ERIC EJ853602: Achieving Cultural Competence: The Challenges for Health Educators

8 Pages·2003·0.16 MB·English

by  ERIC

Continuing Education
Achieving Cultural Competence:
The Challenges for Health Educators
Raffy R. Luquis and Miguel A. Pérez
ABSTRACT
The racial and ethnic diversification of the U.S. population presents a clear call for health educators to surmount
the barriers they have encountered in reaching U.S. racial and ethnic groups with culturally appropriate health
promotion and prevention messages. As the population becomes more culturally and ethnically diverse, the
preparation of culturally competent health educators and the development of culturally appropriate health
education and promotion programs become crucial. Health educators must strive to achieve cultural competency by
understanding the meaning of culture and its complexity within each group; increasing cultural awareness,
knowledge, skills, and desire; and applying the National Standards for Culturally and Linguistically Appropriate
Services until they develop discipline-specific standards. This article discusses some of the issues surrounding
cultural competence and provides some strategies by which health educators can become culturally competent.
Data from the U.S. Census Bureau show mated that by 2020 the percentage of White although Hispanics, the fastest growing
that the U.S. population has reached its non-Hispanic population will be reduced group, share many cultural characteristics,
most diverse composition since the nation to 65% of the total U.S. population (U.S. each of the Hispanic subgroups, such as
was born (Figure 1). Census data also show Census Bureau, 2002). The racial and eth- Mexican, Cuban, and Puerto Rican, is
that the largest population increases in the nic diversification of the U.S. population
last decade were among non-White ethnic presents a clear call for health educators to Raffy R. Luquis, M.S., PhD, CHES, ia an
groups and foreign-born populations (U.S. surmount the barriers they have encoun- assistant professor of Health Education, School
Census Bureau, 2000). According to the U.S. tered in reaching U.S. racial and ethnic of Behavior Sciences and Education, Penn State
Census 2000, 25% of the U.S. population groups with culturally appropriate/compe- Harrisburg, 777 West harrisburg Pike,
is comprised of African Americans, Hispan- tent programs. Middletown, PA 17057; Email rluquis@
ics, Asian/Pacific Islanders, Native Ameri- In addition, each one of these racial and psu.edu. Miguel A. Pérez, PhD, CHES, is an
cans and other racial and ethnic groups. ethnic groups is far from homogenous. In- assistant professor of Community Health,
Population projections indicate that the stead, each one represents a rich kaleido- Health Science Department, California State
number of people represented in these ra- scope of cultural diversity, encompassing University, Fresno, 2345 E. San Ramon Ave. M/
cial and ethnic groups will continue to grow people of different ancestry with unique, yet S 30, Fresno, CA 93740; Email mperez@
in the next few decades; in fact, it is esti- common, values and beliefs. For example, csufresno.edu
American Journal of Health Education — May/June 2003, Volume 34, No. 3 131
Raffy R. Luquis and Miguel A. Pérez
become culturally competent.
Figure 1. Changes on Race and Ethnicity on U.S.
Population Between 1990 and 2000
COMPLEXITY OF CULTURE
Contrary to what some people believe,
everyone, regardless of racial/ethnic back-
ground, has a culture to which he or she
identifies. To illustrate this point, one has
only to examine the countless definitions
provided for culture. Spector (1996) defines
it as the “sum of beliefs, practices, habits,
likes, dislikes, norms, customs, rituals, and
so forth that we learn from our families,
during the years of socialization” (p. 68).
Similarly, Airhihenbuwa (1995b) states that
“culture refers to shared values, norms, and
codes that collectively shape a group’s be-
liefs, attitudes, and behaviors through their
interaction in an with their environment”
(p. 317). What these definitions indicate is
that culture defines a person’s self-percep-
culturally and socially distinct from the by a call to health educators to become part- tion in the context of a larger group and
others (Marin & Marin-VanOss, 1991). ners with federal agencies in the develop- influences how he or she behaves through
The professional literature clearly estab- ment and implementation of culturally a lifetime.
