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What is cultural competence?

This is an excerpt from Cultural Competence in Sports Medicine by Lorin Cartwright & Rene Shingles.

Developing cultural competence is a process in which an athletic trainer learns to appreciate and respect cultural differences and take them into consideration in order to care for patients in a culturally congruent manner (Purnell & Paulanka, 2008). Cultural competence also involves analyzing and criticizing systems of power and privilege (Andersen & Collins, 2007) that create inequities in health care and health care delivery. For example, if a provider establishes office or clinic hours of 9:00 a.m. to 4:30 p.m.—with time off for lunch from noon to 1:00 p.m.—one consequence is that people who work during those times (particularly hourly workers) thus face a systematic barrier to care. A person in this situation must decide if seeking health care is more important than receiving pay. Thus, if a large number of community members are hourly workers, then providing culturally competent care that meets the needs of the community may mean adjusting one's hours of operation to give patients better access to that care. Cultural competence can be developed, and doing so takes time, energy, and commitment; the process requires an active choice followed up with conscious effort.

Scholarly Definitions

Cultural competence has been defined by numerous scholars (Andrews & Boyle, 1995; Campinha-Bacote, 2002, 2007; Giger & Davidhizar, 2007; Leininger, 1978; Purnell & Paulanka, 2005, 2008; Spector, 2004) and organizations (Office of Minority Health, 2005). Although no universally accepted definition exists, many of the definitions address common themes. In terms of individual health care providers, two recurring themes are as follows: (a) recognizing one's own cultural attitudes, beliefs, and biases in order to better understand the patient's culture and health care practices, and (b) acquiring culturally based knowledge and skills in order to provide care in a culturally congruent manner. Other themes focus on the health care system (organizational cultural competence)—for example, being able to work effectively with colleagues from a diversity of cultures.

Here are two scholarly definitions of cultural competence:

• “[T]he ongoing process in which the health care professional continuously strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)” (Campinha-Bacote, 2007, p. 15).
• “[C]ulturally sensitive, culturally appropriate, [and] meeting the complex culture-bound health care needs of a given person, family and community” (Spector, 2009, p. 8).

Definitions from Professional Health Organizations

Various health care organizations have either defined cultural competence or identified it as a desirable value. Here are several examples.

• Health Resources and Services Administration (Bureau of Primary Health Care): Cultural competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status between diverse population groups. Cultural competence also focuses on population-specific issues, including health-related beliefs and cultural values (the socioeconomic perspective), disease prevalence (the epidemiologic perspective), and treatment efficacy (the outcome perspective) (Bureau of Primary Health Care, 2000, p. 3).
• Office of Minority Health (U.S. Department of Health and Human Services): Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals and 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, and 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 (Office of Minority Health, 2005).
• National Athletic Trainers' Association (NATA): NATA addressed cultural competence in the fourth edition of its educational competences, where cultural competence is listed as a foundational behavior of professional practice. Athletic trainers are expected to “understand the cultural differences of patients' attitudes and behaviors toward health care[;] . . . [d]emonstrate knowledge, attitudes, behaviors, and skills necessary to achieve optimal health outcomes for diverse patient populations[; and] . . . [d]emonstrate knowledge, attitudes, behaviors, and skills necessary to work respectfully and effectively with diverse populations and in a diverse work environment” (National Athletic Trainers' Association, 2006, p. 6).

Developing cultural competence is an ongoing process; it happens over time. This process involves developing cultural awareness, knowledge, and skills in order to treat all patients as uniquely as possible. Health care providers and health care organizations alike should participate in the process of developing cultural competence in order to minimize barriers to health care.

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