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Culturally Responsive Practice

People whose health professionals are culturally responsive are more confident and motivated to access the health services they need.

A person’s cultural background can affect the way they communicate, make decisions and manage their health. As a health professional, you need to understand how culture impacts people’s understanding of health, wellbeing, disease and illness.

Culture can influence:

  • a person and their family or community’s knowledge and beliefs about their health conditions or treatment options
  • how much family and community support they need or have access to
  • their ability and willingness to engage with health professionals, services and treatments
  • their past experiences when attempting to manage their own health.

What is cultural responsiveness?

Cultural responsiveness is a new way of thinking about culture. It means being open to new ideas that may conflict with the ideas, beliefs and values of your own culture, and being able to see these differences as equal. For example, in many cultures spiritual beliefs are an important part of overall wellbeing.

It means being respectful of everyone’s backgrounds, beliefs, values, customs, knowledge, lifestyle and social behaviours. It helps you provide culturally appropriate care and support, so people are empowered to manage their own health.

Cultural responsiveness is important for all social and cultural groups, including:

  • Aboriginal and Torres Strait Islander peoples
  • people from culturally and linguistically diverse backgrounds
  • refugees or displaced migrants
  • people at all life stages, including end of life
  • people with different abilities, including intellectual and cognitive disabilities
  • LGBTIQ people
  • people from priority populations and sub-cultures, such as the deaf and vision-impaired community.

Cultural responsiveness involves continuous learning, self-exploration and reflection. It draws on a number of concepts, including cultural awareness, cultural sensitivity, cultural safety and cultural competence.1

Why is it important?

Evidence shows that when there is a lack of cultural responsiveness, health outcomes are much poorer.2 Improving cultural responsiveness can not only remove barriers to accessing healthcare, but may also reduce inequitable health outcomes for marginalised and vulnerable groups.

In Australia, there is a movement towards cultural support planning in health, social and community services.3 4

This includes:

  • language, such as translating and interpreting services
  • food preferences
  • access to health professionals of the same gender
  • religion and spirituality for palliative care and end of life.

How to be culturally responsive

It is important to remember that becoming culturally responsive is an ongoing reflective practice that will continue for as long as you provide healthcare. Over time, you should aim to develop the following skills and knowledge.

  • An awareness and understanding of different cultures, with the ability to accept differences without judgements about right and wrong.
  • The ability to identify risk factors among specific groups without stereotyping people.5
  • The ability to identify risks contributing to increased vulnerability in specific groups, and take action to improve their healthcare outcomes.5
  • An awareness of your own culture, and understanding your inherent biases towards your own cultural values and behaviours.
  • The ability to work with people from different cultures in a way that is safe and supportive, and is not discriminatory or harmful.
  • The ability to respond appropriately to attitudes, feelings and circumstances of different people.6
  • An understanding of the structures and services that are necessary to deliver cultural support and bring about systemic change.7

Tips for getting started

Considering all aspects of culturally responsive practice can be overwhelming. To get started, choose one and go from there.

Develop awareness of your own culture

As a health professional, you need to feel comfortable working with people who are culturally different to you.8 To do this, it is important to be aware of your own culture and understand how it affects your relationships with people from other cultures.Reflect on your own background, beliefs, values and lifestyle. Consider how they affect your thoughts and perceptions of the world, and make you biased to particular ways of thinking and acting. Remember, the way you see the world is just one way of looking at it. Other views are not wrong, they are just different.

Develop awareness of other cultures

It is important to know the history of your local area and how that has impacted the people who are there now. This includes local Aboriginal people and communities, as well as other cultural groups in the area. Your local health district or council should have this information.Learning about your local area will make you appreciate different cultural perspectives and help you understand the social rules, barriers and issues involved in accessing healthcare. This knowledge will improve your ability to respond in a culturally appropriate way.

Find local cultural support services

Get to know the services available in your local area, so you can understand the kind of services people need and refer people to them. Your local council may have a directory of services for cultural groups in your area and provide you with access to advisory groups and resources such as diversity officers and Aboriginal cultural liaison officers.

Keep learning

Continue to develop your cultural knowledge and understanding by completing cultural awareness and Respecting the Difference training. You should also undertake training that improves your knowledge of traditional owners, local history, and contemporary issues facing the local population.Remember, just because you have a specific set of skills and knowledge does not mean you are qualified to work with all culturally diverse people. There are many different cultures and ways of experiencing them. Cultures also change over time, so it is impossible to know everything about every culture or person.

