Culture and society Research paper 2022

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CULTURAL COMPETENCE, HUMILITY AND CULTURAL RESPONSIVENESS IN
RELATION TO PUBLIC HEALTH
by
Course
Tutor
University
City and State
Date

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Introduction
The terms cultural competence, cultural humility and cultural responsiveness refer to
various important aspects of culture in public health that makes it possible for people of different
cultures to be able to coexist, understand and appreciate one another, learn from each other,
provide high quality and competent care as well as promote understanding among health workers
and community even in the light of disparities and inequalities (Rogers, Bower, Malla, Manhire,
and Rhodes, 2017). Although the terms may be used interchangeably in different contexts, the
terms differ in terms of definition, perspective and meaning. This paper explores the aspects of
cultural competence, cultural humility and cultural responsiveness and attempts to analyze their
similarities, differences and interconnection in the field of public health.
Cultural competence
Cultural competence refers to the ability of health care institutions to provide quality
healthcare to all people regardless of their values, beliefs, ethnicity or race (Clifford, McCalman,
Bainbridge, and Tsey, 2015). Therefore, in a broader term, cultural competence refers to the
ability of healthcare providers to offer high quality services that meet the cultural, social and
linguistic needs of the patients and the society at large. Cultural competence therefore demands
of all organizations to have a set of values, beliefs and a code of conduct that guides workers in
the provision of culturally competent services. Cultural competence is necessary since there is
cultural diversity in every part of the world. Cultural competence helps to improve quality of
care by improving patient outcomes. This is so because people who feel that their culture is
respected are able to communicate more honestly and freely without bias therefore providing
accurate information that helps to improve the outcomes of care. Cultural competence can

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therefore be said to reduce health disparities and inequalities which increases the quality of care
as well as patient safety and satisfaction.
Cultural competence in the healthcare system can be improved through provision of
interpreter services to accommodate people from different ethnic backgrounds, recruitment and
retention of minority staff, coordination of formal health institutions with traditional care
providers, introduction of culture specific values and attitudes to accommodate people from
different cultures. Inclusion of family and community members in patient’s decision making,
provide easily accessible care in geographically convenient places and provision of training to
both the community and health workers to increase awareness and skills.
Various organizations have also come up with various guidelines that help to promote
cultural competence within the organization. Government, policy makers and relevant
stakeholders have also come up with various policies and laws that help to regulate service
delivery in order to ensure high standards of cultural competence especially for minority and
marginalized groups such as certain indigenous communities. (Hunt, Ramjan, McDonald, Koch,
Baird, and Salamonson, 2015). Cultural competency has also been entrenched in the teaching
curriculum so as to prepare medical students for their future practice in stable and culturally
competent environments.
Some of the guidelines that have been adopted in learning institutions to address cultural
sensitivity and competence include harnessing for a clear understanding of the impacts of social
cultural factors in healthcare, recognition of bias in different cultures, respecting and tolerating
cultural differences, the responsibility to learn and understand cultural perspectives of health and
disease and the responsibility to fight all kinds of cultural based discrimination such as racism
that may occur in the health institutions (Jongen, McCalman, and Bainbridge, 2017). Lastly, the

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government has created several accreditation bodies that focus on regulation of cultural
competence in hospitals as well as medical learning institutions.
In the recent past, cultural competence has been on the increase due to various other
factors such as the realization of human rights of all people, completion among different
organizations and hospitals as cultural competence is a good business practice as well as pressure
mounted by the government and special interest groups (Kohlbry, 2016). Among the major
efforts that have been made by the institutions include provision of bilingual and bicultural
services effectively and training to increase literacy levels. This works to equip workers with the
necessary skills to set ground for a more culturally competitive workplace.
Lastly, it is also worth noting some of the challenges that have cropped up in various
institutions and in the community at large due to lack of cultural competence. According to
Bainbridge, McCalman, Clifford, and Tsey, 2015 various marginalized and minority groups may
suffer from various illnesses and fail to seek medical services if the healthcare providers do not
offer culturally competent care. This may accelerate health risks of the larger community
especially if the diseases are communicable. There is a high likelihood of increase in diagnostic
errors due to communication and language barriers. Patient dissatisfaction and lowering of
quality standards in the hospital also increases due to lack of cultural competence.
Cultural humility
Bennett, and Gates, 2019 states that cultural humility as opposed to cultural competence
is a process of understanding culture through studying one’s own culture in terms of reflection,
inquiry and self-critique. It helps one to be able to understand and tolerate the weakness in other
cultures by reflecting on one’s own culture and understanding weaknesses and bias in one’s own

