Originated by: Julia Olff
Submitted: 15 Dec 2011
Last updated on:
15 Dec 2011
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It‘s been well established in public health and health care, that understanding diverse cultural backgrounds and the consequent health beliefs and behaviors are essential for providing effective patient care including education and counseling. Cultural competence is considered a key to closing the gap in health care disparities. As a result medical education curriculum worldwide has been adapted to train physicians to be culturally competent. Cultural humility is a framework for applying cultural competence.
Cultural competency training programs offer instructional strategies for delivering culturally appropriate and tailored care to patient populations with diverse values, beliefs, and behaviors. Health care professionals are most often taught a set of facts about the traditional beliefs and practices of certain ethnic and cultural groups and then asked to apply them to their patient interactions.
In 1998 thought leaders in multicultural education such as Drs. Melanie Tervalon and Jann Murray-Garcia expressed concern that the didactic approach to training health care professionals over emphasizes underserved and ethnic minorities and can lead to stereotyping or other negative reactions. In addition, cultural competency training neglects the providers’ beliefs and cultural influences, and focuses solely on the patient. In contrast, the cultural humility framework advanced by Tervalon and Murray-Garcia brings the professionals’ understanding of their own influences into their communications with patients. The goal is to guide professionals toward a respectful partnership with the patient that allows them to explore the assumptions, expectations, and goals they each bring to an interaction to achieve a culturally competent approach to patient care.
This framework involves ongoing self-reflection and self-critique. Health professionals must first acknowledge the assumptions and beliefs that are part of their own belief system influenced by their culture before understanding the patient’s beliefs system. An individuals’ culture is not only shaped by their ethnicity but also by their age, life experiences, physical abilities, gender, language (s), religion, politics, education, sexual orientation, socio-economic status, and residential status. The health care professional is encouraged to practice patient-focused interviewing to learn from the patient, allowing them to talk about their illness or wellness experience.
Chang et al developed a curriculum model called QIAN for health care professionals and patients to follow to help foster the practice of cultural humility and enhance the cultural orientations between professional and patient. The model is based on the works of Chinese philosophers, Chinese cultural values and the current Chinese immigrant’s experience. QIAN or humbleness in Chinese has 4 tenets: the importance of self-Questioning and critique, bi-directional cultural Immersion, mutually Active listening, and the flexibility of Negotiation.
To improve self-awareness of your own cultural influences in your work with patients, Dr. Margie Akin, a Cultural and Linguistic Services Specialist, recommends these self-reflective exercises you can answer on your own or discuss with other health educators. Ask the following:
- Identify your own cultural and family beliefs and values
- Define your own personal culture/identity: ethnicity, age, experienced, education, socio-economic status, gender, sexual orientation, religion etc.
- Are you aware of your personal biases and assumptions about people with different values than yours?
- Challenge yourself in identifying your own values as the “norm”
- Describe a time when you became aware of being different from other people
To learn more about cultural humility and cultural competency take a look at these articles and web sites: