Page 18 - ASCO Cultural Competency Toolkit

Dimensions of Cultural Understanding:
It is useful to view the dimensions of cultural competence and humility as similar to a nested social- ecological model of concentric circles that are interrelated to understand the dynamic interplay among the various individual interpersonal and structural factors. (Guy-Evans, O., 2020) See Figure 1.
Individual and Interpersonal
Developing cultural competence and humility begins with understanding one’s own intersectional identities, background, and culture and recognizing and understanding how attitudes, beliefs, and biases frame one’s perceptions and interactions with others. Because these attitudes and beliefs may also influence communication, decision making, and clinical management, (APA, 2017) awareness is critical in order to mitigate any negative impact that would result from assumptions or biases. Individuals should strive to learn about the lived experiences and sociocultural dynamics that are relevant to building an effective patient-clinician relationship. Individuals should recognize and be sensitive to differences in communication styles both verbal and non-verbal, any language barriers, literacy, health literacy, and numeracy levels, and should seek to provide resources and communication techniques that are most effective for interpersonal interactions. Additionally, individuals should seek to understand the historical and contemporary effects of power, privilege, and oppression, as each influences health, health care access, and health outcomes in different ways across various communities. (APA, 2017) See the Appendix to view assessments that can be used to guide individual and personal reflection.
Structural and Institutional
Cultural competency and humility move beyond individual and interpersonal actions and are supported by structural and institutional scaffolding that ultimately creates an environment and multipronged approach conducive to high-quality, culturally appropriate health care. These include elements like the provision of resources, such as time for clinician development and training, hiring processes that are accessible and equitable, availability of language interpreters translated materials, etc, that would further support the efforts of individuals to develop and engage in culturally competent care. Institutions should seek to be well informed on the impacts of policies on various populations, by soliciting and considering continuous feedback to intentionally develop and revise policies and procedures to ensure impact matches intent.
Specific actions organizations may take include developing patient surveys and advisory boards to gather feedback about service delivery, conducting practice assessments internally or through external consulting groups, creating committees dedicated to patient experience and diversity and health equity, and creating employee resource groups to offer opportunities for underrepresented groups to voice opinions, provide communal support, and discuss new ideas to bring to leadership team’s (Sharma et al, 2015).
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