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Table 1 Definitions and Concepts of Related Terms

From: Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition

TermsDefinition/Concept ExamplesSources
CultureThe integrated pattern of human behaviour that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group.[29]
The accumulated socially acquired result of shared geography, time, ideas and human experience. Culture may or may not involve kinship, but meanings and understandings are collectively held by group members. Culture is dynamic and mobile and changes according to time, individuals and groups.[30]
There is a tendency within healthcare to equate culture with essentialized notions of race and ethnicity, which can lead to practices that separate culture from its social, economic and political context. Narrow conceptualizations of culture and identity may limit the effectiveness of particular approaches, and a focus on specific cultural information may inadvertently promote stereotyping.[31]
Cultural Awarenessa beginning step towards understanding that there is difference. Many people undergo courses designed to sensitise them to formal ritual rather than the emotional, social, economic and political context in which people exist[30]
[is] concerned with having knowledge about cultural but, more specifically, ethnic diversity.[32]
an individual’s awareness of her/his own views such as ethnocentric, biased and prejudiced beliefs towards other cultures (p. e120)[33]
essentially the basic acknowledgment of differences between cultures[34]
recognizing that there are differences between cultures[35]
Cultural Sensitivityalerts students to the legitimacy of difference and begins a process of self-exploration as the powerful bearers of their own life experience and realities and the impact this may have on others.[30]
building on the awareness of difference through cultural acceptance, respect and understanding[36]
builds on cultural awareness’ acknowledgment of difference with the addition of the requirement of respecting other cultures[34]
where students start to analyse their own realities and the impact that this may have on others.[35]
Cultural Humilityincorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.[37]
entails valuing life-long learning and critical self-reflection, along with a respectful and inquisitive approach whereby practitioners are expected to seek knowledge from their clients regarding their cultural and structural influences rather than assuming understanding or expertise about a culture outside of their own[38]
defined as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual’s cultural background and experience.[39]
does not have an endpoint or goal; there is no objective of mastering another culture. Rather it is a continual process of self-reflection and self-critique that overtly addresses power inequities between providers and clients. Attaining cultural humility becomes not a goal but an active process, an ongoing way of being in the world and being in relationships with others and self.[40]
Cultural Securityit legitimises and values cultural differences to ensure no harm is caused and ultimately links understandings and actions[41]
seeks to create interactions between health workers and health service users that do ‘not compromise the legitimate cultural rights, views, values and expectations of Aboriginal people’[42]
Cultural RespectThe ‘Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2004–2009’ identifies the goal of cultural respect as ‘uphold[ing] the rights of Aboriginal and Torres Strait Islander peoples to maintain, protect and develop their culture and achieve equitable health outcomes[42]
The model entails four basic elements highlighting the importance of ‘Knowledge and Awareness’ that informs ‘Skilled Practice and Behaviours’ as well as the development of ‘Strong Relationships’ between (health) institutions, individuals and communities in order to achieve an ‘Equity of Outcomes’[43]
Cultural Adaptationall modifications made to standard service methods in order to make services more acceptable,
relevant, useful, and/or effective for diverse populations
Transcultural Competencethe ability to interact with clientele who come from a range of different cultural backgrounds[43]
Transcultural Effectivenessability of organisations and systems ‘to acknowledge and respond to unique and diverse perspectives and support non- discriminatory practice’ (p. S51). These authors maintain, furthermore, that transculturally competent practitioners should recognise organisational and systemic obstacles and actively seek ways to modify them[43]
Transcultural NursingLeininger (1994) defined transcultural nursing as being a subfield of nursing, focusing on comparative study and analysis of different cultures and is the basis on which the theory of culture care diversity and universality was formed. The goal of transcultural nurses being to “identify, test, understand and use a body of transcultural nursing knowledge and practices which is culturally derived in order to provide culturally specific nursing care to people”[45]
Culturally Unsafe“any actions that diminish, demean or disempower the cultural identity and well-being of an individual’[46, 47]
any action that diminishes, demeans, or disempowers the cultural identity and well-being of an individual[48]
Cultural Destructivenessattitudes, policies, and practices that are destructive to cultures and consequently to the individuals within the culture such as cultural genocide[29]
Cultural Incapacitysystem or agencies that lack the capacity to help minority clients or communities due to extreme bias, paternalism and a belief in the racial superiority of the dominant group[29]
Cultural Blindnesssystem or agencies that function with the belief that colour or culture make no difference and that all people are the same[29]
Cultural Pre-competencean agency that realises its weaknesses in serving minorities and attempts to improve some aspect of their services to a specific population[29]
Cultural Proficiencyagencies that hold culture in high esteem, who seek to add to the knowledge base of culturally competent practice by conducting research and developing new therapeutic approaches based on culture[29]