Noura A. Abouammoh

2.3 Definitions of cultural competence

The literature on cultural competence shows a general agreement on its concepts and common elements. In the field of nursing, in the US, according to Camphinha-Bacote’s (1999) and Betancourt’s et al’s (2003) definitions, cultural competence implies delivering effective care by health practitioners who are expected to understand and appreciate variations of health beliefs and behaviours within cultural groups.

The UK NHS trusts have not agreed on one unique definition of cultural competence. The Central and North West London Foundation Trust, in the following definition, focused on the importance of dealing with patients fairly, in terms of human rights, to deliver culturally competent care, as described here:

“Cultural Competency involves an individual’s ability to treat every person with dignity, respect and fairness, in a way that is sensitively responsive to differences and similarities, and thereby contributes to creating a genuinely inclusive culture” (NHS, 2014a)
On the other hand, NHS Health Education East of England looked at cultural competence from another perspective. Their definition stated that:

“Cultural competence is the ability to provide care to patients with diverse values, beliefs, and behaviours, and tailoring healthcare delivery to meet patients’ social, cultural and linguistic needs. In essence, it is the ability to interact effectively with people of different cultures and address health inequalities” (NHS, 2014)

Although the former definition emphasised the idea of human rights, while the latter focused on cultural competence elements, they both share a common notion and, more or less, similar components. Additionally, the latter definition by the NHS Health Education East of England expanded to specifically introduce the importance of the interaction in the medical cross-cultural encounter.

Furthermore, Papadopoulos (2003), agreed with the general meaning of the previous definitions and highlighted the notion of trans-cultural health, defining it as follows:

“The capacity to provide effective healthcare taking into consideration people’s cultural beliefs, behaviours and needs ... trans-cultural health is the study of cultural diversities and similarities in health and illness as well as their underpinning societal and organisational structures, in order to understand current healthcare practice and to contribute to its future development in a culturally responsive way” (Papadopoulos, 2003, p.5)

Other authors (Stewart, 2002, Ahmed and Bates, 2012) decided to involve “clients” and referred to the term “cultural competence” in healthcare when discussing their perception of the service as being in harmony with their cultural and religious beliefs and not just provided by culturally sensitive providers. This can be specifically important because the whole idea of providing culturally competent care is to benefit patients by improving the quality of care provided to them and achieving their satisfaction with healthcare provision.

Cross et al’s (1989) definition, is widely adopted by a large number of authors, especially in the US (Stork et al., 2001, Brach and Fraserirector, 2000, Anderson et al., 2003) probably because it presents all the elements required to deliver culturally competent care and as it is adopted by the United States Department of Health and Human Services. They defined it as

“A set of attitudes, skills, behaviours, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups” (p. iv)

Culturally competent health care could be compromised when ethnic minorities are cared for by providers from the dominant population, in the same way that they care for the majority; and physician’s own individual values complicate the situation (Leininger, 1995, Betancourt, 2004). Thus, the goal of culturally competent care is to provide a system, and train the health workforce to offer high quality care, taking into account the ethnicity, race, religion, culture, and language of every patient.

Cultural competence is an important component in delivering quality care (Henderson et al., 2011, Renzaho et al., 2013). Knowledge of cultural customs allows health care providers to deliver better care and help avoid misunderstandings among staff, patients, and families (Anderson et al., 2003).

Overall, it seems from the definitions of cultural competence that there is a remarkable similarity in its general concepts and common elements. It appears that many obstacles faced what had started as a “one size fits all” model of healthcare approach, and cross-cultural interaction is one of them. The main goal of providing culturally competent care is to be sensitive to patients’ different cultural values and to reduce the health gap between ethnic minorities and the general population, and improve the quality of health care and treatment outcomes (Betancourt et al., 2003, Henderson et al., 2011, Renzaho et al., 2013).

It should be noted however, that all the definitions of cultural competence discussed focus on providers dealing with various patients’ health beliefs to achieve equality and reduce the health gap among ethnic minority populations, while none of them are based on health providers from ethnic minority populations caring for patients from the ethnic majority. Despite this, both situations share the same elements required to achieve a successful cross-cultural interaction, even if they do not share exactly the same goals, as the latter situation aims to achieve more general goals concerning providing high quality culturally sensitive care to patients who belong to the host culture.