Understanding The Definition and Theory of Cultural Competence

Culture consists of the shared, non-biological, learned components of a group. Culture gives meaning to things and is symbolic, such as language as a shared source of meaning among a group. It is also holistic and integrated, implying that it consists of a system of institutions that come together to meet the needs of the group.

Culture can be made up of different levels, such as a general level (“eastern” culture versus “western” culture) to a more specific level (occupation of an individual or what type of neighborhood that person resides in). A culture can consist of a counter-culture, or a group that goes against a piece of the dominant culture. Personal culture is referred to as idiosyncratic culture, as individuals are influenced by a variety of norms and choose those in line with their personal beliefs (Saneda, 2011).

The Theory of Culture Care Diversity and Universality was first described by Leininger in response to working with children with diverse cultures backgrounds in a mental health setting. Dr. Leininger recognized the role of culture in the care process and sought to better describe it. Since her initiation of care theory in the 1940s, the theory has been built upon for the last few decades to where it stands today (McFarland & Wehbe-Alamah, 2014). Several expressions are often used when it comes to working with individuals where culture needs must be considered. These terms are cultural awareness, cultural sensitivity, and cultural competence.

Cultural awareness is a mindfulness of the similarities and differences between individuals of different cultures. In order to be mindful of cultural differences, an individual, especially one who is providing a service such as a nurse or a social worker, needs to be aware of his or her own cultural characteristics. Without self-awareness, Maschi & Leibowitz (2018) argue that the individual risks imposing his or her own values and judgements on another individual. On the surface of the definition, cultural awareness refers to the sole acknowledgement of differences in various cultures. It does not specify acting in a particular manner (Barsky, 2018).

Cultural sensitivity goes a step beyond the surface awareness that there may be cultural differences among others and stresses understanding how these differences could affect an individual. Part of sensitivity involves one person striving to understand the differences from the perspective of the different culture, rather than from the perspective of an outsider. (Barsky, 2018).

If cultural awareness is an acknowledgement of differences between groups, and cultural sensitivity is understanding how those differences impact groups, then cultural competence refers to the process of acting in a way that recognizes, affirms, and values others while considering their cultural backgrounds and belief systems and not passing judgement (Barsky, 2018). It occurs when care values and expressions are used appropriately and meaningfully (McFarland & Wehbe-Alamah, 2014). It also requires that an individual makes a fundamental change in the way he or she thinks about and interacts with the world around them (Dunn, 2002).

For someone to display cultural competence while working with another individual or group, he or she must demonstrate a specific set of knowledge, skills, and values pertaining to the culture of the other person. Greater than the acknowledgement that differences exist and that these differences may impact a group, cultural competence refers to the deliberate actions one takes in regards of these differences (Barsky, 2018; NASW, 2018).

There is evidence that suggests healthcare providers who are able to display cultural awareness, sensitivity, and competence increase patient satisfaction (Dunn, 2002; Govere & Govere, 2016). In a systematic review of the literature, Govere & Govere looked at seven articles about cultural competency training in healthcare providers and their impact on minority-group patient satisfaction. In five of the studies reviewed, cultural competency training was significantly associated with increased patient satisfaction.

For example, in one study assessing patient satisfaction in a sample of 218 Latina patients, the authors discovered that patient satisfaction scores (obtained via the patient satisfaction (PSQ-III) questionnaire) increased with increased cultural competence in nurse practitioners (as measured by the Inventory to Assess the Process of Cultural Competency Among Healthcare Professionals, or IAPCC). Nurse practitioners (NP) who scored higher on the IAPCC corelated with higher patient satisfaction scores. Specific factors that corelated with increased patient satisfaction included the time spent with NP, NP cultural skill and competence, NP cultural encounter, and NP cultural knowledge (Castro & Ruiz, 2009).

In addition to increased patient satisfaction, cultural competency also leads to greater patient compliance and better medical outcomes for patients (Dunn, 2002). One aspect of developing cultural competency includes sharing information. Just as a healthcare provider must strive to understand the belief system of the patient and how the patient views his or her disease, he or she must also inform the patient of the provider’s culture and how it relates to healthcare. An example includes informing patients of the importance of keeping records of vaccinations and bringing these to doctor’s appointments (Dunn, 2002).

Besides increased patient satisfaction, a diverse and culturally competent environment in the work space leads to increased cooperation, productivity, and improved quality of work among employees. Each employee brings a unique perspective to the team. When diversity is properly managed, opportunities for growth can also be created, which can lead to innovation and the bringing together of new ideas (Conway-Klaassen & Maness, 2017).

In summary, cultural awareness refers to a mindfulness of differences between groups, while cultural sensitivity focuses on understanding how group differences impact diverse individuals (Barsky, 2018). In healthcare, having an awareness and understanding of group differences can lead to changes in the perceptions and reactions of healthcare providers, improving healthcare outcomes for patients (Dunn, 2002).

The process of acting in a way that considers and affirms the culture of another group without passing judgement on that group describes culturally competency (Barsky, 2018; McFarland & Wehbe-Alamah, 2014; NASW, 2018). The lack of culturally competent care has been associated with inaccurate identification of health problems (Smith, 2001). Because a patient’s cultural upbringing influences how they view their overall health and interact with healthcare providers, providing culturally-competent care is essential towards achieving healthy, diverse populations (Conway-Klaassen & Maness, 2017).