the school of health sciences the university of birmingham how can cultural competence be assessed?...

The School of HEALTH SCIENCES

The University Of Birmingham

HOW CAN CULTURAL COMPETENCE BE ASSESSED?

BY MEL STEWART


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


What is Cultural Competence?

• Cultural Sensitivity

• Cultural diversity

• Political correctness


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.’


Elements of Cultural Competence


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.


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.


Repertory Grid of Cultural Competence

A3 JC ELEMENTS CONSTRUCTS 1 2 3 4* 5 6 CONSRUCTS Knowledge of a variety of cultures

3 5 7 2 6 2 Limited knowledge of a variety of cultures

Understanding of how culture can affect treatment

3 5 7 3 4 2 Does not understanding of how culture can affect treatment

Flexible in treatment 4 5 7 3 3 2 Not flexible in treatment

Includes cultural objectives e.g. kneel to pray

2 3 7 3 3 2 Does not includes cultural objectives

Treats everyone equally

5 6 6 5 2 3 Does not treat everyone equally

Does not force own culture on patients

5 6 7 5 1 3 Forces own culture on patients

Respects all patients 5 7 6 6 3 4 Does not respects all patients

Open to new cultures 3 4 7 5 2 3 Closed to new cultures

Understands individual needs of patients

5 7 7 4 2 3 Does not understands individual needs of patients

Non-judgemental 5 7 6 5 2 1 Judgemental 40 55 67 41 28 25


Repertory Grid Clinical CompetenceA3 JC ELEMENTS CONSTRUCTS 1 2 3 4* 5 6 CONSRUCTS Understands individual needs of patient

5 4 7 4 3 4 Doesn't understand individual needs of patient

Good communicator 6 6 6 5 2 4 Poor communicator Experienced 7 6 6 2 5 5 Inexperienced Passionate about work

5 4 4 4 2 2 [Not] passionate about work

Innovative 6 5 4 5 3 4 Not innovative Willing to learn 5 5 6 6 2 3 Unwilling to learn Knowledgeable 6 6 6 2 5 5 Not knowledgeable Interested in wider scope of practice

4 7 7 3 4 5 Not interested in wider scope of practice

Open to new treatment techniques

6 5 6 5 2 4 Closed to new treatment techniques

Interested in education

6 6 7 5 3 3 Not interested in education

56 54 59 41 31 39


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)


Other Characteristics

• ‘Good patient-relation’ skills

• E.g. polite

• Making person feel valued

• Committed

• Efficient

• Works well in a team

etc


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


Other

• Not self-righteous• Encouraging• Tolerant• Culturally aware• Not ageist• Not sexist• Not aggressive• Unbiased

etc


Suggestions for increasing cultural competence

• increasing the numbers of underrepresented minorities in the health professions and health 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


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)


Discussion

Institutional approaches in developing and managing cultural competence


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 293-302

• 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 1241-1245

• Stewart M (2002) The Development of Cultural Competence in Health Care Undergraduates Physiotherapy Vol. 88, No. 10. p 620-29

• http://www3.georgetown.edu/research/gucchd/nccc/framework.html#lc

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