Cultural Competence Framework Research Articles

Appreciating dyslexic thinking in qualitative research: reflections and recommendations for culturally competent, neuro-inclusive academia

AbstractDyslexia and its associated learning challenges are often misconstrued as intellectual deficits, leading to erroneous assumptions that individuals with dyslexia cannot thrive or contribute meaningfully to academic institutions. However, this article contends that the unique thinking patterns associated with dyslexia are complementary to and can substantially enrich the professional practice of qualitative research. The social model of disability emphasises how Higher Education Institutions, rooted in ableist and neurotypical norms, often marginalise and fail to accommodate dyslexic cognitive profiles. Conversely, cultural competency, as an actionable conceptual framework, calls for transformative changes that promote understanding, build meaningful relationships, and ensure effective communication with neurodivergent individuals. Drawing on my experience as a dyslexic academic, I examine critical discussions on disability, neurodiversity, higher education, and qualitative research. Adopting an autoethnographic methodological approach, I highlight my professional strengths within this context, and propose an adaptable cultural competency framework aimed at cultivating neuro-inclusive—and specifically dyslexic-friendly practices, at the individual and organisational levels within academia.

Partnering With Immigrant Patients and Families to Move Beyond Cultural Competence: A Role for Clinicians and Health Care Organizations

The delivery of culturally competent health care is recognized as critical to providing quality, equitable care for marginalized groups. This includes immigrant patients and families who experience significant barriers to health care and poor health outcomes. However, operationalization of cultural competence challenges health care delivery. Complementary concepts have also emerged such as cultural humility, cultural safety, and structural competence, recognizing the need for multi-level approaches involving patients, families, clinicians, health care organizations, the larger community, and policymakers. In this review, we define cultural competency and related frameworks and their applicability to immigrant patients and families. The evolution in terminology reflects an increasingly more comprehensive approach to understanding culture as multidimensional and shaped by social and structural factors. We then highlight strategies at each level, focusing on clinicians and organizations to leverage loci of control most directly within clinicians’ reach. Community-level strategies include community engagement (ie, vis-à-vis community health workers or community advisory boards) for clinical and research practice. Organization-level strategies include “immigrant-friendly,” or “immigration-informed” policies aimed at reducing immigration-related stressors, like limiting cooperation with immigration enforcement agencies or developing medical-legal partnerships to assist with patients’ legal needs. Lastly, policy-level strategies seek to change local and federal policies to address needs beyond health care (eg, education, housing, other social services), taking a “Health in All” policies approach that articulates health considerations into policymaking across sectors. Finally, we conclude with suggestions for future directions that center the experiences of immigrants, with the ultimate goal of sustainably meeting the complex needs of immigrant patients and families.

Cultural competence training of dieticians: development and preliminary evaluation.

Training can improve healthcare providers' cultural competence and increase their awareness of bias and discrimination in medical decision-making. Cultural competences training is lacking in the education of dieticians in the Netherlands. The aim of this study was to describe the pilot-implementation of a cultural competence training for dieticians and preliminary evaluation of the training. A training was developed based on Seeleman's cultural competence framework and previously held interviews with migrants, dieticians, and experts. The training consisted of a mixture of didactic and experiential methods, alternating knowledge transfer with exercises to increase awareness, reflection, and feed-back on recorded consultations, and communication training with migrant training actors. The training was piloted in 8 participating dieticians and preliminary mixed-method evaluation was done using a Cultural Competence Questionnaire, Experience Evaluation Questionnaire, and consultation observations. The questionnaires showed that dieticians were positive about the training. They found it valuable and educational. Participants reported an increase in self-perceived cultural competence and attitudes. Knowledge and skills remained approximately the same. The observations showed that dieticians applied the teach-back method and discussed treatment options more often after training. There was no increase in the use of visual materials. The training was well appreciated and, although a small-scale pilot, this mixed-method study suggests an ability to change cultural competence. The combination of a self-assessment instrument and consultation observations to evaluate cultural competence was highly valuable and feasible. These encouraging results justify a broader implementation of the training.