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culture. Culture has a dynamic nature since it is shaped by cultural influences that change
depending on time and location. Cultural humility is therefore an ongoing process that allows
people to be able to coexist through mutual respect and understanding. The cultural orientation
of people influences their views towards health and illness and it also informs the decisions that
they make regarding health and illness. Cultural humility leans on the background and social
environments and their influence on beliefs and values.
According to Murray-García and Tervalon, 2017, cultural factors that may influence such
decisions include religion, beliefs, norms, customs, educational and economic factors. Cultural
humility therefore helps to build trustworthy relationships among people of different cultures
which helps them to coexist in the same environment by increasing the quality of the interactions
between workers as well as community members.
There are several barriers to cultural humility in many working institutions. Some of
these barriers include; lack of diversification in the workforce which makes people to get so used
to one culture to an extent where they become intolerant of other cultures. Poor leadership that
does not sensitize workers on the essence of cultural humility, poor and ineffective
communication between patients and health workers of different cultural backgrounds,
stereotypes and bias levelled on various cultures, insufficient knowledge on cultural history of
other people and lack of healthy relationships that encourage mutual trust and understanding
(Fisher-Borne, Cain, and Martin, 2015).
In modern healthcare institutions, cultural humility is developed through various ways
such as; cultural immersion programs, reflection on people and profession, cultivating
mindfulness, building healthy relationships, understanding cultural history and breaking down
stereotypes (Foronda, and Baptiste, 2016). Cultural immersion programs are programs that are

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designed to allow medical workers and students to acquire cultural humility through acquisition
of various skills such as self-efficacy and the global view of health and care.
In order to break down stereotypes, there is need to analyze, verify and validate beliefs
regarding other cultures. It is also important to avoid use of stereotypes of classifying individuals
along cultural or ethnic lines. Certain stereotypes observed along cultural lines include
paternalism in male dominated cultures. Health workers who come from male dominated
societies may pay little regard to the views and opinions of women when handling a couple.
There are also stereotypes that are vested on social classes. Many people tend to associate poor
people with negative traits such as illiterate and unhygienic which is rather judgmental and a
barrier to cultural humility.
Understanding cultural history is also one of the ways that may help to increase cultural
humility. Population groups that have had a history of discrimination may tend to develop
negative attitudes towards other people. There may also be various stereotypes about the group.
It is therefore important to understand the history as it helps to differentiate truth from fiction. In
addition, it also helps to appreciate progress as well as pick out individuals who misrepresent
their cultural backgrounds.
Cultural humility requires of individuals to be flexible and humble enough to
accommodate others despite their flaws or weaknesses (Foronda, Baptiste, Pfaff, Velez,
Reinholdt, Sanchez, and Hudson, 2018). To love and treat people right irrespective of who they
are or what they do. In other words, cultural humility requires universal positive regard to all
people in order to be able to associate with them freely and to focus on their strengths and help
them improve on their weaknesses. It is therefore possible to attain cultural humility by

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cultivating health relationships that helps to extinguish stereotypes and eliminate bias imposed
on others.
Cultural responsiveness
Cultural responsiveness refers to the ability to respectfully relate and learn from people
with similar or different cultural backgrounds (Na, Ryder, and Kirmayer, 2016). This is a process
of using culture as a tool of imparting knowledge by empowering people socially, politically,
emotionally and intellectually. Cultural responsiveness can therefore be described as a self-
driven learning process that occurs with the understanding and appreciation of cultural disparities
and continues throughout life as people learn from each other on the basis of cultural interaction.
In health care, cultural responsiveness helps people to assess and improve their behavior due to
the understanding that behavior is reflected and imparted on others too through the process of
cultural responsiveness. In addition, it helps to get rid of judgmental attitudes as well as bias
when addressing cultural issues due to the understanding of cultural relativity which may make
differences even among people of a similar culture.
There is dire need for health workers to cultivate cultural responsiveness as it has several
advantages. For instance, cultural responsiveness is a quick way of learning other cultures that
helps to handle patients well in the field. Learning from a colleague also offers room for clarity
and correction. Cultural responsiveness also encourages team work that in the long run helps to
improve the quality of care. Cultural responsiveness helps to learn from colleagues other factors
that are not necessarily cultural oriented but may help in other areas of practice. Cultural
responsiveness also builds a strong foundation for healthy relationships and good communication
flow among workers.

