Culture and health
- Understanding the particular beliefs, morals, customs and habits of patients of different ethnicities is a primary concern for the health professional and an important element of developing culturally competent practice.
- Cultural knowledge or awareness can provide important insights and an understanding of the particular health needs of specific patient groups and cultures.
- The expectations we have of patients, and the expectations they have of health care professionals, is also affected by cultural norms which may not be shared across different communities.
Watch the video below where the healthcare system in the Congo is compared to the UK
Health and health care systems are different around the world. The primary care, secondary or acute way we deliver health care services in the United Kingdom is not universal, health care is accessed in many different ways across the globe.
The roles, status and professional competence of non-medical health staff varies enormously, as do prescribing regimes and the administration of medicines and treatments.
All of these things can create barriers to services and shape the expectations and health experiences of the migrant or refugee patient.
See Module 5: Barriers To Access for more training on this.
Acquiring cultural knowledge
Acquiring cultural knowledge can assist the health care worker to understand the needs and concerns, expectations and culture of health held by different communities.
So how can you acquire cultural knowledge?
1. Do background research
Start simply: do background research on the patient’s country of origin
- The BBC news website has country profiles that provide a good basic information.
- Check the World Health Organisation country profile information - this will provide valuable insight into health issues, vaccination programs and illness rates.
2. Make meaningful contact
Find ways of making meaningful contact with peoples and communities you are unfamiliar with
- Are there community events, community groups or volunteers that can help you build your understanding and exposure to new cultures - are any other services working with this community - can you share the contacts?
3. Talk to the patient
Ask questions and don’t assume that he or she follows all aspects of a particular culture, understand the individual in the context of their culture - not as a symbolic representation of that culture!
4. Share the knowledge
Share the knowledge across your team
- Perhaps deliver a short briefing on new communities to your colleagues in a team meeting.
- Build a resource file with pictures, maps and key health issues.
5. Use the knowledge
Use the knowledge to shape practice and break down the barriers to your service
- Are there practical things your team can do to break down barriers? Key words in the patient’s first language - please, thank you, hello or goodbye make a real difference.
- Multi-lingual information sheets - think about appointment days and times.
Oromo - a practical case study
Developing cultural knowledge
Your team is informed that the next 30 people from the disputed Oromo region are to be resettled in your catchment area. There will be 10 adults, mainly single women, and 20 children.
You are told that they are being settled as part of the UK’s Resettlement Scheme, and this means they have been vulnerable refugees living in a refugee camp in Kenya.
Your team has been asked to help with the initial health screening.
You have been asked to prepare a briefing for your team on the possible cultural and health needs of these patients.
Read the information contained on the web page (link below) and make a note of the answers to the following questions:
- Where is Oromia?
- The reasons for the Oromo becoming refugees?
- 3 important facts about the Oromo?
- The key religions and key dates (if any)?
Where else would you go for information? BBC country profile for Ethiopia here: Ethiopia profile
As Oromo is formally a part of Ethiopia you will need to look at health information for Ethiopia.
Make a note: what are the key health messages?
World Health Organisation link: WHO Ethiopia Country Profile
The Oromo have also spent time in refugee camps in Kenya - it may be useful to look at the country profile for Kenya.
Are there any other key health messages for your team? Note them down.
World Health Organisation link: WHO Kenya Country Profile
You now have a practical example of how to begin to develop a cultural knowledge base
What you now do with this knowledge is important - any knowledge you gain needs to be shared with the team and used to shape the cultural practice of your team.
What other things can your team do to build cultural knowledge of the Oromo?
1. Meet the community leaders and elders when they arrive
Making an opportunity to leaders and elders when they begin meaningful contact is important. An initial hello can help identify you and your team - making them feel welcome can make later contact easier.
2. Invite community members to meet you and your team and introduce themselves
Asking them to tell you about their community is a good way of gaining insight - but remember there may be some degree of cultural difference within the community, individuals may not want to be bound by tradition or culture.
3. Attend a community event with information about your team
This will not only give them information about your team - but give team members an opportunity to gain contact and knowledge of the community. This will also demonstrate to the community that their health is important to your team.
4. Talk to the patients (using interpreters, as English is not always their first language)
We need to ensure that we are always treating the individual, and individuals can vary, culture in many ways is the environment in which we live and work and the background which shapes our understanding - it may shape our choices but it doesn’t always directly determine them - speak to the person - allow them to make choices!
As you can see there are many ways to develop cultural knowledge:
Building your cultural knowledge, and having the confidence to use it, is an important step in developing open and accessible services.
Having built up some knowledge of the Oromo, and identified key places to access information and key actions you can take to make meaningful contact:
- What are the key cultures and communities your team work with - how much do you know about them?
- What steps can you take to develop your team’s cultural knowledge of the community?
- Try using the toolkit to work on developing this knowledge across your team.