Cultural competence: Steering the business of helping people towards enhanced care quality

By Isaac Mawuko ADUSU (Dr)

The increasingly diverse society in which we live today makes it essential to provide effective, empathetic care across cultural boundaries.

The organizations I consider, when thinking about helping people, have in place a cultural compass that guides them to provide effective, compassionate care in all meaningful engagements with the people they serve. ^1

Understanding Cultural Competence

Cultural competence is understanding individuals and organizations to the extent that they know, respect, and can effectively respond to the cultural and linguistic needs of the people they serve. ^2 It is much more than being aware of the kinds of differences one might encounter when working with different populations. It is knowing and liking these differences well enough to actively integrate this knowledge into policies, practices, and communications. ^3

Cultural competence is fundamental for nonprofits that focus on care and education for people with disabilities. Disabilities affect individuals from every walk of life. Yet, our beliefs and practices, cultural ones, for sure, but also personal or familial, shape how we understand, live with, and seek help for a disability. ^4 When the understanding (or misunderstanding) of cultural competence permeates a program or service, it can become ineffective, or even harmful. ^5

Why Cultural Competence Matters in Helping Professions

Increases Dialogue and Confidence: When educators and caregivers understand the cultural intricacies of the families they serve, they are better equipped to conduct effective communication. ^6 Dialogue directly correlates to confidence in the relationship between educators and families. When communication happens seamlessly, misunderstandings are less likely to emerge. Healthcare beliefs, familial structure, and even language choice impact the fundamental act of communicating. ^7

Increased Availability and Fairness: Numerous communities face long-standing obstacles to healthcare and education, including language barriers, prejudice, and a history of governmental neglect. ^8 The organizations that are truly competent in working with these cultures (and in these communities) tackle these accessibility problems head-on. They make sure all the materials they produce can be easily understood by everyone it concerns. They also strive to make their environments exceptionally welcoming to those who have traditionally found such institutions inhospitable. ^9

Enhances Care Quality and Outcomes: The research base is extensive and precise. When patients are cared for in a culturally and linguistically appropriate manner, they are more satisfied and have greater adherence to treatment plans, as well as improved overall health outcomes.^10 Take the case of dementia care, where cultural differences in attitudes toward aging can arise, necessitating an understanding of those differences to shape more effective interventions and support systems.^11

Boosts Organizational Reputation and Longevity: Organizations that demonstrate cultural competence are perceived as inclusive and responsive, offering effective engagement methods, and are thus magnets for a diverse array of stakeholders, funders, and partners. ^12 This is an enviable reputation to have in the current climate, and one that is hard-earned over the long haul. It also seems to be a promising pathway toward impact. ^13

Recognizes Diverse Populations and Individual Differences: Part of cultural competence is paying differential attention to the particularities of culture. It recognizes a broad range of people by emphasizing the need to be aware of and appreciate their cultural differences, which encompass values, beliefs, and practices. ^14 Evaluating the competence of a group is vital in many interactions we have in our society, particularly in contexts such as healthcare and education. Competency is not about having a superficial knowledge of a group’s practices or an outdated set of beliefs about them; rather, it is about understanding how their practices and beliefs shape the way they think and act. ^15

Implementing Cultural Competence: A Strategic Approach

Achieving cultural competence requires effort and dedication. It is not something we can accomplish quickly and easily. Instead, it is like a marathon: it requires stamina and perseverance to reach the finish line. And even if we cross the finish line, the marathon continues because our communities are constantly evolving. ^16 The strategies that follow provide a framework for cultural competence, which is essential for the marathon.

The Role of Education in Bridging Cultural Gaps

Cultural competence can be instilled by education. If organizations want to achieve the desired cultural outcomes, they need to carry out a two-pronged educational strategy:

1. Expert-led workshops that primarily inform.
2. Practical, hands-on learning that is relevant to the particular cultural contexts of employees. ^17

This not only informs but also empowers healthcare professionals working in the field of helping people to be exceptionally efficient. When cultural competence is given precedence, we not only boost single care encounters to be more equitable but also help to create a healthcare system that is more equitable overall. This is a system that honors each person’s dignity and cultural identity. ^18

Cultural competence isn’t just a buzzword; it’s a guiding principle, steering the business of helping people toward inclusivity, effectiveness, and compassion. For organizations that want to make a difference, cultural competence provides a pathway to achieving that goal.

Footnotes:

1. Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302.
2. Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a Culturally Competent System of Care. Georgetown University Child Development Center.
3. Sue, D.W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29(6), 790-821.
4. Shakespeare, T. (2013). Disability Rights and Wrongs Revisited. Routledge.
5. Kirmayer, L.J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social Science & Medicine, 75(2), 249-256.
6. Flores, G. (2006). Language barriers to health care in the United States. The New England Journal of Medicine, 355(3), 229-231.
7. Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Medicine, 3(10), e294.
8. Smedley, B.D., Stith, A.Y., & Nelson, A.R. (Eds.). (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press.
9. Betancourt, J.R. (2006). Improving quality and achieving equity: The role of cultural competence in reducing racial and ethnic disparities in health care. The Commonwealth Fund.
10. Beach, M.C., et al. (2005). Cultural competence: A systematic review of health care provider educational interventions. Medical Care, 43(4), 356-373.
11. Dilworth-Anderson, P., & Gibson, B.E. (2002). The cultural influence of values, norms, meanings, and perceptions in understanding dementia in ethnic minorities. Alzheimer Disease & Associated Disorders, 16(Suppl 2), S56-S63.
12. Betancourt, J.R., et al. (2014). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 33(2), 276-283.
13. Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14, 99.
14. Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184.
15. Purnell, L. (2013). Transcultural Health Care: A Culturally Competent Approach. F.A. Davis Company.
16. Like, R.C. (2011). Educating clinicians about cultural competence and disparities in health and health care. Journal of Continuing Education in the Health Professions, 31(3), 196-206.
17. Horvat, L., Horey, D., Romios, P., & Kis-Rigo, J. (2014). Cultural competence education for health professionals. Cochrane Database of Systematic Reviews, (5), CD009405.
18. Saha, S., Beach, M.C., & Cooper, L.A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275-1285.
19. Betancourt, J.R., Green, A.R., & Carrillo, J.E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. The Commonwealth Fund.

Dr. Isaac  Adusu is a policy advocate and health and human services management expert who focuses on nonprofit healthcare systems and the leadership development of those systems.

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