Rethinking Cultural Competence: Shifting to Cultural Humility

Authors:

• Helen-Maria Lekas
• Kerstin Pahl
• Crystal Fuller Lewis

Publication Details:

• Published in Health Services Insights
• First published online: December 20, 2020

Introduction

• Cultural Competence: Traditionally, healthcare providers are trained to be culturally competent through exposure to various cultures, aiming to reduce health disparities and improve care quality.
• Criticism: Cultural competence training can inadvertently lead to stereotyping, stigmatizing, or othering patients, and may reinforce implicit racist attitudes.
• Proposal: Shift from cultural competence to cultural humility, emphasizing self-reflexivity, acknowledgment of patients’ expertise, power-sharing, and ongoing learning.

Problems with Cultural Competence

• Stereotyping: Cultural competence suggests static cultural attributes, leading to stereotypes.
• Intersectionality Ignored: Does not account for the multiple social statuses (race, gender, class) influencing beliefs and behaviors.
• Power Imbalance: Can reinforce power imbalances between providers and patients.

Cultural Humility

• Definition: An orientation focusing on self-reflection, appreciation of patients' expertise, power-sharing, and lifelong learning.
• Benefits: Encourages self-awareness and reflection on personal biases, fostering better communication and patient-provider relationships.

Training in Cultural Humility

• New York State Training: A dual-component training involving:
  • Cultural and Linguistically Appropriate Services (CLAS) standards: Focuses on culture, structure, and health equity.
  • Health Habitus Integration (HHI) training: Theoretical framework for integrating cultural and social determinants of health into practice.
• Activities: Writing personal health habitus and conducting in-depth interviews to understand patients better.
• Feedback: Trainees find that personal biases are challenged during training, leading to greater humility.

Evaluation of Training

• Current Efforts: Evaluation of the dual-component training's effectiveness is underway with results expected.

Conclusion

• Shift Needed: Emphasizes the need for a paradigm shift from competence to humility to effectively address health disparities and avoid perpetuating racism.
• Theoretical Support: Supported by literature on implicit bias and intersectionality.

Funding

• Received support from SAMHSA for the cultural humility training program.

References

• Includes key scholarly references and studies supporting the critique of cultural competence and the advocacy for cultural humility.

Cultural humility is posited as a more effective approach than cultural competence, and ongoing research is evaluating its impact on reducing health disparities and improving patient-care provider relationships.