Seeing Our Blind Spots
How to develop cultural competence in your practice.
By Bridgit Finley, PT, DPT
Cultural competence is generally defined as a combination of knowledge about certain cultural groups as well as attitudes toward and skills for dealing with racial and cultural diversity.
The National Institutes of Health identifies cultural respect as an essential factor in reducing health care disparities and improving access to high-quality health care for disenfranchised groups of patients. Cultural competence is the ability to understand, communicate with, and effectively interact with people across cultures. Cultural competence encompasses being aware of one’s own world view.
Why is cultural competence important?
Racial and ethnic minorities have higher morbidity and mortality rates from chronic disease. Among older adults, a higher proportion of African Americans and Latinos, compared to whites, report that they have at least one of seven chronic conditions: asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/depression. These rank among the most costly medical conditions in the United States. Higher proportions of minorities compared to whites do not have health insurance, and many that have health insurance are not able to use it because of costly co-payments. A culturally competent health care system can improve health outcomes and quality of care as well as reduce overall health care costs. In societies that are rapidly becoming multicultural, physical therapists deal increasingly with patients from a variety of racial and cultural identities. As a profession we have pushed for direct access, and now that patients are walking in our door, this is an aspect of care that we will need to embrace.
Waking up to our bias
Stereotyping is a mechanism by which we attempt to give structure to the world that surrounds us based on preconceived notions. Patients with different ethnic or cultural backgrounds can more easily invoke bias as a result of this stereotyping. Stereotyping is when you listen to the fearful whispers about a group of people who are different from you, or when you generalize from a specific occurrence to characterize a whole group. Biases are predominant, and despite best effort, most discriminate either consciously or unconsciously. Recognizing our own biases is the first step toward becoming culturally competent. Once we acknowledge that racial and cultural identity has meaning, we can begin to shape how that meaning affects society and its views.
Where do we go from here?
The first thing we need to do if we are sincere about uncovering our bias is to educate ourselves and do our own research through books, historically accurate films, and historical records. Next, people need to receive and hear feedback and not always demand that the situation has to be pleasant and easy for them. We need to accept that learning about race and effecting change can at times be difficult and destabilizing. We need to be able to sit with our discomfort for long enough to thoroughly understand this concept. Like any other competency, it needs continuous attention so that it can become integrated.
This process fits the concept of reflective practice, the importance of which is increasingly recognized within medicine. Reflection helps professionals and students make sense of complex situations and enables them to learn from experience. When a physical therapist reflects on his or her medical performance, the aspects of cultural competency should be a recurring focal point. Four essential elements contribute to a system’s, institution’s, or agency’s ability to become more culturally competent.- Valuing diversity
- Having the capacity for cultural self-assessment
- Being conscious of the dynamics inherent when cultures interact
- Having institutionalized culture knowledge
These four elements should be manifested at every level of an organization including policy making, administration, and practice. Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization. Evaluate your private practice: How many employees from different ethnic or cultural backgrounds do you employ?
Some common strategies for improving patient–provider interaction
- Provide interpreter services
- Recruit and retain minority staff
- Provide training to increase cultural awareness, knowledge, and skill
Conclusion
Cultural competence is not an isolated aspect of medical care, but an important component of overall excellence in health care delivery. When describing the competencies, we distinguished between the elements of knowledge, attitudes, and skills. It is the integration of these that make up a competency, and it is an ongoing process.
Bridgit Finley, PT, DPT, is a PPS member, founder and chief executive officer of Physical Therapy Central in Oklahoma City, Oklahoma. She can be reached at bfinley@ptcentral.org.