Health educators and cultural competence: implications for the profession

American Journal of Health Studies, Summer-Fall, 2005 by Raffy R. Luquis, Miguel A. Perez

Abstract: The purpose of the study was to assess levels of cultural competency among health educators. Four hundred and fifty-five participants completed the Inventory for Assessing the Process of Cultural Competence-Revised. Results of the study showed that most participants were operating at a level of cultural awareness. Degree in health education, levels of exposure to diverse groups, health education settings, and the number of cultural education programs participants' attended were associated with their level of cultural competence. Findings from this survey support the need for more research in this area to develop discipline-specific guidelines for cultural competency among health educators.

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In 2000, the U.S. population reached its most diverse composition in the last decade. According to the U.S. Census Bureau, non-Hispanic whites experienced a 6% decrease in their share of the population from 75% in 1990 to 69% in 2000 (U.S. Census Bureau, 2000). In addition, population projections suggest that the number of Hispanic, African American, Asian/Pacific Islander, Native American/Alaskan Native and other racial and ethnic groups will continue to grow in the next few decades. In fact, the U.S. Census Bureau (2004) estimates that the White non-Hispanic population will decrease 8% from 69% in the year 2000 to 61% by the year 2020. This racial and ethnic diversification of the U.S. population demonstrates the need to incorporate the concept of cultural competence into every aspect of the planning, implementation, and evaluation process of health education and promotion programs. Further, this diversification demonstrates the need to develop culturally and linguistically appropriate programs designed to train the next generation of health educators (Luquis & Perez, 2003).

Luquis and Perez (2003) propose that the issues surrounding cultural competence and health education present both challenges and opportunities for health educators as they strive to reach the culturally and ethnically diverse U.S. population. Health educators provide services to individuals from diverse cultural, ethnic, and socio-economic backgrounds, and in many cases, they may be the first point of contact within the U.S. health care system. Given their prominent role, it is imperative that health educators possess culturally appropriate skills that will enable them to better interact with their target groups. Hence, the preparation of culturally competent health educators is fundamental to this endeavor. The concept of cultural competence among health educators has evolved from the cultural sensitivity role advocated by the Association for the Advancement of Health Education, currently the American Association for Health Education, (AAHE, 1994) to the current definition by the Joint Terminology Committee (2002). In that report, cultural competence was defined as:

   The ability of an individual to understand
   and respect values, attitudes, beliefs, and
   mores that differ across cultures, and to
   consider and respond appropriately to
   these differences in planning, implementing,
   and evaluating health education and
   promotion programs and interventions
   (pp. 5).

Luquis and Perez further argued that the concept of cultural competence goes beyond an individual's capacity to respect and tolerate values and practices different from their own. Cultural competence also involves organizational practices and policies governing the development, implementation, and evaluation of health education and promotion programs. These recommendations are similar to those contained in the Standards for Cultural Competence for Health Professionals advocated by the Office of Minority Health.

Throughout the last decade, several studies have addressed the areas of culture and health, multicultural issues in health education, and the development of cultural sensitivity and competence among health professionals (Airhihenbuwa, 1995a, 1995b; Garcia & Bregoli, 2000; Pinzon & Perez, 1997; Redican, Stewart, Johnson, & Frazee, 1994; Stoy, 2000). However, few studies have assessed the preparation of health educators in the area of cultural sensitivity and competence. Some studies have focused on the professional preparation of health educators as a way to address cultural sensitivity and competence (Beatty & Doyle, 2000; Doyle, Liu, & Ancona, 1996; Redican et al., 1994). Results of these studies showed that, while many health educators are expected to address the needs of multicultural groups, most professional preparation programs (i.e., college or university) do not provide adequate training in this area. The limited focus of their research, however, fails to provide a complete assessment of cultural competence among health educators. For instance, one might assume that many health educators have obtained mandatory job-related training (i.e., workshops or conferences) in the area of culture and health, multicultural health, and cultural competence in order to address the needs of the diverse populations they serve. In addition, one would presume that professional preparation programs are doing a better job of addressing cultural competence in the preparation of health educators regardless of health education settings. Finally, one might assume that an individual who has earned an advanced degree in health education would possibly attain more training in this area. There is a dearth of investigations that specifically address the degree to which health educators have achieved cultural competence; the levels of cultural competence among health educators; and which variables might have an impact on cultural competency in this group. The purpose of the current study is to assess the levels of cultural competency among professional health educators and to assess the relationship between demographic characteristics, professional experiences, health education settings, cultural diversity training, and the level of cultural competency in this group.