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According to Seeleman, Essink-Bot, Stronks, and Ingleby, 2015, there are also several
barriers that may hinder cultural responsiveness. Lack of respect among workers makes it hard to
see anything good that is worth learning in a person. Poor and disorganized working
environments that may make people unwilling to share and contribute to the positive
development of each other’s personality. It is also likely to find people who have strong egos and
are unwilling to accommodate others or see things in their perspective. False beliefs, stereotypes
and bias associated with other people mays also hinder learning other cultures.
There are several ways through which cultural responsiveness can be cultivated among
health workers. These include; being open minded and inquisitive, high self-awareness, getting
to know others well, resolving personal conflicts, embracing learning and self-reflection
(Laverty, McDermott, and Calma, 2017). Being open minded refers to not creating assumptions
or self-fulfilling prophesies about others but rather taking time to learn and also inquiring in
order to understand deeper. Self-awareness refers to being conscious of personal values and
beliefs which then helps a person to avoid judging others or making conclusions based on what
one believes is good for them.
Avoiding conflicts and resolving them once they occur is also a way in which one can
cultivate cultural responsiveness. Conflicts can be avoided by being able to control feelings so as
to avoid overreacting or being too defensive, seeking justice from relevant authorities and good
use of verbal and nonverbal communication skills to avoid hurting others. Self-reflection allows
one to think of their actions and analyze them so as to know what errors to avoid and to also
learn from mistakes. Reflection also helps to find ways of moving forward. Lastly, it is essential
to embrace learning. Embracing learning involves having an open mind and a teachable
personality that also embraces correction.

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Analysis of the 3 aspects
It is quite evident from the discussion that the three aspects are intertwined and essential
for the maintenance of high quality standards of care. There are a few similarities and differences
in the nature and how the three aspects can be cultivated, the barriers and the advantages of the
three aspects. Forrest, Lean, and Dunn, 2016 explains that culture plays a very important role in
controlling behavior, beliefs and perceptions about health and illness. The three aspects are
important in addressing cultural diversity and its effect on health care in the society by ensuring
that people respect and appreciate other people’s cultures and beliefs.
One of the major difference between cultural competence, cultural humility and cultural
responsiveness is that cultural competence largely focuses on the provision of quality care as
opposed to the other two which refer to a learning process that is aimed at helping health workers
and the community to coexist, understand, appreciate one another and also learn from each other.
This is evident in the fact that cultural competence is acquired through the modification of the
health care system and not the health workers so as to provide culturally competent health care.
According to Germov, 2014, there is a striking similarity between cultural humility and
cultural responsiveness in the fact that they are both lifelong learning processes unlike cultural
competence whose measures can be completed in a day to make a health institution culturally
competent. Cultural humility and responsiveness focus on the development of personality of
health workers such as nurses in such a way that they are able to work together without
developing cultural shock based on the action of others. Cultural humility and responsiveness
also ensures that health workers are able to share knowledge with each other by the fact that the
two are lifelong learning processes.

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It is quite interesting to note that the three aspects are intertwined and all focus on
improving patient safety and quality of care. While competence focuses on the improvement of
the system, humility and responsiveness focuses on equipping the health workers with the
necessary skills and competencies that are essential in effecting cultural competence (Lupton,
2014). The two allow health workers to learn how to cope with cultural differences and to
provide patient centered care that is essential in improving cultural competence.
Conclusion
Culturally competent care is dependent on cultural competence, humility and
responsiveness. Cultural competence is the ability of health care systems to provide care that
meets the cultural, social and linguistic needs of patients in the society. Cultural humility is the
continuous process of learning culture based on self-reflection, inquiry and self-critique. Cultural
responsiveness refers to the use of culture as a tool of learning and understanding people with
similar or different cultures. The three terms therefore refer to different aspects of culture that
when cultivated together are essential is improving the quality of healthcare, patient safety and
satisfaction.

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