lishes the need, opportunity, and methods competent interventions (Denboba, Culture is complex and dynamic
for addressing multicultural issues in Bragdon, Epstein, Garthright, & McCann (Spector, 1996). For the most part the con-
health-related fields including health Goldman, 1998), as well as to become more cept of our culture remains constant; yet
education (Airhihenbuwa, 1995a, 1995b; culturally competent when dealing with our cultural identity can change through
Garcia & Bregoli, 2000; Pinzón & Pérez, diverse groups. This step is a crucial role and time. As individuals interact with people
1997). In addition, numerous articles have responsibility for health educators, because from different racial and ethnic groups, new
been written about multicultural health culturally competent health interventions environments, and new situations, their
education and the methodologies for have been described as an approach to cultural identity is shaped (Bonder, Martin,
dealing with diverse populations (Grassi, achieve the goals of Healthy People 2010 & Miracle, 2001). The resulting cultural
González, Tello, & He, 1999), minority (Denboba et al., 1998; National Center for values and identity influence behavior and
participation in research (Green, Maiskai, Cultural Competence [NCCC], 2002). Spe- health choices made by the individual.
Wang, Britt, & Ebeling, 1997; Spigner, cifically, it has been stated that these types Moreover, culture shapes the way some
1994), and the development of multi- of programs can help achieve the second elements such as gender, class, and sexual
cultural competence (Redican, Stewart, goal of the Healthy People 2010, which seeks identity are viewed. Overall, an individual’s
Johnson, & Frazee, 1994; Stoy, 2000). There- to eliminate health disparities among culture defines how each of these elements
fore, it is imperative that health educators segments of the population (U.S. Depart- (i.e., gender, class, sexual identity) is viewed
become active participants in the develop- ment of Health and Human Services within the context of a particular racial and
ment of discipline-specific guidelines for [DHHS], 2000). ethnic group. For example, among Hispan-
cultural competency. For health educators to be fully involved ics, the male has a defined gender role and
Cultural competency among health in this endeavor and become culturally related behaviors (Marin & VanOss Marin,
educators is a natural evolution from the competent professionals, health educators 1991; Nakamura, 1999), such as being the
cultural sensitivity roles and training advo- must fully understand the relationship be- head of the household and being respon-
cated by the American Association for tween health and culture, the complexity of sible for providing for his family, which
Health Education (AAHE; formerly the As- culture, cultural competence, and the chal- might exert some control over issues of
sociation for the Advancement of Health lenges ahead. The purpose of this article is sexual reproduction and condom use. Simi-
Education) in its Cultural Awareness and to discuss some of the issues surrounding larly, the cultural belief and values of some
Sensitivity: Guidelines for Health Educators cultural competence and to provide some groups have an impact on the ways sexual
(1994). This evolution has been reinforced strategies by which health educators can identity is defined and treated within the
132 American Journal of Health Education — May/June 2003, Volume 34, No. 3
Raffy R. Luquis and Miguel A. Pérez
context of the specific group. pathological agents (cause and effect), cul- The Health and Resources and Service
Finally, research shows that individual ture provides a culturally diagnostic model Administration, Bureau of Health Profes-
ability to function and interact with other by which each individual explains his or sions stated (2002), “No single definition
cultures, and especially a dominant cul- her disease and course of treatment of cultural competence is yet universally
ture, depends to a great extend on the (Nakamura, 1999). For example, some ra- accepted, either in practice or in health pro-
person’s acculturation and assimilation cial and ethnic groups perceive and explain fessions education” (para. 3). As an example,
levels. The terms acculturation and assimi- the cause of illness and disease in terms of they compiled a list of definitions used
lation describe the process by which a per- “soul loss,” “spirit possession” and “spells” by several initiatives and agencies, includ-
son develops a new cultural identity within (Spector, 1996). Similarly, some groups ing those of the President’s Initiative on
the context of his or her survival in a new describe diseases as the consequences of Race and Health and the American Medi-
environment (Huff & Kline, 1999a; Spector, their personal actions, interrelationship cal Association (Table 1). Recently, the
1996). While acculturation describes the with family and community, and super- Report of the 2000 Joint Committee on
degree to which an individual adopts the natural agents (Huff, 1999). Consequently, Health Education and Promotion Terminol-
main culture, assimilation is the process each individual would seek treatment based ogy defined cultural competence as follows:
of integration of a group into mainstream on his or her cultural beliefs. For example,
The ability of an individual to understand
society. Acculturation and assimilation gen- an individual from Mexican culture may be
and respect values, attitudes, beliefs,
erally increase with the length of time the more inclined to visit a curandero; an Afri-
and mores that differ across cultures,
person has resided in the United States and can American may use folk medicine; and
and to consider and respond appropri-
with subsequent generations born in this a Chinese American may follow the ele-
ately to these differences in planning,
country. However, many individuals may ments of the concept of yin and yang to get
implementing, and evaluating health
experience several levels of acculturation relief from a similar illness (Nakamura,
education and promotion programs and
and assimilation. Some individuals may 1999). Thus, health educators must be
interventions (p. 5).
