cultural competence research definition

In search of cultural competence

Psychologists still know little about what constitutes good treatment for people of diverse cultures. But researchers are getting closer by taking a variety of scientific approaches, including studying cultural adaptations of proven treatments.

By Tori DeAngelis

March 2015, Vol 46, No. 3

Print version: page 64

10 min read

• Race and Ethnicity
• Psychotherapy

Cultural competence — loosely defined as the ability to understand, appreciate and interact with people from cultures or belief systems different from one's own — has been a key aspect of psychological thinking and practice for some 50 years. It's become such an integral part of the field that it's listed as one of psychology's core competencies. The federal government, too, views it as an important means of helping to eliminate racial, ethnic and socioeconomic disparities in health and mental health care.

But defining, understanding and applying cultural competence in treatment hasn't been easy. For one thing, researchers are still arguing over the basic ingredients of cultural competence and culturally competent care. What makes a particular therapist, practice, or protocol, culturally competent? While there is plenty of speculation on the topic, answers to these questions are a long way from being settled.

What's more, funding for this kind of research has generally been scant (see " Institute focuses on patients, including their ethnicity "). The National Institutes of Health tends to require a biomedical aspect in most mental health research, including that involving cultural competence. And the one NIH institute dedicated to ethnic-minority health issues, the National Institute of Minority Health and Health Disparities, is one of the lowest funded NIH agencies and tends to put more money into training than research, field leaders say.

In addition, the area has been fraught with disagreement and controversy. Some researchers think interventions should be more radical than they are, while critics assert such interventions are merely another form of "political correctness."

As a result of these complexities, the science of culturally competent treatment has tended to receive short shrift, many say. But thanks to a range of research efforts, that has been changing, according to an expert in the area, Utah State University psychology professor Melanie Domenech Rodriguez, PhD.

"Psychologists of my generation, in collaboration with those of previous generations, are working to put the science more squarely into cultural competence and culturally competent treatment," she says.

Cultural adaptations

This thrust to improve the scientific aspect of culturally competent treatment research means that a central research focus has been a pragmatic one: modifying evidence-based treatments for different groups, otherwise known as "cultural adaptations." The tack follows a long period of treatment and research experimentation beginning in the 1960s that included, among other approaches, involving community members integrally in treatment design and intervention.

While cultural adaptation research doesn't take such a complete grassroots approach, it has the distinct advantage of appealing more to funders. Because it starts with a scientifically validated treatment and adds components to or tweaks it, this kind of research is easier to manage from a research perspective than, say, creating a treatment from scratch.

"If the wheel works relatively well, I'd like to use it," says University of Puerto Rico psychologist Guillermo Bernal, PhD, who with Domenech Rodriguez co-edited the 2012 APA book "Cultural Adaptations: Tools for Evidence-Based Practice with Diverse Populations."

Bernal helped to launch this kind of research in the 1990s when he realized he was informally adapting evidence-based treatments to his clients anyway.

"We very consciously began looking at the protocols of those treatments and deconstructing them in terms of cultural metaphors and assumptions and language," he says.

In the first study utilizing this framework, University of Puerto Rico psychologist Jeannette Rosello, PhD, and Bernal compared how Puerto Rican teenagers with depression responded to culturally adapted versions of cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), compared with peers on a wait list. Both adapted treatments were effective and both were superior to control group outcomes, they found ( Journal of Consulting and Clinical Psychology , 1999).

In a 2008 study published in Cultural Diversity and Ethnic Minority Psychology , Rosello, Bernal and Carmen Rivera-Medina, PhD, compared adapted group and individual versions of cognitive behavioral therapy and interpersonal theory, again with depressed Puerto Rican teens. All were effective, but both group and individual CBT worked faster than either form of IPT, the team found. (These adaptations are all now part of the Substance Abuse and Mental Health Service Administration's Registry of Evidence-Based Therapies, available to the public .)

Other studies have shown similar successes. In a 2014 issue of the Journal of Latina/o Psychology , Marquette University psychology professor Robert A. Fox, PhD, and colleagues looked at the effects of providing a culturally adapted version of their evidence-based parenting intervention Early Pathways to at-risk Latino children. The kids improved significantly on behavioral and emotional measures compared with those on a waiting list, the team found.

Meanwhile, University of California, Los Angeles, associate professor Anna Lau, PhD, and colleagues successfully adapted an evidence-based intervention called The Incredible Years to Chinese-American parents. The adaptation incorporated earlier findings about the kinds of situations most likely to spur punitive parenting practices among Chinese-American parents, such as distress over their children's academic performance or expressed desire for more autonomy. The researchers found the adaptation fostered more positive and fewer negative parenting practices and reduced kids' acting out and depression ( Journal of Clinical Psychology , 2010).

How do they look overall?

In general, meta-analyses confirm the effectiveness of such adaptations.

One, reported by Timothy B. Smith, PhD, Domenech Rodriguez and Bernal in a 2011 article in the Journal of Clinical Psychology , looked at 65 experimental and quasi-experimental studies that included some form of adapted treatment. Adaptations for ethnic-minority clients were moderately more effective than treatment as usual with the same clients, and treatments with many versus few cultural adaptations were particularly effective, they found. In addition, services targeted to one specific group, say, Bhutanese immigrants, were several times more effective than treatments provided to clients from a variety of cultural backgrounds.

Another meta-analysis, reported in the Journal of Counseling Psychology by University of Wisconsin–Madison psychologists Steven G. Benish, PhD, Stephen Quintana, PhD, and Bruce E. Wampold, PhD, analyzed 21 studies comparing psychotherapy interventions that were either culturally adapted or not. The adapted versions had better outcomes, they found.

The team also examined factors that might explain the effectiveness of the evidence-based adapted therapies. Only treatments that explicitly addressed a client's own cultural views of his or her illness had better outcomes than non-adapted treatments. Other variables — such as treatment modality, the ethnic match of therapist and client, and the severity of the disorder — made little difference.

A third meta-analysis reported in the Annual Review of Clinical Psychology in 2014 reached a more reserved conclusion. In a summary of 10 recent meta-analyses — including those of Smith and Benish — Stanley J. Huey Jr., PhD, of the University of Southern California, and colleagues, found that non-adapted psychotherapy was generally effective with ethnic-minority clients — a finding that in part counters criticisms that individual Western-style therapy may not be the best choice for many ethnic-minority people.

That finding held up across cultural groups and mental health problems. Less clear, though, was whether adding culturally tailored strategies provided extra value. Sometimes these additions had a positive effect, but other times their effects were neutral or negative.

A work in progress

Mixed findings like these underscore the fact that the field still has plenty of room to grow. To this end, researchers are exploring areas they think are important to help advance science and practice in cultural competence, both related and unrelated to cultural adaptations.

For example, researchers are developing frameworks to guide the adaptation of evidence-based treatments. Wei-Chin Hwang, PhD, a clinical psychologist at Claremont McKenna College, lays out principles for doing this in ways intended to help researchers create good study designs and best incorporate community input — known as "top down" and "bottom up" approaches, respectively.

In a 2006 article in the American Psychologist , Hwang calls for researchers and practitioners to understand differing cultural beliefs about mental illness and how people of different cultures express and communicate distress, while a 2009 article in Professional Psychology: Research and Practice provides five steps to help researchers collaborate with community partners to generate and support ideas for therapy adaptation. Hwang then describes ways to integrate the two approaches in a chapter in the APA book "Cultural Adaptations." Bernal, too, has developed an adaptation model that examines the roles of language, cultural metaphor and acceptability of treatment to those the adaptation is serving.

Others are adding to or modifying their work with cultural adaptations based on experiences in the field. Lau is taking insights gleaned in her original study — namely, therapists' own ideas on which types of adaptations might best suit different families — and investigating whether and how those insights might help sustain evidence-based interventions for youth. In a study called 4KEEPS, she and psychologist Lauren Brookman-Frazee, PhD, of the University of California, San Diego, are using a grant from the National Institute of Mental Health to assess how more than 1,500 therapists in Los Angeles county are implementing evidence-based treatments up to eight years after initial adoption. Do they stay faithful to the original protocol? More important, says Lau, what are therapists doing on their own to ensure these treatments work in community settings, and can those findings be incorporated into future treatments?

Alfiee Breland-Noble, PhD, who directs the African-American Knowledge Optimized for Mindfully-Healthy Adolescents, or AAKOMA, Project at Georgetown University, brings her existing knowledge of African-American culture into treatments she perceives are already a good fit for this population. For instance, research shows that, for historical reasons, African-Americans can be highly resistant to mental health treatment. That's why Breland-Noble starts with treatments that are more attractive to this group, such as motivational interviewing, with its emphasis on client empowerment. Instead of tailoring the treatment, she includes practices that foster clients' willingness to take part in it.

"My intervention is really designed for treatment engagement, to increase people's willingness to access treatments, including culturally adapted treatments," she says.

