Cultural Competency for Health Science

LibrariansNancy Ottman Press

May 24, 2006

Cultural Competency

A competency based on the premise of respect for individuals and cultural differences, and an implementation of a trust-promoting method of inquiry.

(Durham, M., 2002.)

I Don’t Know

• I don’t know as much about anybody as that person knows about him or herself

• I never will• I don’t know as much about a group of

people different from my own as that group knows

• I never will• I have to believe people when they tell

me about themselves

Without knowing and without judging… can you make a personal connection?

A Collaboration That Worked

•African Americans Reach and Teach Health Ministry (AARTH)

•Mars Hill Graduate School Library (MHGS)

•RML that encourages collaborations between libraries and community-based organizations

AARTH Ministry A faith-based nonprofit established to

help build the capacity of faith houses and institutions that serve people of African descent through:

 • Health education and training• Compassionate service• Access to health resources• Self-advocacy for better health care

systems

Mars Hill Graduate School Library

• Evangelical graduate school that combines faith and health, specializing in counseling and ministry

• 90% of students and 100% faculty are Caucasian

• School hopes to increase its diversity and have greater connection to the Seattle community

• Librarian trying to encourage breadth of thought in graduate students

AARTH Ministry – MHGS Library Collaboration

• Received two NN/LM awards – the first faith-based outreach awards

• AARTH was the primary agency, NOT the library

• Goal: to increase the capacity of African American faith communities to share and provide health information

What Do I Do?

• Ask lots of questions about what information is needed

• Look for culturally relevant health information on the web on topics of interest (AIDS, diabetes, etc.)

• Made up web pages for health topics• Continue to maintain AARTH web site• Help write grant applications

What Do I Do?

• Teach classes with health ministry representatives from churches

• Find answers to specific reference questions

• Sold tickets at a Zimbabwean concert• Attended African American Legislative

Day in the Washington State Capitol

What Did I Do?

• Prayed during the African American Church Week of Prayer for the Healing of AIDS

• Serve on the AARTH Board as secretary

• Do NOT provide direct service to communities

Challenges for Librarian

• I don’t know much about African Americans• There’s a history of Black-White relations • Trust took a long time to build• I wasn’t in control; I was follower, not

leader• My institution was supportive of me, but

uninvolved• I’m not good at picking up verbal and

unspoken clues

Opportunities for Librarian

• Work with groups I never imagined I’d be able to

• Have the opportunity to ask questions—to learn

• Was more widely welcome since the CBOs goals were up front

• Library’s work was spread by others• My institution gained experience and

connections

Shared Concerns and Beliefs

• Concern over health disparities• Belief that information leads to better

choices and can improve health • Concern over the lack of culturally

appropriate health information• Belief that faith communities have a

responsibility for health• Concern that faith communities don’t yet

have enough capacity to provide and share health information

• Belief that prayer isn’t enough; action is necessary

Personal ConnectionI and Thou

• Ask questions—ask for advice• Find something you can offer that will be

personally useful to the other person• Explain what you want; be transparent in

your motives• Discover shared concerns, beliefs, values• Enter the world of the other person• Share experiences• Allow time for trust to develop

Reviewing the Literature

Cultural competency literature

comes mainly from the fields of healthcare, social work, psychology and education, not librarianship.

(Press, N. & Diggs-Hobson, M., 2005)

Developmental Model of Intercultural Sensitivity

• Denial• Defense• Minimization• Acceptance• Adaptation• Integration

(Trader-Leigh, K., 2002)

Denial

•An individual’s own culture is experienced as the only real culture

•Other cultures are avoided •There is no interest in cultural

difference

U.S. Population 1990-2000

• 58% increase - Latino/Hispanic• 50% increase - Asian American/Pacific

Islanders• 16% increase – African Americans• 15.5% increase – American

Indian/Alaska Native• 7.3% increase – CaucasianPeople of color now over 30% of

population

Defense

•An individual’s own culture is the only good one

•World is viewed as “us” and “them”—we are superior

•Critical of other cultures•Defensive, even threatened,

by cultural differences

“Then it’s good that we’re in the old U.S. of A.”

--quote from a Caucasian strategic planning consultant

Minimization

•An individual’s own cultural world is universal

•Deep cultural differences are obscured, trivialized or romanticized

“I don’t think race is all that important. I simply see each person as an individual, not as a member of a racial group.”