have multiple cultural identities because aware of how culture influences personal
they identify with their traditional race and understanding of health and illness, how Although this definition focuses on the
ethnic group as well as with other groups this affects personal health practices, and individual ability to become culturally com-
they interact. Consequently, our cultural how these views can be incorporated into petent, it fails to address the need for orga-
identity defines how we behave in each situ- health promotion interventions. nizations to also become culturally compe-
ation or environment. tent. Consequently, based on all these
CULTURAL COMPETENCE definitions presented on cultural compe-
HEALTH, DISEASE, AND CULTURE In 1994 AAHE became a leader in rec- tence, we suggest that health education de-
Huff (1999) argued that “the relation- ommending that health educators become fines cultural competence as the capacity of
ship between culture and health beliefs and culturally sensitive. Although the recom- an individual and organization to under-
practices is highly complex, dynamic and mendations released at that time were stand, behave, and respect the value, atti-
interactive” (p. 23). It is not surprising that accurate and serve as the basis for cultur- tudes, and beliefs of different cultural
during the last decade the relationship be- ally sensitivity training, health educators groups and to incorporate these differences
tween culture and health and disease has need to be culturally competent as well. in the development and implementation
been explored. Culture influences the for- Consequently, the preparation of culturally and evaluation of policies and health edu-
mation of people’s perceptions of their competent health educators has been ad- cation and promotion programs.
health, which consequently “becomes the dressed several times by professionals in the Cultural Competence and Health
building blocks in constructing health be- field (Doyle, Liu, & Ancona, 1996; Redican Education Settings
liefs and the actions resulting from those et al., 1994; Stoy, 2000). However, terms Health care organizations, community-
beliefs” (Airhihenbuwa, 1995b, p. 317). such as cultural competence, cultural aware- based organizations, and schools that pro-
Moreover, culture influences individuals’ ness, cultural sensitivity, cultural proficiency, vide health education programs must evalu-
diets and nutritional habits, self-care prac- and intercultural competence have been used ate their ability to serve multicultural
tices, communication and attitudes about interchangeably to describe the process by populations. In an organizational context,
health concerns, differences in symptom which health educators become capable of cultural competence can be defined as a set
recognition, health care seeking behavior, working with different racial and ethnic of values, behaviors, attitudes, practices, and
and psychological stress and racism groups. Thus, for health educators to policies within an organization, program,
(Nakamura, 1999; NCCC, 2002 ). become fully prepared in this area, health or among staff that enables them to work
Although the allopathic medical model educators must clearly understand and effectively with multicultural populations
explains illness and disease in terms of define the concept of cultural competence. (Goode & Sockalingam, 2000). Cultural
American Journal of Health Education — May/June 2003, Volume 34, No. 3 133
Raffy R. Luquis and Miguel A. Pérez
Table 1. Selected Examples of Definitions of Cultural Competence
Organization/Author Definition Key Terms
President’s Initiative on Race and Health Cultural competence is the ability to deliver Understanding, valuing,
effective medical care to people from different incorporating, and
cultures. By understanding, valuing, and examining cultural
incorporating the cultural differences of differences, values and
America’s diverse population and examining beliefs
one’s own health-related values and beliefs,
health providers deliver more effective and
cost-efficient care.
