Cultural Competence in Social Care and Health

What is “cultural competence”?

Culture is an aspect of identity, which we all have. Culture is based on a number of things shared with others such as language, shared history, beliefs, attitudes, celebrations, musical taste, dress, diet and many others. Culture is basically about a shared understanding with others of the same culture. Cultures are neither inferior or superior – they are just different.

In health and social care, there has been a shift in recent years towards ‘cultural competence’ as a key aspect of all professional practice. The idea of workers being ‘competent’ in working with others from different cultures is a step on from being ‘sensitive’ to the needs of other people. The notion that professionals need to be competent in working with difference and culture as opposed to being merely ‘sensitive’ about it has gained strength in recent years. The term cultural competence has therefore largely replaced the term cultural sensitivity in social work and health care.

If workers are to be seen as culturally competent, then they need to be able to articulate what cultural competence is. Conversely, the very concept of competence implies that those who do not hold sufficient knowledge and understanding about the role of people’s culture are by definition ‘incompetent’ at their job if they cannot work in an effective way to meet people’s diverse needs.

There is a long standing view that competence is made up of knowledge, values and skills (e.g.: Maclean and Caffrey 2009).

In our view, culturally competent practice involves:

1. Knowledge and understanding of:

· your own culture
· any culture bias you have
· the concept of culture and how this can affect beliefs and behaviours
· specific cultural knowledge

2. A range of values and attitudes, including a commitment to:

· valuing and celebrating difference
· respecting individuality and the role which culture plays in this

3. And a range of skills, including:

· culturally competent communication
· culturally competent assessment
· culturally sensitive care provision

It is important to recognise that culture is an aspect of a person’s identity. It is not their ‘whole’ identity and it does not act as a predictor of how a person will behave and what they will believe. Everyone will choose which aspects of their cultural identity they will ‘own’ and which they will not. As such, each person will have a unique approach to their culture – leading to a complexity of ways in which culture will affect people’s individual needs and preferences.

Cultural Competence and Self Awareness for workers in Health and Social Care

If workers in social and health care are to be culturally competent, they need to develop some key skills and knowledge for effective practice. In order to appreciate the different cultures to which people associate fully and to form effective working relationships with service users and carers, it is important to understand the diversity there is within daily life.

Within all cultures and religious groups there is wide variation in practice and it is important to realise that degrees of strictness and observance are individually defined. Culturally competent workers will appreciate that culture is not monolithic and it will be dangerous to provide services based on stereotypical concepts of, for example, “a Jew”, “a Hindu”, or “a Muslim”. Some people born into a religious community may not consider themselves to be members of that community. For others their religion, traditions and rituals may be important, but they may not observe, say, strict dietary requirements. Therefore, it is important to allow individuals to define their own culture and religion.

The way in which a person views themselves and their identity will be affected by their culture and their religion, but this can vary between different groups and according to individual personal preferences. The way we live our lives is affected by the environment in which we all live.

If we accept that cultures are not better or worse than each other, but are just different, then we need to be clear that some of the ideas and ‘truths’ that we bring to our work are themselves culturally rooted. As workers in social and health care we also have our own culture, both as individuals in society and as employees of organisations and members of teams which have cultures. Culturally competent practice involves understanding the values we bring to our work, and a sophisticated awareness of how oppression, stereotyping of other people’s culture and prejudice operate to disadvantage others. A competent practitioner is able to understand these concepts, see how they relate to their practices, and reflect on their own values and ‘truths’ about both their own and other people’s cultures.

Robinson (2007: 169) states:

“An etic refers to a universal truth or principle, whereas an emic refers to truths that are culture specific.”

People who work with others must have some understanding of the fact that not all of the truths we grew up with are etics in order to appreciate the impact which our own culture and upbringing has had on our beliefs about the world. We cannot work effectively with other people who have different emics to our own if we insist that all of their ‘truths’ (i.e.: their beliefs, values, aspirations etc) should be the same as ours.

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