Cultural Competency
Skills for Health Care
Professionals
2
Cultural Competency Skills for
Health Care Professionals:
Community-Based Modules
Developed by :
Earle Waugh, PhD
Olga Szafran, MSHA
Jean A.C. Triscott, MD,CCFP
Acknowledgements:
 The research was funded by the Pallium 11 Project,
Health Canada
 Funding for the videos from the Dr. Scott McLeod Family
Medicine Fund, Department of Family Medicine and
Centre for the Cross-Cultural Study of Health and
Healing
 Manual development was provided from the Dr. Scott
McLeod Family Medicine Fund
Learning Objectives

Become aware of one’s own beliefs and attitudes
toward individuals of different ethno-cultural groups

To gain an increased understanding of how ethnocultural attitudes influence patient-provider
relationships;

To gain an understanding of factors that can influence
cultural principles, beliefs and values;

To understand the meaning of cultural competency as
it relates to providing patient care;

To conduct a cultural competency self-assessment;
Learning Objectives:
 To describe and give examples of the six stages of the
cultural competency continuum;
 To apply the LEARN Model for cross-cultural
communication;
 To base the learning of cultural competency on filmed
scenarios of four cultural groups in Northern Alberta
Developing Cultural Competency Skills for Health
Professionals:
Introductions and Learning Objective for the Session
Fill out the Clinical Cultural Competency Questionnaire
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Developing Cultural Competency Skills for Health
Professionals:
 Research Presentation : “Toward Culturally Responsive
Care in the Community: Views of five Cultural
Communities on Dementia/End of Life Issues,
(Consensus Group findings),
 Presentation on Definition and Tools of Cultural
Competency
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Developing Cultural Competency Skills for Health
Professionals:
 Video presentations (2) and large group discussion using
the Tools of Cultural Competency; (LEARN) and Cultural
Competency Continuum.
 Small Groups and Cases
 Workshop evaluation
Definition:
Cultural Competency
 ….a set of congruent behaviors, attitudes, and policies
that come together in a system, agency, or amongst
professionals and enables that system, agency, or those
professionals to work effectively in cross-cultural
situations.
(Cross, Bazron, Dennis,& Isaacs,1989)
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Cultural competency is the:
 …acceptance and respect for differences, continuing
self-assessment regarding culture, careful attention to
the dynamics of differences, continuous expansion of
cultural knowledge and resources, and a variety of
adaptations to service models in order to better meet
the needs of minority populations.
(Cross, Bazron, Dennis,& Isaacs, 1989)
Definition:
Cultural competency is the
‘The ability to think, feel and act in ways that
acknowledge, respect, and build upon ethic, (socio)
cultural, and linguistic diversity,”
(Lynch & Hanson,1998)
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Why is Cultural competency
Important for Health Care
Professionals?
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Lack of cultural knowledge
 has been associated with improper diagnosis,
 lack of active compliance,
 social resistance and legal challenges.
Cultural orientation of health
care providers
 Can influence assess and use of health services by
various cultural groups
 Ethno-cultural factors affect the amount and type of
care individuals belonging to various cultural groups
receive
 Cultural competency has the potential to reduce
inequities in access to health services and improve the
health status of cultural communities
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Why is Cultural Competency
Important?
 Both quality of care and the detection of culturallyspecific diseases have been shown to increase with the
provision of culturally-sensitive health care
 Cultural competency improves both the patient-provider
relationship and communication with patients.
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Why is Cultural Competency
Important?
 Cultural competence facilitates patient-provider
interaction in a way that is consistent/with patient’s
values, beliefs, and expectation.
 The development of cultural competence requires
training and education
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Cultural Competence Continuum
 A framework and model for understanding the process
of becoming culturally competent and achieving cultural
competence.
(Cross, Bazron, Dennis, and Isaacs ,1989)
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Cultural Competence Continuum:
 There are six points on the continuum which represents
possible ways of responding to cultural differences.
(Cross, Bazron, Dennis, and Isaacs,1989)
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Cultural Competence Continuum
 1. Cultural Destructiveness (CD)
 2. Cultural Incapacity (CI)
 3. Cultural Blindness (CB)
 4. Cultural Pre-competence (CP)
 5. Cultural Competence (CC)
 6. Cultural Proficiency (CP)
 CD____CI____CB____CP____CC____CP
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Cultural Competence Continuum
 1. Cultural Destructiveness (CD)
 2. Cultural Incapacity (CI)
 3. Cultural Blindness (CB)
 4. Cultural Pre-competence (CP)
 5. Cultural Competence (CC)
 6. Cultural Proficiency (CP)
 CD____CI____CB____CP____CC____CP
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Cultural Competence Continuum:
1. Cultural Destructiveness (CD) - attitudes and practices
that are destructive to cultures and consequently to
the individuals within the culture;
2. Cultural Incapacity (CI) – not intentionally seeking to
be culturally destructive, lacking the capacity to help
minority clients or communities, being extremely
