Cultural Competence

Adam GoodpastureMitch Montgomery

Sara NelsonKat McNally

Cultural Competence can be defined as:

• a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations (American Physical Therapy Association)

• The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients (Betancourt, et al)

Cultural Competence in Physical Therapy

• Prepare yourself, and educate your colleagues

• Recognize cultural differences in:• Religion• Dress• Family dynamics• Decision making• Role of children and elders as

helpers/translators/decision-makers• Healthcare expectations

Educating Colleagues

• Cultural competence is a team effort

• Professional responsibilities:• Educating yourself (it’s an ongoing

process!)• Educating others• Sharing information• Asking when you don’t know

Language: The Beginning

• A language barrier does NOT mean:• That either party is less intelligent than the

other• That you cannot provide treatment• That you don’t have options

www.dliflc.edu

Language

• A language barrier DOES mean:• That you, as a professional, can adapt• That treatment may be more difficult, but is

not impossible• That you can consider your options• Learn words in the patient’s language• Refer patient to a therapist that speaks

their native tongue• Refer patient to a facility with a translator

Religion

• Adapting treatment to fit the patient’s beliefs• In some religions, it is considered disrespectful to touch

someone in a particular area or reveal certain parts of your body.

• Must respect the beliefs of your patients/clients, even if they are not similar to your own.

• Understand that some treatments will not be appropriate for certain religions, and will need to be adapted.

• Religious beliefs can influence patient treatment goals.

Dress• Different cultures have different expectations for appropriate

dress.• Some patients/clients will be uncomfortable with revealing

certain parts of their bodies, due to their culture or religion• hijab (headscarf)• skirt (many Christian religions)• Yarmulke (Orthodox Jewish faith)

• Must learn to adapt therapy to maintain patient comfort

Museumofbadideas.blogspot.com

Family Dynamics

• Family hierarchy is different in all cultures.

• Must be willing to respect input from patient’s family

• Primary decision maker may be different• Age or gender may not be a factor

www.londonnfp.com

Decision Making

• Based upon:• Cultural expectations• Religious beliefs• Familial expectations• Non-scientific or spiritual influences

Role of Children and Elders• As translators• As primary decision makers• As mediators • As key players in the treatment process

latinoleadershipcouncil.wordpress.com

Healthcare Expectations• May be different from what you think is “normal”• Are valid even if they differ from the “norm”• Are determined by a conversation• Need to be tailored to the individual

limitstogrowth.org

Socio-economic Status

Standard of living versus

Quality of treatment

Cultural INcompetence

• Failing to be sensitive to differences

• Failing to consider patient’s background

• Treating all patients as similar

• Treating a language barrier as incompetence

Cultural Incompetence: Examples

• Asking a patient to remove an article of clothing that may violate their religious beliefs

• Making a negative comment about culture, religion, language, race, etc.

• Treating a patient as secondary because of a language difference

Non-Discriminatory Practice

• Adaptability• Innovation• Collaboration• Research

francis-moran.com

Identify with the Patient

• Patients should know:• That their treatment is your first priority• That they are involved in the decision making

process• That their values and beliefs are respected• That they can say no if they are uncomfortable

with something for any reason

Identify with the Patient

• Patients should never:• Feel pressured into doing something they are

uncomfortable with• Feel unimportant

• Patients should feel:• Unafraid to ask questions• Unafraid to share fears, feelings, discomfort,

expectations, etc.

How to Improve

Take the ATPA Cultural Competence Self-Test

Experience something outside of your comfort zone

Resources

• http://www.apta.org• Your colleagues

• Community Groups• Local Civic and Advocacy Associations

• Other clinics• Hospitals

• Religious and community leaders

Real Life Example

References• APTA.org. 4/12/2011. American Physical Therapy Association.

6/20/2012. <http://www.apta.org>.• Betancourt, J.R., Green, A.R., and Carrillo, J.E. 2002. Cultural

competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund.