There is no one definition of cultural competence. Definitions of cultural competence have evolved from diverse perspectives, interests and needs and are incorporated in state legislation, Federal statutes and programs, private sector organizations and academic settings. The seminal work of Cross et al in 1989 offered a definition of cultural competence that established a solid foundation for the field. The definition has been widely adapted and modified during the past 15 years. However, the core concepts and principles espoused in this framework remain constant as they are viewed as universally applicable across multiple systems.
A number of definitions and descriptions of cultural competence were reviewed to compile the selected list. The following definitions of are highlighted because they represent or are based on original and exemplary work and because of their potential impact to the field of health and human services.
Cross et al, 1989
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations.
The word culture is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group. The word competence is used because it implies having the capacity to function effectively.
Five essential elements contribute to a system's institution's, or agency's ability to become more culturally competent which include:
- Valuing diversity
- Having the capacity for cultural self-assessment
- Being conscious of the dynamics inherent when cultures interact
- Having institutionalized culture knowledge
- Having developed adaptations to service delivery reflecting an understanding of cultural diversity
These five elements should be manifested at every level of an organization including policy making, administrative, and practice. Further these elements should be reflected in the attitudes, structures, policies and services of the organization.
National Center for Cultural Competence, 1998, modified from Cross et al
Cultural competence requires that organizations:
- 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 communities they serve.
- Incorporate the above in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities.
Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum.
Betancourt et al., 2002
Cultural competence in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.
Lavizzo-Mourey & Mackenzie, 1996
Cultural competence is the demonstrated awareness and integration of three population-specific issues: health-related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy. But perhaps the most significant aspect of this concept is the inclusion and integration of the three areas that are usually considered separately when they are considered at all.
Roberts et al, 1990
Cultural competence refers to a program's ability to honor and respect those beliefs, interpersonal styles, attitudes and behaviors both of families who are clients and the multicultural staff who are providing services. In doing so, it incorporates these values at the levels of policy, administration and practice. Denboba, MCHB, 1993 Cultural competence is defined as a set of values, behaviors, attitudes, and practices within a system, organization, program or among individuals and which enables them to work effectively cross culturally. Further, it refers to the ability to honor and respect the beliefs, language, interpersonal styles and behaviors of individuals and families receiving services, as well as staff who are providing such services. Striving to achieve cultural competence is a dynamic, ongoing, developmental process that requires a long-term commitment.
At a systems, organizational or program level, cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of:
- policy making;
- infra-structure building;
- program administration and evaluation;
- the delivery of services and enabling supports; and
- the individual.
This often requires the re-examination of mission statements; policies and procedures; administrative practices; staff recruitment, hiring and retention; professional development and in-service training; translation and interpretation processes; family/professional/community partnerships; health care practices and interventions including addressing racial/ethnic health disparities and access issues; health education and promotion practices/materials; and community and state needs assessment protocols.
At the individual level, this means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations.
Cultural competence mandates that organizations, programs and individuals must have the ability to:
- value diversity and similarities among all peoples;
- understand and effectively respond to cultural differences;
- engage in cultural self-assessment at the individual and organizational levels;
- make adaptations to the delivery of services and enabling supports; and
- institutionalize cultural knowledge.
Tervalon & Murray-Garcia, 1998
Cultural humility is best defined not by a discrete endpoint but as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves…a process that requires humility in how physicians bring into check the power imbalances that exist in the dynamics of physician-patient communication by using patient-focused interviewing and care.
American Association for Health Education
Cultural competence is the ability of an individual to understand and respect values, attitudes, beliefs, and mores that differ across cultures, and to consider and respond appropriately to these differences in planning, implementing, and evaluating health education and promotion programs and interventions.
National Alliance for Hispanic Health, 2001
Cultural proficiency is when providers and systems seek to do more than provide unbiased care as they value the positive role culture can play in a person’s health and well-being.
National Medical Association
Cultural Competency (Health) is the application of cultural knowledge, behaviors, and interpersonal and clinical skills that enhances a provider’s effectiveness in managing patient care.