Researchers also are working to incorporate a more individualized understanding of families and culture into culturally competent intervention research and practice. Among them is Steven Lopez, PhD, a cross-cultural psychology researcher at the University of Southern California. He and colleagues including Stanley Sue, PhD, distinguished professor of clinical psychology at Palo Alto University, and others, emphasize the importance of understanding specific factors that inform an individual's or family's presenting problems — not simply the research wisdom about their ethnic group as a whole.

To give a nuanced example, studies of Mexican-Americans with serious mental illness suggest these clients tend to relapse when they return to family members who are inclined toward emotional over-involvement. Studies of European-Americans show they fare worse when they return to homes high in criticism.

But it would be a mistake to assume that emotional overinvolvement is always a relapse trigger for Mexican-American clients, or that high levels of family criticism always predict relapse in European-American clients, says Lopez. Instead, it's important to assess individual families and see what the likely predictors might be for that particular family.

"We are not saying we need a cultural adaptation for Mexican-Americans that includes emotional over-involvement," he says. "It's too static, too set, too stereotyping and it's not considering the individual."

Also at issue is whether it's desirable or even possible to gain specific cultural competence in more than one or two cultures. For instance, although Domenech Rodriguez has spent 18 years collaborating on interventions with partners in Mexico, she continues to learn important lessons about that country's enormous cultural diversity.

"I can't imagine trying to develop the nuances of knowledge I have had to acquire in Mexico with every group imaginable," she says.

Finally, the still-murky definition of cultural competence continues to stymie efforts to properly design studies in the area. To this end, Domenech Rodriguez favors the idea of observing master practitioners and seeing what they have in common. "We really need to do some observational work with people we agree are exquisitely culturally competent," she says.

In a related vein, Sue, Huey and others suggest the approach of first looking at study outcomes, then seeing which factors distinguish those that are particularly effective with ethnic-minority clients.

"We obviously have the usual kinds of recommendations — we need more randomized controlled trials," says Sue. "But I think we should try to get some insights in different ways, such as using specific qualitative strategies."

In some ways, it's a plus that the field is still in a major mode of questioning, Sue adds.

"It means people will keep on studying and analyzing cultural competence and culturally competent interventions," he says.

The result, he believes, will be more helpful and empirically grounded interventions.

Tori DeAngelis is a journalist in Syracuse, New York.

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What is Cultural Competence and How to Develop It?

photo source: Canva.com

This article will help better understand cultural competence and its components. Adopted cross-cultural attitude strategies will help to develop and enhance the ability to practice effective communication in intercultural situations.

Working and living in a global society requires the ability to create interactions and relationships with people who are different from oneself. It is critical to know how to assess our cultural competency and evaluate our own cultural behaviors. Globalization and diversity lowered the barriers that once separated cultures both internationally and domestically (Garneau & Pepin, 2015). Cultural competency skills can help businesses run more productively, and efficiently. Practicing cultural competency skills can also elevate your customer service skills. Exceptional customer service gives you the ability to set your business apart from your competitors and keeps your customers returning to your business.

What is culture?

In 1951, Kluckhohn explained culture as sharing a pattern of thinking, feeling, reacting, and problem-solving. Culture is a dynamic relational process of shared meanings that originate in the interactions between individuals (Carpenter-Song, Schwallie, & Longhofer, 2007). In 2010, Gregory and colleagues emphasized that culture must be considered in historical, social, political, and economic contexts. Betancourt (2004) defined culture as a pattern of learned beliefs, values, and behavior that are shared within a group; it includes language, styles of communication, practices, customs, and views on roles and relationships. Edgar Schein (2010) described a culture as "shared beliefs, values, and assumptions of a group of people who learn from one another and teach to others that their behaviors, attitudes, and perspectives are the correct ways to think, act, and feel." Psychologists argue that unfamiliar culture negatively affects an individual's sensemaking mechanisms and determine their behavioral responses. As a result, individuals cannot accurately perceive, interpret, explain, and predict the behavior of people with different cultural background(s) (Muzychenko, 2008).

What is cultural intelligence?

Cultural intelligence is the ability to interpret the stranger's behavior the way the stranger's compatriots would (Muzychenko 2008). For example, if employees don't feel as if their manager understands or respects their culture, employees may find it hard to trust the leader or work as a team.

What is cultural competence?

Current research on cultural competence focuses on sensitivity to cross-cultural differences and the ability to adapt to other cultural environments (e.g., Hansen, Pepitone-Arreola-Rockwell, & Greene, 2000), or reflective awareness of cultural influences on one's thoughts and behaviors (Chao, Okazaki, & Hong, 2011). Muzychenko (2008) defined cultural competence as the appropriateness and effectiveness of one's behavior in an alien cultural environment. Wilson, Ward, and Fischer (2013) defined cultural competence as "the acquisition and maintenance of culture-specific skills" for very practical reasons:

• function effectively within a new cultural context. 
• interact effectively with people from different cultural backgrounds.

Williams (2001) defined cultural competence as " the ability of individuals and systems to work or respond effectively across cultures in a way that acknowledges and respects the culture of the person or organization being served " p.1.

Why do we need to develop cultural competence?

Developing cultural competence helps us understand, communicate with, and effectively interact with people across cultures. It gives us the ability to compare different cultures with our own and better understand the differences. Unconsciously, we bring our own cultural frame of interpretation to any situation. This is not to say that culture alone determines how one interprets a situation. One's own unique history and personality also play an important role (Hofstede, 2002).

How do we develop an attitude and components of cultural competence?

Developing cross-cultural attitudes allows one to develop skills for better engaging with people from all kinds of cultures. Cross-cultural skills demonstrated through the ability to communicate with respect; recognize others' values, accept knowledge, skills, and talents; and tolerate, engage, and celebrate the success of others. Deardorff defined competence as " the ability to communicate effectively and appropriately in intercultural situations based on one's intercultural knowledge, skills, and attitudes " (Deardorff, 2006, pp. 247-248). We adopted Deardorff (2006) cross-cultural attitude strategies that help you to develop and enhance one's ability to practice effective communication in intercultural situations:

• Practice openness by demonstrating acceptance of difference.
• Be flexible by demonstrating acceptance of ambiguity.
• Demonstrate humility through suspension of judgment and the ability to learn.
• Be sensitive to others by appreciating cultural differences.
• Show a spirit of adventure by showing curiosity and seeing opportunities in different situations.
• Use a sense of humor through the ability to laugh at ourselves.
• Practice positive change or action by demonstrating a successful interaction with the identified culture.

Borchum (2002) described cultural competence as " a non-linear dynamic process that is never-ending and ever expending. It is built on increases in knowledge and skill development related to its attributes " p. 5. We synthesized and adopted Williams's (2001) and Martin and Vaughn's (2007) studies that can assist in better understanding of components of cultural competency. These attributes will guide you in developing cultural competence:

• Self-knowledge and awareness about one's own culture.
• Awareness of one's own cultural worldview.
• Experience and knowledge of different cultural practices.
• Attitude toward cultural differences.

In conclusion, our global society necessitates interactions and relationships with people who are different from oneself. By developing one's own cultural competence, productivity and efficiency may increase and in turn improve one's customer service skills. Customers who feel valued and understood will return for repeat business.

Burchum, J. L. R. (2002, October). Cultural competence: An evolutionary perspective . In: Nursing Forum : (Vol. 37, No. 4, p. 5). Blackwell Publishing Ltd.

Carpenter-Song, E. A., Schwallie, M. N., & Longhofer, J. (2007). Cultural competence reexamined: critique and directions for the future.  Psychiatric Services ,  58 (10), 1362-1365.

Betancourt, J. R. (2004). Cultural competence—marginal or mainstream movement?  New England Journal of Medicine ,  351 (10), 953-955.

Chiu, C.-Y., Lonner, W. J., Matsumoto, D., & Ward, C. (2013). Cross-Cultural Competence: Theory, Research, and Application . Journal of Cross-Cultural Psychology , 44 (6), 843–848.

Garneau, A. B., & Pepin, J. (2015). Cultural competence: A constructivist definition.  Journal of Transcultural Nursing ,  26 (1), 9-15.

Gregory, D., Harrowing, J., Lee, B., Doolittle, L., & O'Sullivan, P. S. (2010). Pedagogy as influencing nursing students' essentialized understanding of culture. International Journal of Nursing Education Scholarship, 7(1), 30. doi:10.2202/1548-923X.2025

Hofstede, G. J., Hofstede, G., & Pedersen, P. B. (2012). Exploring culture: exercises, stories, and synthetic cultures . Boston: Intercultural Press.

Hofstede, G. J., Pedersen, P. B., & Hofstede, G. (2002).  Exploring culture: Exercises, stories, and synthetic cultures . Nicholas Brealey.

Martin, M., & Vaughn, B. (2007). Cultural competence: The nuts and bolts of diversity and inclusion.  Strategic Diversity & Inclusion Management ,  1 (1), 31-38.

Muzychenko, O. (2008). Cross-cultural entrepreneurial competence in identifying international business opportunities .  European Management Journal ,  26 (6), 366-377.

