Cultural Mosaics: How OTs Fit!
On Cultural Competency
Cultural competence is “an awareness of, sensitivity to, and knowledge of the meaning of culture” (Dillard et al. 1992, cited in Awaad, 2003). Cultural competence involves becoming self-aware of values and biases, self-evaluation of how these biases were imposed on racially different clients, having knowledge of information specific to different cultures, and the ability to interact with others of a different culture (Pope-davies et al. 1993, Chan, 1990, cited by Awaad, 2003).
In order to address the topic of cultural competency, occupational therapists must first understand the disparities within the health care system in treating racial/ethnic minorities. These disparities were identified within Betancourt, Green, Carrillo, Ananeh-Firempong (2003), where they reviewed data showing that minority groups often suffer more from multiple conditions (e.g. diabetes), and that this was due to multifactorial contributors. Some of the suggested major contributors were social determinants such as economic status and jobs with higher occupational hazards.
The authors identified three levels of health care where their described “socialcultural barriers” contribute to racial/ethnic disparities. The first of which are organizational barriers, involving the availability of health care to racial/ethnic populations or the underrepresentation of racial/ethnic members in the leadership and workforce of the health care system. Structural barriers involve lack of interpreters and resources to provide culturally relevant and appropriate health education material. Patients may have problems understanding their diagnosis, medications or instructions for self-care and follow-up. The third identified type of barrier was clinical barriers, involving the interaction between the health care provider and the patient. This occurs “when sociocultural differences between patient and provider are not fully accepted, appreciated, explored or understood”.
The authors stated patients may have different health beliefs, medical practices, attitudes towards medical care and trust in the health care system. Therefore establishing a good provider-client relationship and two-way communication is important in improving patient satisfaction, adherence and better health outcomes.
Balcazar, Suarez-Balcazar & Taylor-Ritzler (2009) has developed a conceptual framework for cultural competence for rehabilitation practitioners and students. Through their process involving a review of the literature, they identified various components that are involved in the development of cultural competence. Some of the examples are listed here:
1) Critical awareness of personal biases towards people of different races and cultures.
2) Familiarisation with complex cultural characteristics, history, values, belief systems and behaviours (e.g. health-related practices).
3) Understanding the position of privilege.
4) The process of obtaining cultural knowledge: “understanding of integrated systems of learned behavioural patterns in a cultural group” (e.g. ways in which members of this group talk, think and behave).
5) Skills development with the ability to communicate effectively and empathetically, to consider the client’s beliefs, values, experiences and aspirations. Skills involve: problem solving, understanding forces of oppression and discrimination (e.g. racism, sexism, etc.)
6) Application of all components into practice context. Goal is to improve ability to deliver culturally competent care.
Those who are interested may want to explore the article to consider the applicability of their practice framework. There are many more articles that may be relevant to this discussion, but due to the time limits of this project, we have provided further readings for those who may want to continue reading articles addressing the topic.
References
Awaad, T. (2003). Culture, cultural competency and occupational therapy: a review of the literature. British Journal of Occupational Therapy, 66(8), 356-362.
Balcazar, F.E., Suarez-Balcazar, Y. & Taylor-Ritzler, T. (2009). Cultural competence: development of a conceptual framework. Disability and Rehabilitation, 31(14), 1153-1160.
Betancourt, J.R., Green, A.R., Carrillo, J.M., Ananeh-Firempong II, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-303.
Further Reading
Dressler, D. & Pils, P. (2009). A qualitative study on cross-cultural communication in post-accident in-patient rehabilitation of migrant and ethnic minority patients in Austria. Disability and Rehabilitation, 31(14), 1181-1190.
Hyma, I. & Guruge, S. (2002). A review of theory and health promotion strategies for new immigrant women. Canadian Journal of Public Health, 183-187.
Lewis, A. (2009). Disability disparities: a beginning model. Disability and Rehabilitation, 31(14), 1136-1143.
Lewis, A., Bethea, J. & Hurley, J. (2009). Integrating cultural competency in rehabilitation curricula in the new millennium: keeping it simple. Disability and Rehabilitation, 31(14), 1161-1169.
Matheson, D. (2009). A right to health: medicine as Western cultural imperialism? Disability and Rehabilitation, 31(14), 1191-1204.
Odawara, E. (2005). Cultural competency in occupational therapy: beyond a cross-cultural view of practice. American Journal of Occupational Therapy, 59, 325-334.
