Cultural Competency in Health: A Guide for Policy, Partnerships and Participation

This 85-page resource provides a model to help policy makers and managers with culturally competent policy and planning at all levels of the health system: systemic, organisational, professional and individual. The guide draws together evidence on programmes for increasing cultural competence and research on influences and determinants of healthy living and environments, within culturally and linguistically diverse communities. It provides practical strategies for increasing cultural competency and gives examples of evaluated programmes at the local level that aim to make a difference. In short, the guide advocates that successful health promotion campaigns are those that are culturally sensitive and create long-term partnerships with stakeholders, business and community groups.

Specifically, the guide uses the issue of being overweight/obese to illustrate key principles for building cultural competence in the health system, which are founded on the universal human right to have access to health care that meets one's needs and the reciprocal responsibilities that ensure these rights are upheld:

• Engaging consumers and communities and sustaining reciprocal relationships (reciprocity is here defined as mutual respect and valuing the benefits of diversity, dialogue and shared learning). The idea here is that all health consumers have a right to clear, relevant, accurate messages about their health and healthier living and environments. This process can only be achieved with the close involvement of culturally and linguistically diverse (CALD) background communities, who "share responsibility with the health care sector for accessing consumer views and ensuring messages are culturally relevant and responsive. Approaches that combine community development, capacity building and peer education can help establish reciprocal relationships and strengthen a community's capacity to support its members and liaise with the health sector.
• Using leadership and accountability for sustained change - Central to this principle are charters and frameworks that establish responsibility for cultural competency and set out legislative and ethical obligations for individuals and organisations. Health organisations, policy makers and planners are expected to: seek data; develop infrastructure; set achievable short-, medium- and long-term goals; and use business best-practice tools to achieve sustained cultural responsiveness.
• Building on strengths - know the community, know what works - A population health approach builds this understanding through exchanges of information, sharing of data and interventions based on analysis of diverse community needs.
• Fostering a shared responsibility - creating partnerships and sustainability.

The 4-dimensional model is presented in the form of tables that outline generic competencies in areas such as policy/evaluation, budgeting, management and consumer participation, together with corresponding strategies. Partnership and participation are key threads running through the various components of the model. To cite a few examples:

1. At a systems level, the importance of consumer participation could be expressed by ensuring that CALD background communities are actively and appropriately engaged to participate in designing and implementing interventions (e.g., through involvement of generations and acculturation-influenced perspectives). An illustration would be a government programme that provides financial incentives for community organisations and parent groups to organise community events that promote physical activity and access to affordable fresh fruit and vegetables.
2. At the organisational level in the policy/evaluation realm, culturally competent research on healthier living and environments could be prioritised and generated; then, based on the data that emerged, ethnospecific community groups and local sporting clubs partner to increase healthy lifestyle practices and physical activity for identified age and gender groups.
3. At the professional level, health professionals could seek information on CALD background communities by contacting community health services and multicultural resource centres to access respected community workers/peer educators who have knowledge and expertise in the values and norms of their respective communities in relation to dietary habits, norms, practices, and concepts of activity and leisure.
4. To educate others, a community worker could, at the individual level, translate results from local parent education programmes on healthy eating into press releases and build relationships with ethnic radio stations and ethnic newspapers to disseminate that information, working with interpreters where health professionals don't speak community languages other than English.

The multi-dimensional model is based on the results of qualitative research products commissioned for the project by the NHMRC, which included the analysis of written submissions on the issue and impact of cultural competency, a literature review, and national consultations involving the health, community and ethnic communities sectors. The guide acknowledges diverse views in the landscape of cultural competency, using feedback from the consultation process to highlight current debates in Australia and internationally. Click here to access the separate research and consultation report, "Increasing Cultural Competency for Healthier Living and Environments" [PDF]. In addition, a PowerPoint presentation is provided for the use of interested individuals and organisations in the delivery of workshops and short courses. It may be used to stimulate discussion about the concept of 'cultural competency', and to facilitate awareness of the NHMRC guide. Click here to access it.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.