Abstract
This article was migrated. The article was not marked as recommended. In the 21st century, cultural competence training of the clinical workforce has become a key approach in English-speaking countries to improve the health outcomes of its culturally and linguistically diverse (CALD) populations. Health care delivery has rests upon the shifting sands of migration, globalisation, environment, demography, morbidity and mortality. Core cultural competence training approaches from the disciplines of public health, allied health, nursing, medicine, psychology and psychiatry were reviewed. A new cultural competence model was developed due to these models: i) using numerous definitions; ii) describing different segments of the cross-cultural interaction between patients and health professionals; iii) lacking description, content and depth; and iv) conflating culture with race and ethnicity. The innovative Continuum Model advocates a 3-step approach to training the clinical health workforce that can be applied in any health care setting. The dynamics of health and ethnicity in the local CALD context are explored, then the mediating influences within and outside culture are examined, and finally strategies to achieving cultural competencies in the clinic are provided. This practical model, implemented since 2010, ultimately demonstrates on how providing patient-centred, culturally sensitive care at a health service in Queensland, Australia can be achieved in other cultural contexts and settings.
Highlights
In the 21st century, cultural competence training has become a principal means to address health inequalities and improve health outcomes of culturally and linguistically diverse (CALD) populations in English-speaking parts of the world (Like, 2011)
There is consensus regarding the treatment of patients from diverse cultural backgrounds: cultural competence training has been shown to heighten clinicians’ cultural awareness and enable them to translate their knowledge into skills thereby decreasing the risk for disparate care and poor health outcomes (Mostow et al, 2010)
Cultural competence is defined by complexity: it moves seamlessly between different cultures, worldviews and health belief models, and regards each individual patient and health care encounter as a unique opportunity for clinicians to provide patient-centred care
Summary
Indigenous Liaison Officers educate the workforce on Indigenous culture, and work with patients, community local elders and Indigenous health services at the grass roots level (Aboriginal and Torres Strait Islander Health Unit, 2015) Clinicians caring for these patients require additional time to: elicit patients’ expectations and perspectives; complete an examination; give advice on primary health care and behavioural risk factors (e.g. nutrition, alcohol use); confirm patients’ understanding of their condition(s) and health care; address language barriers (e.g. using interpreters and translated health information); establish a rapport; reduce social and cultural distance by building trust and goodwill; coordinate and improve access to care; and encourage greater patient self-efficacy and follow-up visits (Fiscella & Epstein, 2008; Starfield, Gérvas, & Mangin, 2012). Each theme is followed by a ‘flipped classroom’ where content is linked to clinical practice
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