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There
is no one definition of cultural competence. Definitions of cultural
competence have
evolved from diverse perspectives, interests and needs and are
incorporated in state legislation, Federal statutes and programs,
private sector organizations and academic settings. The seminal
work of Cross et al in 1989 offered a definition of cultural competence
that established a solid foundation for the field. The definition
has been widely adapted and modified during the past 15 years.
However, the core concepts and principles espoused in this framework
remain constant as they are viewed as universally applicable across
multiple systems.
A number of
definitions and descriptions of cultural competence were reviewed
to compile the selected list. The following
definitions of are highlighted because they represent or are
based on original and exemplary work and because of their potential
impact
to the field of health and human services.
Cross et al,
1989
Cultural competence
is a set of congruent behaviors, attitudes, and policies that
come together in a system, agency or among
professionals
and enable that system, agency or those professions to work
effectively in cross-cultural situations.
The word culture is used because it implies the integrated pattern of human behavior
that includes thoughts, communications,
actions,
customs, beliefs, values and institutions of a racial, ethnic,
religious or social group. The word competence is used because
it implies having
the capacity to function effectively.
Five essential
elements contribute to a system's institution's, or agency's
ability to
become more culturally competent which
include:
- Valuing
diversity
- Having the
capacity for cultural self-assessment
- Being conscious
of the dynamics inherent when cultures interact
- Having institutionalized
culture knowledge
- Having developed
adaptations to service delivery reflecting an understanding
of cultural
diversity
These
five elements should be manifested at every level of an organization
including policy making, administrative,
and practice.
Further these elements should be
reflected in the attitudes, structures, policies and services of
the organization.
National Center for Cultural Competence,
1998, modified from Cross et al
Cultural competence requires that
organizations:
- Have
a defined set of values and principles, and demonstrate behaviors,
attitudes, policies, and structures that enable them to work effectively
cross-culturally.
- Have
the capacity to (1) value diversity, (2) conduct self-assessment,
(3) manage the dynamics of difference,
(4) acquire and institutionalize
cultural knowledge, and (5) adapt to diversity and the cultural contexts of
communities they serve.
- Incorporate
the above in all aspects of policy-making, administration,
practice and service delivery,
systematically involve consumers, families
and communities.
Cultural competence is a developmental
process that evolves over an extended
period. Both individuals and organizations are at various levels
of awareness, knowledge and skills along the cultural competence continuum.
Betancourt et al., 2002
Cultural competence in health care
describes the ability of systems to provide care to patients with diverse
values, beliefs
and behaviors,
including tailoring
delivery to meet patients’ social, cultural, and linguistic needs.
Lavizzo-Mourey & Mackenzie,
1996
Cultural competence is the demonstrated
awareness and integration of three population-specific issues: health-related
beliefs and cultural
values, disease
incidence and prevalence, and treatment efficacy. But perhaps the
most significant aspect of this concept is the inclusion and integration
of the three areas
that are usually considered separately when they are considered
at all.
Roberts et al, 1990
Cultural competence refers to a
program's ability to honor and respect those beliefs, interpersonal styles,
attitudes and
behaviors both of
families who
are clients and the multicultural staff who are providing services.
In doing so, it incorporates these values at the levels of policy, administration
and practice.
Denboba, MCHB, 1993
Cultural competence is defined as a set of values, behaviors, attitudes,
and practices within a system, organization, program or among individuals
and which
enables them to work effectively cross culturally. Further, it refers
to the ability to honor and respect the beliefs, language, interpersonal
styles and
behaviors of individuals and families receiving services, as well as
staff
who are providing such services. Striving to achieve cultural competence
is a dynamic, ongoing, developmental process that requires a long-term
commitment.
At a systems, organizational
or program level, cultural competence requires a comprehensive
and coordinated plan that includes
interventions
on levels
of:
- policy
making;
- infra-structure
building;
- program
administration and evaluation;
- the
delivery of services and enabling supports;
and
- the
individual.
This often
requires the re-examination of mission
statements; policies and procedures; administrative
practices; staff recruitment, hiring
and retention; professional development and in-service
training; translation and interpretation processes; family/professional/community
partnerships;
health
care practices and interventions including addressing
racial/ethnic health disparities and access issues; health education
and promotion practices/materials;
and community and state needs assessment protocols.
At the individual
level, this means an examination of one’s own attitude
and values, and the acquisition of the values, knowledge, skills
and attributes that will allow an individual to work appropriately
in cross cultural situations.
Cultural competence
mandates that organizations, programs and individuals
must have the ability to:
- value
diversity and similarities among all peoples;
- understand
and effectively respond to cultural differences;
- engage
in cultural self-assessment at the individual and organizational
levels;
- make
adaptations to the delivery of services and enabling supports;
and
- institutionalize
cultural knowledge.
Tervalon & Murray-Garcia,
1998
Cultural humility is best defined
not by a discrete endpoint but as a commitment and active engagement
in a lifelong process that
individuals
enter into
on an ongoing basis with patients, communities, colleagues, and
with themselves…a
process that requires humility in how physicians bring into check
the power imbalances that exist in the dynamics of physician-patient
communication
by using patient-focused interviewing and care.
American Association
for Health Education
Cultural competence
is the ability of an individual to understand and respect values,
attitudes, beliefs, and mores that differ
across cultures,
and
to consider and respond appropriately to these differences
in planning, implementing, and
evaluating health education and promotion programs and
interventions.
National Alliance for
Hispanic Health, 2001
Cultural proficiency
is when providers and systems seek to do more than provide unbiased
care as they value
the
positive role culture
can play
in a person’s
health and well-being.
National Medical Association
Cultural
Competency (Health) is the application of cultural knowledge,
behaviors, and interpersonal
and clinical skills
that enhances
a provider’s effectiveness
in managing patient care.
U.S. Department of Health
and Human Services:
Administration on Developmental
Disabilities, 2000
The term cultural competence
means services, supports or other assistance that are conducted
or provided
in a manner
that is responsive
to
the beliefs, interpersonal
styles, attitudes, language and behaviors
of individuals who are receiving services, and
in a manner that
has the greatest likelihood
of ensuring
their maximum participation in the program.
Health
Resources and Services Administration, Bureau of Health Professions
Cultural
competence is defined simply as the level of knowledge-based
skills required
to
provide effective
clinical care to patients
from a particular
ethnic or racial group.
Health Resources
and Services Administration, Bureau of Primary Health Care
Cultural
and linguistic competence is a set of congruent behaviors,
attitudes and
policies
that
come together
in a system, agency or
among professionals
that enables effective work in
cross-cultural situations. "Culture" refers
to integrated patterns of human
behavior that include the language, thoughts,
communications, actions, customs,
beliefs, values, and institutions
of racial, ethnic, religious or
social groups. "Competence" implies
having the capacity to function
effectively as an individual and an organization
within
the context of the cultural beliefs,
behaviors and needs
presented by consumers and their
communities.
U.S. Department of
Health and Human Services:
Health Resources and
Services Administration, Maternal and Child Health Bureau,
Title V Block Grant Program
Guidance,
2003
Culturally competent – the
ability to provide services
to clients that honor different
cultural beliefs, interpersonal
styles, attitudes and behaviors
and the use of multi-cultural
staff in the policy development,
administration and provision
of those services.
Office
of Minority Health, National Standards for Culturally
and
Linguistically Appropriate
Services
in Health Care
(CLAS Standards),
2001
Cultural competence
- Having the capacity to function
effectively as an individual
and an
organization
within the context of
the cultural beliefs,
behaviors and
needs presented by consumers
and
their communities.
Substance
Abuse and Mental Health Services Administration,
Center
for Mental Services
Cultural
Competence includes: Attaining
the knowledge,
skills, and attitudes
to enable
administrators
and practitioners
within system of care to provide
effective care for
diverse populations,
i.e., to
work within the person’s
values and reality
conditions. Recovery
and rehabilitation
are more likely to
occur where managed
care systems, services,
and providers have
and utilize
knowledge and skills
that are culturally
competent and compatible
with the backgrounds
of consumers from the
four underserved/underrepresented
racial/ethnic
groups, their families,
and communities. Cultural
competence acknowledges
and incorporates variance
in normative acceptable
behaviors, beliefs
and values
in determining an individual’s
mental wellness/illness,
and incorporating those variables
into assessment and
treatment.
References/Sources
American
Association for Health Education, http://www.aahperd.org/aahe
Betancourt,
J., Green, A. & Carrillo, E. (2002). Cultural competence
in health care: Emerging frameworks and practical approaches. The Commonwealth Fund.
Cross, T., Bazron, B.,
Dennis, K., & Isaacs,
M., (1989). Towards A Culturally Competent System of
Care, Volume I. Washington, DC: Georgetown
University
Child Development Center, CASSP Technical Assistance Center.
Denboba,
D., U.S. Department of Health and Human Services, Health Services
and Resources Administration (1993). MCHB/DSCSHCN
Guidance
for Competitive
Applications, Maternal and Child Health Improvement Projects
for Children with Special Health Care Needs.
Lavizzo-Mourey,
R. & Mackenzie, E. (1996). "Cultural competence:
Essential measurement of quality for managed care organizations."
Annals of Internal
Medicine, 124 919-926.
National Alliance for
Hispanic Health (2001). A Primer for cultural proficiency:
Towards quality
health care services
for Hispanics. Washington, D.C.
National Medical Association,
National Medical Association Cultural Competence Primer, retrieved
from http://www.askme3.org/PFCHC/download.asp on
April 2, 2004.
Roberts, R., et al.
(1990). Developing Culturally Competent
Programs for Families of Children with Special Needs (monograph and workbook); Georgetown University
Child Development Center.
Taylor, T., et al. (1998).
Training and Technical Assistance Manual for Culturally Competent
Services and Systems:
Implications for
Children with Special Health
Care Needs. National Center for Cultural Competence,
Georgetown University Child Development Center.
Tervalon,
M. & Murray-Garcia, J. (1998). "Cultural humility versus
cultural competence: a Critical discussion in defining
physician training outcomes
in multicultural education." Journal of
Health Care for the Poor and Underserved, 9 (2) 117-125.
U.S. Department of Health
and Human Services, Administration for Children and Families,
Administration on Development Disabilities (2000). Amendments
to P.L. 106-402 - The Developmental Disabilities Assistance and
Bill of Rights
Act of 2000.
U.S. Department of Health
and Human Services, Health Resources and Services Administration,
Bureau of Health Professions,
retrieved from http://www.bhpr.hrsa.gov/diversity/cultcomp.htm on April 2, 2004.
U.S. Department of Health
and Human Services, Health Resources and Services Administration,
Maternal and Child
Health Bureau,
Division of State and Community
Health (2003). Maternal and Child Health Services Title V
Block Grant Program, retrieved from ftp://ftp.hrsa.gov/mchb/blockgrant/bgguideforms.pdf on April
13, 2004.
U.S. Department of Health
and Human Services, Office of Minority Health (2001). National
Standards for Culturally
and Linguistically
Appropriate Services in
Health Care: Final Report, retrieved from http://www.omhrc.gov/clas/ on April 15, 2004.
U.S. Department of Health
and Human Services, Substance Abuse and Mental Health Services
Administration, Center
for Mental
Services, retrieved from http://www.bhpr.hrsa.gov/diversity/cultcomp.htm on April 2, 2004.
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