Cultural Competence

In order to identify the impact of different cultures, values and choices upon the delivery of healthcare provision you have to be able to access resources which enable you to understand cultural diversity and simultaneously promote best practice in your clinical area. This unit will support your to build upon knowledge and practice gained as a student in order to strengthen your cultural competence.


Culture and Cultural Competence

The diversity of service users, carers, families and colleagues we encounter in all areas of health care highlights the importance of cultural competence.

Culture can be defined as the values, norms, and traditions that affect how individuals of a particular group perceive, think, interact, behave, and make judgments about their world (Chamberlain 2005 p197). Culture is about how people make sense of experience and is not homogenous, static or a list of traits or beliefs shared by a social group.

We all participate in multiple cultures which are linked to our ethnicity, nationality, social class, and other aspects of our identity like gender, sexual orientation or religion. Culture shapes the way we think, feel and experience our lives. We are also shaped by organisational and professional cultures. Cultural competence is also about understanding how culture influences the way we think and act, the things we value and our understanding of health, illness, personhood, recovery, etc.

Cultural competence is important for individual practitioners as well as for services and organisations. However, there is no single definition of cultural competence. At the level of the individual practitioner, the various definitions usually refer to knowledge, attitudes and skills that allow the practitioner to understand and appreciate cultural differences, and to the capacity to provide effective health care which takes into account people’s cultural beliefs, behaviours and needs.

Developing cultural competence

Developing cultural competence is not a process of learning lists of ‘facts’ about ‘other’ cultures. It is about learning to understand and work with service users from a range of diverse cultural and social backgrounds. A key part of this is learning to be reflective about our how own culture influences our assumptions and the ways we work.

Answer the following questions:

  • what do you think about these concepts?
  • what relevance do they have for healthcare in your work setting?

Record your reflections for your portfolio.

Cultural competence: the Explanatory Models approach

You will have recognised that culture is dynamic; that that there are cultural differences within and between groups; and that recognising that this is key in developing cultural competence.

The Explanatory Models approach (Kleinman and Benson 2006) supports the delivery of person-centred care, as well as the engagement of service users, their carers and their families in care. It also provides you with a way to reflect on you ‘explanatory models’.

The steps in this model are:
Step 1. Ethnic identity. Ask about ethnic identity and whether it matters for the patient.
Step 2. What is at stake? Evaluate what is at stake for patients, families and others in an episode of illness.
Step 3. The illness narrative. Different cultural meanings may have implications for care.
Using the following series of questions develop the patient’s ‘explanatory model’ for their illness:

  • what do you call this problem?
  • what do you believe is the cause of the problem?
  • what course to do you expect it to take? 
  • how serious is it?
  • what do you think this problem does inside your body?
  • how does it affect your body and your mind?
  • what do you most fear about this condition?
  • what do you most fear about the treatment?

Step 4. Psychosocial stresses. What ongoing stresses and social supports are there?
Step 5. Influence of culture on clinical relationships. How does your culture influence your relationships with patients/clients and colleagues?
Step 6. The problems of a cultural competency approach.

  • does the intervention work in this case? 
  • how useful is the focus on cultural difference? 
  • are there issues here which cultural competency alone cannot resolve?

The following activity is in 2 stages and you may want to complete them in stages.

1. Now that you have learned about this model:

  • compare this approach to existing assessment processes in your service
  • consider how your existing assessments take, or don’t take, into account the stages of this model

2. Complete one of the following activities:

a. Your experience of illness
Think of a time when you were ill. Using the Explanatory Models approach, construct your own illness narrative. How do you think your cultural background influenced this narrative? Did your narrative differ from those of the healthcare practitioners who were treating you? If so, how did that make you feel? Did it affect the way you were involved with your treatment?

b. Using the Explanatory model in practice
Practice the Explanatory Models approach with a service user (regardless of specific cultural background) and reflect on the process.

  • were the questions easy to ask? 
  • were you surprised by the results? 
  • did you learn anything which made you reconsider your practice/care for that individual? 
  • what was the service user’s experience of the process? 
  • did it improve the clinical relationship or not?

What influences you? Writing a cultural biography

Write a ‘cultural biography’ that reflects how your own culture has influenced and shaped your beliefs and professional practice. There are a number of ways you could approach this. Here are some suggestions to get you started:

  • how would you describe your own identity?
  • what values are most important to you and why?
  • how do you define health, illness, recovery and well-being? 
  • are these concepts important to you? Why or why not?
  • do your personal definitions of health, illness, recovery and wellbeing (when thinking about yourself) differ from your professional definitions (those you apply at work)?
  • who or what influences the way you think about these concepts? 
  • where did you acquire your attitudes and knowledge?
  • does how you act fit with these definitions? Why or why not?
  • what factors influence the way you put your knowledge and beliefs in to practice?

Discuss your cultural biography with your mentor and record your discussion and reflections for your portfolio.