Beyond Colorblindness in Advertising Education: Multiculturalism and Advertising Pedagogy Since the 2020 Racial Reckoning

Following the protests and racial reckoning of 2020, advertisers renewed their focus on the importance of diversity, equity, and inclusion (DEI), as part of their everyday operations. Several recent examples point to brand equity erosion, or escalation of negative consumer responses, resulting from advertisers missing the mark in their efforts to market to these lucrative, diverse markets. In times of heightened sensitivity to DEI efforts, the once accepted, and possibly well-intentioned strategic defense of colorblindness, or “I don’t see color” approach fails to recognize the continuing significance and deepening ramification of social biases. Sue and Sue’s (2016) cultural competence framework in multicultural education may serve as a solution to combat these biases. Recognizing the need for advertising faculty to make direct links among multiculturalism in the classroom, diversity in industry hiring practices, and authenticity in diverse representation within advertising messages, this paper confronts colorblindness and examine specific pedagogical strategies.

Applications of Transformative Justice Principles for Centering Transgender and Gender Expansive Experiences in Social Work Education and Practice

Social work education has traditionally used frameworks, such as cultural competency, to guide implicit and explicit curricula that shape how we think about communities that live and thrive outside of white supremacist and cis/heteronormative norms and values. While the cultural competency framework intends to promote a level of consciousness and attention that is required to practice with diverse individuals, families, and communities whose identities differ from that of the social worker, it instead inadvertently creates a knowledge base that reinforces harmful power dynamics between social worker and client/community. The cultural competency framework is absent of historical and structural context and lacks critical examination of positionality. The use of such frameworks has positioned social work educators and practitioners as the “experts” about culture, thus reinforcing the oppressive dynamic that allows for transgender and gender expansive (TGE) erasure, white supremacy, and transphobia to go unchecked. Without structural knowledge about the ways in which trans- phobic rhetoric and white supremacist ideology, for example, are reflected in policies and practices, social workers may be unable to develop the skills necessary to challenge these forms of injustice and ultimately hold them- selves, their colleagues, policymakers and the profession accountable. We suggest a shift in positioning that encourages and practices accountability rooted in transformative justice (TJ) principles. Drawing on knowledge and practices which emerge from activist spaces, an accountability frame- work is built upon a systemic understanding that requires shifts in belief, thinking, and behavior at the intrapersonal, interpersonal, institutional, and societal levels. This paper will introduce a suggested framework for social work education to engage in accountability rather than competency-based education and practice, and discuss how it may be applied to guide a response to anti-transgender legislation across the U.S.

The influence of cultural competency in accounting

PurposeThis paper aims to highlight the influence of culture in the accounting profession and introduce/advance a framework for cultural competence in the accounting field.Design/methodology/approachThis paper is written for academics and practitioners, focusing on strategies to promote cultural competency in the accounting profession. It includes professional rationales for accounting management and human resources practitioners recognizing the need for and the factors impeding cultural inclusiveness in the accounting profession.FindingsDue to globalization, cross-border business operations are continuously growing. The need to understand and address cultural differences is imperative.Originality/valueThis article offers solutions to equip leaders in support of human capital management with engaging, retaining and diversity and equity competency for current and future employees and the globalization of their customer base. The research offers recommendations for cultural competencies to help strengthen business, and leadership address culture systematically in their highly complex roles.

Cancer clinical trials in the Philippines.

In this Commentary, we discuss disparities in resources for and access to cancer trials from the perspective of the Philippines, a lower-middle-income country in Southeast Asia, where cancer is the fourth leading cause of death. Geographic disparities play out such that academic institutions and clinical trials are centralized in the island of Luzon, particularly in the capital, Manila. These disparities are compounded by the lack of comprehensive cancer patient and clinical trial registries in the Philippines. Additionally, sociocultural considerations influence clinical trial implementation. Providers must consider the role of a patient's family in the decision to participate in clinical trials; a patient's degree of health literacy; and the economic burden of cancer care, with attention to both the direct and indirect financial toxicities associated with cancer care. Our call to action is threefold. (1) Bolster locally led trials and encourage international collaboration to improve diversity in trial participation and trials' generalizability. (2) Strengthen national trial registries to improve awareness of trials for which patients are eligible. (3) Integrate cultural competency frameworks that move beyond parachutism and parasitism in research and instead promote trust, reciprocity, and collaboration. These challenges may yet evolve, but in emphasizing these barriers, we hope to kindle further dialogue, new insights, and innovative action towards solving these disparities in cancer research, not just in the Philippines, but also in other low- and middle-income countries.