Schein, E. H. (2010).  Organizational culture and leadership  (Vol. 2). John Wiley & Sons.

Williams, B. (2001). Accomplishing cross cultural competence in youth development programs.   Journal of Extension ,  39 (6), 1-6.

Wilson, J., Ward, C., & Fischer, R. (2013). Beyond culture learning theory: What can personality tell us about cultural competence?  Journal of cross-cultural psychology ,  44 (6), 900-927.

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Cultural competence.

• Soon Ang , Soon Ang Division of Leadership, Management & Organization, Nanyang Technological University
• Kok Yee Ng Kok Yee Ng Division of Strategy, Management & Organization, Nanyang Technological University
•  and  Thomas Rockstuhl Thomas Rockstuhl College of Business, Nanyang Technological University
• https://doi.org/10.1093/acrefore/9780190236557.013.567
• Published online: 28 February 2020

Cultural competence refers to an individual’s potential to function effectively in intercultural situations. The myriad conceptualizations of cultural competence can be broadly classified as intercultural traits (enduring personal characteristics that describe what a person typically does in intercultural situations); attitudes (perceptions and evaluations of other cultures); and capabilities (what a person can do to function effectively in intercultural contexts). In terms of empirical evidence, a review of existing report-based instruments (i.e., measures that involve self- or observer-perceptions of cultural competence) shows that only three instruments (Cultural Intelligence Survey, CQS; Multicultural Personality Questionnaire, MPQ; and Intercultural Adjustment Potential Scale, ICAPS) demonstrate strong psychometric properties and incremental predictive validity across cultures. Notably, the CQS has the most extensive evidence on its predictive validity. The field is also seeing an emergence of performance-based measures of cultural competence in the form of situation judgment tests. Finally, there is considerable research on interventions to grow cultural competence and intelligence in individuals. Meta-analyses and systematic reviews generally concluded that training enhances the development of cultural competence and intercultural effectiveness. Effect sizes, however, vary depending on training and trainee characteristics. The field of cultural competence is at an exciting nexus of globalization, increasing diversification within nations, and technological advancements. We suggest that future research should (1) extend our conceptualization of cultural competence to include managing vertical differences rooted in power and status disparity; (2) expand our measurement from psychometric approaches to the use of multimodal analytics; and (3) expand our criterion space of cultural learning.

• cultural competence
• cultural intelligence
• intercultural capabilities
• intercultural traits
• intercultural attitudes and world views

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FYS 101: Cultural Competency

• Setting the Context & Spectrum of Diversity
• Exploration of Identity
• Intersectional Self
• Sense of Belonging
• Cultural Competency
• Stereotypes, Prejudice, and Discrimination
• Microaggressions
• Intersectional Privilege, Oppression, and Marginalization
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• SU: Research Starting Points
• SU: FYS 101 Library Orientation Quiz
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What is Cultural Humility?

The concept of cultural humility was developed by Melanie Tervalon and Jann Murray-Garcia in 1998 to address inequities in the healthcare field. It is now used in many fields, including education, public health, social work, and library science, to increase the quality of interactions between workers  and their diverse community members. Cultural humility goes beyond the concept of cultural competence to include:

• A personal  lifelong commitment to self-evaluation and self-critique
• Recognition of power dynamics and imbalances, a desire to  fix those power imbalances and to develop partnerships with people and groups who advocate for others
• Institutional accountability  ( Tervalon & Murray-Garcia, 1998 )

What is Cultural Competence?

To date, there is no one definition of cultural competence as definitions have evolved from diverse perspectives, interests and needs.  One definition is known as the Cross Framework, which defines cultural competence as 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 ( Cross et al., 1989 ). 

Being culturally competent is a continual process that involves an ongoing critical examination of one’s attitudes, awareness, knowledge and skills in order to negotiate cross-cultural differences to complete tasks and/or create positive living, learning and working environments ( NC State University Office for Institutional Equity and Diversity ). 

Cultural competence encompasses:

• being aware of one’s own world view
• developing positive attitudes  towards cultural differences
• gaining knowledge of different cultural practices and world views
• developing skills for communication and interaction across cultures

Source: NC State, Office for Institutional Equity and Diversity

Cultural Competence and Humility Resources: Books

Cultural Competence and Humility Resources: Videos

Cultural Competence and Humility Resources: Podcasts

These podcasts seek to break cultural barriers and invite listeners to hear real human stories . These podcasts fight against the dehumanization of people from other backgrounds and cultures, and they do it through storytelling.

Resources on The Haudenosaunee

The Haudenosaunee Confederacy (a.k.a. Iroquois or Five Nations Confederacy) encompasses the sovereign Mohawk, Oneida, Onondaga, Cayuga, Seneca, and later the Tuscarora nations.  Haudenosaunee  means "people who build" or "people of the longhouse." The Mohawk are the Keepers of the Eastern Door, the Onondaga are the Keepers of the Central Fire, and the Seneca are the Keepers of the Western Door .

• Skä•noñh - Great Law of Peace Center Skä•noñh Center is an educational collaborative that includes representatives of OHA, the Onondaga Nation, Syracuse University, State University of New York College of Environmental Science and Forestry, Lemoyne College, Onondaga Community College, and Empire State College has been formed to create the content for the new facility.
• Haudenosaunee Conferacy The confederacy, made up of the Mohawks, Oneidas, Onondagas, Cayugas, and Senecas was intended as a way to unite the nations and create a peaceful means of decision making. Through the confederacy, each of the nations of the Haudenosaunee are united by a common goal to live in harmony.
• Indigenous Education Institute (IEI) The Indigenous Education Institute (IEI) was created for the preservation and contemporary application of traditional Indigenous knowledge.The mission and goals were developed in order to provide awareness of the importance of cultural and linguistic diversity in the world today
• Onondaga Nation The Onondaga Nation lies in the middle of the Haudenosaunee territory and is also known as the Central Fire.

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Global Cognition

Cultural competence: what, why, and how.

by Winston Sieck updated September 20, 2021

Building relationships and working successfully with different others can seem like a major challenge.

But you can enjoy the rewards, while keeping frustration to a minimum.

The key to making them work is cultural competence.

What is cultural competence?

Cultural competence is defined as the ability to work effectively with people from different cultural backgrounds. Cultural competence is comprised of four components or aspects:

• a diplomatic mindset,
• agile cultural learning,
• reasoning about other cultures, and
• a disciplined approach to intercultural interactions.

We go through each of these competency areas in more depth, below. Essentially, cultural competence is a set of skills and knowledge that can help you learn, reason, solve problems, and interact comfortably when you’re working with people from different cultures. Cultural competence can be improved through training, education, and experience.

In our increasingly connected world, it’s not surprising that we are encountering people from all manner of backgrounds in our workplaces. Whether you are leading a diverse team to develop a new product, treating patients from different walks of life, promoting stability in a conflict zone, or teaching in a multicultural classroom, cultural competence is critical to your success in the professional realm.

Why improve your cultural competence?

Cultural competence can help you do your job more effectively. What does that mean in practice?

Cross-cultural teamwork has many benefits. But, working in a culturally diverse environment sometimes comes with differences of opinion and tension.

Cultural competence can allow you to detect problems early and prevent knee-jerk reactions is situations that initially seem puzzling or even provoking. This allows you to connect and build mutual trust with the people you work with. These relationships can provide fresh insights and innovative solutions to problems. They can even give you the inside scoop on others in your environment who don’t support your agenda.

Relating better to people you work with, so you can get things done. That’s a realistic objective with obvious benefits.

What are the essential cultural competencies for work?

To address this question, Louise Rasmussen and Winston Sieck of Global Cognition studied professionals with extensive experience working across cultural boundaries. Their paper , “Culture-general competence: Evidence from a cognitive field study of professionals who work in many cultures,” was published in the International Journal of Intercultural Relations .

One of the unique features of their research was that participants were required to have a wide range of cultural experiences to be included in the studies. It was not enough to be deeply immersed in one foreign culture. This enabled the research team to tease out general cross-cultural skills that apply when working with someone from any group.

In addition, in contrast to previous work, the team did not ask these seasoned professionals for their opinions about cultural competence. Instead, the researchers dug into their lived experiences using cognitive task analysis to uncover the skills they used to meet their most challenging interactions.

The researchers identified four broad cultural competency domains that the experts used to create successful cross-cultural relationships.

Diplomatic Mindset

Diplomacy is the art of dealing with people in a thoughtful and effective way. Though it’s often talked about in connection with international relationships, diplomacy and tact can be applied to every interaction we have with people from other cultures or social backgrounds.

A diplomatic mindset starts with a focus on what you are trying to accomplish. And recognizing that you need to work with diverse others to meet your goals. It means being aware of your own worldview and realizing that your own background shapes how you see things.

Doing so helps you understand how you are viewed by the person you are interacting with. It also helps you manage your own attitudes toward the other person’s culture. Making it easier to find ways to get the job done despite your differences.

