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Cultural Competence: Can it be Taught? - Barbara W. Sugland, M.P.H., Sc.D.M...

2. Keynote Overview. What is Cultural Competence?Culture vs. Race/EthnicityCompetence vs. SensitivityStages of Cultural Competence. 3. Keynote Overview. Why is it Important?Increased Ethnic Diversity; Ethnic Disparities in Health;Providers\' Background Different From Patient. 4. Keynote Overview.

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Cultural Competence: Can it be Taught

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Cultural competence can it be taught

Cultural Competence:Can it be Taught?

Barbara W. Sugland, M.P.H., Sc.D.

Maternal & Child Health Institute:

Addressing Health Disparities

St. Paul, Minnesota

June 27, 2002

Keynote overview

Keynote Overview

  • What is Cultural Competence?

    • Culture vs. Race/Ethnicity

    • Competence vs. Sensitivity

    • Stages of Cultural Competence

Keynote overview1

Keynote Overview

  • Why is it Important?

    • Increased Ethnic Diversity;

    • Ethnic Disparities in Health;

    • Providers’ Background Different From Patient

Keynote overview2

Keynote Overview

  • How to Achieve it?

    • Organizational Transformation

    • Personal Transformation

What is cultural competence

What is Cultural Competence?

Cultural Competence

A set of congruent practices, skills, attitudes, policies and structures, which come together in a system, agency, or among professionals, which enable that system, agency or professionals to work effectively in cross-cultural situations.

Cross, T.L., Bazron, B.J., Dennis, K.W., Isaac, M.R. (1999)

What is cultural competence1

What is Cultural Competence?

Cultural Competence

  • Congruence across aspects of service delivery;

  • Aspects of service include:

    • Practices, skills, attitudes (Individual);

    • Practices, policies, structures (Organization)

Culture vs race ethnicity

Culture vs. Race/Ethnicity


  • Shared values, beliefs, traditions, norms, customs, folklore, art, history of a group of people

  • A foundation – “grounds” you

  • Passed on from generation to generation;

Culture vs race ethnicity1

Culture vs. Race/Ethnicity


  • Dynamic & evolving;

  • Shapes attitudes & values;

  • Shapes styles and modes of communication;

  • Shapes notions about health & illness;

  • Shapes health-seeking behavior.

Culture vs race ethnicity2

Culture vs. Race/Ethnicity


  • Historically ascribed to groups of individuals categorized as biologically distinct.

  • Modern Times – “race” is a social construction

  • Physical, behavioral and cultural differences incorrectly ascribed to race;

Culture vs race ethnicity3

Culture vs. Race/Ethnicity


  • A subgroup that shares common ancestry, geography, history, language or culture;

Sensitivity vs competence

Sensitivity vs. Competence

Cultural Sensitivity

  • Heightened awareness of cultural differences

  • Increased ability to interpret and respond to non-verbal or cultural cues

  • Willingness and ability to adapt behavior

Sensitivity vs competence1

Sensitivity vs. Competence

Cultural Competence

  • Incorporate plans, policies & practices to respond to differences

  • Cultural sensitivity is necessary but insufficient for achieving competence

Stages of cultural competence

Stages of Cultural Competence













Stages of cultural competence1

Stages of Cultural Competence

  • Destructiveness-- actively working to destroy or diminish well-being

  • Incapacity -- not actively seeking to destroy, but not actively working to improve well-being

  • Blindness-- unbiased treatment is the most

    effective treatment

Stages of cultural competence2

Stages of Cultural Competence

  • Pre-Competence -- Belief, desire & commitment, not clear on how to move forward

  • Competence-- Belief, desire & commitment + structure, systems & policies in place

  • Advanced Competence -- Competence + Vocal advocates for competent care

Progressing toward cultural competence

Progressing Toward Cultural Competence

  • Conditions for Progress (Individual)

  • Awareness

  • Knowledge

  • Skill

  • Practice (cultural encounters)

  • Personal will

Progress toward cultural competence

Progress Toward Cultural Competence

  • Conditions for Progress (Organizational)

  • Mission & values support competence

  • Policies promote it

  • Programs and services reflect it

  • Hiring strategies facilitate diversity and competence

  • Mechanisms of accountability to reward &


Models of competence

Models of Competence

LIVE & LEARN (Carballeira, 1997)

  • LIVE -- Like, Inquire, Visit, and Experience

  • LEARN -- Listen, Evaluate, Acknowledge, Recommend, and Negotiate

Models of cultural competence

Models of Cultural Competence

  • Sunrise (Leininger, 1993,1999)

    • Stresses world view and social structure of client

    • Several dimensions – Cultural, religious & spiritual, economic, educational, technological, kinship & social, political/legal

    • Providers must explore and validate what the patient says and does

Why is cultural competence important

Why is Cultural Competence Important?