U.S. Department of Health and Human Services Cultural competence comprises behaviors, Behaviors, attitudes, and
attitudes, and policies that can come policies
together on a continuum that will ensure
that a system, agency, program, or individual
can function effectively and appropriately in
diverse cultural interaction and settings.
American Medical Association The knowledge and interpersonal skills that Knowledge and
allow providers to understand, appreciate, interpersonal skills
and work with individuals from cultures other
than their own.
Health Resources and Services Administration, Cultural and linguistic competence is a set of Behaviors, attitudes, and
Bureau of Primary Health Care, Office of Women congruent behaviors, attitudes, and policies policies
and Minority Health that come together in a system, agency, or
among professionals that enables effective
work in cross-cultural situations. “Compe-
tence” implies having the capacity to function
effectively as an individual and an organiza-
tion within the context of the cultural beliefs,
behaviors, and needs presented by consum-
ers and their communities.
Substance Abuse and Mental Health Services Cultural competence includes attaining the Knowledge, skills, and
Administration Center for Mental Health Services knowledge, skills, and attitudes to enable attitudes
administrators and practitioners within a
system of care to provide effective care for
diverse populations, i.e., to work within the
person’s values and reality conditions.
Source: Definitions taken from Health Resources and Service Administration, Bureau of Health Professions, 2002. Definitions of cultural competence.
Retrieved from 7/12/2002 bhpr.hrsa.gov/diversity//cultcomp.htm.
competence can also be defined as “a set 1989, p. 4). for cultural competence requires a compre-
of congruent behaviors, attitudes, and poli- Nevertheless, health educators working hensive and coordinated plan. This plan
cies that come together in a system, agency, in different settings need to realize that the includes interventions at different levels of
or among, professionals that enables this process by which an organization becomes policymaking, infrastructure building, pro-
system, agency, or those professionals culturally competent does not happen over- gram administration and evaluation, the
to work effectively in cross-cultural situa- night. Goode and Sockalingam (2000) state delivery of services and enabling support,
tions” (Cross, Bazron, Dennis, & Isaacs, that at the organizational level the process and the individual. They also add that at the
134 American Journal of Health Education — May/June 2003, Volume 34, No. 3
Raffy R. Luquis and Miguel A. Pérez
individual level within the organization Through cultural knowledge they under- culturally competent.
the person must examine his or her own stand the client’s world view. Cultural en- Understanding and Questioning Culture
attitudes and values and the knowledge and counters provide the health practitioner As previously stated, culture can be
skills needed to become cultural competent with an opportunity to interact with sev- defined in many different ways; however,
(Goode & Sockalingam, 2000). Cultural eral members of a particular group to re- out of all these definitions emerges the
competence includes awareness and accep- fine understanding of that particular group. notion that culture is dynamic, complex,
tance of others’ and one’s own cultural Cultural skill refers to the ability to col- and constantly changing. Culture defines
values, and a commitment to honor and lect culturally relevant data and to use individuals, family, and community, and
respect the beliefs and values of others. culturally specific assessment. Finally, cul- influences how these groups of people
Cultural competence becomes a complex tural desire is the genuine motivation to operate in our society. Consequently, ex-
process rather than an endpoint. Thus, work with people from diverse cultures panding on Freire’s theories, Airhihenbuwa
organizations must create an environment (Campinha-Bacote, 2001, 1999). Health (1995b) encouraged health educators to
that supports an ongoing process of cul- educators can learn from this model, be- engage in raising critical consciousness as a
tural competence. cause it provides another framework to process to understand the issues surround-
Cultural Competence Models define and understand the complexity of ing culture and health education.