Cultural Learning

Professionals who successfully navigate cross-cultural relationships actively learn cultural norms, language and customs in an ongoing fashion. There’s far too much to know about peoples and cultures to think that you can read a book or take a class and be done with it.

Rasmussen and Sieck found that cross-cultural experts deliberately seek out the experiences and relationships that will advance their cultural understanding rather than remaining fixed in their own narrow experience.

They were also sensitive to the limits and biases of their guides. Hence, they’d consult and check a variety of sources such as web sites, books (even fiction), local informants, and colleagues to get a full understanding of the range of views within a culture.

Cultural learning does not only take place in preparation for an interaction, it continues afterward as well. The professionals would often seek feedback from natives of their host country after an experience to find out what they got wrong and what they could do better in the future.

Cultural Reasoning

Cultural reasoning helps you make sense of cultural behaviors that initially seem odd. Like a scientist with an unexpected result, treat puzzling behaviors as opportunities to deepen your understanding of the culture. Dig in and figure out why they do what they do.

If you’re walking into a situation completely fresh, with no context to draw from, all is not lost. Taking a moment to reflect on the ‘why’ likely leads you to discover a few possible alternatives.

Maybe she was trying to get a read on your personal values to gauge how we’ll you’ll work together. Or, maybe he was trying to get a rise out of you, to get a sense of how well you manage conflict.

It may not be possible to figure out a person’s real motivation is in the moment. But, with practice, you’ll find that you can regularly take the point of view of diverse people you’re working with. You can more readily consider their beliefs and desires in the moment and use that perspective to work together more effectively.

Once you discover people’s beliefs and motives, you’re in a better position to spot the differences that cause misunderstandings and conflict . And, you have your hands on the levers to influence their perceptions and decisions if you need to.

Intercultural Interaction

Showing you’ve taken the time to learn a custom or bit of language goes a long way to build rapport with someone from a different culture. Yet, it’s natural to feel awkward and uncertain, or even silly, and so avoid giving it a try.

Fortunately, there is a natural tendency for people to positively respond to someone’s attempts to address language and cultural norms, regardless of their performance level.

For example, using a customary greeting in a person’s native tongue will be seen positively even if it hits the limit of your language skills.

The connection begins in the attempt. Mastery happens over time.

One trick the seasoned professionals use is to plan their critical intercultural communications in advance. This goes beyond rehearsing that greeting to getting your nuanced talking points down before a difficult negotiation.

No matter how much you’ve planned, sometimes interactions go poorly. People from other cultures sometimes want fundamentally different things than you. And, as is the case within any group of people, sometimes they really are just rude.

Cross-cultural experts draw on deep reserves of discipline to face these situations. They manage their reactions and the impression they make, which often earns them greater respect in the process.

How to cultivate cultural competence within your team or organization

You might be able to influence the cultural competence of others within your team or organization. Here are four ways you can get started:

Make cultural competence part of your team or organization’s narrative

To do that, include cultural competence in your policies, mission or vision statements, project plans, and other resources or documents that define your expectations for your people.

Be sure to get buy-in from key stakeholders and influencers within your team or organization. They are the ones who will take your vision from paper and to practice.

Recognize and reward instances of cultural competence. Even if it’s just with positive attention.

Deliberately foster dialogue with and between teammates or subordinates around cultural issues

To get the conversation started, you can share this article. You might organize discussions of cultural issues or experiences around the following activities:

• Get people to report on cultural surprises that occur within the context of your work.
• Discuss them as a group.
• Try to take the cultural other’s perspective.
• Come up with some alternative hypotheses about the beliefs and motivations behind the behaviors.
• Locate cultural mentors inside or outside your team or organization and ask them questions.
• Compare their answers.

Discussions like this can help you set or define a positive vision. Seeing examples of outcomes of handling intercultural interactions wisely will motivate your people to improve their cultural competence.

Provide cultural competence instruction and other professional development

Incorporating a cross-cultural training program can be a reasonable option, if it’s done well. Do you have someone who develops or delivers cultural competence or diversity instruction within your team or organization? Or, are you evaluating existing options on the market?

In either case, be sure the folks who develop the content you use:

• Understand what cultural competence is.
• Promote the specific cultural skills and knowledge that are important for your people to learn.
• Give examples of how cultural competence will change and improve the ways your people do their jobs.

When you talk to instruction developers or vendors, you can use the competencies in this article as a starting point for describing the positive behaviors you expect within your team or organization.

Set realistic objectives for the change you want to see.

It’s important to keep in mind that developing cultural competence is not a one-shot enterprise. It takes time and practice. No single book, article, workshop, course, or even immersion is going to get the job done.

Use the information in this article to define a specific and realistic vision for the changes you want to see within your team or organization. And, make a plan for how you will sustain and advance your people’s cultural competence.

How to avoid pandering and related pitfalls

When you engage with people from other cultures, it can be tempting to think that you can’t be yourself. You might even feel that you need to pretend to be someone who’s willing to go along with pretty much anything.

The thing is, people in other cultures are people too. They have likes and dislikes just like you. And, they can sense when you’re not being real.

Similarly, studying up on other expressions, customs, and interests is great. But it’s important to think carefully about how you use that information.

Picking up others’ gestures or attire can sometimes seem like mocking or intruding on another’s identity.

There’s a fine line between paying respect and pandering. You have to read reactions and adapt to circumstances . Going overboard showing respect can sometimes cause you to lose it.

Instead, be yourself. If you’re genuine, people pick up on that and appreciate it.

Regardless of your industry or the type of workplace in which you are employed, cultural competence plays an important role in your daily environment. As a leader or a part of team, recognizing and dealing cultural differences will create a more productive workplace as well as a happier setting for everyone who is there. In today’s modern world, cultural competence is a necessity for everyone.

Image Credit: rawpixel

Rasmussen, L. J., & Sieck, W. R. (2015). Culture-general competence: Evidence from a cognitive field study of professionals who work in many cultures . International Journal of Intercultural Relations , 14(3), 75-90.

Sieck, W. R., Smith, J. L., & Rasmussen, L. J. (2013). Metacognitive strategies for making sense of cross-cultural encounters . Journal of Cross-Cultural Psychology , 44, 1007-1023.

Click below to check out Save Your Ammo , a guide to cultural competence in demanding situations.

About Winston Sieck

Dr. Winston Sieck is a cognitive psychologist working to advance the development of thinking skills. He is founder and president of Global Cognition, and director of Thinker Academy .

Reader Interactions

December 11, 2017 at 10:56 am

Your Article is spot-on. I have worked in special education, teaching nonverbal communication to those whose neurological syndrome prevented or interfered with perceiving and interpretation of nonverbal signals. I liked the term “mitigation” for instruction in this area. Simple, one-sentence guidelines were teased out to get satisfying results in unstructured play involving small plastic human figures and settings, such as disasters, searches, aggressive wild animals, and exploration. (Thanks to Star Trek for these models.)

December 11, 2017 at 9:42 pm

Thanks for sharing your thoughts and experiences, Jean. Sounds like a fascinating and useful intervention that you developed.

January 8, 2018 at 10:09 am

Thanks for the very interesting article – love the Star Trek references (even as a non-Trekkie). I appreciate the concise way you’ve presented the data and created the 4 broad dimensions. Very easy and fast read, yet chock full of relevant information. Good use of research time!

January 11, 2018 at 12:09 pm

Glad you enjoyed it, Mary – and found it useful. Thanks for stopping by!

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Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients

Diversity is the one true thing we all have in common. Celebrate it every day. — Author Unknown

The 2002 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare , brought into stark focus the issues of inequities based on minority status in health care services. The IOM report concluded that, “Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare” ( 1 ). Persons in racial and ethnic minority groups were found to receive lower-quality health care than whites received, even when they were insured to the same degree and when other health care access-related factors, such as the ability to pay for care, were the same ( 1 ). Clients in minority groups were also not getting their needs met in mental health treatment ( 2 , 3 ). The IOM report was a primary impetus for the cultural competence movement in health care.

Cultural competency emphasizes the need for health care systems and providers to be aware of, and responsive to, patients’ cultural perspectives and backgrounds ( 4 ). Patient and family preferences, values, cultural traditions, language, and socioeconomic conditions are respected. The concepts of cultural competence and patient-centered care intersect in meaningful ways. The IOM’s Crossing the Quality Chasm ( 5 ) document defines patient-centered care as “providing care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (p. 3). Both patient centeredness and cultural competence are needed in striving to improve health care quality ( 6 , 7 ). To deliver individualized, patient-centered care, a provider must consider patients’ diversity of lifestyles, experience, and perspectives to collaborate in joint decision making. Patient-centered care has the potential to enhance equity in health care delivery; cultural sensitivity may likewise enhance patient-centered care ( 6 ). Indicators of culturally sensitive health care identified in focus groups of low-income African-American, Latino American, and European American primary care patients included interpersonal skills, individualized treatment, effective communication, and technical competence ( 8 ). The U.S. Office of Minority Health has set national standards for culturally and linguistically appropriate health care services ( 9 ). The Principal Standard is that health care must “provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs” (p. 1).

