**6. Cultural competence**

into account characteristics shared by the subgroup's members" [19]. The concept is based on the assumption that the group has enough characteristics in common to make a single

Cultural tailoring, on the other hand, is any combination of information or change strategies intended to reach **specific individuals** based on characteristics that are unique to them related

Historically, only a few health promotion programs made serious attempts to develop culturally appropriate strategies to meet the needs of target populations. But with increasing evidence that health promotion programs and materials will be more effective when cultural factors are taken into consideration health service managers seem to be gradually changing their approach. Recently, most interventions have been based on assumptions of culture. While this may be an improvement of the past, much more precision in culture interpretation

Questions have been raised as to whether it is logical to expect a consideration of what is common to a group while still laying emphasis on individual peculiarities. In fact, some authorities have referred to the idea as a paradox [4]. In practice, it is probably unnecessary to expect that one will have to choose between cultural tailoring and cultural targeting when designing and delivering a health service. Instead, it is more important to carefully decide to what extent both approaches need to be combined in order to get the most benefit each offers. There will be situations when the health needs within a target population are so similar that identifying subgroups becomes difficult. In such situations, health tailoring loses its necessity,

A basic understanding that must be borne in mind is that while a group may have certain characteristics in common (beliefs, values, attitudes, etc.), individuals within the group have imbibed these ideas to different extents, a few not at all. A typical example is the widespread

Therefore, strategies for achieving cultural appropriateness should match the nature of the problem being addressed. The World Health Organization's Sustainable Development Goal Number 10 which seeks to eliminate health disparities can only be achieved by programs which have been adapted based on cultural considerations. This way they will succeed where

Previous research abounds to prove that minority groups within populations are at a much higher risk of suffering from adverse health conditions such as cardiovascular disease, cancer, etc. While the epidemiology of these conditions indicates that several factors are at play, sociocultural factors have been found to exert a very strong influence on the occurrence of

to the outcome of interest, and have been **derived from an individual assessment.**

**5. Cultural targeting vs. cultural tailoring: striking a balance**

approach effective. In reality, this is not always the case.

and description is required for better outcomes [20].

while targeting becomes the more important approach.

belief in God in African societies.

other programs have failed.

**4.2. Cultural tailoring**

34 Current Issues in Global Health

As the abovementioned evidence accumulated over the years, solutions in the form of "cultural competence" in health care have been prescribed. This refers to a situation where the importance of culture and cultural disparities is taken into consideration and where the design of health programs and services addresses the peculiar cultural needs of a target population. As a result, understanding and addressing the "social context" has emerged as a critical component of cultural competence [26].

A culturally competent healthcare agency, program, or individual provider can function effectively and appropriately in healthcare delivery to culturally diverse individuals. It also involves understanding, appreciation, and respect for cultural differences and similarities within, among, and between culturally diverse populations. To be culturally competent in healthcare delivery, the health professional needs to be sensitive to the differences between groups, to the differences in outward behavior, and also to the attitudes and meanings attached to emotionally related health issues like depression, pain, and disability [29].

The extent to which a society perceives health information or medication as being relevant to them has a profound effect on their reception to and willingness to use them. Even at individual levels, culture-specific values greatly influence perception of sickness and disease, patient roles, expectations, how much information the patient desires, what treatment modalities are acceptable, gender and family roles, and processes of taking decisions concerning health care [26].

It is important to note that no two patients will interpret what good health care is in exactly the same way. This interpretation will be based on personal backgrounds and experiences which have been found to be influenced to a large extent by factors like age, gender, ethnicity, race, religion, and economic status. These factors influence the perception of the individual who receives a health service or product [30]. Therefore, it is important to note that a culturally sensitive healthcare delivery system limits barriers as regards culture and language thus bringing about desirable health outcomes and positive behavioral adjustments.

neighbors or coworkers discovered his secret, he would become a laughing stock of the community. He would lose his respect, people would keep their distance from him, even avoid

Cultural Sensitivities and Health

37

http://dx.doi.org/10.5772/intechopen.79455

He had been referred to an HIV clinic at the big hospital at the center of town. He was not comfortable going there. He would have preferred a place at the outskirts of town or even another town where he was unknown. He cautiously approached the entrance to the clinic which he identified with the large signboard outside it. As he made to enter, he saw his landlord Chief Alfred Nwosu stepping out of the clinic with a polythene bag in his hand, glancing cautiously in either direction as he made to exit the clinic. Audu swiftly changed his direction and hurried away before he was spotted. He walked back to the car park and drove his car

What went wrong? The clinic was located separately from other clinics in the hospital making it easy to identify its clients. In African countries like Nigeria, HIV is still associated with a lot of prejudice against the victim as most people associate it with sexual promiscuity, even blaming patients for their condition. Audu would rather take his chances elsewhere than be

Dr. Sanjay Patel sat down in his consulting room at the large hospital in Calgary, Alberta, where he worked as an Obs/Gyn consultant providing family planning services. His last client for the day was a middle-aged woman of Asian descent. Her file indicated she was 42 years old and that her name was Mrs. Fei hung Zhao. It also indicated a bad obstetric history and the fact that she already had five children. Three minutes into the interaction, it dawned on Dr. Patel that his client's understanding of English was quite poor. Further enquiry revealed that there was no member of staff who could speak any Chinese. He tried to get across to her with some basic words and a lot of sign language. She refused the hormonal contraception (as an injection or IUCD) which was ideal for women of her age but preferred oral pills. He tried his best to instruct her on how to take them and asked her to return in a month with a family

What went wrong? The Mandarin community comprises about 3% of the Canadian population. It is a conservative society and as such Fei hung was not comfortable discussing birth control with a man, especially one of a different race. Not one member of the Chinese community worked in the hospital. The language barrier ensured that she did not understand most of Dr. Patel's attempt to educate her and her rejection of hormonal contraception was because she felt it would make her fat. She misunderstood the directions on how to take her pills and when to return. By the time she got pregnant, she was shocked and disappointed; she really

When there is a failure to properly appreciate, understand, and even explore cultural differences during the patient-provider interaction, clinical barriers to healthcare delivery arise.

member. Fei hung returned 5 months later; she was 3 months pregnant.

him completely.

away hurriedly. He never came back.

felt she had done all the right things.

**7.4. Clinical level**

seen at the clinic, than to be labeled one of "them."

**7.3. Case study 2 (a transgression of the principle)**

Cultural competency is one of the main ingredients in closing existing disparities in access to health care. It is one-way healthcare providers, and their target audiences can always find a common ground as they address health issues. Patients and doctors, population groups, and healthcare organizations can work together to achieve positive health outcomes in such a way that cultural differences become an advantage instead of a weakness. This is possible when the beliefs, practices, and cultural needs of communities are given high priority [31].

Agreement on what terms to use is not universal as words like "cultural responsiveness," "cultural humility," and cultural effectiveness" have been used, each of which has a unique definition. However, a sense of agreement exists based on the fact that each proponent of the above terms has recognized certain aspects of health delivery, especially the patient-provider relationship, as critical part of the concept. What seems to be lacking, however, is the development of a more comprehensive approach to thinking about and implementing cultural competence in health care at multiple levels and from multiple perspectives in order to overcome barriers which exist at organizational and individual levels.
