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Why it works

Culturally Connected is an approach that brings together cultural humility and health literacy to help care providers and their clients develop shared understanding of each other's values, beliefs, needs, and priorities.

Cultural humility is a perspective that involves practicing lifelong learning, exercising self-reflection and critique, recognizing the dynamics of power and priviledge, and being comfortable with not knowing. Health literacy is a person's ability to access, understand, use, and evaluate health information and services to make decisions about their health and well-being. When health literacy and cultural humility are mutually supported, there is greater potential for care providers to develop shared understanding, to communicate clearly, and to cultivate respectful partnerships with clients.

While developed to support care providers working in the health sector, the Culturally Connected approach and its fundamental practices and tools are also valuable to those working in other sectors, including education and settlement.

Cultural humility is a perspective that involves practicing lifelong learning, exercising self-reflection and critique, recognizing the dynamics of power and priviledge, and being comfortable with not knowing. Health literacy is a person's ability to access, understand, use, and evaluate health information and services to make decisions about their health and well-being. When health literacy and cultural humility are mutually supported, there is greater potential for care providers to develop shared understanding, to communicate clearly, and to cultivate respectful partnerships with clients.

While developed to support care providers working in the health sector, the Culturally Connected approach and its fundamental practices and tools are also valuable to those working in other sectors, including education and settlement.

About
Culturally Connected












Some Aspects of Culture

What is Culture?

Understanding culture is foundational to the Culturally Connected approach. Culture is our way of living. It is complex, dynamic, continually evolving, and constantly influenced by our experiences. The concept of culture includes many different aspects such as age, ethnicity, gender, and gender expression, religion, socio-economic status, etc. There are many different expressions of culture – be it in art, science, humour, law, and sport, just to name a few.

As care providers, it is important to consider culture when approaching our interactions. Culture is central to how people develop and grow, and how we view both ourselves and others. Clients have their own expectations, experiences, beliefs, and communication styles in the same way that care providers have their own assumptions, previous experiences, as well their own knowledge of health and the health system.
Culture influences—but doesn’t determine—our behaviour and our understanding of other people’s behaviour.

It’s also important to consider culture beyond an individual level and reflect on how it exists within groups, organizations and societies. The culture of an environment shapes and influences everyone involved.

An understanding of the definition of culture informs the components of the Culturally Connected approach: cultural humility and health literacy.
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Cultural Safety

Culturally unsafe practices involve any actions that diminish, demean, or disempower the cultural identity and well-being of an individual. Creating a culturally safe practice involves working to create a safe space that is sensitive and responsive to a client’s social, political, linguistic, economic, and spiritual realities. Ultimately, adopting a cultural humility perspective is one of the most effective ways to enable cultural safety - one that will help clients feel safe receiving and accessing care.

Cultural Humility

A cultural humility perspective requires a commitment to lifelong learning, exercising self-reflection and critique, being comfortable with not knowing, and recognizing the dynamics of power and privilege.

Cultural humility involves examining your own values, beliefs, experiences, and biases through self-reflection and lifelong inquiry, and being curious and open to learning about clients’ values, beliefs, and experiences in order to develop mutual understanding, successful partnerships, and cultural safety.

References
Cultural Humility

Indigenous Cultural Safety & Cultural Humility

To address Canada’s legacy of colonization with Indigenous Peoples, executive leaders from British Columbia's five regional health authorities, two provincial health authorities, and the deputy minister for the Ministry of Health signed a Declaration of Commitment to Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal Peoples on July 16, 2015. The Declaration of Commitment recognizes that: Cultural humility builds mutual trust and respect and enables cultural safety; Cultural safety is defined by each individual client's health service experience; Cultural safety must be understood, embraced, and practiced at all levels of the health system including governance, health organizations, and within individual professional practice.

Representatives of the province’s health regulators, including the College of Physicians and Surgeons and the College of Registered Nurses of British Columbia, signed and declared their commitment to making the health services culturally safe for First Nations and Aboriginal Peoples on March 1, 2017. These commitments explicitly recognize that this work is everyone’s responsibility.

To explore cultural humility and cultural safety in working with Indigenous Peoples, two important BC resources are available: the San’yas Indigenous Cultural Safety Training Program and the First Nations Health Authority, and BC Patient Safety & Quality Council's Cultural Safety and Cultural Humility Webinar Action Series.

The San’yas Indigenous Cultural Safety Training Program (ICS)is a facilitated online training program designed to enhance awareness regarding Indigenous people and their history and to strengthen the skills of those who work both directly and indirectly with Aboriginal people.

The First Nations Health Authority and BC Patient Safety & Quality Council Cultural Safety and Cultural Humility Webinar Action Series shares how to be effective allies for advancing cultural safety and humility and what health service staff and allies can do to understand and integrate this work into their practice or interaction with First Nations and Aboriginal Clients.












Health Literacy

Health Literacy

Health literacy is a person's ability to access, understand, evaluate, and use health information and services to make decisions about their health and well-being; as such, it directly impacts an individual’s health outcomes. Individual and systemic barriers exist that can make it difficult for a person to have the skills required to be health literate. Individual barriers may include low levels of education, difficulty understanding the language services are being offered in, living with a disability, social stigma or feeling embarrassed or ashamed to ask questions or go to the doctor, among many others. Systemic barriers to health literacy relate to education, community, health and other services that affect health and well-being.