Dean (2001) argued that cultural com- cultural competence. Whether health edu- Individuals are products of their culture,
petence is a myth and questioned the no- cators follow this model or another model, which provides the filter by which they
tion that one person could become compe- we must recognize that cultural competence interpret their reality. Along these lines,
tent in the culture of another. She states that is an ongoing complex process. health educators must become aware of
it is impossible to become competent in their own cultural “baggage” (i.e., bias and
something (e.g., culture) that is constantly ACHIEVING CULTURAL COMPETENCE beliefs about individuals’ culture) and ques-
changing. Hence, she “proposes a model in Given the multicultural nature of con- tion how this internal cultural perception
which maintaining an awareness of one’s temporary U.S. society, health educators influence the work they do every day.
lack of competence is the goal rather than must strive to achieve cultural competence In other words, if health educators have
the establishment of competence” (Dean, p. and incorporate this concept into their preconceived notions of people’s behav-
624). Based on this notion, health practi- planning, implementing, and evaluating iors based on these individuals’ cultural
tioners must engage in an ongoing process process of health education and promotion background and let these ideas affect their
in which they seek to understand and learn programs. Health educators can achieve this work, they could not effectively serve the
from clients, because they are the experts by understanding the meaning of culture multicultural population. Thus, health
on their culture. We argue, however, that and its complexity within each racial and educators must continuously question
within their role as resource persons, health ethnic group; increasing cultural awareness, and challenge the issues related to culture
educators need to be culturally competent. knowledge, skills, and desire; using sensi- and how culture influences individuals’
This competency may be expressed in the tivity in communication; and applying the behaviors, as they strive to become bet-
form of conversational language skills, National Standards for Culturally and Lin- ter professionals.
experiences abroad, sensitivity to historical guistically Appropriate Services. It is impor- Increasing Cultural Awareness,
events (e.g., Tuskegee Study), and low lit- tant to clarify that health educators must Knowledge, Skills, and Desire
eracy populations. For example, a health not confuse this notion with the idea that The development of basic cultural
educator would utilize radio messages to health educators must become “experts” awareness and knowledge is essential in the
reach a migrant population rather than about every ethnic and racial group resid- professional preparation of health educa-
printed flyers or postcards. ing in the United States. However, the pro- tors. Today, there is a growing literature on
Campinha-Bacote (1999, 2001) suggests cess of cultural competency does require cultural issues (Airhihenbuwa, 1995a; Huff
that cultural competence is a process and that health educators be cognizant of & Kline, 1999a; Nakamura, 1999; Spector,
proposes a model composed of these five differences, which may affect their ability 1996) and there are professional organiza-
levels as essential constructs of cultural to reach target populations, and be profi- tions whose mission is to promote culture
competence: cultural awareness, cultural cient in utilizing techniques to bridge cul- competence (e.g., NCCC). In addition,
knowledge, cultural encounters, cultural tural divisions. In addition, health educa- there are many opportunities to participate
skills, and cultural desire. Each of these tors must acknowledge their lack of in workshops and conferences dealing with
constructs requires health professionals to knowledge of these issues to understand the culture and health, and most universities
become involved in a process. Through need for preparation in this area. In the fol- offer courses that deal specifically with cul-
cultural awareness individuals become lowing sections the authors suggest strate- tural issues (i.e., culture and education,
sensitive to values, beliefs, and practices. gies by which health educators can become minority health).
American Journal of Health Education — May/June 2003, Volume 34, No. 3 135
Raffy R. Luquis and Miguel A. Pérez
One of the challenges that many health courses evaluated from a health education priate intervention strategies reflect the
educators face is that they do not have easy preparation program, not all the courses cultural values, subjective cultural charac-
access to many of these resources and are dealt appropriately with or focused on teristics, and behavioral preferences and
so overwhelmed by their job responsibili- cultural issues. Therefore, health education expectations of members of the target
ties that it is difficult to engage in a learn- preparation programs must include group. Consequently, there is a need to
ing process without compromising their job multicultural courses that address sensitiv- include a cultural assessment as part of
performance. For example, in a recent con- ity, competencies, and required field any needs assessment conducted with
versation between the first author and a experiences as part of their core require- a multicultural population during the
school health teacher during a discussion ment for the program (Beatty & Doyle, development of health promotion and
at a local workshop, the teacher shared with 2000). In addition, a national assessment of disease prevention programs. Huff and
him her frustration in trying to work with professional preparation programs in cul- Kline (1999b) proposed a cultural assess-
children from diverse cultural backgrounds tural sensitivity and competence in health ment framework with specific guidelines
without the proper training or resources to education is well overdue to ensure that for the identification of major areas (e.g.,
manage her daily tasks (R. Luquis, personal every health educator is receiving the demographics and cultural characteristics,
communication, June 18, 2002). Although knowledge and skills needed to effectively epidemiological factors, health beliefs and
health educators at school settings represent serve a diverse population. practices) that need to be considered when
just a portion of all health educators, one Moreover, a multicultural education assessing individuals and communities
may wonder whether health educators at course should go beyond the concepts of from different ethnic and racial groups.
