About Cultural Competency in Nevada (342)Page 2 of 18

1. Cultural Competence in Healthcare

Cultural competency is a set of behaviors, attitudes, and policies that occurs when knowledge, attitudes, and skills are integrated into a person’s daily actions. It requires a self-examination of one’s own cultural and professional background that helps healthcare providers manage prejudices and stereotypes that can affect their behavior when interacting with someone from a different culture (Gradellini et al., 2021).

Cultural competence means you are “culturally humble”—understanding that you are not the expert in all cultural matters. It is a lifelong process during which healthcare providers integrate knowledge into standards, policies, practices, and attitudes aimed at improving the quality of services and the ability to work in cross-cultural situations (NPIN, 2021).

Providing culturally appropriate care creates a healthcare system and workforce that can deliver accessible and effective healthcare regardless of a person’s background. It recognizes that health is inseparable from cultural perceptions of wellbeing (Liu, Miles, and Li, 2022).

Test Your Knowledge

You may find it helpful to try these 10 “True or False” questions first before reading the course. The answers are at the end of the question list.

  1. Implicit bias is a conscious process based on intentional mental associations.
  2. Health equity means that everyone has a fair and just opportunity to be as healthy as possible.
  3. Structural racism refers to ideologies, practices, processes, and institutions that produce and reproduce differential access to power and to life opportunities along racial and ethnic lines.
  4. Cultural sensitivity is a respect for another person’s strengths, culture, and knowledge.
  5. A type of unconscious bias that occurs when our perception is skewed based on inaccurate and overly simplistic assumptions about a group or person is called perception bias.
  6. Evidence shows that interventions focusing on social determinants of health rarely lead to better health outcomes
  7. Perception bias is a type of unconscious or implicit bias that occurs when our perception is skewed based on inaccurate and overly simplistic assumptions about a group a person “belongs” to.
  8. Historically embedded structural racism is a fundamental cause of health inequities in the United States.
  9. Measures of implicit bias rely on the assumption that automatic associations between two concepts will influence behavior in a measurable way.
  10. Bias training has been shown to be more effective when the approach is multipronged, designed with context and professional identity in mind, and when people work and train together.

Answers: Questions 1 and 6 are False; all the others are True.

1.1 How Culture Influences Healthcare Providers and Affects Patients

Whether you are aware of it or not, culture influences healthcare practices and can affect a provider’s perceptions, practices, and decision-making. All forms of knowledge and practice are influenced by culture.

Image: Two Women

Source: CDC.

In 2002, the National Academies published a report called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. It analyzed barriers to accessing care, historic and contemporary inequities, and pressures for cost-containment. The report looked at the clinical encounter itself and found evidence that stereotyping, biases, and uncertainty on the part of healthcare providers contributes to unequal treatment (IOM, 2003).

A key finding was that people in racial and ethnic minority groups received lower-quality healthcare than whites, even when they were insured to the same degree and when other healthcare access-related factors—such as the ability to pay for care—were the same. Additionally, clients in minority groups were not getting their mental health needs met. The report provided a primary impetus for the cultural competence movement in healthcare (Stubbe, 2020).

1.2 Cultural Sensitivity, Awareness, Safety, and Humility

Cultural sensitivity, awareness, safety, and humility are important aspects of cultural competence. Awareness means you strive to improve your understanding of the norms and customs of multi-cultural groups. Safety means you work to protect the culture of vulnerable groups by identifying biases and power imbalances within organizational structures. Humility means you keep an open mind and a non-judgmental approach to patient care. Competence means you integrate knowledge into specific standards, policies, practices, and attitudes (Shepherd et al., 2019).

Self-awareness and self-assessment of cultural concepts helps us understand that values often assumed to be universal can be relative in nature. Working to understand the influences of diverse but interrelated determinants of health offers new models of care that account for more than just biology and medicine.

Healthcare providers who are unaware or insensitive to the process by which cultural identity develops can—regardless of their own race or ethnicity—minimize the importance of racial and ethnic experiences. They may fail to identify cultural needs or recommend appropriate treatments and may unwittingly operate from a superior perspective, take a patient’s reactions or disagreements personally, and view a client through a veil of societal biases or stereotypes (SAMHSA, 2016).

1.3 Characteristics of Culture

Culture is commonly divided into two broad categories: collectivistic or individualistic. Most cultures include characteristics of both, although within any given culture, there are individual variations. Being familiar with characteristics of collectivistic and individualistic cultures can help a provider personalize patient care and understand where patients and family members fall within their cultural continuum (Canadian Paediatric Society, 2024).

