Last Thursday night as I shared this blog with my family, I was quickly grounded by my 13year old. As a family we regularly regroup at the end of the week sharing our high and lows. Last week I decided to share my blog. As I shared I was all smiles, clearly very pleased with myself and my evolving IT skills. With deep thought, slight sass and a small eye roll, my 13year old politely said “That’s great Mum, so tell me what is cultural competence and what is your job again”? I was grounded and...... thankful. Both my husband and I deeply value the innocence and connection our children give us to the world. Often these moments, while a little deflating, provide us with matters that require deep thinking. My 13 year olds understanding in the terminology of cultural competence was clearly influencing her worldview and she posed a great question. A question that I have and continue to ask myself regularly….. What does “cultural competence” mean?
The scholars Sapir and Whorf (1962) believe that language shapes the way we see the world. This implies that the language we use to communicate can influence our social reality. Across the world, the terminology of cultural competence is slightly different and this can make understanding the term challenging. For example, the United States is influenced by the American scholars of cultural competence, while in Australia our definition in many ways is still evolving..... perhaps influencing our social reality.
After exploring the literature around cultural competence it is clear that this is not a single universally accepted definition of cultural competence, however many definitions share key elements (Betancourt, 2002; Brach & Fraser, 2000). These elements include: valuing diversity, having the capacity for cultural self-assessment, being conscious of the dynamics inherent in cross-cultural interactions, institutionalising the importance of cultural knowledge, and making adaptations to service delivery that reflect cultural understanding (Humphery, 2000; Ranzijn et al., 2008).
Cultural competence as defined by Cross, Bazron, Dennis, and Isaacs (1989) from an American paradigm, remains one of the most frequently cited definitions. Cross et al. (1989) define cultural competence as a set of congruent behaviours that come together and enable individuals to work effectively with people from different cultural groups. This definition is accepted by the peak body of cultural competence in Australia, the National Centre for Cultural Competence. While a report by the Indigenous Higher Education Advisory Council (IHEAC) defines cultural competence as:
“Cultural competence is the awareness, knowledge, understanding and sensitivity to other cultures combined with a proficiency to interact appropriately with people from those cultures in a way that is congruent with the behaviour and expectations that members of a distinctive culture recognise as appropriate among themselves. Cultural competence includes having an awareness of one's own culture in order to understand its cultural limitations as well as being open to cultural differences, cultural integrity and the ability to use cultural resources. It can be viewed as a non-linear and dynamic process which integrates and interlinks individuals with the organisation and its systems” (Report of IHEAC Annual Conference, 2007, p. 5).
While all definitions are a little different, the commonality indicate that cultural competence is a journey that requires us to critically look at ourselves and then start to reflect and act on how our actions, beliefs, behaviours, policies and words can impact another (Biles, Coyle, Bernoth & Hill, 2016). It requires us to connect with fellow humans and learn from each other. Cultural competence can be both the focus of individuals and institutions and is lifelong….we will not be given a gold star and be told that we are culturally competent EVER! Sounds hard doesn’t it? And a bit squirmy in your seat kind of challenging? But fear not, there are many strategies to support individual and institutional journeys.
For some time, Universities Australia has mandated the inclusion of cultural competence as a core component in all university degrees. How we “do” cultural competence in Australia, what it means for curriculums, learners, teachers etc. and how the learning would/could/should be measured drives contemporary research in this space within Australia today. While we haven’t completely sorted embedding cultural competence we are certainly started to unpack its definition. The terminology of cultural safety in Australia (traditionally a term created and practised in New Zealand) has helped us find our way. Cultural safety has certainly become a way forward for health professionals and healthcare systems as we start to consider what a safe environments means for consumers of healthcare and education. How this plays out on national level is still unfolding and can certainly be translated into many difference areas. While “cultural responsive” is a term used to determine how effective our strategies have been in respond to the needs of individuals and groups from another culture. Cultural awareness, cultural diversity, cultural sensitivity are all terms and skills that assist ones journey in cultural competence. They are skills that will help us learn and connect. Which brings me to the point about cultural competence being deeply personal. To critically reflect on our own skills, behaviours and attitudes we need to be ready to rumble with a number of our emotions and be ready to embark on a journey of change. For organisations this mean effective change management. After all cultural competence is about change management…isn’t it? In my view, the brave leaders choose to have cultural competence as strategy, the “not so brave” call this valuing diversity. There is power in the words we choose and yes we do have a choice! But first, we need to understand the meaning behind the words.
Essentially our knowledge in the words of cultural competence shapes our world. So start to consider your words and what they mean to other people. Rumble with your words and don’t be afraid to change.
So, my dear 13 year old, I hope this helps you understand the term "cultural competence" and …………
P.S I am a university lecturer!
* Next blog will be in two weeks. Don’t forget to like and share with your networks
* Full consent for "story sharing" given by 13 year old
References
Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: emerging frameworks and practical approaches (Vol. 576). New York, NY: Commonwealth Fund, Quality of Care for Underserved Populations
Biles, J., Coyle, J., Bernoth, M., & Hill, B. (2016). I am looking for my truth: Undergraduate nursing students’ journeys in Indigenous Australian cultural competence. Journal of Australian Indigenous Issues. Retrieved from: http://primo.unilinc.edu.au/primo_library/libweb/action/dlDisplay.do?vid=CSU2&docId=dtl_csu76414')
Brach, C., & Fraser, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57(2), 181–217.
Council, C. R. (2010). National Indigenous Reform Agreement: Baseline Performance Report for 2008-09: Report to the Council of Australian Governments. COAG Reform Council.
Cross, T., Bazron, B., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care. Child and Adolescent Service System Program, Vol. 1.
Hains, A. H., Lynch, E. W., & Winton, P. J. (2000). Moving Towards Cross-cultural Competence in Lifelong Personnel Development : A Review of the Literature. Culturally & Linguistically Appropriate Services. Early Childhood Research Institute on Culturally, Linguistically Appropriate Services. University of Illnois: Urbana-Champaign.
Humphery, K. (2000). Indigenous health and western research. Vic Health Koori Health Research & Community Development Unit, Discussion Paper, 2.
Ranzijn, R., McConnochie, K., Day, A., Nolan, W., & Wharton, M. (2008). Towards cultural competence: Australian Indigenous content in undergraduate psychology, Australian Psychologist, 43(2), 132–139.