other settings are lacking the preparation cultural competence and discuss the areas Although health educators have success-
they need in this area and are experiencing of race, gender, class, and sexual orientation fully used traditional planning and imple-
a similar situation. (Abrums & Leppa, 2001), as issues of op- mentation models (i.e., PRECEDE/
Almost a decade ago, Redican et al. pression, racism, and discrimination based PROCEEED), they must integrate those
(1994) found that the state departments of on gender and sexual orientation still exist suggestions that incorporate cultural
education do not actively promote or in our nation. Finally, national organiza- assessment into the development of health
design culturally sensitive material for tions such as AAHE should continue advo- education and promotion interventions.
teachers. Thus, the questions become, has cating for the implementation of policies This action goes directly to the core of the
this situation changed in the last few years? that require every state to provide support responsibilities and competencies for the
Are health teachers getting the resources and training in the area of multicultural health education profession.
and support they need from the school education for school teachers and health Health educators must develop cultural
administration to become culturally com- educators working in other health service desire or motivation to work with people
petent educators? In addition, Redican et al. organizations. For example, many schools from different racial and ethnic back-
found that many of the states expect teach- can easily accomplish this task by offering grounds. Developing this desire can be chal-
ers to receive preparation in cultural train- in-service training in multicultural educa- lenging for some people, as most health
ing from professional preparation pro- tion, with similar content as college courses, educators practicing in the United States are
grams. To exacerbate this problem, most as part of their yearly workshops. In addi- White non-Hispanic and perhaps lack the
professional preparation programs do not tion, books and guidelines such as the Cul- experience of working with diverse groups.
provide adequate training in this area. tural Awareness and Sensitivity: Guidelines Health educators must make an effort to
Redican et al. (1994) reported that institu- for health educators (AAHE, 1994) must be take every opportunity they have to inter-
tions of higher education preparing health updated to reflect the current demograph- act with people from other racial and eth-
educators were not active in offering cul- ics, cultural issues, and the need for cultural nic groups (Stoy, 2000). For example, every
tural sensitivity training as part of the pro- competence in the field of health education. day we are faced with opportunities to in-
fessional preparation. Health educators must also develop cul- teract with students, colleagues, friends,
Doyle et al. (1996) found that although tural skills and culturally appropriate inter- neighbors, clients, and others from differ-
some professional preparation programs ventions when dealing with people from ent cultural backgrounds. The more health
have taken some actions toward the devel- diverse groups. This process requires that educators make the effort to seek out
opment of cultural sensitivity courses, few health educators learn how to conduct a these encounters, the better they will be able
programs address the cultural competen- comprehensive cultural assessment to de- to work within a multicultural society. In
cies needed for health educators to effec- termine the explicit needs and appropriate addition, this effort might provide the
tively serve the diverse population. Beatty interventions for the people being targeted motivation to question their cultural
and Doyle (2000) also found that although (Campinha-Bacote, 2001, 1999). Marin knowledge and to seek ways to improve
multicultural content was included in the (1993) recommended that culturally appro- their cultural competence. Health educators
136 American Journal of Health Education — May/June 2003, Volume 34, No. 3
Raffy R. Luquis and Miguel A. Pérez
who are motivated to work within a appropriate services to people with limited Airhihenbuwa, C. O. (1995a). Health and
multicultural population are not only do- English proficiency. Health educators must culture: Beyond the western paradigm. Thousand
ing a good service to the community they ensure that every health education and pro- Oaks, CA: Sage Publications.
serve, but also to the profession. motion program they implement includes Airhihenbuwa, C. O. (1995b). Culture,
National Standards for Culturally and bilingual/bicultural staff and education health education, and critical consciousness.