U.S. Department of Health and Human Services:
Administration on Developmental Disabilities, 2000
The term cultural competence means services, supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs, interpersonal styles, attitudes, language and behaviors of individuals who are receiving services, and in a manner that has the greatest likelihood of ensuring their maximum participation in the program.
Health Resources and Services Administration, Bureau of Health Professions
Cultural competence is defined simply as the level of knowledge-based skills required to provide effective clinical care to patients from a particular ethnic or racial group.
Health Resources and Services Administration, Bureau of Primary Health Care
Cultural and linguistic competence is a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations. "Culture" refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups. "Competence" implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.
U.S. Department of Health and Human Services:
Health Resources and Services Administration, Maternal and Child Health Bureau, Title V Block Grant Program Guidance, 2003
Culturally competent – the ability to provide services to clients that honor different cultural beliefs, interpersonal styles, attitudes and behaviors and the use of multi-cultural staff in the policy development, administration and provision of those services.
Office of Minority Health, National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards), 2001
Cultural competence - Having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.
Substance Abuse and Mental Health Services Administration, Center for Mental Services
Cultural Competence includes: Attaining the knowledge, skills, and attitudes to enable administrators and practitioners within system of care to provide effective care for diverse populations, i.e., to work within the person’s values and reality conditions. Recovery and rehabilitation are more likely to occur where managed care systems, services, and providers have and utilize knowledge and skills that are culturally competent and compatible with the backgrounds of consumers from the four underserved/underrepresented racial/ethnic groups, their families, and communities. Cultural competence acknowledges and incorporates variance in normative acceptable behaviors, beliefs and values in determining an individual’s mental wellness/illness, and incorporating those variables into assessment and treatment.
References/Sources
American Association for Health Education, http://www.aahperd.org/aahe
Betancourt, J., Green, A. & Carrillo, E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. The Commonwealth Fund.
Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.
Denboba, D., U.S. Department of Health and Human Services, Health Services and Resources Administration (1993). MCHB/DSCSHCN Guidance for Competitive Applications, Maternal and Child Health Improvement Projects for Children with Special Health Care Needs.
Lavizzo-Mourey, R. & Mackenzie, E. (1996). "Cultural competence: Essential measurement of quality for managed care organizations." Annals of Internal Medicine, 124 919-926.
National Alliance for Hispanic Health (2001). A Primer for cultural proficiency: Towards quality health care services for Hispanics. Washington, D.C.
National Medical Association, National Medical Association Cultural Competence Primer, retrieved from http://www.askme3.org/PFCHC/download.asp on April 2, 2004.
Roberts, R., et al. (1990). Developing Culturally Competent Programs for Families of Children with Special Needs (monograph and workbook); Georgetown University Child Development Center.
Taylor, T., et al. (1998). Training and Technical Assistance Manual for Culturally Competent Services and Systems: Implications for Children with Special Health Care Needs. National Center for Cultural Competence, Georgetown University Child Development Center.
Tervalon, M. & Murray-Garcia, J. (1998). "Cultural humility versus cultural competence: a Critical discussion in defining physician training outcomes in multicultural education." Journal of Health Care for the Poor and Underserved, 9 (2) 117-125.
U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Development Disabilities (2000). Amendments to P.L. 106-402 - The Developmental Disabilities Assistance and Bill of Rights Act of 2000.
U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, retrieved from http://www.bhpr.hrsa.gov/diversity/cultcomp.htm on April 2, 2004.
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Division of State and Community Health (2003). Maternal and Child Health Services Title V Block Grant Program, retrieved from ftp://ftp.hrsa.gov/mchb/blockgrant/bgguideforms.pdf on April 13, 2004.
U.S. Department of Health and Human Services, Office of Minority Health (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report, retrieved from http://www.omhrc.gov/clas/ on April 15, 2004.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Services, retrieved from http://www.bhpr.hrsa.gov/diversity/cultcomp.htm on April 2, 2004.