Five key predictors of culture-related communication problems have been identified in the literature: cultural differences in explanatory models of health and illness, differences in cultural values, cultural differences in patients’ preferences for doctor–patient relationships, racism and perceptual biases, and linguistic barriers ( 10 ). Physicians are often poorly cognizant of how their communication patterns may vary with respect to the characteristics of the individual they are treating ( 11 ). This unconscious preconceptualization is termed implicit bias , which refers to the attitudes or stereotypes that affect understanding, actions, and decisions in an unconscious manner ( 12 ). All people experience these—even those who strive to maintain a multicultural orientation and openness to diversity. Health care providers must openly reflect on and discuss issues of the patient’s culture, including ethnicity and race, gender, age, class, education, religion, sexual orientation and identification, and physical ability, along with the unequal distribution of power and the existence of social inequities, to effectively coconstruct a treatment plan that is patient centered and culturally sensitive.

Merging Cultural Competence With Cultural Humility

Cultural humility ( 13 ) involves entering a relationship with another person with the intention of honoring their beliefs, customs, and values. It entails an ongoing process of self-exploration and self-critique combined with a willingness to learn from others. Authors have contrasted cultural humility with the concept of cultural competence. Cultural competence is characterized as a skill that can be taught, trained, and achieved and is often described as a necessary and sufficient condition for working effectively with diverse patients. The underlying assumption of this approach is that the greater the knowledge one has about another culture, the greater the competence in practice. The concept of cultural humility, by contrast, de-emphasizes cultural knowledge and competency and places greater emphasis on lifelong nurturing of self-evaluation and critique, promotion of interpersonal sensitivity and openness, addressing power imbalances, and advancement of an appreciation of intracultural variation and individuality to avoid stereotyping. Cultural humility encourages an interpersonal stance that is curious and other-oriented ( 14 , 15 ).

The infusion of cultural humility into cultural knowledge has been coined competemility : the merging of competence and humility ( 16 ). Cultural competemility is defined as “the synergistic process between cultural humility and cultural competence in which cultural humility permeates each of the five components of cultural competence: cultural awareness, cultural knowledge, cultural skill, cultural desire, and cultural encounters” ( 16 ). The competemility position allows a meaningful connection with each patient as a unique individual, with diverse perspectives, culture, and lifestyles. Cultural competemility necessitates a consciousness of the limits of one’s knowledge and the awareness of the ever-present potential for unconscious biases to limit one’s viewpoint ( 15 , 16 ).

Practicing Cultural Competence and Cultural Humility

Cultural competence, cultural humility, and patient-centered care are all concepts that endeavor to detail essential components of a health care system that is sensitive to patient diversity, individual choice, and doctor–patient connection. A culturally competent health care workforce highlights five components: cultural awareness, knowledge, skill, desire, and encounters. Cultural humility focuses on identifying one’s own implicit biases, self-understanding, and interpersonal sensitivity and cultivating an appreciation for the multifaceted components of each individual (culture, gender, sexual identity, race and ethnicity, religion, lifestyle, etc.), which promotes patient-centered approaches to treatment. The new concept of competemility is the synergistic combination of cultural competence with cultural humility. Health care professionals need both process (cultural humility) and product (cultural competence) to interact effectively with culturally diverse patients ( 17 ).

Establishing a collaborative mutual partnership with diverse patients requires an open, self-reflective, other-centered approach to understanding and formulating the patients’ strengths and difficulties and coconstructing the treatment plan. Below are tips for practicing cultural competence and cultural humility.

Get to know your community. Who lives there, and what are the resource disparities in the community? Is there a large immigrant or refugee population? What are the most common ethnicities and languages spoken? What is the climate in the community regarding cultural diversity?

• Consider whether politics or laws, such as immigration laws or a recent federal government move to eliminate protections in health care for transgender Americans ( 18 ), are adding to the stress of diverse communities.
• If you, as the physician, are a person of color, consider how that affects your practice and work with diverse patients. If you are European American, reflect on the implicit biases that may affect your practice with diverse patients and theirs with you.
• Pay attention to office practices: do they enhance an atmosphere of welcoming everyone? Are interpreter services available, if needed?
• Ask patients by which pronoun they would prefer to be addressed.
• Use a journal to jot down potential implicit biases and observations about rapport building, for ongoing self-reflection.
• Don’t assume. Ask the patient about background, practices, religion, and culture to avoid stereotyping.
• Reassure by words and actions that you are interested in understanding the patient and helping to coconstruct a plan to fit his or her needs. State upfront that this is a collaborative process and that you welcome input on the process (communicating openly with each other) and the product (treatment plan).
• Ask directly what the patient wants to achieve with the psychiatric consultation/treatment. This can help identify patient goals and treatment methods.
• A family genogram may help clarify family dynamics, cultural background, and possible generational trauma.
• Ask directly about experiences of discrimination, bullying, traumas, or harassment. Are there fears associated with minority status?
• Identify strengths, interests, and resilience factors.
• Discuss patient-centered care to determine whether this is understood or if this is an unfamiliar practice. Get patient input about collaborating in health care decisions. For patients who are accustomed to the doctor being the one making all the decisions, consider initiating a request for decisions, even small ones, to reinforce with them that you want to know their preferences and help them become comfortable with making health care decisions and communicating wants and needs.
• Inquire about what the patient feels would be helpful. Are there cultural practices or herbal remedies that they have already tried—and what was the result? Are there religious, cultural, or individual convictions that affect choice of treatment?
• Ask during the session whether the patient has any clarification of information that he or she didn’t feel the physician appropriately understood. If using an interpreter, make sure that he or she is interpreting the full discussion (and not summarizing, which loses the nuance and some meaning).
• After the session, ask the patient if he or she felt understood, if he or she understands the process, and if there is anything else he or she would like to add to be better understood.
• Model coconstruction of the treatment plan by asking about goals and helping the patient consider possible methods of meeting those goals.
• Clarify the patient’s preference for family involvement and, depending on the age and competence of the patient, what information will be communicated to the family.

Dr. Stubbe reports no financial relationships with commercial interests.

Cultural Competency: Research

• Clinical Resources
• Public Health Resources
• Additional Resources

GW Resources

• GW Anti-Racism Coalition (ARC)
• Cultural Competence Resources for professional development in the area of cultural competence, compiled by SMHS Office of Diversity and Inclusion
• Race in America Lecture Series GW Office for Diversity, Equity, and Community Engagement

Resources from Organizations

• National Center for Cultural Competence at Georgetown University
• Think Cultural Health a part of the DHHS Office of Minority Health
• Cultural Competency in Nursing Education American Association of Colleges of Nursing
• 2020 Institute for Nursing Leadership Critical Conversation on Health Equity and Racism Video from the American Academy of Nursing Institute for Nursing Leadership. A summary report is also available.
• Culturally Competent Nursing Care: A Cornerstone of Caring Office of Minority Health
• AAMC Publication "Assessing Change: Evaluating Cultural Competence Education and Training"
• Tool for Assessing Cultural Competence Training (TACCT) "67-item self-administered assessment tool that can be used by medical schools to examine all components of the entire medical school curriculum"
• NIH Ending Structural Racism
• Health Initiative of the Americas (UC-Berkeley) Resources include: - Research directory, reports, and policy briefs - Spanish-English dictionary of health terms
• Cochrane Equity Methods Group - resources for planning, conducting, and reporting your equity-relevant systematic review - additional training and support for conducting equity-related reviews

Training Opportunities

• Implicit Bias: A Practical Guide for Healthcare Settings 40-minute training video for healthcare practitioners and trainees
• Implicit Bias (DCRX: THE DC CENTER FOR RATIONAL PRESCRIBING) "This module provides an overview of implicit bias, and how it is manifested in everyday clinical decision-making. Viewers will learn about the underlying psychology and neuroscience of implicit associations, and assess their own biases to increase self-awareness. This course also describes debiasing strategies and best practices to mitigate risks of the impact of bias on treatment and care."
• Cultural Competence Courses Courses availalble in various formats and for a variety of different audiences "CDC TRAIN is a gateway into the TRAIN Learning Network, the most comprehensive catalog of public health training opportunities. TRAIN is a free service for learners from the Public Health Foundation."
• Minority Health/Health Disparities Courses Courses availalble in various formats and for a variety of different audiences "CDC TRAIN is a gateway into the TRAIN Learning Network, the most comprehensive catalog of public health training opportunities. TRAIN is a free service for learners from the Public Health Foundation."
• Learning Resources Webinars, learning modules, webinars, and videos from the National LGBTQIA+ Health Education Center, a program of the Fenway Institute more... less... Topics include Introduction to LGBTQIA+ Health; Collecting Sexual Orientation and Gender Identity Data; Pre-Exposure Prophylaxis (PrEP); HIV/STI Treatment and Prevention; LGBTQIA+ Children and Youth; Behavioral Health; Transgender Health; and more.
• Addressing the need for lgbtq-affirming cancer care: a focus on sexual and gender minority prostate cancer survivors "This training aims to help social workers and other health care professionals better support sexual and gender minority cancer patients, with a specific focus on the needs of sexual and gender minority prostate cancer survivors."

