By: Serena Cavalier
When people think of medical advancements, they most likely think of scientific breakthroughs, new and promising treatments, and state-of-the-art technology. While progress in all of these areas is needed to improve the state of medical care, healthcare also must progress in ways that address the personal aspect of the profession. Patients must be respected and cared for on a human level. One medical advancement that has only recently been given the attention it deserves is cultural competence education — an essential skill for healthcare providers to provide quality healthcare to patients.
What is cultural competence?
The term cultural competence has many definitions. While the specifics have not been agreed upon, all the definitions share common themes. The American Psychological Association defines cultural competence as “the ability to understand, appreciate and interact with people from cultures or belief systems different from one's own” (DeAngelis, 2015). It involves respecting and valuing varying aspects of diverse cultures including beliefs, customs, practices, and language. A culturally competent person approaches people of all ethnic backgrounds with respect for the influence that their culture has on their identity and worldview.
In a global society where we interact with individuals from varying cultural backgrounds daily, cultural competence is essential (The Pennsylvania State University, 2023). It is a skill required to build connections and meaningful relationships by allowing for respectful intercultural communication.
Why is cultural competency important in healthcare?
Many personal, biological, and environmental factors shape people’s health. Culture is one of these factors. Culture impacts health in a variety of ways including (Tulane University, 2024):
Perception of own health
Care-seeking behaviour
Expectations of care
Ability to access resources
Preferences and willingness to engage in treatment
Involvement of friends and family in health-related decisions
In the Western context, the medical system has been built upon and shaped by institutions that promote Euro-Western ideologies. Some examples of this limited perspective include a lack of recognition of psychiatric illnesses documented to only impact those from certain cultures, and a central focus on germs as the root of disease, whereas foods and specific organs are focused on in other cultures, (Luptor, 2013). These beliefs are not always aligned with those held by other cultures. To combat this long-held cultural ignorance, education in understanding and respecting the cultures of others is needed.
Quality healthcare relies on quality communication between the health professional and the patient; it is required to assist patients in making informed decisions surrounding their health and easing discomfort. Cultural awareness promotes respect that builds the foundation for a healthy provider-patient relationship to create trust in the healthcare context. A study found that amongst an immigrant population in Canada, those who reported stronger levels of trust in their physician also reported better physical health (Zghal et al., 2020). Many patients in North America who are minorities have experienced discrimination by the healthcare system. Most of the time, medical-based discrimination comes from ignorance and a lack of education at the fault of the medical system and healthcare professionals. Teaching cultural competency can address these pitfalls.
What does cultural competency training look like?
Different approaches to training in cultural competence have been proposed, but three main models are typically implemented. The first approach is knowledge-based and primarily focuses on social determinants of health, correcting common misconceptions, and defining culture (Kripalani et al., 2006). The second approach is attitude-based and utilizes self-reflection to help students challenge their unconscious biases (Kripalani et al., 2006). The final approach is the skills-based approach which teaches cross-cultural communication skills. A combination of all three approaches is likely the most effective in improving the cultural competence of health professionals (Kripalani et al., 2006).
It is important to recognize that training in cultural competence needs to be ongoing and integrated into medical clinical education to be effective (Kripalani et al., 2006). Culture is complex, and it requires more than a couple of workshop sessions to truly increase awareness. Cultural competence must be held at the same importance as scientific medical teachings. It must be a professional skill developed throughout years of study.
Teaching cultural competence must be accompanied by true diversity and inclusion within medical educational institutions. Diversity should be reflected in both the student and faculty populations (Kripalani et al., 2006). To teach cultural competence means it must exist in the setting where it is being learned. Educators in cultural competence must have a nuanced understanding of minority cultures that can only be attained through lived experience. Otherwise, this training becomes misinformed and performative. Institutions must lead as an example of equity, diversity, and inclusion for all cultures.
Has cultural competence training proven successful?
For healthcare providers, cultural competence training has proven beneficial. Health professionals across many studies have shown that after cultural competence training, they had improved knowledge and better attitudes when treating patients of different cultures and better communication skills when doing so (Govere & Govere, 2016). More importantly, patients have reported better experiences while seeking care after their healthcare providers received some form of cultural competency training. They felt they were receiving personalized care (Govere & Govere, 2016). While reported experiences are insightful, many potential benefits are yet to be formally studied like improved referral rates and attentive pain treatment.
These reported experiences highlight the need for cultural competence education to be made universal across all forms of healthcare education. No patient should feel dismissed or unheard by their medical team. By educating health professionals to respect and value all cultures, patients can feel comfort and support regardless of their cultural background.
References
DeAngelis, T. (2015, March). In search of cultural competence. Monitor on Psychology. https://www.apa.org/monitor/2015/03/cultural-competence
Govere, L., & Govere, E. M. (2016). How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews on Evidence-Based Nursing, 13(6), 402–410. https://doi.org/10.1111/wvn.12176
Kripalani, S., Bussey-Jones, J., Katz, M. G., & Genao, I. (2006). A prescription for cultural competence in medical education. Journal of General Internal Medicine, 21(10), 1116–1120. https://doi.org/10.1111/j.1525-1497.2006.00557.x
Luptor, D. (2013, January 1). The cultural assumptions behind Western medicine. The Conversation. https://theconversation.com/the-cultural-assumptions-behind-western-medicine-7533
The Pennsylvania State University. (2023, May 1). What is cultural competence and how to develop it?. Penn State Extension. https://extension.psu.edu/what-is-cultural-competence-and-how-to-develop-it
Tulane University. (2024, May 22). How to improve cultural competence in health care. Tulane University School of Public Health and Tropical Medicine. https://publichealth.tulane.edu/blog/cultural-competence-in-health-care/
Zghal, A., El-Masri, M., McMurphy, S., & Pfaff, K. (2020). Exploring the impact of health care provider cultural competence on new immigrant health-related quality of life: A cross-sectional study of Canadian newcomers. Journal of Transcultural Nursing, 32(5), 508–517. https://doi.org/10.1177/1043659620967441
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