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Defining culture and its impact on practice.

Culture as the Iceberg Model

Culture is defined as a body of learned beliefs, traditions, and guides for behaviors that are shared among members of a particular group. It shapes our behaviors and serves as a roadmap for both perceiving and interacting with the world. Culture is passed on from generation to generation, but it is constantly, though slowly, changing. In his book, Beyond Culture (1976), Edward T. Hall likens culture to an iceberg in that there are things we can plainly see about it that are on the surface such as music, dress, foods, and sports. These are the elements we first notice when visiting a new country. But these things alone do not represent a person's culture. There are aspects of culture that we cannot see, but that actually represent the greater part of one's culture. These deeper aspects of culture are about beliefs, values and thought patterns that guide people's actions and are the more significant components of defining one particular culture. Some examples include:

attitudes toward life and death, structure and expectations of the family, concept of time, etc. It takes time to become aware of and understand these deeper elements of culture, which tend to impact interpersonal relations, communication, health care beliefs, and actions much more than the superficial things that we usually may perceive as culture. Failure to understand and recognize these elements of culture and the layers that compose them, as well as how they influence each other is the main reason misunderstandings occur when interacting across cultural groups.



Variations within Cultural Groups

When we think of culture, we tend to make assumptions or generalizations based on one characteristic, such as race, but in reality, a person's culture is shaped by multiple influences, that can include nationality, language, gender, socioeconomic status, occupation, religious beliefs, education, legal status, and level of acculturation to their place of residence. We must consider these factors when looking at individuals within the same cultural group. For example, a young person and an elderly person in the same family may have completely different viewpoints on an issue, even though they are in the same "cultural group". It is important to recognize that making assumptions or generalizations about a person based on a group they belong to may lead to erroneous conclusions. The key is that in every interaction you have with others, you avoid the misunderstandings that can happen by placing people into "boxes."

Effects of Culture on Health Care

It is impossible to underestimate the impact that culture can have on health care. Culture affects all of the following:

* how people communicate and understand health information,

* how people think and feel about their own health,

* when and from whom people seek care, how people respond to recommendations for lifestyle change and treatment (such as changes to diet, etc.), and

* how health care professionals communicate with their patients.

For instance, many patients will follow their own culture's traditional or folk medicine treatments even when they are under the care of a medical doctor. Providers may need to accept this, discuss it openly, and find a way to negotiate with that patient to ensure that the disease will be properly addressed with both biomedical western treatments and alternative, non-western treatments.

Even before the point of interaction between the health care provider and patient, culture affects health care because it affects people's health belief systems and how a health problem is solved. Different cultural groups view the following ideas differently:

* how they define and categorize health and illness,

* how they explain illness and what causes it, how they view cause and effect between illness and treatments,

* how they define the "scope of practice" for healers or doctors, and

* when they seek health care.

For example, some patients may choose not to seek health care because they understand their symptoms to be the result of a certain behavior in their lives, the result of overindulgence or divine punishment. These complex ways in which culture can impact health care often lead to misunderstandings between provider and patient, ineffective treatment, and even lack of seeking treatment and care.

Developing Cultural Competency

Cultural competency is one of the main ingredients in closing the disparities gap in health care. Cultural competency has been defined as "a set of congruent values, behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations" (adapted from Cross, 1989). It is the ability of health organizations as a whole, and of each individual practitioner in each of their roles, to recognize cultural beliefs, values, attitudes, traditions, language preferences and the health practices of different populations, and the ability to apply that knowledge to produce a positive health outcome. Quite simply, cultural competent health care services are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of all patients. Being respectful is to acknowledge and honor each person's unique characteristics and all the things that make them who they are.

To develop and practice cultural competency in a health care organization, each individual staff member must make a commitment; but also systemic efforts must be made at the organizational level.

Culturally competent individuals must have a mixture of knowledge, skills, beliefs and attitudes that help them establish trust and communicate with others. Everyone from the medical doctor, nursing staff, administrative staff, and front office staff must become aware of their need to improve their cultural competency.

Organizations must have:

* Policies and procedures in place that value diversity (Implementing the CLAS standards is a way to ensure a more culturally competent environment that supports its staff and patients),

* Self-assessments, and

* Acquired and institutionalized cultural knowledge and adaptation to the diversity and cultural contexts of the individuals and communities served. (Can be achieved through staff development and training)

Achieving cultural competency is a developmental process that evolves over time and requires a commitment to expand your knowledge, skills and communications as you interact with your patients.

Ways to honor cultural differences and practice respect.

* Ask questions of patients that respectfully acknowledge these differences and build the patient's trust.

* Use general knowledge of common beliefs, values and norms as a 'starting point' with the patient to discuss his/her personal beliefs and practices.

* Be aware of your own cultural beliefs and values in order to recognize where they may differ from the patient's and to evaluate patient's responses objectively.

* Determine the degree to which the patient or family holds to their cultural background, if at all. This is to avoid stereotyping or ignoring the potential influence of culture, and to reduce the risk of miscommunication.


by Evangelina Orozco, Leadership Development and Training Specialist, NCFH
COPYRIGHT 2012 National Center for Farmworker Health, Inc.
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Title Annotation:Newsline
Author:Orozco, Evangelina
Publication:Migrant Health Newsline
Geographic Code:1USA
Date:Jan 1, 2012
Previous Article:Resources on cultural competency and language barriers.
Next Article:Tips on cross-cultural communication.

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