Week 4 Presentation & Articles

Articles Notes

The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care

Introduction to Cultural Competence

  • Campinha-Bacote's model emphasizes that cultural competence is an ongoing process essential for quality healthcare delivery.

Importance

  • Acknowledges the growing multicultural demographics and health disparities that necessitate cultural understanding in healthcare.

Model Overview

  • Focuses on continual development through five constructs: cultural awareness, knowledge, skill, encounters, and desire.

  • Provider competence directly impacts care quality.

Definitions of Constructs:

  1. Cultural Awareness: Self-examine cultural backgrounds and minimize biases.

  2. Cultural Knowledge: Gain educational foundation in diverse cultures, focusing on health beliefs, disease prevalence, and treatment efficacy.

  3. Cultural Skill: Collect relevant data and conduct informed assessments while recognizing ethnic variations.

  4. Cultural Encounters: Engage in direct cross-cultural interactions and assess clients’ linguistic needs.

  5. Cultural Desire: Foster genuine care for clients' backgrounds, committing to lifelong learning.

Applications

  • The model is applicable in various healthcare domains and organizations to enhance service delivery.

Future Directions

  • Stress on measuring cultural competence and addressing the gap in assessing cultural desire. Campinha-Bacote developed the Inventory for Assessing the Process of
    Cultural Competence Among Healthcare Professionals (IAPCC). The IAPCC is a 20-item instrument that measures the model’s constructs of cultural awareness, cultural knowledge, cultural skill, and cultural awareness. The IAPCC does not measure the construct of cultural desire. This is an area for further development

Article 2:

Part I: Culture

  • Culture is a shared pattern of beliefs, values, behaviors, practices, norms, customs, symbols, and knowledge that characterize a particular group of people

    • culture shapes an individual’s perception, interactions, and a framework for how people relate to one another and their environment

Terms:

Ethnocentrism: one’s own cultural view is the best and views it as the standard/superior to others. sometimes, we are all a little bit ethnocentric

Xenocentrism: the reverse of ethnocentrism. you consider other cultures better than one’s own. may have a preference for other cultural practices compared to their own.

Cultural Relativism: assessing culture by its own standards and not in comparison to another. it essentially views cultures from a neutral point of view and suspending judgements/biases

Part II: History of Cultural Competence

  • Cultural competency in healthcare was introduced in the 60s/70s. there was a recognition of cultural and linguistic barriers that contributed to health inequities.

  • But what is Cultural Competence?

    • the ability of an individual to work effectively in cross-cultural situations.

Part III: Cultural Competence Model

  • The Cultural Competence Continuum Model structures the act of gaining cultural competence through a succession of stages as it is an ongoing process.

    • Cultural Destructiveness is when one considers the mainstream culture superior to the minority ones

      • ex: requiring a hijabi woman to remove her covering

    • Cultural Incapacity is believing false/unkind information about others, stereotyping and assumptions

      • ex: providing only information in English because you assume that everyone will speak English

    • Cultural Blindness is the belief that the dominant cultural norms can be applied to all of the cultures

      • ex: having identical dietary recommendations to all patients with the same condition regardless of their background.

    • Cultural pre-competence is having a desire and commitment to diversity but lacking the information and resources

      • ex: getting a Hispanic clinician to assist the Hispanic patients instead of becoming more culturally competent

    • Cultural Competence is when skills are acquired and there is a continuous effort to serve a diverse population

      • ex: including menu items for diverse cultures and having educational materials in different languages

    • Cultural Proficiency is when you continuously engage in activities that add to the knowledge base, and develop new approaches

      • ex: responding positively, being adaptable, etc.

  • The Campinha-Bacote Cultural Competence model views cultural competence as a process rather than an end result. there are five interdependent constructs called ASKED

    • Cultural Awareness is a cognitive process of seeking awareness, appreciation, and sensitivity to patient culture. this requires an in-depth exploration of your own personal biases/prejudcies towards others

    • Cultural Skill takes time and requires technique flexibility. For example, using open ended respondent interview questions to effectively conduct a culturally sensitive assessment

    • Cultural Knowledge is seeking and obtaining information on patient culture which helps to avoid stereotyping and biases

    • Cultural Encounters is directly engaging in face-to-face cultural interactions to modify existing beliefs about another group and prevent stereotyping. this can be done through exploring the media, driving through communities, arranging cultural encounters, etc.

    • Cultural Desire is the essential construct of the cultural competence model. this is the inner motivation to WANT to become culturally competent and not HAVE to

  • to achieve cultural competency in nutritional practice, utilize professionally trained interpreters

    • use caution when using interpreters from a patients family or community because a client could be embarrassed or not understand the terminology being used, the interpreter may decide some information isn’t important or embelish.

    • professional interpreters should be knowledgeable on medical terminology, and client preference for an interpreter must be considered (age, gender, dialect)

Part IV: Patient-Centered Care

patient-centered care aims to improve the quality of healthcare by including patients’ perspectives and actively involving patients in their care. in the Medical Model, healthcare providers treat the disease rather than the patient as a whole, but in the patient-centered model, the patient is treated holistically, which includes their culture.

Patient Centered Approach (5 A’s)

Assess: assess for risk factors, behaviors, symptoms, attitudes, preferences etc. if the patient seems reluctant, sensitively ask about their concerns. seek to understand their customs and values as well as be cognizant of any differences in the healthcare where they are from versus where you are from.

Advise: specify all of their treatment options as well as how their QOL can be improved.

Agree: collaboratively select goals based on patient interest and motivation to change. for both Advise & Agree, make sure to understand what has previously worked for this patient. also, make sure to describe all the intervention options without jargon (and check for understanding). Real solutions happen if the patient makes the interventions work in the context of their daily lives

Assist: provide info and skills and help problem-solve barriers to reach goals. make sure to assist the patient in breaking down the barriers to reach their goals.

Arrange: make plans for follow-up (visits, phone calls, email reminders, etc.). Also, check for understanding by having the patient repeat back to you what was covered in their own words.