Patterns of Social Interaction and Lifeways which Affect Health and Healthcare of Families in Saudi Arabia and the Gulf States

Background: Lifeways of Saudi Arabia and neighboring Gulf States form a unique pattern. A large portion of healthcare providers are foreign nationals. Purpose: The absence of insight into these unique lifeways by healthcare providers may limit their caring activities. Review of related literature has suggested that dissonance between clients and care providers may be a barrier to care. Method: Purnell’s Cultural Competency framework was utilized to focus on communication, family roles and organization, developmental tasks, social status, family dynamics, workforce issues, biocultural ecology, high-risk behavior, physical activity, nutrition, pregnancy, fertility, birth, spirituality, and death from the standpoint of healthcare delivery. Results: Each of the sectors discussed illuminate important ways in which Saudi and Gulf society are similar and different from the body of research related to this area. Conclusion: This inquiry has added perspectives which may be useful for provision of care by healthcare practitioners who are unfamiliar with some of the health related lifeways in Saudi Arabia and Gulf. Keywords: Lifeways; Health; Healthcare; Families; Gulf-States

An Approach to Cultural Competence Education into the Pharmacy Curriculum: Glances from the Cuban Framework

Cultural competence is crucial for improved health outcomes in populations. In addition to knowledge and skills, cultural competence involves a confident attitude that underlines regard across all cultures. The importance of cultural competence training has been considered in several pharmacy education statements as part of the Pharmacists’ Patient Care Process. Nevertheless, there is a significant discrepancy in the implementation of cultural competence in a curriculum. There is no consensus on how this could be implemented from a view of logical and pedagogical coherence. Consequently, a cultural and interdisciplinary approach should be considered in the curriculum design process respecting the laws and pedagogical principles that guide the process of training professionals at the universities and pharmacy schools. The main purpose of the study is to describe a cultural background to implement cultural competence education in the Cuban pharmacy curriculum. The data for this study was collected through an overall literature review. Using terms specific to Cuban health care, culture, and education, combined with terms linked to cultural competence, global health, and pharmacy education. Relevant statements by the Pan American Health (PAHO) and World Health Organizations (WHO) were extracted. Electronic sites for the American Journal of Pharmaceutical Education, Currents in Pharmacy Teaching and Learning, and Pharmacy Education were reviewed. Scopus, Google Scholar, EBSCO Host, International Pharmaceutical Abstracts, and Web of Knowledge databases were examined. The outcomes of this study reveal that Cuba is a culturally rich country with complex and diverse perspectives on health. Cuban culture is the result of extremely broad and tedious transculturation processes; therefore, it is not possible to exhaust the subject in a single inquiry. Health and education in Cuba are politically entwined; statistical data, arguments, and related information are not always available to be studied or compared. This study identifies the need for a sincere effort toward global pharmacy education’s purpose; respect for religious values, traditional beliefs, historic and political factors were also taken into consideration to design a framework for cultural competence with Cuban pharmacy curricula. The repercussions of the current study will be valuable to developing curricular improvement processes aimed at implementing cultural competency in pharmacy education taking into consideration an essentially cultural perspective. Furthermore, this study offers a background to simplify culturally sensitive exchanges among practitioners, undergraduates, stakeholders, and other faculties of pharmacy members from Cuba and other nations when they involve health care and pharmacy practice or education.

‘It absolutely needs to move out of that structure’: Māori with bipolar disorder identify structural barriers and propose solutions to reform the New Zealand mental health system

ABSTRACT Objectives This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Design A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Results Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. Conclusion A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau.