biased, believing in racial superiority of the dominant
group, and assuming a paternal posture towards the
“lesser” races;
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Cultural Competence Continuum:
3. Cultural Blindness (CB) – expressing a philosophy of
being unbiased, believing that culture/ethnicity/race
makes no difference and all people are the same,
believing that approaches traditionally used by the
dominant culture are universally applicable;
4. Cultural Pre-Competence (CP) – becoming aware of
weaknesses in serving minorities and attempting to
improve some aspects of their services to a specific
population;
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Cultural Competence Continuum
5. Cultural Competence (CC): accepting and respecting
differences, continual self-assessment regarding
culture, being attentive to the dynamics of difference,
continually expanding cultural knowledge, and
adapting service delivery in order to better meet the
needs of minority populations;
6. Cultural Proficiency (CP) – holding culture in high
esteem, seeking to add to the knowledge base of
culturally competent practice, and developing new
approaches based on culture.
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Cultural Competence Continuum
1. Cultural Destructiveness (CD)
2. Cultural Incapacity (CI)
3. Cultural Blindness (CB)
4. Cultural Pre-competence (CP)
5. Cultural Competence (CC)
6. Cultural Proficiency (CP)
7. CD____CI____CB____CP____CC____CP
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In order to move along the cultural competency
continuum professionals must:
 Value diversity
 Understand cultural biases;
 Be conscious of the dynamics of cultural interactions;
 Internalize cultural knowledge; and
 Develop adaptations to diversity.
 Each conditions must function at every level of the
health care system in order for that system to provide
culturally competent care
“Learn” Model for CrossCultural Communication
The LEARN process enables health providers to elicit, discuss, and
negotiate relevant cultural, social, and personal information
relevant to an illness episode. (Berlin and Fowkes 1983)
The Guidelines are:
L Listen with sympathy and understanding to the patient’s
perception of the problem
E Explain your perceptions of the problem
A Acknowledge and discuss the differences and similarities
R Recommend treatment
N Negotiate agreement
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Use of the Learn Model
 Improves cross-culture communication
 Increases awareness of cultural issues
 Obtains better patient acceptance of treatment plan
 The primary focus is a suggested process for improved
communication, which is seen as the fundamental need
in cross-cultural patient-physician interaction
(Berlin & Fowkes, 1983)
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Community-Based Modules
 Learning Modules are based on research finding from
the cultural communities
 Research was based on end-of-life and dementia care
which involved the elderly, and senior members of the
respective communities in Northern Alberta,
Canada.(Waugh E, Szafran O, Triscott JAC, 2010)
---Aboriginal (Cree) ----Chinese -(Cantonese, Mandarin)
---Francophone
---Lebanese Muslim
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Community-Based Modules
 The modules should not be regarded as being the norm
for all such communities, as variability exists even
within a cultural group.
 During the research process, it became evident that
which health care professionals were aware of issues
surrounding cultural competence in patient care, they
had received little or no training in cultural
competence.
 Health care professionals expressed a need for formal
culturally-sensitive training.
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Community-Based Modules
 Films were developed as teaching tools to give some
real-life depth to cultural issues in dementia and endof-life care. The professional script writer, Mary-Ellen
Perley, Directors, Omar Moaullem and Michael Olsen.
 The cases were based on important issues related to the
the respective communities.
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Module 1: Cultural Competency
 Skills In Aboriginal Community –Cultural Awareness
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Module 2: Cultural Competency
 Skill in Development in the Chinese Community –
Cultural Perceptions of Medical Intervention
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Module 3: Cultural Competency
 Skill Development in the Franco-AlbertansCommunication & Cultural Understanding
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Module 4: Cultural Competency
 Skill Development in Lebanese Muslin Community –
Caregiving & End-Of-Life Issues
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References:
 Cross TL, Bazron BJ, Dennis KW, Isaacs MR.(1989) Towards a
Culturally Competent System of Care, Volume 1. Washington,
DC: CASSP Technical Assistance Centre, Centre for Child
Health and Mental Health Policy, Georgetown University Child
Development Centre.
 Lynch EW, Hanson MJ,(1998) Developing Cross-Cultural
Competence: A Guide for Working with Children and Their
Families. Baltimore: Paul H Brookes.
 Berlin EA, Fowkes W.(1983)A teaching framework for crosscultural health care. Application in family practice. The
Western Journal of Medicine 139(6):934-938.
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References:
 Book Manuscript:” At the Interface of Culture and
Medicine: Contemporary Canadian Studies: University of
Alberta Press: Two chapters: Waugh E, Triscott J,
Szafran O., “Towards Culturally Responsive Care in the
Community: views of five Cultural Communities on
Dementia/End of Life Issues, (Consensus Group
findings), Triscott J, “Language and Culture”. In the
University of Alberta Press: November 2010.