Saha S (Portland VAMC), Morse E
(Oregon Health & Science University), Newman P
(Oregon Health & Science University), Gough A
(Portland State University)
The last few years has seen a proliferation of programs training physicians in "cultural competence." There is wide variation, however, in the conceptualization of this term and in the knowledge, attitudes, and skills thought to comprise cultural competence. We sought to develop a comprehensive framework of constructs representing this broad concept.
We conducted a systematic review of conceptual models of cultural competence among health professionals. We excluded articles primarily addressing institutional cultural competence and articles focusing on specific populations or diseases. Two reviewers qualitatively analyzed each article for distinct constructs included as dimensions of cultural competence. A final framework was established though discussion among reviewers.
From 770 abstracts, we identified 26 articles by unique first authors. From reference lists and web sites we identified 9 additional articles, monographs, and book chapters. Our analysis revealed four principal dimensions of cultural competence. Sociocultural Awareness describes an understanding of the meanings of race, ethnicity, culture, and social class and their influences on illness, health, and health care. Cultural Sensitivity encompasses nonethnocentric attitudes (cultural humility) and willingness to accommodate different preferences (cultural flexibility). Cross-Cultural Communication includes skills including assessing beliefs (sociocultural assessment) and negotiating different interpretations of illness and preferences for therapy (cultural negotiation). Patient-Centeredness describes attitudes and skills associated with valuing patients’ perspectives and engaging patients as partners. Additional dimensions not directly relevant to the concept of culture, such as knowledge of epidemiological patterns of disease by race/ethnicity and ethnopharmacology, were included in some models.
Current models of cultural competence are highly varied but share several common themes.
This composite framework is an important first step towards informing the appropriate content of cross-cultural education programs and evaluating their potential to improve quality and reduce disparities in patient care.