The Role of Cultural Competency in Prevention

Across the United States, about 40 percent of people identify as Black, Indigenous, or People of Color (BIPOC) and 60% identify as white alone, not Hispanic or Latino, according to the U.S. Census Bureau. And our country is getting more and more diverse—by 2050, the Pew Research Center projects that only 47% of the country will be white alone while BIPOC populations will grow their respective shares of the population.

Despite their growing representation in the U.S. population, BIPOC communities continue to face numerous health disparities, and prevention is no exception. BIPOC people face more and worse barriers to accessing care, are more likely to be uninsured, and have worse health outcomes than white people. In Ohio, for example, infant mortality rates are almost three times higher among Black infants than they are for white infants.

At Prevention Action Alliance, we believe that everyone has a role in prevention. We also believe that everyone has a role in combating racism and discrimination. One way you can do your part is to ensure that you deliver culturally competent prevention services.

What Is Cultural Competency?

The Centers for Disease Control and Prevention defines cultural competency in three ways—as a set of behaviors, attitudes, and policies; as a process; and as an integration and transformation of knowledge.

Cultural competency is, according to the CDC, “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.” It’s also a developmental process that evolves over time. As the CDC puts it, both people and organizations are at various stages of a cultural competency continuum. Finally, cultural competence involves integrating and transforming knowledge about cultures into standards, practices, policies, and attitudes to use in appropriate cultural settings.

This last step, integration and transformation, results in delivering better prevention services and getting better prevention outcomes.

In using its definition, the CDC defines competence as the ability to work within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities. The CDC defines cultures as the patterns of behavior of racial, ethnic, or social groups.

According to the CDC and the Community Anti-Drug Coalitions of America, culture includes, but is not limited to:

  • Language
  • Thoughts
  • Communications
  • Actions
  • Customers
  • Beliefs
  • Values
  • Institutions
  • National origin
  • Immigrant/refugee status
  • Education
  • Gender identification
  • Sexual orientation
  • Religion
  • Hobbies and interests
  • Location
  • Housing status
  • Employment
  • Socioeconomic status
  • Health status
  • Substance misuse/mental health status
  • Age
  • Literacy
  • People with disabilities
  • Family structure

The Continuum of Cultural Competency

Research by Terry Cross of the National Indian Child Welfare Association and published in the Journal of Child and Youth Care Work defined cultural competency as a continuum. That continuum ranged from cultural destructiveness to cultural incapacity to cultural blindness to cultural pre-competence to advanced cultural incompetence.

Cultural destructiveness is precisely what it sounds like—a set of attitudes, policies, and practices that harm cultures and their people. Cultural incapacity, Cross wrote, is the inability to help underrepresented communities while maintaining a bias towards them. It’s marked by disproportionate applications of resources, belief in the supremacy of the dominant culture, and discrimination towards Black, Indigenous, and People of Color (BIPOC). Organizations that are culturally blind act as though culture makes no difference and that solutions that worked for one culture are universally applicable. This belief ignores cultural strengths, encourages assimilation, and blames victims for their problems, according to Cross.

On the positive side of the spectrum, cultural pre-competence is marked by the acknowledgment of differences. Culturally pre-competent organizations assess their attitudes, policies, and practices towards culture, and they pay careful attention to cultural differences. At the same time, they work to hire unbiased employees, consult with communities of different cultures, and actively decide what they can and cannot provide to clients from other cultures.

Advanced cultural competence acknowledges and values cultural differences. These organizations contribute to the knowledge base of cultural competence, develop new approaches based on culture, hire staff who specialize in culturally competent prevention, and publish the results of their culturally competent work, according to Cross.

Cross also wrote that “no matter how proficient an agency may become, there will always be room for growth,” implying that even agencies with advanced cultural competence can strive to be even more culturally competent.

Principles of Cultural Competency

According to the CDC, the principles of cultural competence include:

  • 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
  • Institutional cultural competence

It’s also important to note that cultural competency is defined as effectively operating within different cultures. As such, it is different than cultural awareness, cultural sensitivity, or implicit bias training, which don’t have the same emphasis on capacity. Cultural competency might include, but cannot be replaced by, cultural awareness or sensitivity and implicit bias training.

Why Is Cultural Competency Important in Prevention?

Research has found that people from BIPOC communities experience worse behavioral health outcomes than white people.

Because cultural competency focuses on effectively operating within different cultures, being culturally competent has a direct, beneficial effect on the communities you serve. Providing culturally competent prevention services improves the quality of care for those services, according to the CDC. Conversely, providing care that isn’t culturally competent creates disparities in the outcomes.

For those reasons above, cultural competency is a key component of the Strategic Prevention Framework, a process to understand and address substance misuse and related problems in our communities. Alongside sustainability, cultural competence is one of two components of the SPF that must be present throughout the cycle of assessment, capacity, planning, implementation, and evaluation.

As a preventionist, you want what’s best for your community. You learn about evidence-based prevention and work hard to provide equitable services to all in your community. Learning about cultural competency and becoming more culturally competent helps you ensure that you’re providing the best standard of service to everyone in your community.

Learn more about the Strategic Prevention Framework and how to use it with fact sheets and infographics from Prevention Action Alliance.

How Preventionists Can Improve Their Cultural Competency

First and foremost, preventionists who want to improve their or their organization’s cultural competency must realize that learning cultural competency is a process. It takes time, and you can’t put an end date on the process. Cultures change over time and cultural competency must likewise evolve.

Consider starting your cultural competence journey with a self-assessment, such as the one on page 14 of CADCA’s primer on cultural competence. Then, use that self-assessment as a map for how to improve cultural competency in all aspects of your organization.

Next, you need to commit to defining your values and principles, learning about the cultures of the communities you serve, having systematic dialogues with members of the cultures you serve, respecting those cultures’ differences and strengths, adapting your work to the cultural context of your community, and incorporating culturally-appropriate knowledge into your work.

That last item, incorporating these items into all aspects of the organization, is perhaps the most important one. Work to include cultural competency in every part of your organization and its initiatives to ensure that the work you’re doing is reaching those you’re serving in a meaningful and effective way. Consider having all of your staff trained in cultural competency on an ongoing basis to improve outcomes, or working with interpreters and community leaders to foster an open dialogue between you and the community you serve.

Then, you have to make that work a self-improving cycle. Even the most culturally competent people and organizations can become more culturally competent. It is, according to the Substance Abuse and Mental Health Services Administration, “a dynamic, ongoing process that begins with awareness and commitment and evolves into culturally responsive organizational practices.”

It’s also vital to use the Strategic Prevention Framework and that means including cultural competency in every stage of the process. According to CADCA, you can build in cultural competency by, for instance:

  • Collecting data that’s reflective of the community, employing translators who mirror the community, and listening to local experts.
  • Identifying gaps in your coalitions and planning to recruit candidates to fill those.
  • Looking for leaders with strong ties to the community you serve.
  • Selecting interventions that target the root causes of substance misuse.
  • Providing information in ways that match the community’s linguistic needs.
  • Enhancing the skills of coalition members, staff, and volunteers to engage in culturally competent work.
  • Selecting an evaluator with experience working with culturally diverse groups.

For more resources on improving your or your organization’s cultural competency, we recommend: