Cultural Competence: An Overview _____________________________________________________________
RELIGIOUS, CULTURAL, AND ETHNIC BACKGROUNDS
identify as either male or female), among others. Gender expression : The way in which an individual expresses gender outwardly through appearance (e.g., clothing, make up, physical features), behaviors, and personality styles, often culturally defined as masculine or feminine. Gender expression can, but does not always, reflect the person’s gender identity; individual preference, comfortability, culture, and societal and sociopolitical acceptance can influence gender expression. Gender role : A set of societal expectations about how some- one should behave based on their gender, often categorized as masculine or feminine. Sex : The biological and physiological characteristics that differ- entiate male and female, such as chromosomes, hormones, and reproductive organs. The terms “sex” and “gender” are often incorrectly used interchangeably; however, it is important to differentiate between the two and be able to identify that sex is biological and gender is a social construct. Gender traits and roles common for men in Western societ- ies are often related to views of masculinity, and include an emphasis on strength, courage, leadership, independence, dominance, and assertiveness. Issues related to male gender identity, including inadequate help-seeking, denial of pain and weakness, and not showing emotion, have several impor- tant implications for health. Research has shown that male gender identity has been associated with risky behavior and an increased risk for negative health consequences, including injury, disease, and death [53; 54; 55]. Gender roles among women are related to femininity and include being polite, accommodating, nurturing, passive, and helpful. Women are often viewed as caregivers and tend to prioritize the needs of others above personal needs. In addition, providing gender-sensitive care to women involves overcoming the limitations imposed by the dominant medical model in women’s health, improving advocacy for oneself [53]. In addition, the concept of masculinity may lead to inad- equate help- and information-seeking behavior and a reduced likelihood of engaging in behavior to promote health. These behaviors appear to be rooted in a decreased likelihood for men to perceive themselves as being ill or at risk for illness, injury, or death [53; 54; 55]. Although men are more likely than women to lack a regular healthcare provider and to avoid seeking help or information, women are more likely to have a chronic condition requiring regular monitoring and are more likely to have forgone necessary health care and/or medication due to the cost [53]. Men’s beliefs about masculinity and traditional male roles affect health communication and literacy, and healthcare practitioners should consider male-specific beliefs and percep- tions when communicating with male patients. For example, because men tend to focus on present rather than future health, concepts of fear, wellness, and longevity often do not work well in health messages. Instead, healthcare practitioners should focus more on “masculine” concepts, such as strength,
Religion, culture, beliefs, and ethnic customs can influence how patients understand health concepts, how they take care of their health, and how they make decisions related to their health. Without proper training, clinicians may deliver medical advice without understanding how health beliefs and cultural practices influence the way that advice is received. Asking about patients’ religions, cultures, and ethnic customs can help clini- cians engage patients so that, together, they can devise treat- ment plans that are consistent with the patients’ values [37]. Respectfully ask patients about their health beliefs and customs and note their responses in their medical records. Address patients’ cultural values specifically in the context of their health care. For example, one may ask [37]: • “Is there anything I should know about your culture, beliefs, or religious practices that would help me take better care of you?” • “Do you have any dietary restrictions that we should consider as we develop a food plan to help you lose weight?” • “Your condition is very serious. Some people like to know everything that is going on with their illness, whereas others may want to know what is most important but not necessarily all the details. How much do you want to know? Is there anyone else you would like me to talk to about your condition?” • “What do you call your illness and what do you think caused it?” • “Do any traditional healers advise you about your health?” Practitioners should avoid stereotyping based on religious or cultural background. Each person is an individual and may or may not adhere to certain cultural beliefs or practices com- mon in his or her culture. Asking patients about their beliefs and way of life is the best way to be sure you know how their values may impact their care [37]. GENDER The term “gender” refers to the established and expected norms, behaviors, and roles associated with being a girl, boy, woman, or man. Because gender is a social construct, the definition of gender is unique to any given society and/or collective group and changes over time. Gender is hierarchi- cal and produces inequalities that often intersect with one or more social and/or economic inequalities. Other important terms related to gender include [50; 51]: Gender identity : A person’s internal identification and experi- ence of gender, which may or may not correspond to physiology or designated sex at birth. Gender identities include cisgender (identify as sex assigned at birth), transgender (identify as a different sex than assigned at birth), and non-binary (do not
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