Core Concepts in Cultural Competence
Quiz Learning Activities Resources Key Concepts Lecture Case/Story Introduction

Key Concepts (printable)

Cultural Competence


Cultural Competence is a set of values, behaviors, attitudes and practices within a system, organization, program or among individuals that enables them to work effectively across cultures. Cultural competence refers to the ability to honor and respect the beliefs, language, interpersonal styles and behaviors or children and families receiving medical care, as well as those of the staff who are providing such care. Cultural competence is a dynamic, ongoing developmental process that requires a long term commitment and is achieved over time.


Examine Cultural Competence in the following examples:

Example 1: Maria Hernandez arrives late for her appointment, and explains that she spent a few hours with her elderly aunt on the way to her appointment. The nurse, Ella, greets Maria warmly and comments on Maria’s devotion to her family. Ella understands that in the Hispanic community, caring for family often comes before an individual need such as an appointment.

Example 2: When Gina, the social worker, enters an examining room she is already alert to the fact that the family she is meeting may have views about healthcare that are different than her own. She inquires about the family’s beliefs, drawing on her knowledge of the culture, but primarily interested in what the family tells her about their unique views.

Example 3: Fred, the pharmacist, becomes frustrated with an Asian family who has been using herbal remedies. With great authority, he tells them that they are “doing the wrong thing.” Fred is not behaving in a culturally competent manner.


When meeting a patient or family for the first time, be aware that their beliefs and practices may differ from your own. Try to learn as much as you can about the family's life and how they view the world.


Culture is defined as the sum of one's beliefs, rituals, customs and practices that guide thinking, decisions and actions in a patterned way. They are learned throughout a lifetime and passed on through generations.


Examine Culture in the following examples:

Example 1: Among some cultures in India, the occasion on which a child first eats solid foods is celebrated with great ceremony.

Example 2: “Family” is defined differently in different cultures: in some cultures, “family” means primarily parents and children. In other cultures, “family includes a large number of relatives, loosely related.

Example 3: Disabilities are viewed differently in different cultures. In some cultures, people with disabilities are hidden, in others they are believed to be endowed with special gifts. In some cultures, people with disabilities are encouraged to become independent and live independently; in others, it is the family’s wish and responsibility to care for the disabled person.


Because of differences between cultures, patients’ behaviors and beliefs may be different from one’s own.

Explanatory Model

The Explanatory Model is the belief system that people from a given culture have about what has caused their illness and what the illness does to them. Patients’ beliefs about what will help cure them depend on their explanatory model.


Examine the Explanatory Model in the following examples:

Example 1: A Romani patient may believe that bad luck, bad behavior or contamination has caused his illness.

Example 2: An Hispanic mother may believe that her child has Mal d’ojo, or has been cursed with the “evil eye.”

Example 3: An Asian patient may believe she is having a difficult birth because of an imbalance between hot and cold in her body. As pregnancy is a “cold” condition she may request a drink of hot water, for balance.


In order to learn about your patients’ explanatory model, you may want to ask something like: “I know different people have very different ways of understanding illness... Please help me understand how you see things."

Health Beliefs

Patients’ beliefs about their health. Health beliefs include cultural beliefs about what causes illness, what will help illness and who is best prepared to help the illness. The “Health Belief Model” as defined by Becker, postulates that patients weigh more general beliefs such as whether or not they really believe they are ill and whether they believe the treatment offered by the physician will offer relief, against potential disadvantages of the treatment.


Examine Health Beliefs in the following examples:

Example 1: A mother’s health belief may involve the idea that a particular amulet will protect her daughter.

Example 2: Some Native American tribes health beliefs include the idea that taking a photograph of a person will rob the person of his or her soul.

Example 3: A mother may believe that her daughter doesn’t have asthma, but just coughs occasionally and that the inhaled steroids are dangerous for her daughter. She may therefore decide that the potential risks of the medication outweigh the benefits.


A patient whose health belief is that his illness is a punishment for past sins may not believe that biomedical care will help him. He may believe that he will only get better when he atones for his sins.

Social Factors

Social Factors refer to environmental factors which affect how the family functions. These include (but are not limited to) financial factors (such as socioeconomic status or type of – or lack of – insurance), logistical factors (such as transportation or juggling many demands), housing, childcare and accessible health care. Social factors sometimes also include family relationships or family dynamics which affect a child or family member. This often, in turn, influences emotional factors.


Some examples of Social Factors are:

Example 1: Some families do not buy medications that they need because they do not have insurance or cannot afford the co-pay.

Example 2: A child may come to clinic dirty, not because the mother doesn't care about cleanliness but because the water has been off and the landlord refuses to return her phone calls.

Example 3: A child's divorced parents may be angry at each other, causing tension in the family and interfering with the consistency of his care as he moves between their homes.


It is always important to learn as much as you can about the social factors that affect a family. This will help you understand the choices they make and the constraints they are under.


The adoption of the behavior patterns of the dominant culture; the process of assimilating new ideas into an existing cognitive structure. Acculturation is the process of acquiring a second culture. Assimilation is the process of replacing one's first culture with a second culture.


Some examples of Acculturation are:

Example 1: A first generation Italian who lives in an Italian enclave in the United States may continue to speak just Italian and to follow the norms and mores of his Italian origins. This person will not have become highly acculturated to American culture.

Example 2: The granddaughter of a Chinese immigrant has gone to American schools and will now attend an American college. She spends time primarily with her American friends, dresses as they do and shares their values and interests. She has become highly acculturated into American culture.


The degree to which a patient holds the health beliefs of his country-of-origin will depend in part on how acculturated he has become to American culture.

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