Multicultural competence:: beyond the basics

Abstract

To the Editors: I was very pleased to see the interest and attention given to the issue of cultural or multicultural competence presented in the October 2000 issue of the Journal. The articles were extremely relevant and timely in light of the very obvious changes in our communities and our efforts as practitioners to provide care that meets the specific needs of diverse populations, as evidenced by measurable outcomes. The disparities in health status that exist in our country are a national concern and should be of particular interest to dietitians who must work to prevent and treat nutrition-related chronic diseases that are seeped in culture. As Dr Curry indicated, “a sense of urgency is needed if we are to further increase research and educational efforts in multicultural counseling and communication” ((1)Curry K Multicultural Competence in Dietetics and Nutrition.J Am Diet Assoc. 2000; 100: 1142-1143Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar). This sense of urgency will hopefully take us beyond simply understanding diversity and emphasizing sensitivity in a theoretical sense to more concerted efforts to put cultural competence in practice at the individual and institutional level. In fact, some researchers suggest that we must excel beyond cultural competence to the level of cultural humility. Cultural humility involves a commitment to self-evaluation and self-critique, to redressing the power in the patient-provider dynamic, and to establishing mutually beneficial, nonpaternalistic, and advocacy roles with communities, individuals, and defined populations ((2)Tervalon M Murray-Garcia J Cultural Humility Versus Cultural Competence A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.Journal of Health Care for the Poor and Underserved. 1998; 9: 117-125Crossref PubMed Scopus (1475) Google Scholar). A number of cultural competency models exist, as noted by Harris-Davis and Haughton in their article “Model for multicultural nutrition counseling competencies” ((3)Harris-Davis E Haughton B A Model for Multicultural Nutrition Counseling Competencies.J Am Diet Assoc. 2000; 100: 1178-1185Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar). Though many of us may favor one approach more than another, the point has been clearly made that a body of theory exists, and we have no excuse as practitioners or educators not to move forward in preparing ourselves and students to achieve the competencies necessary to achieve our goals. And we certainly do not have to feel obligated to stay within only one theoretical framework. Even Dr Campinha-Bacote, a recognized expert in the field of cultural competence has, based on continuing exploration, expanded her four-stage cultural competence model (cultural awareness, cultural knowledge, cultural skill, cultural encounters) to incorporate a fifth stage: cultural desire, or the art of caring. Though this new construct of the model has been challenging to operationalize, its development indicates the level of flexibility we will need to work effectively in this area of specialization. We must remain lifelong students and adapt our communication and counseling skills based on increasing scientific evidence and the demands of our customers and patients. Information on the food and health-related practices of the many cultures that we work with is more than simply interesting and nice to know. We need to know and to stay well informed in order to be effective, since this really boils down to a quality of care issue. Additionally, cultural and linguistic competence may become an important regulatory and legal issue in the near future.