Accrediting Indigenous Australian Content and Cultural Competency Within the Bachelor of Laws

The most recent version of the Council of Australian Law Deans Law School Standards calls for embedding Indigenous cultural competence in Australian law degrees as a matter of best practice. To support this work Universities Australia has produced several reports that establish a best practice framework for Indigenous cultural competence, which is reinforced by the Universities Australia Indigenous Strategy 2017-2020. Universities and law schools have a responsibility to drive this change, to be reflective, and to contribute to an expanding community of practice on Indigenous cultural competence in legal education. This paper explores how Charles Sturt University embedded Indigenous cultural competency across core curriculum content of the Bachelor of Laws. The authors provide a detailed explanation of the course pedagogical mapping and specific subject content that was submitted for institutional accreditation.

Integrating Social Justice Practices into Graduate Training: Collaborating with Stakeholders to Adapt Professional Development in Puerto Rico

Treating trauma has become an international social justice concern, with increasing numbers of graduate training programs prioritizing how to conceptualize needs and interventions within a trauma-informed framework. Minimal research and guidelines exist for adapting these trauma-informed practices for the local community context. Additionally, trauma-informed practices often fail to consider ongoing structural issues faced by oppressed communities such as poverty and racism. Social work, psychology, and counseling graduate training programs often rely on a cultural competency framework instead of a social justice framework that addresses racism and Whiteness. During our graduate Counseling and School Psychology training program at the University of Massachusetts Boston, we collaborated with stakeholders at a school and community center in San Juan, Puerto Rico to culturally adapt and deliver trainings in trauma-informed practices for staff using an ecological validity framework. Using our work in Puerto Rico as a case study, this paper addresses the cultural adaptation of trauma-informed practices and factors to consider when implementing trauma-informed practices, emphasizing the need for creating safety. Strategies for embedding this trauma-informed work into mental health graduate training programs and recommendations for working with individuals from marginalized groups in school settings are discussed.

Compulsively Moral: OCD, Ethics, and the Law.

Compulsively Moral: OCD, Ethics, and the Law.

Culturally competent, safe and equitable clinical care for Ma¯ori with bipolar disorder in New Zealand: The expert critique of Ma¯ori patients and Wha¯nau.

Objective:Research designed to increase knowledge about Māori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Māori patients with bipolar disorder and their whānau regarding the nuances of cultural competence and safety in clinical encounters with the health system.Methods:A qualitative Kaupapa Māori Research methodology was used. A total of 24 semi-structured interviews were completed with Māori patients with bipolar disorder and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data.Results:Three themes were evident from participants’ critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Māori patients and whānau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Māori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whānau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whānau as well as patient wellbeing.Conclusion:The standard of clinical care for Māori with bipolar disorder in New Zealand does not align with practice guidelines, Māori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Māori patient and whānau experiences of care.

A qualitative evaluation of the implementation of a cultural competence project in rural Victoria

ObjectiveTo explore the complex factors influencing the implementation of cultural competency frameworks for Aboriginal and Torres Strait Islander peoples within rural, Victorian, mainstream health and community service organisations. MethodsSemi‐structured telephone interviews were conducted with key individuals from 20 public health and community services in rural Victoria who had participated in the Koolin Balit Aboriginal Health Cultural Competence Project (KB‐AHCC project). Interviews were recorded and transcribed verbatim and a content analysis was undertaken. The findings informed the selection of six case study sites for more in‐depth analysis. Following this, an expert reference group provided feedback on the findings. Findings from the different data were triangulated to identify eight factors. ResultsKey factors acting as barriers and/or enablers to implementing cultural competence frameworks were: comprehensive, structured tools; project workers; communication; organisational responsibility for implementation; prioritising organisational cultural competence resourcing; resistance to focussing on one group of people; and accountability. ConclusionsEmbedding cultural competence frameworks within rural, mainstream health and community services requires sustained government resourcing, prioritisation and formal accountability structures. Implications for public healthFindings will inform and guide the future development, implementation and evaluation of organisational cultural competence projects for rural public health and community services.

