CULTURAL COMPETENCE
Cultural competence means a commitment to learning about cultural differences, developing cross-cultural skills, and learning from our mistakes along the way. The term multicultural competence surfaced with a mental health publication by psychologist Paul Pedersen (1988) at least a decade before the expression cultural competence became popular. Pedersen’s multicultural competence model emphasizes awareness, knowledge, and skills. Mental health and medical care professionals have been at the forefront of promoting cultural Cultural Competence, Healthcare, and Treatment Cultural competence in healthcare means delivering effective, quality care to individuals with diverse beliefs, attitudes, values, backgrounds, and behaviors (Tulane University, 2021). This requires systems to personalize health care according to cultural differences. It also requires understanding the potential impact that cultural differences can have on the counseling process. Culture is not stagnant but is a changing system of beliefs and values shaped by our interactions with one another, institutions, media, and technology, and by the socioeconomic determinants of our lives. In healthcare, cultural humility may be defined as being aware of how people’s culture can impact their health behaviors and, in turn, using this awareness to cultivate sensitive approaches to treating patients. To deliver individualized, patient-centered care, a provider must consider patients’ diversity of lifestyles, experiences, and perspectives to collaborate in joint decision-making. Patient-centered care can enhance equity in health care delivery; cultural sensitivity may enhance patient-centered care. Perceived practitioner competence is a factor that varies based on the racial/ethnic background of the patient. Research has shown that perceived physician cultural competency differs most among racial groups, with White patients reporting the highest degree of perceived cultural competency in their physician (Galic, 2021). It is not surprising that White patients report higher levels of perceived cultural competency with their physicians because most of the physicians in this country can be described as White. In other words, it is expected that individuals will feel more comfortable with and more easily trust individuals they perceive to be similar. Accordingly, data shows that perceived cultural competence is much lower among African American women. Galic (2021) found that nearly half of the African American women they studied reported that their physician did not understand their cultural background. Half is a significant amount when considering healthcare because feeling misunderstood by your physician could amount to efforts or a lack of efforts that result in poorer health or death. Differences between healthcare providers and patients can affect communication. This can, in turn, impact clinicians’ and patients’ decisions about treatment. For example, a clinician may misinterpret a patient’s silence as a lack of interest in receiving care. As a result, the clinician may not order a diagnostic test when the patient’s response reflects their respectful behavior. When healthcare providers fail to recognize the differences between them and their patients, they may inadvertently deliver lower-quality care. Cultivating skills that improve cross-cultural communication can be crucial in delivering equitable care. Cultural competency helps reduce disparities in healthcare by promoting seamless adaptation of services to meet unique needs throughout the community, including racial and ethnic disparities. In order to increase the cultural competence of the healthcare delivery system, health professionals must be taught how to provide services in a culturally competent manner. Although many different training courses have been developed across the country, these efforts have not consistently been standardized or incorporated into training for health professionals. Training courses and teaching methods vary greatly, ranging from three-hour seminars to semester-long academic courses. Moreover, cultural competence is a process
competence. The consequences of a poor diagnosis due to a lack of cultural understanding, for example, can be very costly to the patient—especially in medical service delivery. The notion of cultural competence is also challenged by intersectionality, which suggests that the beliefs and values a patient brings to the clinical encounter are shaped by the intersection of their different characteristics, such as race, class, gender, and sexual orientation. rather than an ultimate goal and is often developed in stages by building upon previous knowledge and experience. Health systems are beginning to adopt comprehensive strategies to respond to the needs of racial and ethnic minorities for numerous reasons. There are increasingly more state and federal guidelines that encourage or mandate more excellent responsiveness of health systems to the growing population diversity. Also, many health systems are finding that developing and implementing cultural competence strategies are good business practices to increase providers’ and patients’ interest and participation in their health plans among racial and ethnic minority populations. Cultural competence of the provider impacts patient satisfaction. When surveys are conducted to assess patient satisfaction following medical visits and hospital stays, they often do not assess whether patients have experienced discrimination during their treatment. This is important because this is often a common complaint of individuals from marginalized populations. Thus, these surveys fail to ask diverse groups of patients whether they have received culturally competent care. Kevin Nguyen, a health services researcher at Brown University School of Public Health, parsed data collected from the government-mandated national surveys in new ways and found that, underneath the surface, they spoke to racial and ethnic inequities in care. Nguyen found that Black, Asian American, Native Hawaiian, Pacific Islander, and Hispanic or Latinx/Latine beneficiaries reported worse experiences across the four measures. Nguyen said that the surveys commonly used by hospitals (called Consumer Assessment of Healthcare Providers and Systems, or CAHPS) could be far more helpful if they were able to go one layer deeper, for example, asking why it was more challenging to get timely care, or why they do not have a personal doctor (Bichelle, 2022). Furthermore, Nguyen studied whether patients in one Medicaid managed-care plan from ethnic minority groups received the same care as their White peers. He examined four areas: access to needed care, a personal doctor, timely access to a checkup or routine care, and specialty care (Bichelle, 2022). Specific marginalized groups also experience dissatisfaction with healthcare services. Lesbian, gay and bisexual (LGB) people report greater dissatisfaction with counseling and psychotherapy services than their heterosexual counterparts (Bishop, Crisp, & Scholz, 2022). Greater dissatisfaction with counseling services may result from experiences of microaggressions resulting from a lack of service provider cultural competence. Microaggressions are subtle statements and behaviors that unconsciously communicate denigrating messages to people of color or marginalized groups. Data shows that LGB participants perceived counselors and psychologists as more culturally competent if they demonstrated: inclusive intention, awareness of heteronormativity, knowledge about issues impacting LGB people, and openness to diversity (Bishop, Crisp, & Scholz, 2022). This finding shows that it is not sufficient to be open to diversity; it also requires that we have some knowledge of issues that impact this population. If you are a counselor working with the LGBTQ population, you should be aware of heteronormativity. Heteronormativity is the belief system that heterosexuality and binary gender roles are the only norms that exist and can be applied to every individual in society.
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