Cultural Competence

By Kelsey Hill

Cultural competence refers to a program’s ability to honor and respect those beliefs, interpersonal styles, attitudes and behaviors both of families who are clients and the multicultural staff who are providing services. In doing so, it incorporates these values at the levels of policy, administration and practice (Roberts, 1990). This article includes research from focus group data and cultural competence literature to assess the degree of cultural competency in Kalamazoo healthcare professionals. The author argues that cultural competency is needed in the Kalamazoo community to better suit black mothers and in regards to services and education and improve health outcomes.

“There are a lot of resources in Kalamazoo for pregnant women. I mean, compared to the greater population… I don’t want to imply that this is a hopeless situation. There are a number of programs in place in the community to help women get the stuff they need for the babies, to provide education for them. I honestly could make countless referrals during the pregnancy and it’s still not working.” -Kalamazoo Social Worker

“Resource rich, outcome poor” is a phrase often used to describe the black infant mortality disparity in Kalamazoo, MI. The first time I heard this I was flooded with questions about what this meant; are we really the “land of the promise” where a college degree is guaranteed and adequate healthcare is at our fingertips? It wasn’t until a few weeks ago when my classmate stated her dislike of this phrase that I began to dissect it more thoroughly. She posed the questions, WHAT are these resources, WHO is delivering them, and WHO are they for? It was then that I began to question the link between health care professionals and African American mothers in our community and think about the ways cultural disconnect could be feeding our problem.

Over the last ten weeks, I have had the privilege to take a closer look at the Black Infant Mortality Initiative in Kalamazoo by facilitating and sitting in on focus groups with community residents and healthcare professionals. Through these stories, I have heard various perspectives, opinions, and experiences that speak the realities of how this issue is affecting our community. From what I have observed, the realities of the mothers and community residents closely affected by the loss of black infants does not always correlate with the stories told by healthcare professionals. This creates a dilemma when trying to create solutions and move forward with this initiative. How can we create effective change in our community if we aren’t at a common place of understanding?

From our initial review of the focus group data, we have found the cultural competency of healthcare professionals is a common theme that needs attention in our community. According to Roberts et al. (1990)

cultural competence refers to a program”s ability to honor and respect those beliefs, interpersonal styles, attitudes and behaviors both of families who are clients and the multicultural staff who are providing services. In doing so, it incorporates these values at the levels of policy, administration and practice.

The National Institutes of Health (NIH) (2015) explains that cultural competence is critical to reducing health disparities and improving access to high-quality health care that is respectful and responsive to address every patient”s diverse needs. In Kalamazoo, the role of cultural competence in health care professionals is needed in order to respect and best serve black mothers, increase attendance to doctor’s appointments and adherence to medical treatments and services, and effectively create and implement educational programs.

First, cultural competency of professionals is needed to respect, understand, and properly care for black women and families in Kalamazoo. In our focus groups, many women expressed that they feel they are less cared for than white women in our healthcare community. For example, a community resident stated

They [hospital workers] just send you out the hospital and, and send you on your way—it’s nothing. Only, only help you got is the Y and the sexual assault program…And that’s why us African Americans go other places cuz there’s nothing out here for us. In Kalamazoo, Michigan we don’t have nothing. For us young black mothers who lost kids, we don’t have nothing. They don’t help you get over that. I mean, they, they, they don’t. It, it’s seems like they just don’t care.

In addition, a labor and delivery nurse stated

And I think perhaps culturally, the visits seem so mundane. You come in, you see a practitioner. They don’t do anything to you or for you necessarily so the perception seems to be a lot that well, ‘Why do I have to go do that?’ There’s no understood value.

It is apparent that the health services being provided in our community are not suited for the black mothers who need them. There seems to be a disconnection between who is providing these services and how they are being received. A social worker explained that “…it’s almost like not even in the same mindset as what we might look at things, and so its hard to put on those lenses and look at their experience.” How can we say we are “resource rich” when our community members are saying that the services being provided are not suited for black women and the professionals providing these services cannot understand their patient”s circumstances?

In addition, many of our focus group participants brought up the barrier that exists in creating successful educational programs for black mothers. Our community have expressed that black mothers are more likely to listen to other family and community residents, such as mothers, aunts, and grandmothers, than white healthcare professionals. A Kalamazoo health professional stated

In our community if you take a look at the other programs they don”t really culturally represent the community that they’re trying to serve. Their heart is probably there but it’s not the diversity that is needed in the home visitation group to represent high-risk groups.

A Kalamazoo social worker stated

As a staff, we have primarily white nurses working on the floors giving them the education. With some of my African American families I have pulled in our Safe Kids Coalition employee who is African American. Sometimes I feel like she can get the message through better than I can. But I think sometimes it comes better… the message comes better and I wish we had more African American diversity with our staff but also with the case workers in the community too. That’s kind of an issue we have as a county.

A Kalamazoo labor and delivery nurse stated

Or if I’m telling you how to put your baby back to sleep, and safe sleep, and sleeping this, but your culture and your community is telling you to do it a different way. How do we make those connections so that I’m giving you information that’s useful to you and not just this story that’s up over here.

It is apparent that the services we have in this community are not tailored to the population that is in need of maternal and infant health.

The National Center for Cultural Competence (NCCC) (2004) states that cultural competence requires organizations to:

  • Have a congruent defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally
  • Have the capacity to value diversity, conduct self assessment, manage difference, acquire and institutionalize cultural knowledge, and adapt to diversity and cultural contexts of communities they serve
  • Incorporate the above in all aspects of policy development, administration, practice and service delivery, and systematically involve consumers families and communities

The primary role of cultural competency in regards to infant death is; first, to address the racial, ethnic, linguistic, and cultural diversity within the state and provide risk reduction and bereavement support services, and second, to support the systems-building process and collaboration of professionals and institutions to create a common purpose and set of goals (Frank & Bronheim, 2007). Specifically in the African American population, is it necessary to address knowledge of historical and cultural differences to achieve this in our health care systems today (Eiser, 2007).

In 2004, the NCCC initiated the Cultural Broker Project in order to encourage the use of cultural brokering as an approach to enhancing the delivery of culturally competent care and improve health outcomes. A cultural brokering is defined as bridging, linking, and mediating between groups of different cultural backgrounds that hold a range of roles in the healthcare community. In order to create a culturally competent environment, we need to systematically address the cultural barriers and practices in our professionals. I believe Kalamazoo could benefit from a cultural brokering program in our healthcare community. In addition, I recommend that anti-racism training be implemented in all professional trainings. It is our responsibility to respect our patients, our neighbors, and our community in order to create culturally competent care and tackle the black infant mortality issue in Kalamazoo.