Cultural competence and understanding

Key messages for primary care practitioners

Health beliefs and values vary between cultures, and between individuals within those cultures, and can impact both on health and behaviour in relation to health and health services.
Understanding differences in health beliefs and values between the practitioner and the patient is necessary to achieve desired health goals for any patient. For patients from cultures unfamiliar to the practitioner these differences may require more exploration.
It is valuable for practitioners to familiarise themselves with the cultural background of their patients. It is however preferable not to make assumptions about any individual’s health beliefs or values on the basis of their cultural background. Ask them about their own understanding and concerns.

Beliefs about health and illness and health associated values can vary considerably, both between individuals in any given cultural group and between cultures. These differences in turn influence behaviour, including health seeking behaviour on the part of patients, and interpretation and diagnosis by health care practitioners.

Many factors are linked to people's cultural perspectives including their ethnicity and place of origin, education, religion, values, gender, age, family and social status. When dealing with any patient, even one who shares your broad culture, it is very important to recognise that their beliefs and values about health and healthcare may be quite different to your own. Exploring differences in understanding is necessary to achieve a desired health goal. It is also important to explain the National Health Service to new patients.

With regard to patients whose cultural background differs to your own, you may find that, in order to fully understand their perspective you have to ask more questions. Although learning through books or courses will be helpful in understanding different cultural perspectives on health, general beliefs, particularly cultures, may not apply to the specific patient you are dealing with. It is preferable not to make assumptions about anyone's beliefs or values, no matter what culture they belong to. Instead to ask them about their own understanding and about what is important to them regarding their health issues, and why. Establish what is acceptable to them in terms of diagnostic investigations, or proposed treatments.

All practitioners should also be very aware of their own prejudices, beliefs and assumptions, which they may bring to their professional encounters. Working with patients from different cultures is an opportunity for practitioners to learn and broaden their own understanding of the human condition.

Useful resources

Newham language shop cultural profiles [external link]

e-GP online e-learning resource [external link] for NHS General Practitioners and doctors undertaking specialty training for UK general practice, jointly developed by the Royal College of General Practitioners and e-Learning for Healthcare

Transcultural Health Care Practice: An educational resource for nurses and health care practitioners [external link] available on the Royal College of Nursing website

Black and minority ethnic groups health needs assessment chapter [external link] by PS Gill, J Kai, RS Bhopal and S Wild

Culture, Health and Illness, 4th edition. By Cecil G Helman. London, Arnold. 2000