Qureshi, A. & Collazos, F. (2005). Cultural competence in the mental health treatment of immigrant and ethnic minority clients. Diversity in Health and Social Care, 2, 307-317.
In order to address the topic of cultural competency, occupational therapists must first understand the disparities within the health care system in treating racial/ethnic minorities. These disparities were identified within Betancourt, Green, Carrillo, Ananeh-Firempong (2003), where they reviewed data showing that minority groups often suffer more from multiple conditions (e.g. diabetes), and that this was due to multifactorial contributors. Some of the suggested major contributors were social determinants such as economic status and jobs with higher occupational hazards.
The authors identified three levels of health care where their described “socialcultural barriers” contribute to racial/ethnic disparities. The first of which are organizational barriers, involving the availability of health care to racial/ethnic populations or the underrepresentation of racial/ethnic members in the leadership and workforce of the health care system. Structural barriers involve lack of interpreters and resources to provide culturally relevant and appropriate health education material. Patients may have problems understanding their diagnosis, medications or instructions for self-care and follow-up. The third identified type of barrier was clinical barriers, involving the interaction between the health care provider and the patient. This occurs “when sociocultural differences between patient and provider are not fully accepted, appreciated, explored or understood”.
The authors stated patients may have different health beliefs, medical practices, attitudes towards medical care and trust in the health care system. Therefore establishing a good provider-client relationship and two-way communication is important in improving patient satisfaction, adherence and better health outcomes.
Balcazar, Suarez-Balcazar & Taylor-Ritzler (2009) has developed a conceptual framework for cultural competence for rehabilitation practitioners and students. Through their process involving a review of the literature, they identified various components that are involved in the development of cultural competence. Some of the examples are listed here:
1) Critical awareness of personal biases towards people of different races and cultures.
2) Familiarisation with complex cultural characteristics, history, values, belief systems and behaviours (e.g. health-related practices).
3) Understanding the position of privilege.
4) The process of obtaining cultural knowledge: “understanding of integrated systems of learned behavioural patterns in a cultural group” (e.g. ways in which members of this group talk, think and behave).
5) Skills development with the ability to communicate effectively and empathetically, to consider the client’s beliefs, values, experiences and aspirations. Skills involve: problem solving, understanding forces of oppression and discrimination (e.g. racism, sexism, etc.)
6) Application of all components into practice context. Goal is to improve ability to deliver culturally competent care.
Those who are interested may want to explore the article to consider the applicability of their practice framework. There are many more articles that may be relevant to this discussion, but due to the time limits of this project, we have provided further readings for those who may want to continue reading articles addressing the topic.
References
Awaad, T. (2003). Culture, cultural competency and occupational therapy: a review of the literature. British Journal of Occupational Therapy, 66(8), 356-362.
Balcazar, F.E., Suarez-Balcazar, Y. & Taylor-Ritzler, T. (2009). Cultural competence: development of a conceptual framework. Disability and Rehabilitation, 31(14), 1153-1160.
Betancourt, J.R., Green, A.R., Carrillo, J.M., Ananeh-Firempong II, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-303.
Further Reading
Dressler, D. & Pils, P. (2009). A qualitative study on cross-cultural communication in post-accident in-patient rehabilitation of migrant and ethnic minority patients in Austria. Disability and Rehabilitation, 31(14), 1181-1190.
Hyma, I. & Guruge, S. (2002). A review of theory and health promotion strategies for new immigrant women. Canadian Journal of Public Health, 183-187.
Lewis, A. (2009). Disability disparities: a beginning model. Disability and Rehabilitation, 31(14), 1136-1143.
Lewis, A., Bethea, J. & Hurley, J. (2009). Integrating cultural competency in rehabilitation curricula in the new millennium: keeping it simple. Disability and Rehabilitation, 31(14), 1161-1169.
Matheson, D. (2009). A right to health: medicine as Western cultural imperialism? Disability and Rehabilitation, 31(14), 1191-1204.
Odawara, E. (2005). Cultural competency in occupational therapy: beyond a cross-cultural view of practice. American Journal of Occupational Therapy, 59, 325-334.
Qureshi, A. & Collazos, F. (2005). Cultural competence in the mental health treatment of immigrant and ethnic minority clients. Diversity in Health and Social Care, 2, 307-317.