Key Terms and Definitions

"Attitudes and behaviors, which are characteristic of a group or community." ( HRSA , 2019)

• Cultural Competence

"A set of similar behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations." ( HRSA , 2019)

Another definition for cultural competence comes from the Center for Substance Abuse Treatment. Substance Abuse: Administrative Issues in Outpatient Treatment . Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 46.) Chapter 4. Preparing a Program To Treat Diverse Clients . 

• The capacity for people to increase their knowledge and understanding of cultural differences
• The ability to acknowledge cultural assumptions and biases
• The willingness to make changes in thought and behavior to address those biases

Cultural Humility

"It is a process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners. It is a process that requires humility in how physicians bring into check the power imbalances that exist in the dynamics of physician-patient communication by using patient-focused interviewing and care. And it is a process that requires humility to develop and maintain mutually respectful and dynamic partnerships with communities on behalf of individual patients and communities in the context of community-based clinical and advocacy training models." (Tervalon and Murray-Garcia,1998)

Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998 May;9(2):117-25. doi: 10.1353/hpu.2010.0233. PMID: 10073197 . Access the PDF via Himmelfarb.

Masters C, Robinson D, Faulkner S, Patterson E, McIlraith T, Ansari A. Addressing Biases in Patient Care with The 5Rs of Cultural Humility, a Clinician Coaching Tool. J Gen Intern Med. 2019 Apr;34(4):627-630. doi: 10.1007/s11606-018-4814-y. Epub 2019 Jan 8. PMID: 30623383 ; PMCID: PMC6445906.

Cultural Safety

See: Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition (Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P., 2019). The article presents a number of definitions for different terms, as collected from a literature review, and recommends a definition for cultural safety. 

Culturally Adapted Health Care

See January 2020 article from County Health Rankings for background reading 

Critical Consciousness

"critical consciousness... places medicine in a social, cultural, and historical context and ... is coupled with an active recognition of societal problems and a search for appropriate solutions" (Kumagai & Lypson, 2009)

Kumagai, A. K., & Lypson, M. L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education: Academic Medicine , 84 (6), 782–787. https://doi.org/10.1097/ACM.0b013e3181a42398

Statistical Discrimination

"occurs when providers respond to the inherent uncertainty of the diagnostic and treatment processes by interpreting the data and information relevant to a minority patient differently from the way they do with white patients"... involves "misusing and misapplying factually accurate information to reach an inaccurate conclusion concerning the specific patient."

See pages 98-99 in Matthew (2015). 

Matthew, D. (2015). Just medicine : a cure for racial inequality in American health care . New York University Press.

Available online through Himmelfarb. 

Structural Competency

"the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance,” trauma, psychosis) also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health" ( Metzl & Hansen 2014 )

See also: Spring 2014 article, With Understanding Comes Empowerment , from New Physician and Sep 2014 article,  Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge , from AMA Journal of Medical Ethics. 

Conducting Research

• Considerations for employing intersectionality in qualitative health research. Abrams JA, Tabaac A, Jung S, Else-Quest NM. Soc Sci Med. 2020 Aug;258:113138. doi: 10.1016/j.socscimed.2020.113138. Epub 2020 Jun 16. PMID: 32574889; PMCID: PMC7363589.
• Sexual & Gender Minority Research Office (SGMRO) (NIH) "The Sexual & Gender Minority Research Office (SGMRO) coordinates sexual and gender minority (SGM)–related research and activities by working directly with the NIH Institutes, Centers, and Offices. The Office was officially established in September 2015 within the NIH Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI)."
• Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev. 2016 May 3;1:2. doi: 10.1186/s41073-016-0007-6. PMID: 29451543; PMCID: PMC5793986.
• Integrating Sex-Gender for Informative Clinical Trials: Points to Consider " Integrating sex-gender considerations into clinical trials facilitates analysis of biological and social variables and gender-sensitive methodologies that support scientific rigor, lead to clinical relevance, and protect vulnerable participants. This overview of best practices includes links to tools and references to support sex-gender integration into clinical trials."
• Equity and Inclusion Guiding Engagement Principles "guiding engagement principles for placing diversity, equity, and inclusion at the center of health research partnerships. Developed by PCORI’s Advisory Panel on Patient Engagement, the four principles—Inclusion, Equitable Partnerships, Trust/Trustworthiness, and Accountability/Actionability—are offered to ensure that diversity, equity, and inclusion are an explicit goal of partnerships from the start."
• Indigenous Research Toolkit (UBC) "the resources on this page comprise a toolkit that will assist researchers already involved in Indigenous research with the various steps of their research collaborations"
• Sex/Gender Methods Group (Cochrane) Background and resources for addressing sex and gender in health research synthesis, including systematic reviews
• PhenX SDOH Toolkit Find standard data collection protocols for research
• Minority Health and Health Disparities Research Framework [NIMHD] "The framework serves as a vehicle for encouraging NIMHD- and NIH-supported research that addresses the complex and multi-faceted nature of minority health and health disparities, including research that spans different domains of influence (Biological, Behavioral, Physical/Built Environment, Sociocultural Environment, Healthcare System) as well as different levels of influence (Individual, Interpersonal, Community, Societal) within those domains. The framework also provides a classification structure that facilitates analysis of the NIMHD and NIH minority health and health disparities research portfolios to assess progress, gaps, and opportunities."

Database Search Tips

Mesh (medical subject heading) terms for  pubmed  and  medline  searches:.

• Cultural Competency
• Cultural Diversity
• Culturally Competent Care
• Clinical Competence
• Professional Competence
• Stereotyping
• Unconscious, Psychology
• Weight Prejudice

CINAHL Subject Heading terms for CINAHL  searches:

• Transcultural Care
• Transcultural Nursing
• Professional Practice

Search Filters:

• Health Equity Filters (ISSG Search Filters Resource)
• Population Groups Filters (ISSG Search Filters Resource)
• Health Disparities and Minority Health (Ovid Expert Searches, scroll down to find)

Additional Databases

• Sage Research Methods Core Research methods full-text collection provides access to 1,000+ books, reference works, and journal articles in research methods, statistics, and evaluation.
• Health Equity: Public Health Genomics and Precision Health Knowledge Base (CDC) "online, continuously updated, searchable database of genomics and precision health information and publications relevant to health equity. Health equity is when everyone has the opportunity to be as healthy as possible. Search terms are derived from a list provided by the Association for Territorial Health Officials which includes terms such as diversity, health disparities, and others. The search algorithm combines terms in health equity with those of genomics and precision health"
• AHRQ Social Determinants of Health Database (Beta Version) "These files contain the beta version of AHRQ’s database on Social Determinants of Health (SDOH), which was created under a project funded by the Patient Centered Outcomes Research (PCOR) Trust Fund. The purpose of this project is to create easy to use, easily linkable SDOH-focused data to use in PCOR research, inform approaches to address emerging health issues, and ultimately contribute to improved health outcomes." more... less... "Variables in the files correspond to five key SDOH domains: social context (e.g., age, race/ethnicity, veteran status), economic context (e.g., income, unemployment rate), education, physical infrastructure (e.g, housing, crime, transportation), and healthcare context (e.g., health insurance). The files can be linked to other data by geography (county and zip code). The database includes two documentation files and two types of publicly available data files."
• Office of Minority Health Resource Center "The Office of Minority Health Resource Center is a nationwide service of the Office of Minority Health that provides minority health literature, research and referrals for consumers, community organizations and health professionals. The Resource Center offers a variety of information resources, including access to online document collections, database and funding searches, and customized responses to requests for information."