Care providers play an important role in supporting the health literacy of individuals and health system users. Care providers can support health literacy by communicating information in ways that improve a client’s understanding and ability to act on health information they receive. Improving health literacy can contribute to better client safety and care, better understanding of the health system, increased health promotion and prevention, and improved quality of life.

Communication can break down when there is a gap between what is said (the intent) and what is heard or understood (the impact). Both care providers and clients use their unique histories, cultures, and assumptions as filters to communicate and understand information. Because everyone's filters differ, gaps in communiation and understanding can occur.

Many factors influence communication and health literacy when care providers meet with clients and families. Factors like time constraints, complex health information, language barriers, and power inequities impact the ability to communicate successfully. Health literacy can be improved by supporting the skills of individuals and clients and by reducing barriers within the health system.

References
By working from a cultural humility perspective and by supporting health literacy, care providers can develop mutual understanding with their clients.

Culturally Connected

Cultural humility can lead to mutual empowerment, respect, partnerships, optimal care, and lifelong learning. Ultimately, the aim of a cultural humility perspective is to generate cultural safety. Health literacy can be improved by supporting the skills of individuals and by reducing barriers created by health professionals and the health system. A Culturally Connected approach combines the principles and techniques of health literacy with the respectful perspective of cultural humility to help clients and care providers work together to develop a shared understanding of each other’s values, beliefs, needs, and priorities.

Cultural humililty and health literacy are complementary. When health literacy and cultural humility are supported at the same time, there is greater potential for care providers to develop shared understanding, to communicate clearly, and to cultivate respectful partnerships with clients. Individually, health literacy and cultural humility both provide helpful ways to communicate and engage with clients, but when mutually supported, the complex factors which influence an individual’s understanding, evaluation, and use of health information are considered.

Using the Culturally Connected approach in practice means adopting a cultural humility perspective toward others – being open, curious, reflective, questioning - and using various health literacy tools and techniques.

Being Culturally Connected

This resource provides you with the fundamental practices and tools to support cultural humility and health literacy with clients. Two case study videos help demonstrate how the Culturally Connected approach can be applied in practice. In each case, we see a care provider being responsive to their situation and encounter with a client – drawing on the fundamental practices and tools that best support the situation.

Case 1: Supporting a Newcomer Client Experiencing Challenges Settling into a New City

This case looks at a meeting between Kerri, a counselor at a newcomer health clinic, and Marcela, a recent immigrant struggling to settle into a new city. In it, we’ll consider how Kerri uses a CulturallyConnected approach to support mutual understanding and the development of a respectful relationship.

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Featured fundamentals and tools

Case 2: Supporting a Family's Decision around Care Plans

This case features a meeting between Caroline, a nurse practitioner; Ramon, an 11 year old boy; and Ramon’s parents. In their meeting, Caroline demonstrates the use of a CulturallyConnected approach to support shared understanding and the development of an acceptable care plan for Ramon.

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Featured fundamentals and tools
While each case highlights a few key learnings, you can read more about all the fundamental practices and tools that are inherent to a Culturally Connected approach below.

Fundamental Practices

Communication and understanding between clients and care providers can be enhanced by applying the fundamental practices of the Culturally Connected approach. In addition to adopting the four main components of cultural humility, care providers can use fundamental health literacy strategies to ensure clear communication and understanding.

Practice lifelong learning

Understanding yourself and the clients you work with is a lifelong process. Foster curiosity and growth through opportunities to reflect, learn, and better understand yourself and others.

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Exercise self-reflection and critique

Take time to reflect on your personal history and biases to help you become more aware of the ideas and assumptions you hold about yourself and others.

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Recognize the dynamics of power and privilege

Recognize the power and privilege you have as a result of your expert knowledge, skills, and access to resources, and reflect on the impact this power can have on your interactions with clients.

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Be comfortable with not knowing

Balance your own expert knowledge as a care provider with an openness to learn from clients and their experiences.

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Communicate clearly

Everyone benefits from clear information. Plain language is a way of writing and speaking that delivers information clearly so that it is understood by those who need and use the information.

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Use appropriate body language

Body language plays a key role in communication. Consider eye contact and the use of touch and space when interacting with clients.

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Use visuals

The use of visuals can improve the accessibility of information and are often very helpful in communicating health information.

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Tools

The tools are strategies and techniques that support a Culturally Connected approach. Care providers can experiment with these tools to see which ones are helpful with different clients and situations.

L.E.A.R.N.

L.E.A.R.N. is a communication tool that can be used to improve communication, enhance awareness of personal and cultural beliefs, and help determine acceptable care plans.

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Teach-back

Giving clients an opportunity to 'teach it back to you' in their own words is a great way to ensure comprehension and understanding.

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Kleinman's Explanatory Model

Psychiatrist and anthropologist Arthur Kleinman suggests that care providers ask their clients questions to gain insight into the client’s worldview, culture, social context, and spirituality. Exploring what is most important to clients can help build a trusting relationship between clients and care providers.

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Ask Me 3™

Ask Me 3™ is an exercise that helps you anticipate the type of questions a client will want answers to.

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D.I.V.E.R.S.E.

D.I.V.E.R.S.E. is a tool that can be used to develop a personalized care plan incorporating a client’s values and beliefs.

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SHARE

SHARE is a five-step process for shared decision making through meaningful conversation.

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Tips for Working with Interpreters

Care providers can use several strategies to help ensure a successful interaction when working with interpreters.

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