Cultural Humility and Cultural Competency

Introduction

Cultural competence and humility are core CHW skills. Serving a community well depends on understanding the cultural backgrounds of the people you help — and that takes more than respecting diversity. It means listening closely, staying curious, and using what you learn to build trust, collaborate more effectively, and tailor health services to each community's beliefs and needs. When CHWs adapt their approach this way, they improve access to care and outcomes, reduce health disparities, and support the well-being of diverse groups.

In this lesson, we'll explore why cultural competence and humility are essential to providing culturally safe care, and how these skills strengthen communication, shape health interventions, and deepen the positive impact CHWs have on community health.

Lost in Translation

In the bustling heart of a multicultural neighborhood in Los Angeles, Janaya, a committed CHW, took on the challenge of connecting a diverse urban community to health services. Confident in her expertise, she was determined to bridge the gap between medical advice and cultural practices. However, her interaction with Mr. Chen, a respected Chinese elder in the local Asian community, became a profound lesson in the nuances of cultural sensitivity.

Mr. Chen, who had recently been diagnosed with type 2 diabetes, was struggling to adjust to his new dietary restrictions. Janaya, eager to assist, reached out with the intention of implementing a straightforward plan to manage his condition. In their first meeting, she presented a detailed health strategy focused on significantly reducing his rice consumption — a staple in Mr. Chen's diet — emphasizing the benefits of low-glycemic alternatives to help control his blood sugar levels. Janaya mistook Mr. Chen's polite nods for agreement, unaware of the deep cultural connection and the comfort he found in his traditional meals.

The outcome of their interaction was not what Janaya had anticipated. Throughout their meeting, Mr. Chen became increasingly withdrawn. When Janaya proposed scheduling a follow-up visit to check on his progress, Mr. Chen declined, signaling a clear reluctance to continue engaging with her.

Janaya's Perspective of the Meeting

Janaya entered the meeting with a pragmatic, solution-oriented mindset, typical of many Western healthcare approaches, which prioritize efficiency and the immediate implementation of dietary changes to address health concerns. This method is often viewed as straightforward, focusing on quickly pinpointing issues like excessive rice consumption and devising strategies to reduce its impact on health.

Mr. Chen's Perspective of the Meeting

Conversely, Mr. Chen, whose dietary habits are deeply entwined with his cultural heritage and the symbolic significance of rice, expected a discussion that would honor his traditions and personal values. The mismatch in their expectations — Janaya's emphasis on direct dietary interventions versus Mr. Chen's desire for a conversation that acknowledged the complexity of changing deeply rooted cultural eating practices — underscores the essential role of cultural sensitivity in community health work.

What is Culture?

Culture is our way of life. It lays the foundation of our collective identity. It is the beliefs, behaviors, and characteristics shared by members of a particular group or society, influencing our perceptions, interactions, and the way we live together. It creates a common bond while also guiding social norms and behaviors.

Essentially, culture is defined as:

… the set of attitudes, values, beliefs, and behaviors shared by a group of people, but different for each individual, communicated from one generation to the next. — Matsumoto, 1996

Culture is characterized by...

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Culture is Influenced by...

The Impact of Today's Society on Identity and Intersectionality

Everyone sees the world from their own perspective. What's yours? Check any of the statements below that resonate with you to see your viewpoint.

Types of Identity

Did any of the statements in the previous exercise identify with you? Each one of those statements represents a reality that comes from someone who has a distinct identity as they experience life on a day to day basis. Flip through the flashcards below to see some examples of several different types of identity.

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More often than not, we find ourselves identifying with more than one type of identity (for example: white middle-class woman, genderfluid Latinx). This combination, or intersection, of multiple identities is crucial to begin understanding our society and how different individuals interact.

The term intersectionality, first coined by legal scholar and civil rights activist Kimberlé Crenshaw in a 1989 paper, is the framework showing how social identities (race, gender, and class) coincide to create unique combinations of discrimination and privilege. It illustrates that people's experiences in life cannot be understood solely based off of one part of their identity.

Intersectionality in the Healthcare System

Meet Carlos. Carlos is a 25 year old gay Latino man living in a predominantly conservative area. He encounters significant barriers to accessing healthcare, influenced by his intersecting identities.

Two Factors

1. Carlos' health concerns are sometimes overlooked by healthcare providers, who are uncomfortable discussing the specific sexual health needs of gay men.
2. Carlos has confronted assumptions made about his language ability, socioeconomic status, and health literacy, impacting the respect and attention given to his healthcare needs.

The Intersection

Although Carlos has experienced both of the factors listed above, neither fully encapsulates his experience; his experience is unique and must encompass both parts of his identity (gay, Latino).

The Cultural Iceberg

In order to truly understand how culture shapes someone's behaviors, you must take into account the things readily visible to you but, more importantly, the things remaining below the surface. In 1976, an anthropologist by the name of Edward T. Hall first developed the cultural iceberg to illustrate the hidden as well as the more visible aspects of a culture.

Two layers of culture

Why this matters

Naming your own identity — visible and invisible — is how bias becomes visible. The strengths you bring (like noticing money pressure quickly, or leaning toward practical solutions) can also become blind spots when they lead you to fix things before really listening.

Cultural Competence

Cultural and linguistic competence refers to a set of consistent behaviors, attitudes and policies within an organization or among professionals that support effective work in cross-cultural situations.

Cultural competence is an important goal for both individuals and organizations alike.

