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Cultural Competence and Health Education 49

workforce and that is supported by policies, procedures, and delivery systems that
provide services from which the targeted population can receive benefits. It is expected

that the organization can ensure that services are available and accessible, that they are
provided by a diverse health education team, and that the targeted population uses

the services and finds satisfaction in the quality of the service and a racial concordance
with the providers (Betancourt et al., 2003, p. 296). Thus, using Betancourt ’ s frame-
work, cultural competence at the organizational level is measured by the outcomes of
a communication process used by the health professional.
Some of the same sociocultural barriers found at the organizational level may be
present in the structural interventions of this framework. Betancourt addresses socio-
cultural barriers in such areas as oral and written language, comprehension and compli-
ance, and access to health education providers. Cultural competence in using structural
interventions may require an interpreter during appointments to read materials aloud
and to verify instructional communications between provider and client. Awareness and
adoption of healthy behaviors — the ultimate goals in the health education process — are
more likely to result when the target population understands the health education pro-
cess, the messenger, and the message.
Clinical or community barriers in Betancourt ’ s cultural competence framework are
found in the interaction between the provider and the participant or family. Effective
interventions at the clinical or community level depend on the health educator ’ s creation
and capture of opportunities to understand, accept, appreciate, explore, and integrate the
sociocultural differences that exist between the provider and the receiver. Without such
opportunities the health educator – participant relationship may fail to be mutually pro-
ductive. A lack of trust and differences in spiritual values and in health beliefs, practices,
and attitudes are linked to participant dissatisfaction with the health education process,
programs, and providers; failures in compliance; and poor communications, all of which
are deterrents to the adoption of healthy behaviors.
In summary, organizationally, structurally, and clinically, cultural competence entails
a framework that allows an understanding of the importance of social and cultural infl u-
ences on an individual ’ s health beliefs and behaviors and that allows a consideration of
these personal factors at any point of intervention. Succinctly, Betancourt ’ s framework
defines organizational cultural competence as the ability to ensure that the leadership and

workforce of a system is diverse and representative of its target population. Structural cul-
tural competence is the ability of a system to provide full access to quality services and
programs for everyone in the target population. Cultural competence in relation to the
community is the ability of providers to communicate with clients to acquire and integrate
knowledge of their sociocultural factors and to use that knowledge to encourage aware-
ness and adoption of healthy behaviors. In essence Betancourt ’ s concept provides direc-
tion for the implementation of programs, and it offers an expanded view of cultural
competence that is useful to the health professional in the effective delivery of health edu-
cation information, programs, and services to a multicultural population.
For the health educator the challenge is to identify the model, framework, or construct
that best identifies the characteristics most important to the health education process.

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