Moving beyond culture competency to cultural humility acknowledges patients’ authority over their own lived experience
Health care delivery often involves a one-size-fits-all approach. As clinicians, we treat a patient with a particular diagnosis similar to the last patient we saw with the same diagnosis because it’s efficient—we think. But shifting that mindset is one of the best opportunities we have to help people truly thrive. An individual’s lived experience is rich, diverse, and complicated. And what it takes for each individual to live his or her healthiest life possible is as unique as each person is. In other words, a patient’s full life experience should inform how we shape their treatment.
To achieve a deeper understanding of our patients, it is essential for providers to practice “cultural humility” and acknowledge the unique elements of every individual’s identity. Many of us may be familiar with cultural competency—being respectful and responsive to the health beliefs and practices—and cultural and linguistic needs—of diverse population groups.
But cultural humility goes even deeper. It requires you to step outside of yourself and be open to other people’s identities, in a way that acknowledges their authority over their own experiences.
My own life experience has influenced my perspective on this. An important part of my identity is rooted in the relationship with my mother, my family, my history, and my experience as a woman of color. I was raised by a single mother, in an area with limited resources. I observed how my mother was treated differently compared to others because of her lighter skin. I witnessed the injustices that many faced based on implicit biases and how that affected not only their health but their ability and willingness to seek care from people who represented systems that oppressed them.
These early experiences have helped me understand just how important it is to look beyond my own frame of reference. When I bring that lens to patient interactions, the experience is better for us both. They feel listened to and understood, and I can shape treatment that fits with their lives.
An important part of my identity is rooted in the relationship with my mother, my family, my history, and my experience as a woman of color.
I work for the Northeast/Caribbean AIDS Education and Training Center at the François-Xavier Bagnoud Center in Newark, N.J. For the women I work with—largely women of color with HIV/AIDS—the disease is just one aspect of their lives. They do not view themselves as solely people with HIV/AIDS. They are mothers, sisters, friends, employees, and neighbors. Some openly discuss their race and ethnicity, and others do not mention those aspects of their identities at all.
By seeking to see someone in the way in which they identify instead of the way we might automatically categorize them, we are able to offer them the care they want and the care they need.
These women have also faced barriers to accessing health care that are rooted not only in their disease but in their lived experience. For example, an infectious disease doctor and nurse practitioner that I worked with shared the case of a patient at the clinic who diligently sought medical case management and care for her HIV. However, the same patient refused care by a physician for her cervical cancer because of earlier traumatic experiences. Unfortunately, this story is not unique. So while clinicians could treat aspects of her HIV, deeper work has to be done to address other elements of her identity to encourage her to get treatment for cancer.
Best Practices for Providers
As a Health Policy Research Scholar, I have been studying how we can provide better care to patients based on their lived experience. Based on my research and experience in the field, I encourage providers in all health-related environments to incorporate some of the following best practices:
- Ask About Identity First
Your patients don’t identify as their disease. Who they are is complex, and how they define themselves will have a big impact on how they receive and respond to their care. If you understand their values, and the various aspects of who they are, you will be able to better understand their barriers and strengths. This includes understanding the people and places in their lives, their passions, their commitments, and their priorities. I start by simply asking them to tell me about themselves. I ask them to tell me about their friends and family, their daily lives. I remind myself that there is likely a piece of them that is key to their life, that I may not even have considered before, and that will be important to incorporate into their care.
- Disease Is Not the Only Issue
In many cases, disease is not the first thing on a patient’s mind. They may be facing barriers to safe and affordable housing, sufficient food, or stable employment that turn into barriers to accessing health care. While you as a clinician may be concerned with how to get them to their appointment, they are preoccupied with how to get their child to school. By fully understanding the complexity of their daily lives, you can support them in other ways that can also positively influence their health. Ask them about their life and work to understand what motivates them to seek care and what barriers they might face. A referral to transportation options or social services might be the key to helping them focus on their health.
- Listen More Than You Speak
While we often view our own roles as helping patients, practicing cultural humility entails working with patients—actually walking alongside them—to achieve their health goals. They will always know more than you do about their needs, and they should have the dominant voice in the conversation.
- Reflect on Your Own Identity
Practicing self-reflection is an essential component of cultural humility. In order to be open to the identities of others, we need to be aware of the perspective that we are applying from our own histories. Be critical. Ask yourself why you make the assumptions you do, or what parts of your own life might inform your understanding of your patient’s. Your identity can also be a bridge to empathy. I use my own experience as a woman of color to better connect with patients, even if I may not share the same experience as a woman with HIV.
Cultural humility isn’t about studying someone to better figure them out. It’s about acknowledging power imbalances, developing partnerships, and practicing self-reflection. When we integrate these concepts in the delivery of care, we lift up the voices of our patients.
We need more practitioners who acknowledge and integrate cultural humility into their daily practice. It’s not an instantaneous process; it’s long and at times tough, acknowledging biases we have within ourselves. You will have good days and bad days. And cultural humility is essential to working with your patients as people, and to improving health and well-being in an equitable and meaningful way.
This article was originally published in Robert Wood Johnson Foundation's Culture of Health Blog. Dr. Jennifer McGee-Avila is now a Cancer Prevention Postdoctoral Fellow at the National Cancer Institute, National Institutes of Health.