What is “cultural competence”?
Culture is an aspect of identity, which we all have. Culture is based on a number of things shared with others such as language, shared history, beliefs, attitudes, celebrations, taste in music, clothing, diet, and many others. Culture is basically about a shared understanding with others of the same culture. Cultures are neither inferior nor superior, they are just different.
In health and social care, there has been a shift in recent years towards ‘cultural competence’ as a key aspect of all professional practice. The idea of workers being ‘competent’ to work with others from different cultures is a step beyond being ‘sensitive’ to other people’s needs. The notion that professionals need to be competent to work with difference and culture rather than merely ‘sensitive’ to it has gained traction in recent years. Therefore, the term cultural competence has largely replaced the term cultural sensitivity in social work and health care.
If workers are to be seen as culturally competent, then they must be able to articulate what cultural competence is. Rather, the very concept of competence implies that those who do not have sufficient knowledge and understanding of the role of people’s culture are, by definition, ‘incompetent’ at their job if they cannot work effectively to meet the various people’s needs.
There is a longstanding view that competence is made up of knowledge, values and skills (eg Maclean and Caffrey 2009).
From our point of view, culturally competent practice involves:
1. Knowledge and understanding of:
your own culture
any cultural biases you have
the concept of culture and how this can affect beliefs and behaviors
specific cultural knowledge
2. A range of values and attitudes, including a commitment to:
valuing and celebrating difference
respecting individuality and the role that culture plays in this
3. And a variety of abilities, including:
culturally competent communication
culturally competent assessment
culturally sensitive care delivery
It is important to recognize that culture is an aspect of a person’s identity. It is not your ‘total’ identity and does not act as a predictor of how a person will behave and what they will believe. Everyone will choose which aspects of their cultural identity to ‘own’ and which not. As such, each person will have a unique approach to their culture, leading to a complexity of ways in which culture will affect people’s individual needs and preferences.
Cultural competence and self-awareness for health and social care workers
If health and social care workers are to be culturally competent, they need to develop some key skills and knowledge for effective practice. In order to appreciate the different cultures with which people fully associate and to form effective working relationships with service users and carers, it is important to understand the diversity that exists in daily life.
Within all cultures and religious groups there is wide variation in practice and it is important to realize that degrees of rigor and observance are individually defined. Culturally competent workers will appreciate that culture is not monolithic and that it will be dangerous to deliver services based on stereotyped concepts of, say, “Jew,” “Hindu,” or “Muslim.” Some people born into a religious community may not consider themselves members of that community. For others, their religion, traditions and rituals may be important, but they may not observe, for example, strict dietary requirements. Therefore, it is important to allow people to define their own culture and religion.
The way a person sees themselves and their identity will be affected by their culture and religion, but this can vary between different groups and according to individual personal preferences. The way we live our lives is affected by the environment in which we all live.
If we accept that cultures are not better or worse than each other, but simply different, then we must be clear that some of the ideas and ‘truths’ we bring to our work have cultural roots. As health and social service workers we also have our own culture, both as individuals in society and as employees of organizations and members of teams that have cultures. Culturally competent practice involves understanding the values we bring to our work and a sophisticated awareness of how oppression, other people’s culture stereotypes, and bias operate to harm others. A competent practitioner is able to understand these concepts, see how they relate to her practice, and reflect on her own values and ‘truths’ about her own culture and that of other people.
Robinson (2007: 169) states:
“An etic refers to a universal truth or principle, while an emic refers to truths that are specific to a culture.”
People who work with others need to understand the fact that not all the truths we grew up with are etics in order to appreciate the impact our own culture and upbringing has had on our beliefs about the world. We cannot work effectively with other people who have different emics than ours if we insist that all their ‘truths’ (ie their beliefs, values, aspirations, etc.) must be the same as ours.