Cultural Competence & Determinants of Health

Culture

Set of basic assumptions and values, orientations to life, beliefs, policies, procedures & behavioural conventions that are shared by a group of people and that influence (but do not determine) each member’s behaviour and his/her interpretations of the meaning of other people’s behaviour

How does culture affect health from a patient perspective?

• Culture and health beliefs/belief systems

• Religious beliefs and health

• Beliefs about death

• Need for self-autonomy

• Need for shared decision making – decision making shared with family

• Health literacy (and language)

How does culture affect health from a professional perspective?

• Ethical issues – patient best interest vs respect for patient beliefs

• Personal culture and religious/spiritual beliefs

• Communication

• Stereotyping

Cultural competence

Requires that organisations have a defined set of values and principles, and demonstrate behaviours, attitudes, policies and structures that enable them to work effectively cross-culturally

Cultural competence involves:

1) Cultural awareness

2) Cultural knowledge

3) Cultural skills

4) Cultural encounters

5) Cultural desire

Cultural competence ladder

• Cultural destructiveness — intentional practices, policies, attitudes that are destructive to a culture

• Cultural incapacity — lack of capacity to help minorities due to paternal attitudes towards non-mainstream cultures

• Cultural blindness — belief that dominant culture approaches apply to all cultures

• Cultural pre-competency — desire to deliver quality services, e.g. hiring minority staff

• Cultural competency — respect for difference, education awareness & adaptability

• Cultural proficiency — holding culture in high esteem — research & translation

What should pharmacist’s approach to cultural difference be?

• Awareness of the influences that sociocultural factors have on patients, pharmacists, and the clinical relationship.

• Acceptance of the responsibility to understand the cultural aspects of health and illness

• Willingness to make clinical pharmacy settings more accessible to patients

• Recognition of personal biases against people of different cultures

• Respect and tolerance for cultural differences

• Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia, and other kinds of biases and discrimination that occur in health care (pharmacy) settings

Principles of culturally competent communication

1. Be respectful

2. Recognise that people’s past experiences may shape their health beliefs and expectations’

3. Be mindful of communication practices (eye to eye contact, shaking hands, interpersonal distance, use of first names)

4. Explore what the patient thinks

5. Explain your view-point and health care provision strategy