Page 79 - Cultural Competence in Health Education

Cultural Competence and Health Education 57

Stage Development in Cultural Competence Training
Recognizing that the development of cultural competence is an evolving process over
time, Carney and Kahn (1984) developed a five - stage model to address the acquisition

of the attitudes, sensitivity, knowledge, and skills needed to achieve cultural compe-
tence. The model is general but progressive; it is constructed around the concept that
one ’ s ability to reach the higher stages is influenced by the challenges and resources

in one ’ s work environment. Thus the development of cultural competence is a collab-
orative effort between the health educator and the work environment. If resources such
as appropriate supervision and job - related experiences are available, the health educa-
tor is able to mature from stage one toward the higher stages of development.
In stage one, health educators have limited knowledge, stereotypical attitudes, and
little to no counseling experience. Lacking accurate views of cultures dissimilar
to their own, health educators may construct programs and materials that represent
only their own culture. Thus health educators in stage one need training to build a
knowledge base on culture theory; this base will include direct experiences gained
from internships and volunteer experiences with the dissimilar culture of interest.
Progression from this initial stage involves equipping health educators with a
knowledge of the dissimilar culture and its current lifestyle patterns that assists the edu-
cators in adapting their attitudes in order to build working relationships with individu-
als and groups within the culture. Health educators who progress to stage two become
more aware of their own cultural views, but they are still challenged by stereotypical
and ethnocentric views held by themselves or others. Training in stage two requires a
more structured environment that permits a deeper knowledge of the culture and expo-
sure to experiences that challenge the ability to communicate within the venues of the
culture. Carney and Kahn (1984) suggest that these training needs can be met through
supervision, role modeling, and critical incident experiences that help health educators
to deal more critically in assessing their own attitudes, sensitivities, knowledge, and
skills. Carney and Kahn also suggest that it is an educator ’ s own critical assessment that
really moves him or her to stage three of cultural competence development.
In stage three the health educator may experience a greater sense of personal inad-
equacy for working with culturally dissimilar groups. Carney and Kahn (1984) account
for this effect by pointing out the educator ’ s immaturity in this stage and his or her
focus on self. This observation explains why health educators in this stage can find it a

struggle to move away from doing things the old way to doing things in a new way to
fi t a cultural group to which they are still learning how to relate. The training goal of
stage three is to assist health educators in appreciating and respecting the differences
of others. Supervisory assistance may include experiences that allow health educa-
tors to walk in the shoes of the culturally different group, continuing academic study,
participation in lectures and workshops, and ongoing self - examination of personal
attitudes and sensitivity awareness. The training environment should be supportive
in addressing the challenges of these kinds of experiences and should provide diver-
sity and balance in the cultural groups represented by those providing the academic
study, lectures, workshops, and self - examination experiences.

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