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Explaining Cultural Competence vs Cultural Awareness

healthcare professional holding hand of patient

Cultural competence is a term that has been in use since the 1980s to describe the ability of professionals to provide effective, high-quality services to people from diverse backgrounds. The term has lasted for good reason. While no term is perfect, cultural competence is broad enough to encompass many new elements, while specific enough to be meaningful. There have been many terms that have been proposed as replacements for cultural competency, in healthcare specifically, but none has taken over as the dominant one, while cultural competency has persisted. Let’s take some time here to discuss why.

First off, it is important to examine the two parts of term cultural competence: “culture” and “competence.” Culture is a very broad term that describes a shared system of beliefs, values, and learned patterns of behavior. We all have various cultural influences based on our ethnicity, nationality, language, gender identity, age, religion, sexual orientation, physical ability, profession, hobbies, etc. Any of these can have myriad influences on healthcare and the interaction between patients and healthcare professionals. 

“Competence” implies that the professional is capable of working effectively with all people taking into account this diverse range of cultural perspectives and including them in the process of care. This requires a great deal of patient-centeredness, and it has been argued that cultural competency is simply a component of patient-centered care, but that’s another discussion altogether. 

When the term cultural competence in healthcare came to the fore, a big reason for its popularity was the idea that it was action-oriented, meaning there was something that we could do. This contrasted with “cultural awareness” or “cultural sensitivity” which were common terms at the time but had a passive connotation and no specific skill set associated with them. Most experts in the field now think of awareness and sensitivity, along with other terms such as “cultural humility” as crucial components of cultural competency. One model helps to put this in perspective by proposing three interrelated domains of cultural competency: 

  1. The affective domain: incorporates fundamental attitudinal aspects such as cultural humility, sensitivity, and openness among others.
  2. The cognitive domain: includes cultural awareness, knowledge, and understanding.
  3. The behavioral domain: the action-oriented arm which involves cross-cultural skills, self-reflection and critique, and the concept of cultural proficiency.

Cultural competence has persisted in part because it is a fluid concept. What it takes to be competent in providing healthcare to a diverse range of patients, changes and broadens as new concepts are introduced. As an example of this fluidity, providing care to patients who identify as gender non-binary is not something that was commonly considered in the 1980s. Now, however, this is considered an important part of cultural competence and the term encompasses these changes. There are clearly cultural factors involved, and healthcare professionals today need to have a level of competence in this that include attitudes, knowledge, and specific skills.

Now that we have a sense of what cultural competence is, we can discuss why the arguments that have been proposed against cultural competence have not succeeded in displacing it. First, the idea that it only involves a specific body of knowledge about cultural groups, or a specific skill set, is misguided. As we have seen, the three domains of cultural competence include these as well as an affective or attitudinal domain. This argument is more of an issue of having a fixed notion of cultural competency that does not grow and change. The same is true for argument that the term “competency” is skills based and does not allow for attitudinal components such as cultural humility. 

More relevant is the argument that cultural competency does not include the broader structural or systemic issues that underly disparities in care particularly for race. It probably is not appropriate to try and fold this into the term cultural competency. It is clearly important and may simply be a separate but interrelated competency. Finally, culture is a broad term, but many would argue that socioeconomic factors do not fall under the term culture. We teach about social determinants of health simultaneously with cultural competency, and while it may not overlap completely, it is practical to fold it in (and sociocultural competency is a mouthful).

In summary, the term cultural competency has stuck for many decades in the healthcare setting because, like language itself, it is fluid, not static. It adapts to meet the needs of our ever-changing healthcare environment and constantly diversifying patients. Each proposed replacement term turns out to be too specific and less dynamic. Rather than getting stuck on terms, we are better off sticking with one and shaping it to meet our needs. 

If you are interested in learning more about cultural competency and cultural awareness, take our ResCUE Model Course for Cross-Cultural Care.