Bridging Cultures, Improving Health: Mastering Cultural Competency in Community Health Programs

This episode delves into the critical concept of cultural competency in healthcare design. We explore how this essential skill goes beyond mere cultural awareness, encompassing behaviors, attitudes, and policies that enable effective work in diverse communities. Listeners will gain insights into the importance of cultural competency, its key components, and practical strategies for application in community health program design. Through a real-world case study and discussion of challenges, this episode provides healthcare professionals and program designers with the knowledge to create more inclusive, effective, and equitable health interventions. Join us as we uncover how cultural competency can transform healthcare design and significantly improve community health outcomes.

Tami Moser [00:00:00]:
Welcome back to the Community Health Management Design Podcast. I'm doctor Tammy Mosier. And in this episode, we're diving deep into the concept of cultural competency, a crucial skill for anyone working in health care design and community health. So let's start with what cultural competency is. The definition of cultural competency in health care refers to the ability to effectively and respectively, respect fully, deliver health services that are compatible with the cultural health beliefs, practices, and needs of diverse patient populations. And the reality is in the types of designs you're doing, you may only have one patient population and you need to uncover their needs in terms of their culture, or you may have many. And that really just depends on your service and who within the community you're actually targeting. But it's more than just awareness or sensitivity.

Tami Moser [00:00:52]:
It's about developing a set of behaviors, attitudes and policies that come together in a system, agency or among professionals to enable effective work in cross cultural situations. And behaviors and attitudes, you can absolutely train and educate people to hold the behaviors and attitudes that you find necessary to deliver your service. And part of what actually supports that are the policies you put in place for this and the ongoing cultural development within your team. Right? There is a culture that you develop that says, we are going to focus on cultural competency and what our patients need. Right? What their health beliefs and practices support. And so this becomes sometimes very complicated, and sometimes it's very simple. It really just depends. So why is cultural competency important in health care design? Improved patient outcomes is the first one.

Tami Moser [00:01:51]:
Right? When health care providers understand and respect cultural differences, patients are more likely to follow treatment plans and engage in preventative care. And let me just point, they are also much more likely to talk to you about what they're doing and be open and upfront. Okay? And that also improves patient outcomes. The second is reduced health disparities. So cultural competency helps address the systemic inequalities that lead to poor health outcomes for minority populations. Number 3, you see increased patient satisfaction. Patients who feel understood, heard, and respected are more likely to trust their healthcare providers and the system as a whole. And 4, legal and ethical compliance.

Tami Moser [00:02:35]:
Many countries now have laws and regulations requiring cultural competency in healthcare and understanding what your local county, state, town, city, or federal, guidelines are surrounding this. And some of this can be actually connected with funding sources. Right? So they may have legal and ethical compliance rules and contracts you have with them that handle your payment. And so you need to be very clear on what that means. Key components of cultural competency are 1, cultural awareness. So recognizing one's are, 1, cultural awareness. So recognizing one's own cultural background and biases are really what this entails, and everybody has biases. I don't care if you think you're the most open minded person in the the world with no discriminatory thoughts or practices.

Tami Moser [00:03:34]:
You still do have biases. Everybody does. It's it's very difficult to eliminate them. And in reality, most people have a very difficult time in acknowledging their biases. And so thinking that through becomes really important. Whatever team you put together to handle and deliver your community health program, part of your design needs to go into them understanding their own biases and then clearly understanding what attitudes and behaviors you expect for them and what policies are in place to guide cultural competency in your organization. And you've gotta start out with self awareness, which is cultural awareness of your own background. The next is cultural knowledge.

Tami Moser [00:04:26]:
So understanding different cultural practices, beliefs and health behaviors of the actual population and community you're trying to serve. 3 is cultural skill. This is the ability to conduct culturally sensitive assessments and interventions, and handling your language associated with this is really important. And let me just make one point here. Cultural competency is not political. This is not something that is only embraced or understood by one side or one one part of the political continuum. This is really about making sure that you can deliver on what your program is designed to do. And so think of it as a key cornerstone of being effective in it as an offering.

Tami Moser [00:05:18]:
If you do not take this into consideration, you might fail in being able to reach your particular community effectively and then not be able to deliver on what you promise. And so, you know, if me talking about this brought up political ideology in your mind, please take a moment and set that to the side no matter what it is. I that I have no comment or opinion on that, but cultural competency stands outside of that. And it's, you know, do you wanna be effective or not? And that's the question in your program design. And so the cultural skill is the ability to actually understand how to be culturally sensitive and make sure that your assessments and interventions, your program design, actually is has boundaries associated with that skill. Right? So if you're skillful, then your community is going to be much more likely to be engaged in your assessments and interventions. The less skilled you are in this area, the more likely they will not engage with your assessments and interventions. They will not engage with your assessments and interventions.

Tami Moser [00:06:28]:
The 4th is cultural encounters, and this is engaging directly with individuals from diverse cultural backgrounds. Depending on where you were raised and the communities that you're involved in and the community in and the community demographic profiles, you may or may not have had many encounters where the cultures are very diverse and people have a very broad background. Or you may have encountered that quite or you may have encountered that quite often, therefore, you're more comfortable with it, let's say. And number 5, cultural desire. The motivation to want to engage in the process of cultural competence. And this is something you're gonna have to really evaluate in your team as a whole. If they understand and they have a desire and a motivation to wanna engage in a way that acknowledges their own bias from their background, but builds cultural knowledge about their community. And then couple that with the cultural skills, and then you're gonna have a better number of and out comes from cultural encounters.

Tami Moser [00:07:41]:
So the key components, those 5 are things you need to consider as you're looking at this. So let's let's talk about how you apply cultural competency in health care design. When designing community health programs, consider these 6 strategies. The first is community engagement, and this involves members of the target community in all stages of program design and implementation. If you're not sure if you're gonna be able to identify all of the elements of a culture that could be problematic in your design, you don't understand the culture well enough, or you know that there's certain kind of hidden things there that if you're not directly a part of the culture, you're probably not gonna be able to identify, then community engagement involving members within that culture that understand it forwards and backwards and are able to look at your program design and your implementation plans and go, but but you gotta think about this here. That can be very helpful. Right? But, again, you have to set aside one of the things that happens when you design anything like this is that you get very emotionally attached to what you've done. Right? You've put in a lot of hard work to get it designed, and it's a lot of blood, sweat, and tears of your own.

Tami Moser [00:09:02]:
And when you come out and have finished it, you can look at it like your baby. You know? Nobody should have anything negative to say about your baby. However, both internal and external community members related to this design should be or are needed to actually find things that will be problematic before they're problematic. And that's what community engagement can help you do. The second is needs assessment. So conduct thorough research to understand the specific health beliefs, practices, and needs of the community. This may be a literature review where you look for studies surrounding that community, other kinds of health care interventions that have been written up for the community you're wanting to target, and you may be able to identify some of the health beliefs, practices, and needs of that community as they're identified in those studies. Or this could partially come from an engagement a pre engagement with the community, with surveys to really understand it more effectively if you think you can.

Tami Moser [00:10:10]:
Maybe you have 5, 10, 20 members of the community you want to target who are already patients or interact with you in some way where you might be able to have them help you with needs assessment, fill out a needs assessment, and that can give you some understanding. So there's some options there. Language accessibility. Ensure all materials and communications are available in the languages spoken by the community and at a grade level that they would understand. And at this time, our average reading level in the United States is 5th grade. You can, when writing anything up in Word, actually go to tools and get a grade level. And so it will tell you what level you're writing at, in that document, and you wanna aim for 5, 5th grade. 8th grade was what it was a decade ago.

Tami Moser [00:11:10]:
So we're not going up. We're going down. But the bottom line is, you know, I hold 2 doctorates, a PhD and a doctorate in behavioral health. So I'm highly educated. I can obviously understand more complex instructions or information. But while I could read and understand something that is at a higher grade level, let's say 16, 17, 18, someone that may have or be a target of your community health plan may very well lack the ability to understand at that grade level. You drop it to a 5 and they have no problem understanding and neither do I, nor would I be insulted at it being right at that level. It's just, oh, these are easy to understand instructions.

Tami Moser [00:12:05]:
They don't require a lot of, in-depth thought to try to get to what you're really trying to say in that. And so, I just say write everything at 5th grade level and you're good to go because then anyone, and I have put quotes around that word, although you can't see me. Anyone would actually be able to understand those. So always think about that language accessibility. It's not just about offering multiple languages or the languages that are spoken by your peers. Important to kind of tease out of that. The important to kind of tease out of that. The 4th is cultural adaptation.

Tami Moser [00:12:52]:
So this is modifying evidence based interventions to fit the cultural context without losing their core components. So this can be if you're actually taking a program that's been done somewhere else and you're wanting to adapt it to work for your community, this is one of the elements that you really need to consider. What do you need to modify to fit the cultural context of the community you want to offer it in without losing the core components of that plan that were successful in the location it was offered? And this just requires, again, some thought. It doesn't necessarily mean it's difficult to do. If you understand the culture of the community well enough, then you'll be able to to go, okay. We can't deliver in this way here. It it wouldn't be applicable in this cultural context. But if we shift this and this, then we can offer it, and we're still providing those core components.

Tami Moser [00:13:54]:
Number 5 is a diverse workforce. So recruit and train a diverse team that reflects the community you're serving. I mean, this is one of those shortcuts, if you will, to being effective in relationship to cultural competency. Have people on your team that are a part of that community. They reflect the values, the culture. They appear similar. I mean, there is something to be said for me going in to get care and having my care provider look like me, talk like me, reflect on or acknowledge things that matter to me. This doesn't mean everybody needs to look the same as the community, and looks are really not the best measure, but there is something to be said for that.

