uckl

and

Lib

rary

] at

17:

30 3

0 N

ovem

ber

2014

Page 19: Cultural Competence for Libraries and Librarians in Health Care Institutions

16. Foster EC, Warden GL. The health care environment. In: Holst R, Phillips SA,editors. The Medical Library Association guild to managing health care libraries. NewYork: Neal-Schuman; 2000.

17. Keller SG. The secret power of community connections. Ref Libr 1996;54:29-44.

18. Gruppen LD. Physician information seeking: improving relevance through re-search. Bull Med Libr Assoc 1990;78:165-72.

19. Doyle J, Wellik K. Information and education services. In: Holst R, Phillips SA,editors. The Medical Library Association guide to managing health care libraries. NewYork, NY: Neal-Schuman Publishers; 2000.

20. Baker MB, Manbeck V. Consumer health information for public librarians.Lanham, Maryland: Scarecrow Press; 2002.

21. Center for Health Care Strategies, Inc. (2004). Who has health literacy prob-lems? http://www.chcs.org. (22 Jun 2004).

22. U.S. Department of Health and Human Services (2001). Healthy people 2010.http://www.healthypeople.gov/document/tableofcontents.htm. (23 Jun 2004).

23. American Medical Association. Cultural competence compendium. Chicago:American Medical Association; 1999.

24. Argyle M. Intercultural communication. In: Samovar L, Porter R, editors.Intercultural communication: a reader. Belmont California: Wadsworth; 1991.

25. Porter R, Samovar L. Basic principles of intercultural communication. In:Samovar L, Porter R, editors. Intercultural communication. Belmont California:Wadsworth; 1991.

26. Anderson J. A comparison of Arab and American conceptions of “effective”persuasion. In: Samovar L, Porter R, editors. Intercultural communication. Belmont,California: Wadsworth; 1991.

27. Anderson P. Explaining intercultural differences in nonverbal communication.In: Samovar L, Porter R, editors. Intercultural communication: a reader. Belmont, Cali-fornia: Wadsworth; 1991.

28. Ishii S, Bruneau T. Silence and silences in cross-cultural perspective: Japan andUnited States. In: Samovar L, Porter R, editors. Intercultural communication: a reader.Belmont, California: Wadsworth; 1991.

29. Bennet C. Comprehensive multicultural education. Needham Heights, MA:Allyn & Bacon; 1995.

30. Zhang J. Cultural diversity in instructional design. Int J Instr Media 2004;28:299-307.

31. Hash M (2000). Policy initiatives set he standard for culturally competent healthservices. http://www.diversityrx.org/CCONF/00/00_proc_03.htm. (18 Jun 2004).

32. Newman J. Managing cultural diversity: the art of communication. RadiolTechnol 1998;69:231-46.

33. Korzenny F. Relevance and application of intercultural communication theoryand research. In: Samovar L, Porter R, editors. Intercultural communication. Belmont,California: Wadsworth; 1991.

34. Halvorson, GC (2000). Managed care and culturally diverse populations. http://www.diversityrx.org/CCCONF/00/00_proc_05.htm. (23 Jun 2004).

35. Spector R. Cultural diversity in health and illness. Stamford, CT: Appleton &Lange; 1996.

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