Health and Social Care in the Community

12

(5), 380–381

380

© 2004 Blackwell Publishing Ltd

The need to comply with the Race Relations (Amend-ment) Act 2000 (H. M. Government 2000) has broughtdiversity awareness to the forefront in the managementand delivery of public services in the UK. It is no longerenough to pay lip service to the concept of culturalsensitivity. Those responsible for services must be seento be promoting culturally competent practices throughwhich meaningful and effective care can be provided.The culturally competent practitioner understands thatculture is a way of being in and experiencing the worldthat determines an individual’s view of why a healthor social problem has occurred, how the professionalshould behave, and the treatment or care that shouldfollow. Inherent in this understanding of the nature ofculturally competent practice is the need for profession-als to develop both knowledge and skills as they becomemore attuned to the communities they serve. It is alsoimplicit in this understanding that the service, practitionersand policy makers, should seek to reflect changes inthe communities around them, both in practice and intheir own membership. Thus, competence in this con-text is an evolving state in which the practitioner is con-stantly incorporating new perspectives into an existingknowledge base through the application of reflectiveskills. Culturally competent practice is of particularimportance in community care settings because these pro-vide the first, and in many instances, the only contactthat an individual may have with health and social careservices. The gatekeeper of a service has a particularresponsibility to the rest of their service, including thosein secondary and tertiary care. First-contact providers inany service who do not show respect for the clients’beliefs and values, and who refuse to adapt to meet thechanging needs of the local community are unlikely toestablish a basis for concordance in the planning oftreatment or care, thus reducing its effectiveness.

In compiling this special edition of

Health and SocialCare in the Community

, we set out to address the develop-ment of cultural competence in community settings byexamining a range of issues: practice, policy, prejudice,topics that receive little attention, and the nature ofresearch itself. The papers we present here demonstratethat the provision of culturally competent care is notstraightforward. For example, palliative care is rootedin White, middle-class Christian traditions, but Owens

& Randhawa’s paper (pp. 414–421) raises questionsabout the appropriateness of such care, and demon-strates the amount of thought and concern necessaryto meet patients’ needs. Both thought and concern aredependent on communication, a theme evident in sev-eral papers in this collection. Issues about communica-tion are particularly evident in care situations in whichthe practitioners and clients do not share the samelanguage. So much of the therapeutic relationship isdependent on the ability of these two individuals to talkto one another, and develop a partnership based ontrust to which the practitioner brings expertise, educa-tion, resources and, most importantly, the self as toolsto assist the client (Peplau 1952, Travelbee 1971). Aninability to communicate inevitably detracts from thedevelopment of the therapeutic relationship, but asGerrish

et al

.’s paper (pp. 407–413) shows, the introduc-tion of a third party to interpret can be problematic.Practitioners and interpreters need to understand oneanother’s roles and how best they can work together.Practitioners need to understand that interpreting ismore than substituting one vocabulary for another, andinterpreters need to develop a familiarity with thecontext in which they are working and the aims to beachieved. Both need to find ways of working togetherand with the client (Leather & Wirz 1996).

The lack of a shared language between practitionersand clients undermines the therapeutic relationshipand disenfranchises clients by preventing them fromaccessing the services they need. Gerrish

et al

. (pp. 407–413) argue that the situation is compounded by practi-tioners who control access to interpreting services andwho are reluctant to use them either because they per-ceive those services as being of poor quality, prefer torely on relatives or simply cannot be bothered. Thissituation will only change when clients begin to demandservices as part of their human rights. Bringing aboutsuch a change requires a measure of empowerment.This is a somewhat vague term used by health andsocial care professionals to refer to the enablement ofclients to access and use services, and it may indeeditself be culturally constructed. However, Fazil

et al.

’spaper (pp. 389–397) shows that, in working with clientsexperiencing multiple forms of disadvantage and pov-erty, empowerment must be both culturally competent

Blackwell Publishing, Ltd.

Editorial

Paula McGee

1

& Mark Johnson

2

1

School of Health and Policy Studies, Faculty of Health and Community Care, University of Central England in Birmingham,

Birmingham, UK

2

Mary Seacole Research Centre, De Montfort University, Leicester, UK

Editorial

© 2004 Blackwell Publishing Ltd, Health and Social Care in the Community

12

(5), 380–381

381

and directed towards those factors that will help to alle-viate the most pressing problems, such as negotiatingone’s way through the benefits system.