--quote from a member of a diversity task force

Acceptance

•An individual’s own culture is experienced as one of many equally complex worldviews

•Acceptance, however, does not mean agreement

•There is a curiosity about and a respect for differences

“I don’t remember seeing discrimination against Koreans in Seattle, but Abbie told me that she has experienced discrimination. I guess I haven’t been aware. I find it so interesting to talk with Abbie about it.”

• --Quote from a library staff member

Adaptation• Experiencing another culture

results in perceptions and behavior appropriate to that culture

• Worldview expands to include other worldviews

• Possible to look at the world through the eyes of others

• Adapts behavior to communicate more effectively

• I look to my church for health information• It’s important for my whole body to be

buried so I can’t donate organs, even after death

• When the pastor is praying, I voice the agreement I feel

• No reporters came to our press conference on health disparities; they just want flashy stories like Black-on-Black violence

• I feel that recent African immigrants to the U.S. look down on me.

• If I participate in a clinical trial, how can I be sure I won’t be treated as a guinea pig?

Integration

•Able to move in and out of different cultural worldviews

•Adapts easily to situations that demand intercultural competence

Librarians are Ready

• We already accept our patron’s needs as important

• We already know how to question to find out more about what someone else needs

• We know we don’t know everything • We have curiosity• We aren’t as threatening as other

professions

The Culturally Competent Librarian

Attitude

A. Is becoming culturally aware and sensitive to his or her own heritage, along with the cultural heritage of others.

B. Can conduct self-assessment and is aware of how his or her own values, biases, attitudes, and beliefs may affect different or minority patrons.

C. Is comfortable with differences that exist between the librarian and patrons.

The Culturally Competent Librarian

D. The culturally competent librarian values:

Individual identity: what makes individual unique.Group identity: reference base that may incorporate family, race, ethnicity, gender, religion, age, etc.Universal identity: common aspects that all share as human beings.

The Culturally Competent Librarian

II. Knowledge

A. Seeks to possess specific knowledge and information about the particular group with which he or she is working.

B. Seeks to understand the sociopolitical system with respect to its treatment of minorities.

The Culturally Competent Librarian

C. Has knowledge and understanding of characteristics of information-seeking and information use.

D. Is aware of institutional barriers that prevent minorities from gaining information.

The Culturally Competent Librarian

III. Skills

A. Generates, sends, and receives a wide variety of verbal and non-verbal responses.

B. Develops and implements institutional strategies in partnership with communities, including: setting goals, assessing need, developing a diverse work force, and evaluating services.

C. Can incorporate his or her values and knowledge in policy making, practice, administration, and service delivery.

The Culturally Competent Librarian

D. Is able to play partner roles:consultant- serving as resource personoutreach- moving out of libraries and into patrons’ communitiesombudsman- accompanying partners and patrons through bureaucratic mazes and proceduresfacilitator of indigenous support systems- structuring activities to supplement, not supplant, existing information-seeking systems.

Practically Speaking…

1. Distinguish between behaviors that are crazy/wrong/rude and those that result from oppression and survival.

2. Don’t personalize suspicions of your motives.

3. Monitor your own reactions and question your own beliefs.

Practically Speaking…

4. Your credentials might not be enough to. Your trustworthiness may be tested. Factors like authenticity, sincerity and openness might be more important than credentials.

5. You might not be the best person to serve the patron. Consider options.

(Sue, D.W. & Sue, D., 2002)

AARTH Board Members

Nancy Ottman Presspressno@speakeasy.net

Cultural Competency Continuum Model

• Cultural Destructiveness• Cultural Incapacity• Cultural Blindness• Cultural Pre-Competence• Basic Cultural Competence• Advanced Cultural Competence

(Taylor, C. ,1994)

Advanced Cultural Competence

• Seek knowledge• Develop skills to interact in diverse

environments (real engagement)• Actively educate less-informed

individuals about cultural differences• Act as change agents• Are comfortable interacting in

multicultural settings• Champion diversity

Cultural Destructiveness

•View culture as a problem •Believe people should be more like the “mainstream.”

Cultural Incapacity

• Lack cultural awareness and skills• Believe in racial superiority of

dominant group, paternalistic to others

• Brought up in a homogenous society and therefore behave in ways that don’t recognize systematic inequities

• Have never questioned inequities

Cultural Blindness

•Believe culture makes no difference

•See others in terms of their own culture

•Claim that all people are alike

Cultural Pre-Competence

•Recognize that there are cultural differences

•Start to educate themselves and others about those differences

•Realize shortcomings in interactions within diverse environments

Basic Cultural Competence

•Accept, appreciate, and accommodate cultural differences

•Value diversity and accept and respect differences

•Understand and manage the dynamics of difference when cultures intersect