Health Disparities, Systemic Racism, and Failures of Cultural Competence

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Instead, it has adopted a culture-based agenda through the framework of cultural competence to address disparities despite a paucity of supporting data. Cultural competence is ethnocentric in orientation and its content sustains biases that are long-standing in health care. Moreover, Cultural competence is based on a number of flawed assumptions and is not structured around a set of clearly stated ethical values. In this paper, we will demonstrate ways in which Cultural competence reflects embedded ethnocentrism, perpetuates entrenched biases, and fails to recognize the depth and breadth of systemic racism as these relate to the stated goal of Cultural competence—the mitigation of health disparities. In addition, we offer a reframed approach to health disparities in medical education.

Exploring Child Life Role and Impact of Providing Psychosocial Care During Short-Term Medical Missions

Certified Child Life Specialists (CCLSs) have been engaged with other health profession-als to provide care within international short-term medical missions (STMMs). However, there is minimal research describing the care they provide, their professional roles, and the impact of their services on the beneficiaries, as well as the volunteer CCLSs. This exploratory, survey-based, descriptive study reports findings regarding roles and experiences of 55 CCLSs who volunteered to provide psychosocial care for children and families on STMMs. They reported providing play, normalization, psychological preparation for medical procedures, and emotional support, resulting in observable reduction in patient and parent anxiety. Nonpharmacological pain management and education for capacity building regarding psychosocial care were not routinely provided. Using Campinha Bacote’s cultural compe-tency framework and Knowles’ adult learning theory, we explored the reciprocal impact for CCLSs volunteering on STMMs. CCLSs reported improvement in their own cultural competency, professional skills, and child life competencies. Findings suggest providing psychosocial care on STMMs benefited patients, families, and the CCLSs. A brief commentary on children’s rights and ethical considerations for those in a child life role on STMMs is included. Practice and research implications are provided to enable greater understanding of the child life role in STMM contexts and to inform prospective CCLS volunteers of this opportunity, as well as to educate STMM organizations about the role of child life.

The Cultural Competence of Educational Leaders: Developing a Conceptual Framework and Assessment Tool for Leadership Development

The purpose of this article was to describe the foundational development of a conceptual framework for cultural competence of educational leaders based on an extensive literature review and to develop the CCEL instrument. Exploratory factor analysis (EFA) procedures were used on the data ( n = 252) to determine the psychometric properties of the CCEL and its validity and reliability. The purposefully selected participants were Master’s degree students in educational leadership programs with University Council for Educational Administration institutional membership. EFA of the data revealed three factors of cultural competence: cultural beliefs and motivation, cultural skills, and cultural knowledge.

The evolution of cultural competence theories in American (United States) nursing curricula: An integrative review.

Baccalaureate nursing students develop cultural competence through curricula of theories and frameworks which evolve to reflect new knowledge, but their synthesis and impact upon health quality outcomes is not known. A cross-platform literature review was conducted to identify innovation and use of cultural competency theories and frameworks in nursing. Optimal literature included a formal theory, pedagogy, measures, and outcomes, which were then classified and evaluated. Additional perspectives and interventions were reviewed for potential influence on curricula and impact through the lens of integrative review. A shift in theory from essentialism to constructivism has occurred in undergraduate curricula. Challenges to measuring outcomes have been noted. All studies reported positive outcomes but suffer from self-selection, unvalidated instruments, and little to no longitudinal data. Nursing students are exposed to culturally competent care via several validated and canonical frameworks, but self-efficacy and long-term impact have not been assessed.

Decolonizing Prisons

Underrepresented communities are overrepresented in correctional systems worldwide. In Hawaiʻi, Native Hawaiians represent a disproportionately high percentage of people in all levels of the criminal justice system. This chronic overrepresentation of Hawaiʻi’s indigenous community embodies systemic inequality, discrimination, racism, and colonialism across multiple institutions and generations. Our paper describes a cultural competence framework developed for the State of Hawaiʻi Department of Public Safety to address this injustice through the integration of cultural and indigenous values, knowledge, and practices to agency structure, processes, programs, and facilities. The project offers diverse, context-specific, decolonizing mechanisms designed to support systemic transformation.