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As soon as you make a statement about a particular culture, you’re going to find that many more people from that culture don’t fit into that particular stereotype, says Josepha Campinha-Bacote, PhD, RN, CS, CNS, CTN, FAAN. Campinha-Bacote, president of Transcultural C.A.R.E. Associates in Cincinnati, has developed a model framework to guide health care professionals in providing culturally and linguistically appropriate services. "My whole model is to prevent stereotypes and reinforce the concept of intra-ethnic variation. There are more differences within cultural groups than across cultural groups," she says. The components are cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. Here is an overview of each component:
• Cultural awareness:
You have to be aware of your own biases and prejudices toward a particular group and deal with them, Campinha-Bacote says. Being aware of your own cultural or professional values helps you avoid the tendency of an individual to impose his or her beliefs and values on members of another culture, she says. "For instance, take homeless people. The homeless are a transient population," she notes. "One day you work, and one day you don’t. Every homeless person is not the same." Case managers shouldn’t be quick to label a particular group as noncompliant, she points out. Instead, explore what kind of case management services may be required to meet the needs of that particular group.
• Cultural knowledge:
"People have stereotypes, but they need to get cultural knowledge about other people," Campinha-Bacote says. She recommends that case managers consult web sites and books to learn more about other cultures, especially their values, beliefs, and life ways. Biocultural ecology is one area where case managers need knowledge so that they know what diseases are common to a particular group and what drugs may be contraindicated, Campinha-Bacote points out. For example, certain Asian groups have a high incidence of tuberculosis, and African Americans are more susceptible to cardiovascular disease and diabetes than other groups. Don’t just become aware of the values, beliefs, life ways, and practices, but learn about the physiological, anatomical, and pharmaceutical differences in the patients you deal with, she says.
• Cultural skill:
This may be a key issue for case managers, Campinha-Bacote says. "Maybe you can’t get to a web site, you don’t have a book with you, and you are standing in front of someone. Cultural skills [represent] your ability to do a cultural assessment, to know what questions you can ask to elicit their cultural beliefs," she says. Use open-ended questions that are culturally relevant. She cites examples that include:1
— What do you think caused your illness?
— What kind of treatment do you think you should receive?
— What do you fear most about your illness?
— What are the chief problems your sickness has caused?
— What do you think is the way to cure it?
More than 30 different cultural assessment tools are available, Campinha-Bacote says. Review all the tools available and develop questions that fit your specific caseload.
• Cultural encounters:
"There are certain things that only face-to-face interaction will validate. Make sure your expose yourself to a few encounters to validate the knowledge you’ve learned by books and web sites and people," says Campinha-Bacote. For instance, in her own Cape Verdian culture, if you offer someone water, they say, "no thank you" the first time to be courteous. "In some cultures, yes’ doesn’t mean yes’ and no’ doesn’t mean no’," she says. If you have encounter after encounter, you will realize these things, she adds. However, keep in mind that interacting with a few people from a specific ethnic group does not make you an expert on the group.
• Cultural desire:
You can have the right words for someone of another culture, but if your heart isn’t there, whatever you try won’t work, Campinha-Bacote says. "If you can’t get to the part that shows you care, then you don’t really care, no matter how much knowledge you have. People respond to caring," she says. Remember that learning cultural competence is an ongoing process. "The process of cultural competence is a process of becoming and not being. When you ever think you get it all, you don’t."
|Internet resources on cultural competency|
|•||Office of Minority Health, U. S. Department of Health and Human Services: www.omhrc.gov|
|•||Diversity RX: www.diversityrx.org|
|•||National Mental Health Association cultural competency position paper: www.nmha.org|
|•|| National Center for Cultural Competence
"Getting Started" checklist:
|•||Agency for Health Care Research and Quality Minority Health Research: www.ahcpr.gov/research/minorix.htm|
|•||Transcultural Nursing Society: www.tcns.org|
|•||Cross Cultural Health Care Program: www.xculture.org|
1. Kleinman A, Eisenburg L, Good B. (1978) "Cultural illness and care," Annual of Health, 88(251):136-147.
For more information, see: Campinha-Bacote J. (1998). The Process of Cultural Competence in the Delivery of Healthcare Services, 3rd edition. Cincinnati: Transcultural C.A.R.E. Associates Publishers. Contact: Dr. Campinha-Bacote, President Transcultural C.A.R.E. Associates, 11108 Huntwicke Place, Cincinnati, OH 45241.