Cultural Competence: An Overview _____________________________________________________________
RACIAL BACKGROUNDS Race and color impact the ways in which individuals interact with their environments and are perceived and treated by others. Race is defined as groups of humans divided on the basis of inherited physical and behavioral differences. As part of the cultural competence process and as a reflection of cultural humility, practitioners should strive to learn as much as possible about the specific racial/ethnic populations they serve [37]. However, considerable diversity exists within any specific culture, race, or ethnicity [37]. Cultural beliefs, tradi- tions, and practices change over time, both through generations and within an individual’s lifetime. It is also possible for the differences between two members of the same racial/ethnic group to be greater than the differences between two people from different racial/ethnic groups. Within-group variations in how individuals interact with their environments and specific social contexts are also often present. As with all patients, it is vital to actively listen and critically evaluate patient relationships. All practitioners should seek to educate themselves regarding the experiences of patients who are members of a community that differs from their own. Resources and opportunities to collaborate may be available from community organizations and leaders. Finally, preferred language and immigration/migration status, if the patient is comfortable providing the information, should be considered. Interpreters should be used when appropriate, with adherence to best practices for the use of interpretation services. Stressing confidentiality and privacy is particularly important for undocumented workers or recent immigrants, who may be fearful of deportation. Black Patients “Black” or “African American” is a classification that serves as a descriptor; it has sociopolitical and self-identification rami- fications. The U.S. Census Bureau defines Black or African American as “a person having origins in any of the Black racial groups of Africa” [38]. According to the Pew Research Center, in 2023 an estimated 48.3 million individuals self-identified as Black or African American, including more than 5 million self-identified Black individuals that indicated being born in a country other than the United States [39]. This group tends to be young; 30% of the Black or African American population in the United States is younger than 20 years of age. In 2023, the median age for this group was 32.6 years, compared with the general U.S. population median age of 38.2 years [39]. In terms of educational attainment, 90.1% of Black or African American individuals had a high school diploma or equivalent and 27.6% had a bachelor’s degree [40]. Geographically, more than 56% of the United States Black or African American population lives in the South, with the largest population of individuals residing in Texas (3.7 million), Florida (4.0 million), and Georgia (3.7 million) [39].
Historical adversity and institutional racism contribute to health disparities in this group. For the Black population, patient assessment and treatment planning should be framed in a context that recognizes the totality of life experiences faced by patients. In many cases, particularly in the provision of mental health care, equality is sought in the provider- patient relationship, with less distance and more disclosing. Practitioners should assess whether their practices connect with core values of Black culture, such as family, kinship, com- munity, and spirituality. Generalized or Eurocentric treatment approaches may not easily align with these components of the Black community [42]. Providers should also consider the impact of racial discrimination on health and mental health among Black patients. Reports indicate that expressions of emotion by Black patients tend to be negatively misunderstood or dismissed; this reflects implicit or explicit biases. Asian Patients “Asian” is a single term widely used to describe individuals who have kinship and identity ties to Asia, including the Far East, Southeast Asia, and the Indian subcontinent. This encompasses countries such as China, Japan, Korea, Vietnam, Cambodia, Thailand, India, Pakistan, and the Philippines. Native Hawaiian and Pacific Islander are often combined with Asian American in census data. The Pacific Islands include Hawaii, Guam, Samoa, Fiji, and many others. There are more than 25 Asian/Pacific Islander groups, each with a different migration history and widely varying sociopolitical environ- ments in their homelands [38]. As of 2022, 24.7 million individuals in the United States identified as Asian [43]. Individuals of Chinese (excluding Taiwanese) descent represent the largest Asian subgroup in the United States (5.5 million), followed by Asian Indian (4.9 million), Filipino (4.5 million), Vietnamese (2.3 million), Korean (2.1 million), and Japanese (1.6 million) [43]. In terms of educational attainment, 92.3% of Asian individuals in the United States had a high school diploma or equivalency, and 59.3% had a bachelor’s degree in 2022 [40; 43]. Geographically, individuals of Asian descent live in all regions of the United States, although the majority of individuals (55%) were located within just five states in 2019. Among Asian individuals in the United States, 6.7 million (30%) reside in California, followed by New York (1.9 million), Texas (1.6 million), New Jersey (958,000), and Washington (852,000) [44]. Asian American groups have differing levels of acculturation, lengths of residency in the United States, languages, English- speaking proficiency, education attainment, socioeconomic statuses, and religions. For example, there are approximately 32 different languages spoken among Asian individuals, and within each Asian subgroup (e.g., Chinese), multiple dialects may be present [36].
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