Cultural Competency

Cultural competency is an evolving concept in health services research, with no universally agreed-on definition. Although not a new concept, the term first became widely used in public health and health services in the 1990s. It remains prominent in current considerations of addressing racial/ethnic disparities in health status and access to care. With a focus on the increasing population diversity of the United States and the persistence of racial/ethnic disparities in health, public health, medicine, nursing, social work, and other health science disciplines are adapting the concept to address current issues in working with diverse population groups. The inference is that there are identifiable organizational, community, and policy strategies that facilitate or impede the delivery of services to specific cultural groups or communities. The federal Health Resources and Services Administration's (HRSA) Bureau of Health Professions (BHPr) Web site offers several interrelated definitions of cultural competency across various federal agencies. An element common to [Page 270]all definitions is the ability to function effectively (in healthcare or other settings) with people who are culturally different. A less widely endorsed strategy as a condition to the above is some degree of self-reflection or awareness of one's (provider, researcher, policymaker) social position, relative power status, cultural values and practices, and even worldview. Many definitions of cultural competency across federal agencies and provider groups recognize culturally competent skills as encompassing the ability to incorporate culturally defined health beliefs and practices, language and communication patterns, and health-seeking behaviors of specific groups into practice, research, and policy.

In furthering the understanding of cultural competency, it is helpful to consider the meanings of the constituent terms, culture and competency. Culture refers to a unique configuration of behavioral norms, beliefs, and shared understanding of the world that guides everyday life and is common to a particular population subgroup. In every cultural subgroup, there are prescriptive means to transmit culture to new group members and intuitional practices to ensure its continuity and utility in attaining individual and collective goals in life. A common language or dialect is typical of many but not all cultural groups, and although shared historical, migratory, and ancestral roots are important markers in defining group membership, there is increasing diversity within groups due to globalization (social and economic forces' contribution to population migration and bringing cultural groups into regular contact with one another) and transnationalism (cultural groups maintaining ongoing contact with the homeland of origin through media, commerce, and transportation systems). All cultural groups, (including dominant Western White groups), possess locally adapted patterns or codes of conduct or performances of daily life that are unapparent to casual observers or outsiders, making it inappropriate for practitioners or researchers to impose rigid interpretations or categorization of beliefs and behaviors on any one group. Importantly, culture provides a lens for group members to interpret illness symptoms and engage in preventive and health-seeking behaviors. Competency, an ill-defined term in the human performance literature, implies skills or abilities to perform role requirements in a specific context. Burgoyne refers to “being competent” as meeting the job demands, while “possessing competencies” means having the knowledge, skills, and attitudes to perform the job. Typical applications of the concept may be found in health services delivery, community, intervention development and evaluation, provider education, and studies of patient-consumer experiences with services.

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