Page 134 - Cultural Competence in Health Education

112 Cultural Competence in Health Education and Health Promotion

in African American children (Haight, 1998). (Given the importance of this domain
among racial and ethnic groups, a chapter on spirituality and culture, Chapter Five,
offers in - depth information in this topic.)
The last two cultural domains are also interconnected as they involve people ’ s
perceptions about health care practices and health care practitioners. The health care
practices domain focuses on traditional, magicoreligious, and biomedical beliefs; indi-
vidual responsibility for health; self - medicating; responses to pain; and views toward
such medical issues as mental health and organ donation. For centuries people ’ s health
has been maintained by many different healing and medical practices. (Chapter Four is
dedicated to the cultural practice of complementary and alternative medicine and
holistic health and the impact of this practice on the field of health education.) In

addition it is important to recognize that cultural and religious beliefs infl uence views
on organ donation and blood transfusion. Although some racial and ethnic groups favor
organ donation, others (as well as some religious organizations) are against it because of
fear of medical institutions or a belief that it will result in suffering in an afterlife
( Purnell & Paulanka, 2003). Health practitioners, including health educators, must
explore health care practices and related beliefs among multicultural groups in order to
provide culturally congruent health interventions. Finally, culture also affects people ’ s
perceptions and use of traditional health care practitioners and folk healers, and it
affects views on gender in relation to health care. Cassar (2006) has noted that Muslim
and orthodox Jewish women prefer a health care provider of the same sex during preg-
nancy and delivery. Some groups perceive older male physicians to be more knowl-
edgeable and trustworthy than their younger counterparts; yet others consider folk and
magicoreligious healers to be superior to traditional physicians or nurses (Purnell &
Paulanka, 2003). Public health educators and other health professionals need to under-
stand these perceptions among multicultural groups as they will infl uence people ’ s use
of traditional health prevention services.

A Culturally Competent Model of Care
Campinha - Bacote (1998, 1999, 2001, 2007) has developed a conceptual model of cul-
tural competence that suggests that cultural competence in delivering health care ser-

1
vices is a process. This process comprises fi ve essential constructs: cultural awareness,
cultural knowledge, cultural encounters, cultural skills, and cultural desire.
Cultural awareness is the cognitive process through which the health professional
becomes sensitive to the values, beliefs, and practices of different cultural groups. This
process involves a honest exploration of one ’ s own cultural background and views as
well as a self - examination of one ’ s own biases and prejudices toward other racial and
ethnic groups. Moreover, this is only the fi rst step in the journey toward cultural com-
petence; health educators must go beyond awareness and develop other needed compo-
nents of cultural competence (Campinha - Bacote, 1998, 2007).
As individuals move through the process of acquiring cultural competence, they
must also go through a process of developing cultural knowledge in order to under-
stand different racial and ethnic groups ’ worldviews. This cultural knowledge includes

7/1/08 2:54:01 PM
c06.indd 112 7/1/08 2:54:01 PM
c06.indd 112