Linguistically Appropriate Services materials in every language represented in Journal of Health Education, 26, 317–319.
Health educators can learn from and the target population. These are examples American Association for Health Education
incorporate some of the recommendations of ways the field of health education can (AAHE). (1994). Cultural awareness and sensi-
from federal initiatives in the area of cul- incorporate the CLAS recommendations. In tivity: Guidelines for health educators. Reston,
ture and health. In December 2000 the addition, the CLAS standards could serve VA: Author.
Office of Minority Health (OMH) released as a framework for the development of Beatty, C. F., & Doyle, E. I. (2000).
the Final Standards for Cultural and Lin- culturally and linguistic standards for the Multicultural curriculum evaluation of a pro-
guistic Competency (CLAS) (OMH, 2002). field of health education. fessional preparation program. American Jour-
The purpose of the CLAS is to “respond to nal of Health Studies, 16, 124–132.
the need to ensure that all people entering CONCLUSION Bonder, B., Martin, L., & Miracle, A. (2001).
the health care system receive equitable and The racial and ethnic diversification of Achieving cultural competence: The challenge
effective treatment in a culturally and lin- the U.S. population presents a clear call for for clients and healthcare workers in a
guistically appropriate manner” (para. 1). health educators to conquer the barriers multicultural society. Generations, 25(1), 35–42.
The standards provide a blueprint to fol- they have encountered in reaching cultur- Campinha-Bacote, J. (1999). A model and
low for building culturally competent ally diverse groups in the United States. instrument for addressing cultural competence
health care organizations and workers. The As the population becomes more culturally in health care. Journal of Nursing Education, 38,
CLAS standards are primarily directed at and ethnically diverse, the preparation of 203–209.
health care organizations, but the OMH culturally competent health educators and Campinha-Bacote, J. (2001). A model of
encourages individual providers and other the development of culturally appropriate practice to address cultural competence in re-
health professionals to use the standards to health education and promotion programs habilitation nursing. Rehabilitation Nursing,
make their practices more culturally and become fundamental. This article provides 26(1), 8–12.
linguistically accessible. a discussion of some of the issues surround- Cross, T. L., Bazron, B. J., Dennis, K. W., &
Although not all the standards are ap- ing cultural competence and some strate- Isaacs, M. R. (1989). Towards a culturally com-
propriate for the field of health education, gies by which health educators can be- petent system of health care: A monograph of ef-
several of these can be easily applied to come culturally competent. Cultural com- fective services for minority children who are se-
health education programs in all settings. petence has been identified as a requirement verely emotionally disturbed (vol. 1). Washing-
For example, Standards 2 and 3 call for the to deal with a diverse population. Until the ton, DC: National Technical Assistance Center
implementation of strategies for the recruit- field of health education develops disci- for Children’s Mental Health, Georgetown Uni-
ment and retention of diverse staff repre- pline-specific definition and guidelines for versity Child Development Center.
sentatives of the target population and the cultural competency, reliance on definitions Dean, R. G. (2001). The myth of cross-
ongoing education and training of staff in and models developed to address these cultural competence. Families in Society, 82,
culturally and linguistically appropriate issues within the health care system is our 623–630.
services. Several times at national and local best option to address cultural competency. Denboba, D. L., Bragdon, J. L., Epstein, L.
health conferences health educators and To better serve our profession, clients, G., Garthright, K., & McCann Goldman, T.
others alike have discussed the issue of students, and community, we, as individu- (1998). Reducing health disparities through
recruitment and retention of diverse staff. als and organizations, must strive to achieve cultural competence. Journal of Health Educa-
It is time for the field of health education cultural competency at all levels. Although tion, 29, S47–S53.
to take some actions in promoting health many challenges are still ahead, we must Doyle, E. I., Liu, Y., & Ancona, L. (1996).
education as a viable career for culturally overcome these as we serve a multicul- Cultural competence development in university
diverse students at colleges and high schools tural population. health education courses. Journal of Health
across the country. Similarly, there should Education, 27, 206–213.
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