Cultural Competence in Health Care Andrea Moxley, Nidhi Mahendra, and Carmen Vega-Barachowitz, American Speech-Language-Hearing Association Page 3 of 3

• Create a simple 8.5" x 11" laminated communication board with large, clear pictures of things such as water, food, toilet seat, wheelchair, person sleeping, person in pain. This will enable individuals with language barriers, severe aphasia, or tracheotomy tubes to communicate basic needs.
• Develop a directory of interpreters with their contact information, as well as a list of bi/multilingual facility staff that may be able to assist with translation needs.

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Andrea Moxley, is ASHA's project manager in the Office of Multicultural Affairs. Contact her at amoxley@asha.org.
Nidhi Mahendra, is a certified SLP and a postdoctoral fellow in the department of speech and hearing sciences at the University of Arizona. Contact her at nidhi@email.arizona.edu.
Carmen Vega-Barachowitz, a native of Puerto Rico, is director of the speech-language pathology department at Massachusetts General Hospital in Boston. Contact her at cvegabarachowitz@partners.org.

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Definitions

• Culture: The thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
• Cultural and linguistic competence: A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.
• Culturally and linguistically appropriate services: Health care services that are respectful of and responsive to cultural and linguistic needs.
• Interpreter: A person specially trained to translate oral or signed communications from one language to another.
• Translator: A person specially trained to translate written text from one language to another.
• (From National Standards for Culturally and Linguistically Appropriate Services in Health Care. (2001). Washington D.C.: U.S. Department of Health and Human Services, OPHS Office of Minority Health.)

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Strategies for Enhancing Cultural Sensitivity

General Strategies

Professionals can enhance their cultural sensitivity by:

• Becoming aware of differences in cultural attitudes toward health, disability, and illness. These differences affect attitudes toward augmentative and alternative communication devices, surgery, aggressive medication, feeding and tracheotomy tube placement, etc.
• Asking explicit questions and identifying clients' views about their problem, its cause, its appropriate treatment, and their expectations from the treatment process
• Establishing a collaborative relationship with clients' families
• Respecting a family's autonomy in decision-making
• Validating the client's or family's opinions as legitimate views of a situation-this helps to create an atmosphere of trust and mutual respect.

Specific Strategies

• Conduct in-service training using case study approaches to highlight the influence of CL variables on a particular client's functioning. In-service topics should routinely emphasize inter-cultural sensitivity and should be targeted not only to certified nursing assistants but also to other clinical and administrative staff.
• Become aware and make colleagues aware of resources and experts available through ASHA and state associations. ASHA has a registry of speakers and consultants on multicultural issues. Similarly, the California Speech-Language-Hearing Association has an online resource center that provides names and locations of bilingual SLPs.

References and Resources

American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author.

Battle, D. E. (2002). Communication disorders in multicultural populations (3rd ed.). Woburn, MA: Butterworth-Heinemann.

California Speech-Language-Hearing Association. Online Resource Center. www.csha.org/resource.htm.

Chen, G. M., & Starosta, W. J. (1998). Foundations of intercultural communication. Boston: Allyn & Bacon.

Helman, C. G. (2000). Culture, health, and illness (4th ed.). Woburn, MA: Butterworth Heinemann.

Kleinman, A. (1988). The illness narratives. New York: Basic Books.

Smedley, B., Stith, A., & Nelson A. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Report produced for the Institute of Medicine. Washington, DC: National Academy of Sciences.

U.S. Census Bureau. (2000). Language use, English ability and linguistic isolation for the population 5 years and over by state: 2000. www.census.gov/population/cen2000/phc-t20/tab01.pdf.

From the American Speech-Language-Hearing Association. Used with permission. www.asha.org.

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