The School of HEALTH SCIENCES The University Of Birmingham HOW CAN CULTURAL COMPETENCE BE ASSESSED? BY MEL STEWART

The School of HEALTH SCIENCES Objectives To Investigate the notion of cultural competence Examine ways which attempt to measure cultural competence Share the experiences of undergraduates engaged in the self-assessment of cultural competence Discuss institutional approaches in managing cultural competence

The School of HEALTH SCIENCES What is Cultural Competence? Cultural Sensitivity Cultural diversity Political correctness

The School of HEALTH SCIENCES Common Definitions 'a set of congruent behaviours, attitudes and policies that come together in a system agency or among professionals that enables effective work in cross-cultural situations.' (HHSOMH 2000). Chandra (1996) in 'Facing up to Difference - A toolkit for creating culturally competent health services for black and minority communities' ‘denote services perceived by black and minority ethnic users as being in harmony with their cultural and religious beliefs and not just provided by people who are, or assumed to be ‘culturally sensitive.’

The School of HEALTH SCIENCES Elements of Cultural Competence

The School of HEALTH SCIENCES National Center for Cultural Competence - Georgetown University 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 the communities they serve. incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities.

The School of HEALTH SCIENCES Method The study employed a repertory grid approach The repertory grid is a formal way of demonstrating the mathematical relationship between specific constructs (these are normally given as adjectives), and elements – the people construing them.

The School of HEALTH SCIENCES Repertory Grid of Cultural Competence

The School of HEALTH SCIENCES Repertory Grid Clinical Competence

The School of HEALTH SCIENCES Characteristics of a Clinically Competent Practitioner Experienced (11) Good Communication skills (11) Knowledgeable (10) Caring (10) Professional (9) Enthusiastic (8) Confident (7) Approachable (6) Other characteristics (11)

The School of HEALTH SCIENCES Other Characteristics ‘Good patient-relation’ skills E.g. polite Making person feel valued Committed Efficient Works well in a team etc

The School of HEALTH SCIENCES Characteristics of a Culturally Competent Practitioner Relating to others (n=9) Open (n=8) Acceptance (n=5) Understanding (n=5) Knowledge (n=5) Not judgemental (n=4) Equality (n=5) Individuality (n=3) Communication (n=3) Respect (n=3) Other

The School of HEALTH SCIENCES Other Not self-righteous Encouraging Tolerant Culturally aware Not ageist Not sexist Not aggressive Unbiased etc

The School of HEALTH SCIENCES Suggestions for increasing cultural competence increasing the numbers of underrepresented minorities in the health professions and hea l th care leadership understanding and managing socio-culturally based variations in health beliefs, values, and behaviours Enhance professional education in cultural diversity interaction Efforts should be made to know about, an avoid behaviours that might be offensive, impractical or irrelevant Updating education in cultural diversity

The School of HEALTH SCIENCES Factors contributing to the Development of Cultural Competence in Undergraduate Health Care Curricula Awareness and acceptance of the wide range of cultural diversity (in developing systems of care) The acquisition of knowledge of cultural differences and similarities and knowledge of client’s culture Knowledge of one’s own cultural values and identity Ability to communicate effectively across cultural groups Utilisation of knowledge to adapt services and skills The development of a lifelong learning and reflection that includes the examination of attitudes and values of cultural groups (Stewart 2002)

The School of HEALTH SCIENCES Discussion Institutional approaches in developing and managing cultural competence

The School of HEALTH SCIENCES References Chandra, J (1996). Facing up to Difference. A Toolkit for creating culturally competent health services for black and minority ethnic communities. King’s Fund, London. U.S. Department of Health and Human Services, Office of Minority Health, Resources for Cross Cultural Health Care. (2000). Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda. Joseph R. Betancourt, Alexander R. Green, J. Emilio Carrillo and Owusu Ananeh- Firempong (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care Public Health Reports, Volume 118, Issue 4, Pages Niemeir JP, Burnett DM, Whitaker DA (2003) Cultural Competence in a the Multidisciplinary rehabilitation Setting: Are we falling short in meeting needs? Archivives of Physical and Medical Rehabilitation Vol84,Pages Stewart M (2002) The Development of Cultural Competence in Health Care Undergraduates Physiotherapy Vol. 88, No. 10. p