What is cultural competence?

There are various approaches to cultural competence - most practical models agree that cultural competence requires:

  • Awareness of one’s own cultural attitudes, beliefs and behaviours
  • The attitude held about working across cultural differences
  • Knowledge of different cultural practices, world views and belief systems
  • An ability to use skills and knowledge across cultures

Watch the video below on the importance of cultural competence.

PTT model

A useful approach to Cultural Competence has been developed in the United Kingdom by Papadopoulos, Tilki, and Taylor (PTT1998).

This PTT model applies four stages to developing cultural competence within a health care setting.

Cultural Awareness
Cultural Knowledge
Cultural Sensitivity
Cultural Competence

Stage 1: Cultural Awareness 

Awareness of one’s own cultural attitudes, beliefs and behaviours becomes Cultural Awareness.

As we saw in unit 1 this means:

Understanding and examining the cultural values and beliefs that shape who we are and what we do as individuals and as groups.

Importantly we also need to recognise that our values and attitudes also shape how we see others and influence and impact on how we deliver health care to them.

Stage 2: Cultural knowledge 

Unit 2 described and illustrated ways we can build a professional understanding of the cultures and communities we work with.

Which of these can provide useful cultural knowledge?

  1. History of a community:
    Understanding why a community is here and the experiences that have shaped it can help inform why a community may be sensitive, unsure, traumatised, isolated.
  2. Geography and climate:
    The UK can be very dark, wet and cold. If you are not used to rain you may not want to wander out. Many cultural habits are shaped by geography and climate and coming to the UK can be disruptive to normal behaviour restricting activity and social interaction.
  3. Information about diet:
    Western food habits and western style supermarkets can be very disorientating, understanding that in this or that culture men may not cook or shop, that culturally familiar foods are difficult to find causing a disruption to diet and then impacting health.
  4. Religious practices:
    Would it be appropriate to book an appointment for a muslim man at 12.30pm on a Friday during Ramadam; or ask to meet Orthodox Jewish elder from Ethiopia on a Saturday?
  5. Background information about endemic diseases and illnesses:
    Knowledge based practice, an understanding of what illness a person may present with or may be worried about having acquired.
  6. Attitudes towards mental health:
    The understanding of the term mental health can vary enormously - in many cultures there is no distinction between mild and moderate or severe, a diagnosis of mental illness can have life long implications for many people as it is never something that is cured.

Stage 3: Cultural Sensitivity

How does your team reflect on the knowledge and awareness it has to think about health care for different cultural groups and patients?

Can you build bridges across cultures linking patients into your services?

Cultural sensitivity is all about a holistic approach that recognises cultural difference.

Respect for difference, building trust across cultures and ensuring effective communication across cultural and linguistic barriers are all important to developing a culturally sensitive health care practice.

Think about:

  • Do you value some beliefs more than others?
  • Do some patients have better support and outcomes than others - are their any reasons for this?
  • Do you use interpreters, or do you rely on informal unqualified help from friends or family?
  • Are patients offered choice and information to help them make decisions about health care?
  • How do you build trust between your team and the patient group?

Stage 4: Cultural Competence

Cultural competence is a practical skill, framed by knowledge and awareness and an acceptance that difference in culture, origins or beliefs should not be a barrier to a responsive and accessible health service.

Applying the cultural awareness, cultural knowledge and sensitivity in the clinical or health care system means applying the skills and knowledge you have gained to improve patient outcomes and gaining the confidence to challenge cultural bias, racism or discrimination.

Culturally competent practice

  • It is of course anti-discriminatory practice, but it is also economically sound practice.
  • Using an interpreter correctly once is far cheaper than using an interpreter three times and badly with a patient- it also builds trust and confidence with the patient reassuring her that you know what you are doing!
  • Remember - discrimination is not just deciding to take an action that is oppressive - it is also the choosing NOT to do something you know can help.