A cisgender person's gender identity (and often gender expression) matches the sex they were assigned at birth (American Psychological Association, 2019).
Class is determined by the amount of wealth a person has access to through family support, inheritance, property, investments and is not limited to wage-earning (Louisiana State University, 2020).
Colorblindness is defined as the process by which a person attempts to ignore the existence of race or skin color in service of seeing past race and just seeing the person (Apfelbaum et al., 2012).
Race is a component intertwined with everyday life, and it would be naïve to assume it doesn't play a major part.
However, this deemphasizing of race ignores the actual lived experience of people of color in the U.S.
Culture is a set of shared languages, ideas, customs, traditions, beliefs, and practices shared by a group of people (American Sociological Association, 2021).
What are culture and individual identity?
Client-centered practice dictates that we treat each client as a unique being. Some important ideas to keep in mind in cross-cultural interactions are the following:
Culture is dynamic and complex and is influenced by outside forces such as technology and globalization.
Culture influences one’s identity, but identity is multilayered and is derived from multiple sources. A client typically holds multiple identities based on life circumstances and experiences. These identities stem from affiliations to family, community, profession, religion, nation, and others.
A client’s identity is a product of intersections of race/ethnicity, education, socioeconomic class, sex, age, sexual orientation, (dis)ability, religion, etc.
What are terms and definitions that represent multicultural responsiveness?
Cultural humility
Cultural humility is an attitude and process by which providers strive to address issues of power differences between professionals and clients, value and respect clients by continuous engagement in self-reflection, and self-critique as life-long learners and reflective practitioners. (Penn State College of Medicine, 2021)
Cultural intelligence
Cultural intelligence is the ability to interact effectively with culturally different clients, and it relies on cultural metacognition—knowledge of your own attitudes, values, and skills, and those of the clients, makes for an effective encounter. (Mangla, 2021)
Cultural responsiveness Cultural responsiveness is about reciprocity, respect, and mutuality. It involves exploring differences, being open to valuing clients’ knowledge and expertise, and recognizing the unique cultural identity of each individual client. (Fong, 2017)
Culture safety Cultural safety recognizes the barriers to clinical effectiveness that occurs from a power imbalance between provider and patient. Cultural safety is a sociopolitical idea about the unconscious and unspoken assumptions of power held by health providers of groups that have been historically marginalized. It is about the trust and safety experienced by a client when treated with respect and understanding and is included in the decision-making process.
Cultural safety requires that as health practitioners we examine ourselves and the potential impact of our own culture on clinical interactions. This requires that we question what we bring to the table that could decrease the quality of healthcare for our patients and exam our own personal biases, attitudes, beliefs, stereotypes, and prejudices to reduce bias and achieve healthcare equity. (Jones & Tipene-Leach, 2019)
What are the influential theories relevant to culture?
The familiar image of culture as an iceberg shows that the important and deeper meanings of culture are hidden from view. Culture shapes our beliefs and world view. Values are at the core of differences in cultural beliefs, attitudes, and behaviors. The following are some dominant and influential theories.
Schwartz’s Theory of Basic Values identifies ten core universal values that are common to all cultures, with defining goals and behaviors that are essential for human survival and existence as socially organized groups. (Australian National University, 2020) The differences between cultures lie in how these values are prioritized and the behaviors they elicit.
Hofstede’s Cultural Dimensions Theory (2021) provides a systematic framework for six cultural dimensions shared by all cultures:
Power Distance (equality versus hierarchy)
Individualism (individual freedoms versus collective responsibilities)
Uncertainty Avoidance (informal versus formal)
Masculinity (competition versus collaboration)
Time Orientation (short-term versus long-term)
Indulgence (free gratification versus restraint)
American anthropologist and cross-cultural researcher, Dr. Edward Hall classified cultures on the basis of communication as high-context (HC) cultures and low-context (LC) cultures. The communication style of HC culture is indirect and meaning is implicit. Communication in LC culture is direct and explicit. (Neuliep, 2017) The U.S. is a low-context culture.
It is best to view these cultural characteristics as lying along a continuum rather than as polar opposites. For example, it is the relative degrees of individualism versus collectivism that differentiates cultural groups. Individuals from a collectivist culture are still individuals, but the degree to which they factor others into their decisions is different from those from a strong individualistic perspective.
What are the implications for practice?
How do we use our knowledge, skills, and attitudes to provide culturally responsive and culturally effective care?
Knowledge about key cultural characteristics is helpful, but it is important to know that over time people are acculturated and socialized to the larger context and dominant ways of doing and being.
Acculturation is a process in which members of one cultural group adopt the beliefs and behaviors of another group. (Berry, 2019) The extent to which individuals become acculturated varies; social integration requires a certain degree of acculturation from diverse cultural groups as well as an inclusive attitude by the dominant social groups.