  • Ethnic Disparities in Health

    • Rates of disease & morbidity higher among racial/ethnic subgroups

    • Some improvements – gains modest and uneven

Why is cultural competence important1

Why is Cultural Competence Important?

  • Increased Ethnic Diversity

    • Non-whites ~ 31% of US Population

    • Increase of 25% since 1990

    • Density of Ethnic Populations

  • Providers’ Background Different From Patient

Why is cultural competence important2

Why is Cultural Competence Important

  • Context for Understanding and Responding to Differences

  • Guidance for How to Connect with Patients;

  • Framework for Enhancing Quality of Care

Achieving cultural competence

Achieving Cultural Competence

  • Achieving Competence Requires:

    • Organizational Transformation

      • Philosophy

      • Structure, practices, protocols

      • Partnership & collaboration

    • Personal Transformation

      • Notions about self relative to others

      • Capacity (skills and proficiency)

      • Courage

Achieving cultural competence1

Achieving Cultural Competence

  • Practices of Successful Organizations:

    • Define Culture Broadly

      • Beyond ethnicity, heritage, language

      • Shared attributes (gender, sexual orientation)

      • Shared life experiences (violence, homelessness)

Achieving cultural competence2

Achieving Cultural Competence

  • Practices of Successful Organizations:

    • Value client’s cultural beliefs

      • Genuine concern and respect

      • Ability to learn about needs and challenges of community

      • Willing to understand clients’ life experiences

Achieving cultural competence3

Achieving Cultural Competence

  • Practices of Successful Organizations:

    • Recognize Communication is Complex

      • Communication is more than shared language

        • Language differs across cultures

        • Linguistic variation within cultures

        • Cultural variation within language

        • Variation in literacy for all groups

Achieving cultural competence4

Achieving Cultural Competence

  • Practices of Successful Organizations:

    • Facilitate Exchange between Provider and Community

      • Create a “learning loop”

    • Active Community Involvement

      • Community Advisory Boards

      • Community Volunteers, Lay Workers

Achieving cultural competence5

Achieving Cultural Competence

  • Practices of Successful Organizations:

    • Collaborate with Other Agencies

      • Health & Educational Institutions

      • Health & Social Service

      • Health & CBO’s

Achieving cultural competence6

Achieving Cultural Competence

  • Practices of Successful Organizations:

    • Institutionalized Cultural Competence

      • Mission & values support competence

      • Hiring and job descriptions stipulate it

      • Ongoing staff training & development

      • Services & outreach reflect it

      • Mechanism for accountability and feedback

Achieving cultural competence7

Achieving Cultural Competence

  • Personal Transformation

    • Know and Understand Culture (broadly)

    • Value Diversity

    • Seek Opportunities to Experience Culture

Achieving cultural competence8

Achieving Cultural Competence

  • Personal Transformation

    • Self-reflection and Self-examination

      • Styles, Attitudes & Behaviors

      • Limitations

      • Biases

Achieving cultural competence9

Achieving Cultural Competence

  • Start small, identify “winnable battles”

  • Organizational

    • Agency mission, staff retreats, workshops

    • Anonymous feedback from clients

    • Anonymous feedback from staff

  • Personal

    • Attend diversity or healing racism workshop

    • Ask clients and colleagues for feedback

      • Clients and colleagues from different backgrounds

Achieving cultural competence10

Achieving Cultural Competence

  • Organizational

    • Identify partners and establish partnerships

    • Explore ways to collaborate and support

  • Personal

    • Partner with colleagues

    • Broaden network of co-workers and contacts

    • Increase exposure to diverse groups

Achieving cultural competence11

Achieving Cultural Competence

  • Lobby for change;

    • Funding to deliver & sustain competence

    • Flexibility in service delivery strategies

    • Staff training and continuing education

  • Professional memberships

  • Academic institutions and training centers

  • Research, Public Policy & Advocacy

  • Organizations