Datasets and Data Sources

• Minority Health Social Vulnerability Index (SVI) uses data from the United States Census Bureau and other public sources to help identify communities that may need support before, during, and after disasters, with a focus on minority racial, ethnic, and language groups as well as medical vulnerability. The dashboard has three sections: a sidebar menu, a bar chart, and a map

Governent Reports and Publications

• National Healthcare Quality and Disparities Reports (AHRQ) "Tools for measuring healthcare quality, including the National Healthcare Quality and Disparities Reports, AHRQ Quality Indicators, and ambulatory clinical performance measures."
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	is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group. The word is used because it implies having the capacity to function effectively. Cultural competence is defined as a set of values, behaviors, attitudes, and practices within a system, organization, program or among individuals and which enables them to work effectively cross culturally. Further, it refers to the ability to honor and respect the beliefs, language, interpersonal styles and behaviors of individuals and families receiving services, as well as staff who are providing such services. Striving to achieve cultural competence is a dynamic, ongoing, developmental process that requires a long-term commitment. cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of: this means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations. The Commonwealth Fund. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. 124 919-926. Washington, D.C. on April 2, 2004. (monograph and workbook); Georgetown University Child Development Center. National Center for Cultural Competence, Georgetown University Child Development Center. 9 (2) 117-125. on April 2, 2004. on April 13, 2004. retrieved from on April 15, 2004. on April 2, 2004. Sign In to NPIN Community The NPIN Community Portal will shut down on Nov. 1. Click here to learn more . Health Communication Strategies Campaign Resources Annual Observances Cultural Competence Nowhere are the divisions of race, ethnicity, and culture more sharply drawn than in the health of the people in the United States. Despite recent progress in overall national health, disparities continue in the incidence of illness and death among African Americans, Latino/Hispanic Americans, Native Americans, Asian Americans, Alaska Natives, and Pacific Islanders, as compared with the US population as a whole. Health and human service organizations are recognizing the need to enhance services for culturally and linguistically diverse populations. Providing culturally and linguistically appropriate healthcare services requires an understanding of cultural competence . What is Cultural Competence? What's the difference cultural competence, awareness, and sensitivity, how does cultural competence apply to hiv/aids, viral hepatitis, std, and tb prevention, hiv/aids, tb and cultural competence, general cultural competence information, assessing organizational and practitioner cultural competence, understanding and targeting specific populations. Cultural and linguistic competence is 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. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. (Adapted from Cross, 1989).( 1 ) Cultural competence requires that organizations: have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally. have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve. incorporate the above in all aspects of policy making, administration, practice, service delivery, and involve systematically consumers, key stakeholders, and communities. Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge, and skills along the cultural competence continuum.( 2 ) Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes .( 3 ) Principles of cultural competence include:( 4 ) Define culture broadly. Value clients' cultural beliefs. Recognize complexity in language interpretation. Facilitate learning between providers and communities. Involve the community in defining and addressing service needs. Collaborate with other agencies. Professionalize staff hiring and training. Institutionalize cultural competence. Improved quality of care is the outcome measure that indicates whether implementing training programs, policies, and culturally or linguistically appropriate standards makes a difference. A new trend in the literature suggests that using cultural competency in a focused or strategic way can be a helpful adjunct to the quality improvement process. For example, if a program wants to analyze patterns of broken appointments, it might examine variables such as age, gender, or race/ethnicity. If the analysis reveals that adolescents have the highest rate of broken appointments, the program can target specific strategies to this group. Does the clinic need to have weekend hours, when teens can more easily slip away from home? Would providing free transportation or reminder calls from caseworkers help? Does the provider reflect a youth-sensitive approach to the clinic's client base?( 5 ) Cultural competence emphasizes the idea of effectively operating in different cultural contexts, and altering practices to reach different cultural groups. Cultural knowledge, sensitivity, and awareness do not include this concept. Although they imply understanding of cultural similarities and differences, they do not include action or structural change.( 6 ) From Health Resources and Services Administration (HRSA) Care ACTION: Improving HIV/AIDS Care in a Changing Environment, August 2002, Mitigating Health Disparities Through Cultural Competence: The recent National Academy of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care states that "racial and ethnic minorities tend to receive a lower quality of health care than nonminorities, even when access-related factors, such as patients' insurance status and income, are taken into account."( 7 ) These findings and others like them are not news to people concerned with the care of individuals living with HIV disease. Study after study has demonstrated unequal access to care and poorer health outcomes among certain segments of the HIV-positive population. For example, analysis of data from the HIV Cost and Services Utilization Study revealed that compared with nonminorities, women and African Americans with HIV disease who are receiving care are less likely to receive antiretroviral therapy, protease inhibitors, and prophylaxis for pneumocystis pneumonia. These disparities remained even after adjusting for gender, age, education, and insurance coverage.( 8 ) Follow up in 1997 revealed improvements, but African Americans and Hispanics were still only about half as likely as whites to participate in HIV clinical trials or to get experimental medicines. Other minorities were also less likely than whites to get experimental treatment.( 9 ) Disparities in access to quality care extend beyond race and gender to other segments of the population that are often marginalized. For example, HIV-infected injection drug users are less likely to receive antiretroviral therapy than non-drug users are.( 10 ) It follows that disparities in access to quality HIV care are related to disparities in survival, which have been reflected in AIDS mortality data for some time.( 11 ) Being competent in cross-cultural functioning means learning new patterns of behavior and effectively applying them in the appropriate settings.( 12 ) For HIV/AIDS prevention and treatment to succeed, the special needs and life contexts of those who are marginalized because of race, ethnicity, socioeconomic status (SES), sexual orientation, age, or gender must be sensitively addressed. Cultural competence must be demonstrated not only by intervention programs and staff, but also by surveillance staff, researchers (and their investigations), as well as by those delivering prevention services, care, and treatment programs to those who are HIV-infected. Learn More About Cultural Competence Case Studies in Cultural Competency From the AIDS Education Training Center--National Multicultural Center Electronic Library From the AIDS Education Training Center--National Multicultural Center AIDS Education and Training Center National Multicultural Center Web resources on cultural competency including marginalized populations, provider stigma, and HIV health literacy TB and Cultural Competency From the New Jersey Medical School Global Tuberculosis Institute Resources from the AIDS Education Training Centers National Resource Center Cultural Competency and Tuberculosis Care: A Guide for Self-Study and Self-Assessment Case Studies: Videos From the American Academy of Family Physicians National Standards for Culturally and Linguistically Appropriate Services in Health Care From the Health and Human Services Department's Office of Minority Health The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS) From the Office of Minority Health A Physician's Practical Guide to Culturally Competent Care From the Office of Minority Health, the Website offers CME and CEU credit and equips health care professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations From the Office of Minority Health Cultural and Linguistic Competency From the Office of Minority Health Culture, Language, and Health Literacy HRSA list of online cultural competency resources. Includes culture/language specific and disease/condition specific resources, guidelines for clinicians, research, online training resources, health professional education resources, and more HIV Provider Cultural Competency Self-Assessment From the AIDS Education and Training Center National Multicultural Center From National Minority AETC: Patient Provider Interaction  Web Resources from The Provider's Guide to Quality and Culture What is cultural competence? Cultural competence is the ability to participate ethically and effectively in personal and professional intercultural settings.  It requires knowing and reflecting on one’s own cultural values and world view and their implications for making respectful, reflective, and reasoned choices, including the capacity to imagine and collaborate in cross cultural contexts. Cultural competence is ultimately about valuing diversity for the richness and creativity it brings to society.    With a growing Aboriginal and Torres Strait Islander population, almost half of all Australians having both parents or one of them born overseas, and a range of other factors affecting the cultural makeup of our society, we are living in an increasingly diverse global community. More often, we are called on to work, learn and teach in situations where there is more than one culture at play. Acquiring the capacity, knowledge and experience necessary to create effective and ethical relationships in diverse cultural environments is crucial. Cultural competence explained Header image: CCLP in Murramurrang, South Durras (by Michael Johnston). Education and training Our innovative teaching, research and engagement programs place the University of Sydney at the forefront of addressing cultural competence in Australia. Cultural Competency Certificate Prepares Students for a Diverse World Florida Tech is widely recognized for its international diversity and focus on preparing students for success in the global workforce. Central to this commitment is the university’s Cultural Competency Certificate, an immersive experiential learning program that cultivates students’ awareness, knowledge, and understanding of world cultures, customs, and communities. Completion of the certificate results in an acknowledgement on the student’s transcript, making it a valuable credential.  This achievement can be included in job applications, resumes, CVs, and graduate school applications. Students in the program must satisfy a criterion by engaging in a range of activities, courses, workshops, and other integrative experiences that demonstrate the value of diverse experiences, voices, and perspectives.  Experiences that count toward the certificate include studying abroad, participation in diversity clubs or organizations, attending cultural events, completing a qualifying academic course, and professional work such as an internship or practicum. Launched in 2015 as part of Florida Tech’s Quality Enhancement Plan (QEP) — a requirement for accreditation by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) — the program initially emphasized international cultural awareness. In 2020, the program was refocused on a broader spectrum of cultural understanding, reflecting the ongoing globalization of campuses, society, and the world. To complete the program and obtain the certificate, students must earn eight non-credit points. All the criteria, except the First-Year Experience (FYE 1000) , require the completion of reflection questions, which can be found in Engage . Engage is the engagement platform used by all Florida Tech students to manage their involvement in clubs, organizations, and unique opportunities like the Cultural Competency Certificate. Florida Tech Ph.D. student Emily Happy graduated with a bachelor’s degree in applied mathematics and the Cultural Competency Certificate in May 2023. As an undergraduate, she also participated in Florida Tech’s Study Abroad program in Oxford, England, and earned a master’s degree in statistics with data science from the University of Edinburgh in 2024.  “The Cultural Competency Certificate enriched my undergraduate experience at Florida Tech by an extraordinary amount. My experiences studying abroad and taking classes forced me to get out of my comfort zone in amazing ways. It helped me to connect to many people and even changed my entire outlook on attending graduate programs,” Happy said.  In Spring 2022, for her Applied Discrete Mathematics course, Happy completed a project using counting formulas to determine there are 2.47 quadrillion ways to earn the certificate—through a combination of 71 qualifying courses, 30 diversity organizations, and 57 events per semester.  Her research also revealed that many students, by their junior year, have already met the requirements for the certificate without realizing it.  “The program itself is wonderful because it is co-curricular, and most of the things required for the certificate are things students are going to do anyway. It is just a matter of making them aware of the program and having them complete the reflection questions,” said Nancy Garmer, Associate Dean of Libraries, and former program coordinator of the Cultural Competency Certificate program. Each of Florida Tech’s academic colleges offers at least four courses that emphasize cultural competency. Therefore, no matter what a student majors in, they can earn points toward the certificate while taking qualifying courses that relate to their academic pursuits. Studying abroad is one of the most impactful ways for students to earn points. International students studying at Florida Tech automatically earn two points toward the certificate for attending school in the United States. Domestic students can choose to both earn course credits and certificate points through one of Florida Tech’s Study Abroad programs in places such as England, Puerto Rico, Spain, Taiwan, France, or China, just to name a few.  The capstone reflection is the final project that reflects on the student’s cultural experiences. Prior to presenting the project, students must have six points of qualifying criteria. The format of the capstone is flexible. According to Garmer, students have created websites, videos, podcasts, essays, video games, and more for their capstone projects. “My favorite part of coordinating the program was seeing the capstone projects. The students study abroad, take classes, and then they have this capstone where they must synthesize all their experiences into one. It was phenomenal to see how they grew and what they learned,” Garmer said. For the 2024-2025 school year, the Cultural Competency Certificate program will be overseen by the Office of Student Affairs. Dean of Student Affairs, Cat Nanney, is eager to utilize her office’s resources to enhance the cultural competency experience for all students. “I am excited to grow the program and make students aware of the opportunities that are available,” Nanney said. Nanney hopes that upon completion of the program, students will become great leaders that will thrive in a culturally diverse world. “Yes, you are learning about different cultures, finding a sense of belonging, and feeling more comfortable and confident in the world around you, but this program is also about how to lead with respect,” Nanney said. Looking ahead, there is optimism that the program will remain integral to the Florida Tech experience. “I hope the program takes hold and becomes part of the culture of Florida Tech because of the immense value it brings to our students,” Garmer said. “Over the past decade, it has evolved significantly to become what it is today. My hope is that it will continue to adapt and grow, ensuring it meets the ever-changing needs of our students.” For a closer look at the experiences and events within the Cultural Competency Certificate, students can follow the program on social media , where program highlights, student journeys, and upcoming opportunities are shared. Related Articles Platt Welcomes Estonian Space Officials to Spaceport Center Kimberly Ryan Named MVP for August Moske Named to Top 25 Women Chief Data Officers List Ashok Pandit Retires After 42 Years at Florida Tech 364 IMAGES A Simple Guide to Cultural Competence why is multicultural competence important? PPT PPT A Simple Guide to Cultural Competence Cultural Competence VIDEO Personal Rules of Skepticism Cultural & Linguistic Competency Linguistic Competence and Performance Cultural Competence for Early Child Care Providers Gaining Commitment for Cultural Competence Development Communicate with Confidence COMMENTS In search of cultural competence In search of cultural competence What is Cultural Competence and How to Develop It? What is Cultural Competence and How to Develop It? PDF Cultural Competence in Research of research, cultural competence can be crucial to successfully recruiting and retaining diverse individuals as study subjects.6 It is important to differentiate Cultural Competence in Research from Community Based Participatory Research and Community Engagement. Cultural competence in Research is an Cultural Competence in Research According to a report and program of Harvard Catalyst (2017), cultural competence is essential for researchers to ensure 1) effective interactions between researchers and participants, 2) adequate analysis of results, and 3) appropriate engagement in study design and implementation. Researchers need to be culturally aware and sensitive to ... Cultural competence dimensions and outcomes: a systematic review of the This review will benefit researchers exploring cultural competence as one of the research variables impacting research outcomes. What is known about this topic. A number of conceptual models have been developed to describe cultural competence elements. ... Definition and dimensions of cultural competence. Cultural Competence Summary. Cultural competence refers to an individual's potential to function effectively in intercultural situations. The myriad conceptualizations of cultural competence can be broadly classified as intercultural traits (enduring personal characteristics that describe what a person typically does in intercultural situations); attitudes ... A critical review of cultural competence frameworks and models in A critical review of cultural competence frameworks and ... Cross-Cultural Competence: Theory, Research, and Application Cultural competence (alternatively: cross-cultural competence, intercultural or multicultural competence, and various other terms, such as cultural sensitivity) is a psychological construct ... PDF Cultural Competence Considerations in Human Subjects Research The ability to work effectively across cultures in a way that acknowledges and respects the culture of the person or organization being served. Cultural Competence involves treating people in a way that makes them feel that their ideas, values, traditions, or behaviors are acknowledged and respected. J.H. Hanley (1999)-Beyond the tip of the ... Research Guides: FYS 101: Cultural Competency One definition is known as the Cross Framework, which defines cultural competence as 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 ( Cross et al., 1989 ). Being culturally competent is a continual process that involves ... Cultural Competence: What, Why, and How Cultural competence is defined as the ability to work effectively with people from different cultural backgrounds. Cultural competence is comprised of four components or aspects: a diplomatic mindset, agile cultural learning, reasoning about other cultures, and. a disciplined approach to intercultural interactions. Introduction to Cultural Competence 1. Introduction to Cultural Competence. Hoshi was born and grew up in Japan. He has been living in the United States for nearly 20 years, going to graduate school and working as a systems analyst, while his family has remained in Japan. Hoshi entered a residential treatment center for alcohol dependence where the treatment program expected ... Cultural Competence and Ethnic Diversity in Healthcare Cultural Competence and Ethnic Diversity in Healthcare (PDF) Cultural competence: definition, delivery and evaluation A research project commissioned by mental health service providers was undertaken to deal with the increasing need for cultural competence in a number of mental healthcare settings. Practicing Cultural Competence and Cultural Humility in the Care of Practicing Cultural Competence and Cultural Humility in ... Cultural Competence and Beyond: Working Across Cultures in Culturally In this article, cultural competence, a very popular framework for working across cultures, is critically examined and some of the major issues with using this framework are explored. An alternative to this framework, 'culturally dynamic partnership', is presented as being a more equitable and inclusive way of working across cultures. Cultural Competency: Research Cultural Competence. "A set of similar behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations." (HRSA, 2019) Another definition for cultural competence comes from the Center for Substance Abuse Treatment. Substance Abuse: Administrative Issues in ... Definitions of Cultural Competence Definitions of Cultural Competence (Georgetown University) Cultural Competence In Health And Human Services Cultural and linguistic competence is 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. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs ... Cultural Competence: An Important Skill Set for the 21st Century Cultural competence is the ability of a person to effectively interact, work, and develop meaningful relationships with people of various cultural backgrounds. Cultural background can include the beliefs, customs, and behaviors of people from various groups. Gaining cultural competence is a lifelong process of increasing self-awareness ... Cultural Competence or Cultural Humility? Moving Beyond the Debate The concept of cultural humility caught fire in fields including medicine, nursing, public health, community psychology, and social work. Indeed, by 2019, Tervalon and Murray-García's (1998) original article alone had been cited in over 1,500 peer reviewed articles. A wealth of tools including cultural humility trainings, curricula, and a 2012 videotape by health education professor Vivian ... What is cultural competence? Cultural competence is the ability to participate ethically and effectively in personal and professional intercultural settings. It requires knowing and reflecting on one's own cultural values and world view and their implications for making respectful, reflective, and reasoned choices, including the capacity to imagine and collaborate in cross cultural contexts. 'Cultural Competence is for Everyone': Cultural Competence in the 2.3 Cultural competence. Cultural competence can be simply described as the ability to understand the needs and norms of populations different from one's own (Kumasi & Hill, Citation 2013).In a library context, this translates to negotiating differences between a group's norms and library service operations, such as adapting customer service to accommodate groups' differing ways of ... Cultural Competence in Nursing: Addressing the Social Determinants of This definition suggests that cultural competence can occur at the individual nurse level and the macro level of a health care organization's norms and policies. Culture. Culture encompasses the integrated patterns of human behavior, including the language, thoughts, communication styles, actions, customs, beliefs, values, and institutions ... 11: Understanding Civility and Cultural Competence This page titled 11: Understanding Civility and Cultural Competence is shared under a CC BY-SA 4.0 license and was authored, remixed, and/or curated by OpenStax via source content that was edited to the style and standards of the LibreTexts platform. Cultural Competency Program Engages Florida Tech Students Florida Tech is widely recognized for its international diversity and focus on preparing students for success in the global workforce. Central to this commitment is the university's Cultural Competency Certificate, an immersive experiential learning program that cultivates students' awareness, knowledge, and understanding of world cultures, customs, and communities. assignment essay homework phd report review speech thesis