The Demand for Cultural Competency in Healthcare

Cultural competence is a product of the 1960s and 1970s, rooted in the sociopolitical climate of the civil rights movements. Founded on the belief that increasing our knowledge of other cultures directly enhances our competence effectively, it has gained acceptance all throughout the healthcare system.

The 2002 Institute of Medicine (IOM) report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare," exposed healthcare disparities for minorities, attributing these to biases, stereotypes, prejudice, and clinical uncertainty among providers. It found that racial and ethnic minorities often received lower-quality healthcare compared to whites, even when insurance coverage and access factors were similar.

Cultural Competency — Recognizing Reasons for Medical Mistrust

Why Cultural Competence Matters for CHWs

Cultural Competence, for CHWs, is a key component that'll bridge the people in your community and the healthcare system. It involves assisting the individuals in your community with accessing suitable healthcare to achieve the best possible health outcomes while maintaining an understanding and respect for your clients' cultural beliefs, behaviors and needs.

Improving services and care through cultural competence may include:

• Assisting your client with overcoming language barriers
• Simplifying healthcare processes and procedures for patients
• Facilitating and undergoing screenings and providing resources for transgender healthcare
• Partnering with traditional healers for integrated care
• Participating in specialized training regarding LGBTQ+ health concerns
• Implementing culture-specific approaches in health promotion
• Representing and belonging to the community served

CHWs are trusted bridges between communities and the healthcare system. That trust is exactly what cultural competence protects. You are often the first — and sometimes the only — person who speaks a client's language, shares their neighborhood, or takes the time to understand what health means inside their culture. When you get that right, people who have learned to avoid the system stay engaged; when you get it wrong, the mistrust described above only deepens.

Think back to Janaya and Mr. Chen. Janaya was skilled and well-intentioned, but by treating a rice-based diet as a problem to solve rather than a tradition to honor, she lost the relationship before it began. Cultural competence is what turns that same conversation into a partnership — one where the client feels seen and stays in care.

What cultural competence makes possible

• Builds trust with communities that have been harmed or ignored by the healthcare system in the past.
• Strengthens communication by accounting for language, values, and the beliefs below the waterline that shape how people hear health information.
• Improves access and follow-through because clients are far more likely to stay engaged with care that respects their culture.
• Reduces health disparities by tailoring education and interventions to each community's real needs instead of a one-size-fits-all plan.

Understanding Cultural Competence Through Ethnocentrism and Ethnorelativism

There are several methods guiding our comprehension and application of this crucial skill. Below we will begin to explore the model of ethnocentrism and ethnorelativism, which seeks to explain the path towards achieving cultural competence.

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Enhancing cultural competence entails a PERMANENT shift from ethnocentrism and ethnorelativism, marking an irreversible growth in appreciating and understanding cultural differences.

The Cultural Competence Continuum

Cultural competence is a complex concept and one that unfolds over time and develops along a continuum — from less culturally aware to more culturally proficient. No one is fixed at a single point; you may be further along on some dimensions than others.

From destructiveness to proficiency

A CHW says, 'I treat every client exactly the same, no matter where they come from.' Which stage of the cultural competence continuum does this best describe?

Contradicting "Competency"

While cultural competency training is valuable it may encourage assumptions about specific groups.

Cultural Humility

Cultural Humility is about committing to a lifelong journey of self-reflection and recognizing our own biases. By embracing humility toward cultural differences, individuals can cultivate trust, foster inclusivity, and support equity and social justice.

Cultural Humility:

• Emphasizes genuine dialogue, openness to learning from diverse backgrounds, and mutual respect.
• Appreciates the complex nature of intersecting identities.
• Recognizes the diversity of experiences within any one cultural group.
• Encourages ongoing learning and curiosity rather than arriving at an expert, "competent" endpoint.

Janice and Anaya - Moving from Assumption to Understanding

The Significance of Cultural Humility for CHWs

As Janice and Anaya's story demonstrates, cultural humility is particularly crucial for CHWs. Considering that their role involves a constant close collaboration with individuals from a diverse array of cultural backgrounds on the intimate issue of transforming their health, an ongoing commitment to learning, asking questions, and self-reflection is essential. This dedication ensures CHWs have the capability to provide respectful, effective support tailored to the unique cultural needs and perspectives of those they serve.

Cultural Humility Checklist

The Four Pillars of Cultural Humility for CHWs

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By blending cultural competence and humility, CHWs are equipped to understand and value diverse cultures while staying curious about the individual experiences of the people they serve. This guarantees an environment where patients feel respected and encouraged to express their cultural identities and health needs, paving the way for culturally safe care.

Culturally Safe Care

Culturally safe care is an approach to healthcare that is respectful of, and responsive to, the health beliefs, practices, and needs of diverse patients. It aims to ensure that healthcare delivery is free from racism and discrimination, and that people are supported to draw strengths from their identity, culture and community.

CHWs play an important role in advocating for and implementing culturally safe care practices, serving as essential liaisons who ensure healthcare services are aligned with and respectful of the unique cultural contexts and preferences of the individuals they serve.

Examples of the Critical Role CHWs play in Facilitating Culturally Safe Care

The examples emphasized above underscore the pivotal role CHWs play in delivering culturally safe care. CHWs stand at the crossroads of healthcare and community, embodying the principles of cultural competence and humility. Their work goes beyond the mere translation of medical jargon or navigation of healthcare systems; it involves mindfully listening to and comprehending the cultural contexts of the individuals they serve, advocating for their needs, and ensuring that healthcare practices are inclusive and respectful of diverse cultural beliefs and practices. CHWs bridge the gaps between healthcare providers and patients, facilitating a healthcare environment where all individuals feel seen, respected, and valued.