Develop respectful relationships

To empower people to manage their own health, it is important to develop respectful relationships with individuals, families and communities. This involves developing a deep understanding of the person’s motivations, beliefs, needs and preferences, which leads to better communication and trust.

Develop a cultural support plan

A cultural support plan should include the person’s cultural group, important social rules for that group and any significant events that could impact their ability to manage their own health, such as past or ongoing trauma. This plan can be adapted to the individual’s needs and updated on a regular basis.

The impact of trauma

Trauma is an emotional response to a major catastrophic event and can occur at an individual or community level. Intergenerational trauma is when the effects of trauma are transferred from the first generation of trauma survivors to their children and future generations.9

In Australia, there are many cultural groups who have experienced trauma and intergenerational trauma, particularly Aboriginal and Torres Strait Islander peoples. Trauma impacts their identity and culture, which in turn impacts their confidence and ability to access healthcare and manage their own health.

For Aboriginal and Torres Strait Islander peoples, colonisation and associated traumas have affected their identity and culture over many generations. There are many people who have been disconnected from their own culture and connection to place, including members of the Stolen Generations. This is also seen in people who have come to Australia as refugees after experiencing natural disasters, war, genocide and oppression.

These groups experience high levels of racism, discrimination and marginalisation in Australia. This causes ongoing trauma and influences their ability to engage with their own healthcare, treatments and outcomes. It is important to acknowledge and consider the impact of trauma on healthcare when developing a culturally responsive practice.

How to support people who have experienced trauma

You may need to adapt your programs and services for people who are affected by trauma and intergenerational trauma.

This may involve:

  • understanding trauma and its impact on individuals, families and groups
  • creating environments where people feel physically and emotionally safe
  • employing culturally competent staff and adopting practices that show respect for specific cultural backgrounds
  • helping trauma survivors regain a sense of control over their daily lives and involving them in the healing journey
  • sharing power and governance by involving community members in the design and evaluation of programs
  • integrating and coordinating care to meet the needs of people on a holistic level
  • supporting safe relationship building as a way to promote healing and recovery.10

References

  1. Australian Indigenous Doctors’ Association. Cultural safety for Aboriginal and Torres Strait Islander doctors, medical students and patients (2013). [Position Paper]. Parkes ACT: AIDA; 2013 [updated 2013; cited 2017 Jun 3].
  2. Department of Health (Victoria). Review of Current Cultural and Linguistic Diversity and Cultural Competence Reporting Requirements, Minimum Standards and Benchmarks for Victoria Health Services Project. [Literature Review]. Melbourne: Statewide Quality Branch, DoH; 2009 [updated 2009 Aug; cited 2018 Jan 16].
  3. Department of Communities Disability Services and Seniors, Department of Child Safety Youth and Women. Cultural support plan. Brisbane: Queensland Government; 2017 [updated 2017 Jul 10; cited 2018 Jan 15].
  4. Department of Health & Human Services Victoria. Managing personal, emotional, cultural and spiritual needs in palliative care. Melbourne: DoHHS; 2014 [cited 2017 Oct 20].
  5. NSW Health. Policy Directive: NSW Health policy and implementation plan for healthy, culturally diverse communities 2012-2016. North Sydney: NSW Health; 2012 [updated 2012 Apr 26; cited 2018 Jan 15].
  6. Tucker CM, Marsiske M, Rice KG, et al. Patient-Centered Culturally Sensitive Health Care: Model Testing and Refinement. Health Psychology. 2011;30(3):342-50.
  7. Thomson N. Cultural respect and related concepts: a brief summary of the literature. Australian Indigenous HealthBulletin. 2005;5(4):1-11.
  8. McMillan F. Culturally Responsive Health Care. [Position Paper]. Deakin West, ACT: Indigenous Allied Health Australia; 2013 [updated 2013 Apr 29; cited 2017 Jun 5].
  9. Bombay A, Matheson K, Anisman H. Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada. Journal of Aboriginal Health. 2009;5(3):6.
  10. Atkinson J. Trauma-informed services and trauma-specific care for Indigenous Australian children. [Resource Sheet produced for the Closing the Gap Clearinghouse]. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies; 2013 [updated 2013 Jul; cited 2018 Jan 16].

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