What is Culture?

1. What is Culture? • Culture is shared values, norms, traditions, customs, history, and beliefs of a group of people. • Culture has a multitude of aspects • Cultural factors include geography, age, socioeconomic status, religion, gender, education, language, politics, sexual orientation, and not just race, language and ethnicity. • Culture shapes how people experience their world, make decisions about quality of life, work and how people relate to others. • It’s dynamic. One of the most important aspects of culture is what is not seen, that which controls values and thought patterns.

2. CC Definitions “To be culturally competent doesn’t mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and willing to accept, that there are many ways of viewing the world” --Okokon O. Udo

3. CC Definitions “The process in which the [service or program] provider continuously strives to achieve the ability to effectively offer services within the cultural context of a client (individual, family or community)”. Campinha-Bacote 1998

4. Cultural Humility • a lifelong process of self-reflection and self-critique • does not require mastery of lists of "different" or peculiar beliefs and behaviors supposedly pertaining to certain groups of patients • the provider is encouraged to develop a respectful partnership with each [client] through client-focused interviewing, exploring similarities and differences between their own and each client's priorities, goals, and capacities • the most serious barrier to culturally appropriate care is not a lack of knowledge of the details of any given cultural orientation, but the providers' failure to develop self-awareness and a respectful attitude toward diverse points of view. Melanie Tervalon and Jann Murray-Garcia, 2001

5. Cultural Competency and Humility • Cultural Awareness: A deliberate action of becoming sensitive to the values, beliefs, lifestyle and practices of the client’s culture. Appreciating the client’s problem solving strategies. • Cultural Knowledge: Obtaining information about the world views of other cultures. The way individuals or groups of people view the world to form values about their lives • Cultural Skill: The ability to gather relevant data concerning a client’s health history and problems and being able to use that knowledge to conduct a cultural assessment and culturally based physical assessments. • Cultural Encounters: Face to face; the process of engaging in cross-cultural interactions with clients from culturally diverse backgrounds. • Cultural Desire: Is the “wanting to” process of cultural competency. Genuine caring and desire to work with clients that are diverse. Campinha-Bacote, 1998

6. Individual Awareness and acceptance of difference Awareness of own cultural values Understanding the dynamics of difference Development of cultural knowledge Ability to adapt practice to the cultural context of the client Organizational Valuing diversity Cultural self assessment Managing for the dynamics of difference Institutionalization of cultural knowledge Adaptation to diversity-policies, structure, values, services Five Elements of Cultural Competence

7. Kleinman-Explanatory Model • What do you call your situation? Do you have a name for it? • What do you think has caused your situation? • Why do you think it started when it did? • What does your situation do to you? How does it work? • How severe is your disability? Will it have a long or a short course? • What kind of program options do you think would be helpful? • What are the most important results you hope to receive from the program? • What do you fear most about your situation? • What are the chief problems your situation has caused you?

8. “LEARN” Model • L Listen with empathy to the client’s perception of the problem • E Explain your perceptions of the problem • A Acknowledge and discuss the differences and similarities • R Recommend treatment • N Negotiate agreement

9. Altered Data Gathering • Family History • Life/Community Events • Dreaming and Difficulties with Sleep • Indirect Interviewing Style • Depersonalization • Story Telling • Special Events

10. Citations for Models • Kleinman: Kleinman AK, Eisenberg, Good B: Culture Illness and Care; Clinical Lessons from Anthropologic and Cross-cultural Research. Ann Int. Med 1978;88:251-258 • LEARN:Berlin E.A. and Fowkes W.C.: A Teaching Framework for Cross-Cultural Health Care. WJMed 1983; 139: 934-938. • Altered Data Gathering: Cross Cultural Health Care Program, 2000

11. Being Culturally Appropriate with Clients • Seek information (country of origin, reason for migration, length of time in this country, number of generations in this country, languages spoken, family and kinship network, religious beliefs, beliefs about causality and fate, child rearing practices, sex roles, kind of community, life space, overt and covert reasons for seeking help, help seeking behavior, education, occupation, experiences with discrimination, degree of acculturation, degree of cultural conflicts) The Culturalogic Interview by Gloria Johnson-Powell