By Solène DESNOUE & Anatole TÉNARD
Introduction : Whether for economic, social or political reasons, the arrival of families with different cultural backgrounds is now a fact in many countries. This new reality represents a major challenge for health and social service professionals (such as psychologists, nurses, psychiatrists, doctors or social workers). Professionals are confronted with new problems and influencing factors that are different from those they are familiar with. Indeed, when these families come into contact with health, social or education services, they already have some expectations based on what they have already seen or been through. These expectations come from their experience and culture. It is therefore important for professionals to provide care and services that take into account the particular cultural context from which these families come. The cultural impact on ways to express oneself, and on values and family dynamics are also elements to take into account during the intervention of the specialist. In order to best welcome immigrant families into care settings, it would be appropriate to rethink our ways of intervening and to conceive differently our communication with them. The goal is to provide an adequate professional support and meet families’ expectations while respecting our professional and institutional obligations.
The process of cultural competence
Cultural competence is a concept described by Campinha-Bacote (2003). It refers to the continuous process in which the professional struggles to acquire the skills and availability to work effectively within the patient’s cultural context (individual, family, community). It’s the ability to “be in presence” of these families. Cultural competence includes five elements: cultural desire, cultural awareness, cultural knowledge, cultural skills and cultural encounters.
Cultural desire is the motivation of the professional to become competent. It is the desire to learn from other cultures. This motivation would be based on humanistic values. According to this vision, the professional is committed to take care of all persons received in the care service, regardless of their values, beliefs or practices. It’s an openness to differences, flexibility, respect for differences and the desire to learn. This implies the ability to remain humble.
Cultural awareness is the awareness of one’s own prejudices and judgments about people who are different from oneself. It is an ongoing process where the professional is consistently learning about similarities and differences between cultures. For example, the professional may ask the patients questions about their knowledge of the current country’s medical system as well as the one in place in their own country. Cultural awareness is this process of questioning and dialogue between the professional and its patients.Cultural knowledge refers to the process of researching and acquiring information about various cultural groups. For example, knowledge about cultural beliefs and values related to physical and mental health. These informations enable us to better understand the perceptions and behaviors that families may have.
Cultural skills are the ability to collect data about the problem as presented by the person, in addition to performing a culture-based assessment. But we must warn professionals against some beliefs claiming that there is a unique culture for a country, or worse, for a continent. Culture being dynamic, it adapts and changes over the life of an individual, a family, and a group, and over time. It is important to continue the efforts to educate professionals to be more open-minded, to avoid generalizations, and to stay abreast of variations between and within cultures. For example, with families, it is important to remember that each child is unique, as is his or her background. That is why we must adapt more to the specific needs of the child and his or her parents.
Cultural encounters consist of a face-to-face meeting between representatives of a cultural group, for example a family, and the professional. In these multicultural encounters, a particular challenge with respect to interaction and communication is in the hands of an interpreter. The work with an interpreter requires to arrange otherwise the traditional framework of the interviews. First, there is usually a need for longer maintenance times, given translation and more questions. In addition, the presence of the interpreter modifies the contact of the family with the professional. It can indeed be disturbing for parents to have to use a third person to express their questions or communicate some family or personal realities. This may give the impression of being in a situation of dependence, the interpreter playing a central role in the discussion. To this is added the concern of the professional and the parents in the accuracy of the translation and the message transmitted. Indeed, even if some interpreters have professional training, it is often the case that the professional is forced to use members of the ethnic community or even of the family. This can cause a problem of reliance of the translation or confidentiality of the information. There may also be role conflicts when for example the family interpreter also speaks of his situation. This is why the professional must always contact patients directly. In addition, a preliminary meeting with the interpreter can allow a better preparation of the interview.
Conclusion : The Campinha-Bacote model (2003) shows the importance for professionals to address each family and each individual in a unique way. It is important to pay attention to preconceived ideas and the reflex of associating certain behaviors with a particular culture. It would be advisable to favor an individualized approach in which the caregiver’s intervention is based on what the person says. It also means learning to progress according to the rhythm and needs of families.
Words we have learned :
- Cultural backgrounds : Origines culturelles
- Expectations : Attentes
- Ongoing process : Processus continu
- To stay abreast : Se tenir au courant
- The accuracy of the translation : L’exactitude de la traduction
Bibliography :
Robichaud, F. (2010). Les familles et l’immigration : apprécier les différences et faire face aux défis. In C. Lacharité & J.-P. Gagnier (Eds.), Comprendre les familles pour mieux intervenir (pp. 229-251). Montréal : Gaëtan Morin.
Campinha-Bacote, J. (2003). The process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. Cincinnati, Ohio: Transcultural C.A.R.E Associates.