Tami Moser [00:14:48]:
Right? You feel more comfortable around people like you. That's just human nature for the most part. So when you recruit and train a diverse team that reflects the colors of the community, a context of not skin color, but just personality, color, then you get closer to being able to provide people with a comfort level that can be very helpful with these programs. Number 6 is continuous learning, and this is implement ongoing cultural competency training for all staff members. This is not a one and done thing. Right? This can be very layered depending on how complicated that culture is in the context you're trying to work in. So you may have, you know, entry level training on this culture, then some mid level training on this culture, and then a higher level training. This could be spread out over weeks or months.

Tami Moser [00:15:48]:
It could be spread out over the whole program at different times. It may be I'm gonna offer it once, and then we'll have refresher trainings. I mean, this can look many different ways. But the goal is to understand that it's a continuous learning process. It's very difficult to understand other cultures, and those are cultures in our own communities too. We think it's easy, and that's part of the danger. It's like, oh, I understand that. I've lived next door to, you know, that community for a long time.

Tami Moser [00:16:16]:
I understand. My kids go to school with their kids, and we hear about, you know, the different cultural components of so we understand. It's like, no. You really don't. You've got surface level understanding. It it takes a really good amount of time to understand cultural differences, and that's part of the challenge with cultural competency. And so it's important for you to just know I'm gonna design x into this program and at the cost of the program. Again, it's about effectiveness.

Tami Moser [00:16:44]:
Right? So let's look at a case study. Some of you may be familiar with the reach 2010 initiative. So the racial and ethnic approaches is to community health, that's what reach stands for, was a 2010 initiative launched by the CDC focusing on eliminating health disparities among various ethnic groups in the United States. One successful project under this initiative was the Vietnamese reach for health initiative coalition in Santa Clara County, California. This program dramatically increased cervical cancer screening rates among Vietnamese American women by 1 partnering with community organizations. 2, using culturally tailored media campaigns. 3, providing language appropriate educational materials. And 4, training Vietnamese American physicians on culturally competent care.

Tami Moser [00:17:31]:
This Vietnamese American physicians on culturally competent care. This case study demonstrates how cultural competency can lead to significant improvements in community health. And you'll see one of the materials available to you is the reach, guidelines from the CDC. So that particular, attachment in your material in your, additional resources section, is something you can look at. If you're really kind of considering and need to consider the cultural competency components closely, then that, document may be very helpful for you. So I would recommend taking a look at it. So what are the challenges and considerations here? Well, while striving for cultural competency, it's important to remember, 1, you wanna avoid stereotyping. Cultural competency doesn't mean assuming all individuals from a culture share the same beliefs or practices.

Tami Moser [00:18:26]:
That is often not the case. 2, recognize intersectionality. So people have multiple identities that intersect and influence their health experiences. And by multiple identities, this can be, you know, we all have multiple roles in life. Right? I can be a mother. I can be a spouse. I could be a business partner. I can be a name the role I play.

Tami Moser [00:18:53]:
I can be a teacher. And within all of those roles, like, I'm a child, you know, every role, there can be influences on your both health experiences and your relationship to health. And so that intersectionality is important to remember. Acknowledge power dynamics. Be aware of the historical and systemic factors that affect health disparities within the culture you're looking at. The bottom line is there are differences. And if you go to the CDC or the Department of Health and Human Services and start looking at some of the reports, look at some of the reports that show us different health outcomes in different types of cancer across the United States or look at the studies that have been done that show, you know, the likelihood if you're in a certain community of getting a certain type of screening, versus another. And you will start to see real disparities, that pop up.

Tami Moser [00:19:55]:
So just be aware of those power dynamics. Embrace cultural humility. Recognize that cultural competency is an ongoing process of learning and self reflection. In other words, it's always it can be very surprising, when you think about cultural awareness, your own biases, you may not even really acknowledge those yet or understand them. And through self reflection over time, more of that will become clear to you. Or by paying closer attention because of training you've had here, you have an interaction and you're able to step back from that and go, oh, that was really this bias of mine at play, and I didn't even recognize that was happening. But because I'm paying closer attention because we're working toward making sure that our design and the people involved really pay attention to cultural competency. And I've embraced that cultural humility.

Tami Moser [00:20:49]:
I've at least accepted the fact that I have biases I may not even recognize, and I need to pay attention to identify them. That can really help. You do better in this area, right, and continue to learn. It's an ongoing process. So cultural competency is not just a buzzword. It's a critical skill for anyone designing and implementing community health programs. By understanding and respecting cultural differences, we can create more effective, equitable, and impactful health interventions. So we're going to look at some practical tools for conducting culturally competent needs assessment.

Tami Moser [00:21:30]:
Until then, keep reflecting on your own cultural assumptions and how they might influence your work in community health and community health program design. Thank you for listening and remember in healthcare design, cultural competency isn't just nice to have, it's essential for success.