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Table 2 Key Definitions and Concepts of Cultural Competency

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

TermDefinition/Concept ExamplesSources
Cultural Competencya set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations.[29]
acknowledges and incorporates - at all levels - the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally-unique needs.[29]
a culturally competent counsellor must acquire ‘awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society’, i.e., develop the ‘ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds[43]
the ability of individuals to establish effective interpersonal and working relationships that supersede cultural differences by recognizing the importance of social and cultural influences on patients, considering how these factors interact, and devising interventions that take these issues into account[53]
the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet patients’ social, cultural, and linguistic needs[54]
a more comprehensive, skill-based concept that purposefully involves the system in addition to the patients and has been conceived of as an on-going quality improvement process, relevant across individual, organisational, systemic and professional levels[50]
a complex know-act grounded in critical reflection and action, which the health care professional draws upon to provide culturally safe, congruent, and effective care in partnership with individuals, families, and communities living health experiences, and which takes into account the social and political dimensions of care[55]
the ability to work and communicate effectively and appropriately with people from culturally different backgrounds. While appropriateness implies not violating the valued rules, effectiveness means achieving the valued goals and outcomes in intercultural interactions[33]
the ability to acknowledge, appreciate, and respect the values, preferences, and expressed needs of clients. Cultural competence is also the ability to resolve differences and identify solutions that reduce interference from various cultural factors…This article defines cultural competency as encompassing open-mindedness and a respect for people, families, and societies of various cultural backgrounds. Being able to translate this cultural knowledge and these skills into practice may help enhance the cultural appropriateness of healthcare.[51]
the development of a skill set for more effective provider-patient communication. They stressed the importance of providers’ understanding the relationship between cultural beliefs and behaviour and developing skills to improve quality of care to diverse populations. Several informants expressed concern about the persistence of stereotypic teaching strategies (such as treating Hispanics one way and African Americans another). They mentioned additional components that were underemphasized such as empathy, exploring socioeconomic issues, and addressing bias in the clinical encounter[56]
Social workers describe cultural competence as a continual process of striving to become increasingly self-aware, to value diversity, and to become knowledgeable about cultural strengths[57]
frequently approached in ways which limit its goals to knowledge of characteristics, cultural beliefs, and practices of different non-majority groups, and skills and attitudes of empathy and compassion in interviewing and communicating with non-majority groups. Achieving cultural competence is thus often viewed as a static outcome: One is “competent” in interacting with patients from diverse backgrounds much in the same way as one is competent in performing a physical exam or reading an EKG.[58]
an awareness of cultural diversity and the ability to function effectively, and respectfully, when working with and treating people of different cultural backgrounds. Cultural competence means a doctor has the attitudes, skills and knowledge needed to achieve this. A culturally competent doctor will acknowledge:
 That New Zealand has a culturally diverse population.
 That a doctor’s culture and belief systems influence his or her interactions with patients and accepts this may impact on the doctor-patient relationship.
 That a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding
At the level of the individual practitioner, cultural competence enables increased awareness and understanding of the perspectives and lived realities of Māori clients, which in turn facilitates genuine engagement, trust, and information sharing contributing to enhanced clinical outcomes.[59]
Organisational Cultural CompetencyTo achieve organizational cultural competence within the health care leadership and workforce, it is important to maximize diversity. This may be accomplished through:
 Establishing programs for minority health care leadership development and strengthening existing programs. The desired result is a core of professionals who may assume influential positions in academia, government, and private industry.
 Hiring and promoting minorities in the health care workforce.
 Involving community representatives in the health care organization’s planning and quality improvement meetings.
Organisational cultural competence involves strategies that maximise diversity and incorporate leadership and workforce issues. Specifically, ethnic matching and working with communities. The lack of diversity in health care leadership and the workforce has been identified as a barrier to culturally competent care, and studies have shown that health care quality and racial and ethnic diversity are linked[60]
Systemic Cultural CompetencyTo achieve systemic cultural competence (e.g., in the structures of the health care system) it is essential to address such initiatives as conducting community assessments, developing mechanisms for community and patient feedback, implementing systems for patient racial/ethnic and language preference data collection, developing quality measures for diverse patient populations, and ensuring culturally and linguistically appropriate health education materials and health promotion and disease prevention interventions.[54]
At the system level, the structures of the health care system are attended to and include strategies, such as ethnicity data collection and strategic planning. Ethnicity data collection can assist in the planning of improvements to services by comparing access to services and outcomes of care.[60]