Understanding the difference between collectivistic and individualist cultures helps providers understand a person’s cultural and personal background and how this influences their perceptions of health, illness, death, and beliefs about causes of disease. This creates a cultural sensitivity that helps us understand cultural influences, how illness and pain are experienced and expressed, where patients seek help, and the types of treatment patients prefer (Canadian Paediatric Society, 2024).

Source: Canadian Paediatric Society, Caring for Kids New to Canada; Centre for Innovation and Excellence in Child and Family Centred Care at SickKids Hospital, Toronto. How Culture Influences Health: Caring for Kids New to Canada—How Culture Influences Health. Used with permission.

Characteristics of Collectivistic and Individualistic Cultures



Focus on “we”

Focus on “I”

Promote relatedness and interdependence

Value autonomy

Connection to the family

View ability to make personal individual choices as a right

Value respect and obedience

Emphasize individual initiative and achievement

Emphasize group goals, cooperation, and harmony

Lesser influence of group views and values, and in fewer aspects of life

Greater, broader influence of group views and values


1.4 Creating a Respectful Healthcare Environment

The foundation of good quality healthcare rests on respectful, non-judgmental decision making and good clinical reasoning. Respect means recognizing a patient’s value and honoring and acknowledging their dignity. It strengthens a clinician’s moral commitment to their patients and supports authentic interactions. Conveying respect has positive effects on health outcomes, patient satisfaction, and mutual trust (Bridges et al., 2021).

Respect is demonstrated in practice by incorporating the perspectives of patients and community members into policies and practices. Clinicians and organizations should be responsive to feedback from patients about how best to build a patient-centered culture of respect. Learning about a patient’s experiences of respect helps build clinical partnerships and promotes positive health outcomes (Bridges et al., 2021).

Historical factors have influenced healthcare practices and contributed to a mistrust of the healthcare system. For example, patients from Indigenous and culturally and linguistically diverse backgrounds frequently report that healthcare staff is disrespectful, unwelcoming, and unfriendly. Healthcare personnel can provide a safe cultural environment by reflecting of their own cultural beliefs, understanding patient rights, and acknowledging patient-clinician power dynamics (Kayrouz et al., 2021).

1.5 Diversity

Broadly defined, diversity is the inclusion of varied attributes or characteristics. Diversity education encourages providers to understand their position of power and privilege in society, develop a critical consciousness*, and recognize their own implicit biases and those of the institutions and systems in which they work (Togioka et al., 2022).

*Critical consciousness: a reflective awareness of the self, others, and the world and a commitment to addressing issues of societal relevance in healthcare.

Most states do not train providers who are demographically representative of the surrounding population. There is mounting evidence that diversifying the workforce to reflect the population served is key to providing high-quality, high-value, culturally effective care (Lett et al., 2019).

Several studies examining race/ethnicity at the undergraduate, graduate, and faculty level have reported modest improvements in the proportions of underrepresented racial/ethnic and sex groups within medicine. These studies have shown that the medical workforce has indeed become more diverse but have not accounted for the shifting demographics of the U.S. population (Lett et al., 2019).

Gender diversity is key to improving cultural competence. In nursing, the male advantage has been described as a “glass escalator,” in which men are put on a fast track and pushed to achieve positions that include greater responsibility, higher salary, and more organizational benefits. While diversity is necessary and important, equity is also needed to decrease disparities and mitigate the impact of discrimination (Togioka et al., 2022).

The lack of gender diversity is also evident in management positions. For example, more than half the pediatricians and gynecologists in the U.S. are now female, yet department leaders remain predominantly male. Men are more likely to be selected for editorial board membership and achieve status as an associate or full professor, department chair, or medical school dean. Men also earn more at each academic rank (Togioka et al., 2022).

1.6 Health Equity

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities (CDC, 2022, December 16).

Heart disease, cancer, diabetes, and stroke are the most common causes of illness, disability, and death in the United States. Many of these chronic conditions are more common, are diagnosed later, and result in worse outcomes for some groups, such as people of color, people in low-income neighborhoods, and people who are members of marginalized communities.

Despite efforts to reduce health disparities, they persist. Such disparities do not have a single cause: they are created and maintained through multiple, interconnected, and complex pathways, including social determinants of health, environment and community conditions, behavioral factors, and availability and quality of medical services.

Achieving health equity requires healthcare organizations and personnel to provide culturally competent care, valuing everyone equally, addressing avoidable inequalities, acknowledging historical and contemporary injustices, and eliminating healthcare disparities (CDC, 2022, December 16).

Achieving health equity requires addressing social determinants of health and health disparities. It involves acknowledging and addressing racism as a threat to public health and the history of unethical practices in public health that lead to inequitable health outcomes (CDC, 2022, December 16).