Facilitating empowerment within the context of cul-tural competence means challenging complacency andfatalism. Several papers in this collection demonstratethat stereotypical beliefs about members of minorityethnic groups persist against a growing evidence-baseof more accurate descriptions. South Asian familiesexperience just as many difficulties in caring for elderlyor disabled relatives as other sections of the populations.Moreover, as Katbamma

et al

. (pp. 398–406) demon-strate, those family members charged with responsibil-ity for care, far from receiving support from relatives,are frequently isolated and left to cope alone. Such evi-dence challenges the prevailing policy of communitycare that is based on a belief in social and kinship networksthat are ready and available to provide help.

In another example of this need to move provisioninto the twenty-first century, Keating & Robertson(pp. 439–447) demonstrate ways in which stereotypicalbeliefs about Black Caribbean and Black African peoplehas led to serious shortcomings in mental health ser-vices. Black people are reluctant to access such services,which they experience as inappropriate to their needsand in which they see practitioners acting as agents ofsocial control. Consequently, they will only seek help intimes of extreme urgency or when forced to do so byother agencies. The degree of prejudice and fear sur-rounding mental health services for Black people is amajor health and social care issue. Separating mythsfrom reality is essential if Black people are to receive thehelp they need, which, as Edge

et al

. (pp. 430–438) sug-gest, may be quite different to the needs of White peo-ple. The diagnosis of postnatal depression among Blackwomen is a neglected area of study. This paper not onlychallenges the stereotypical belief that Black women donot experience this type of depression, but also suggeststhat cultural beliefs and practices may produce a differ-ent type of experience, resulting in a lower rate ofdepressive symptoms. Such findings present a wake-upcall for practitioners to critically evaluate their diagnos-tic tools and reappraise their attitudes.

Other subjects that are also under addressed in theliterature are included in this collection. Attitudes todomestic violence have been extensively examined fromthe perspectives of women victims, but far less attention

has been paid to the views and experiences of its perpe-trators. Lee’s paper (pp. 422–429) provides an unusualopportunity for men’s voices to be heard explainingwhy they beat the women with whom they live. Weacknowledge that some of this material is disturbing,but the paper raises issues with which health and socialcare practitioners must grapple if they are to empowermen to change their behaviour within the contexts ofmale dominated cultures. Hussain

et al

. (pp. 382–388)also call for a change of behaviour among researcherswith regard to the conduct of randomised controlled tri-als. Current thinking about this matter emphasises theneed for samples to be representative of the population,but recruiting members of Black and other minority eth-nic groups into studies requires researchers to confrontthe legacy of oppression. This has caused members ofsome groups to take a negative view of research, equat-ing it with experimentation on human beings. In otherinstances, there is a legacy of bitterness because cooper-ation in study after study has failed to bring aboutpromised improvements. Participative models of inquirythat involve Black people as partners in studies mayhelp to address these legacies and facilitate the creationof more representative sampling.

We offer the papers in this collection as valuablecontributions to the literature on diversity in health andsocial care, insisting that these issues are central to themainstream. There are many challenges ahead for prac-titioners in meeting the needs of clients, but as Notter

et al

. (pp. 448–453) indicate, there is also great commit-ment and imagination, a willingness to try somethingnew that may refresh the whole. We welcome suchcommitment and we hope that this collection ofpapers will be of help to all those who seek to meet thischallenge.

References

H. M. Government (2000)

Race Relations (Amendment) Act 2000(c.34)

. [WWW document.] URL http://www.hmso.gov.uk/acts/acts2000/20000034.htm

Leather C. & Wirz S. (1996)

The Training and Development Needsof Bilingual Support Workers in the NHS in Community Settings

.Centre for International Child Health, London.

Peplau P. (1952)

Interpersonal Relations in Caring

. G. P. Putnam,New York, NY.

Travelbee J. (1971)

Interpersonal Aspects of Nursing

. F. A. Davis,Philadelphia, PA.