References
Australian National University. (2020). Values: Schwartz theory of basic values | ANU. ANU | Integration and implementation sciences (I2S) is a discipline providing concepts and methods for conducting research on complex real-world problems. https://i2s.anu.edu.au/resources/schwartz-theory-basic-values
Berry, J. (2019). Acculturation: A personal journey across cultures (elements in psychology and culture). Cambridge: Cambridge University Press. https://doi.org/10.1017/9781108589666
Curtis, E., Jones, R., Tipene-Leach, D. et al. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 18, 174. https://doi.org/10.1186/s12939-019-1082-3
Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing cultural understanding and diversity in applied behavior analysis. Behavior Analysis: Research and Practice, 17(2), 103-113. https://dx.doi.org/10.1037/bar0000076
Hofstede Insights. (2021). National culture. https://hi.hofstede-insights.com/national-culture
Mangla N. (2021). Working in a pandemic and post-pandemic period–Cultural intelligence is the key. International Journal of Cross Cultural Management, 21(1), 53-69. https://doi.org/10.1177/14705958211002877
Neuliep, J. W. (2017). Intercultural communication: A contextual approach (7th ed., international student ed.). Sage.
Penn State College of Medicine Faculty and Staff Resources. (2021, June 15). Diversity, equity and belonging. Author. https://faculty.med.psu.edu/resources/diversity/#topic-diversityglossary
Cultural awareness is the recognition and conscious observation of the similarities and differences between cultures (National Center for Cultural Competence, n.d.).
Cultural humility emphasizes humble and empathetic communication with clients and reduces reliance on bias or implicit assumptions, and instead encourages intentional listening and openness to various cultures (AOTA, 2020).
Disability culture represents a social identity of empowerment and awareness of mental and physical disabilities and challenges societal norms and medical and institutional oppression. Disability culture accepts human differences, vulnerability, and interdependence (AOTA, 2021).
Diversity is broadly defined as the unique attributes, values, and beliefs that make up an individual (Taff & Blash, 2017) when compared with the context of a group or population. Diversity comes in many forms, including, but not limited to, socioeconomic status, race, sex, ethnicity, age, disability, sexual orientation, gender identity, and religious beliefs (AOTA, 2020).
Equity is an approach that ensures everyone is given an equal opportunity; this means that resources may be divided and shared unequally to make sure that each person can access an opportunity. Equity considers that people have different access to resources because of a system of oppression and privilege. Equity seeks to balance that disparity. "Equity is often confused with equality; however, they are significantly different. Equality ensures that everyone receives the same benefit or consequence" (AOTA, 2020).
Gender identity refers to the internal perception of one's gender and how a person labels oneself. It can correlate with or differ from a person's assigned sex at birth (HRC, 2020).
Generalizations are defined as "statements about common trends within a group, but with the recognition that further information is needed to ascertain whether the generalization applies to a particular person" (Galanti, 2000).
These statements are not necessarily negative and can be helpful and intended to guide people in their actions.
Usually qualified by words such as "often," "sometimes," and "may."
"Inclusion is the acceptance and support of diversity wherein the uniqueness of beliefs, values, and attributes is welcomed, valued, and leveraged for maximum engagement" (Taff & Blash, 2017).
"Inclusion is not simply tolerance. [It] inherently embraces the value of all individuals and is the active response to diversity by fostering acceptance, respect, belonging, and value for everyone. To support diversity, inclusion must be actively pursued" (AOTA, 2020).
Intersectionality is defined as the interconnected nature of identities such as race, class, and gender and the interdependent systems of power and privilege that result from the interconnectedness (Perlman, 2018).
For example, a heterosexual black female-identified person may experience power and privilege differently than a queer black female-identified person or a heterosexual white female-identified person.
Microaggressions are defined as often unconscious everyday behaviors that denigrate someone from a historically marginalized or non-dominant group (Sue et al., 2007).
They are small, but if experienced chronically, a person can feel "death by a thousand tiny cuts."
As developed and defined by Ramugondo (2015), occupational consciousness is the "ongoing awareness of the dynamics of hegemony [the social, cultural, ideological, or economic influence exerted by a dominant group], and recognition that dominant practices are sustained through what people do every day, with implications for personal and collective health" (p. 488).
Occupational alienation — When people lack control over their occupations and experience meaninglessness or purposelessness (Hocking et al., 2011).
Occupational deprivation — When people are denied access to occupation over an extended time, with negative consequences for health & well-being (Hocking et al., 2011).
Occupational marginalization — When people's need to exert choices and decision-making power as they participate in occupations is hindered (Adapted from Townsend & Wilcock, 2004).
Occupational imbalance — Imbalance speaks to being occupied too much or too little to experience meaning and empowerment (Townsend & Wilcock, 2004).
Occupational apartheid — Depriving individuals, groups, and communities of meaningful and purposeful activity through segregation due to social, political, and economic factors and social status reasons (Simo-Algado et al., 2002).
Occupational justice refers to the right of all individuals to participate and have equity in occupational choice to increase their well-being (AOTA, 2020).
People of color include U.S. citizens who do not identify only as White under the current U.S. Census ethnicity categories (Raypole, 2020).
Privilege is access to resources (social power) that are only readily available to some people because of their social group membership; it is an advantage or immunity granted to or enjoyed by one societal group above and beyond the common advantage of all other groups (National Conference for Community and Justice [NCCJ], 2021).
The term race has many definitions (Zevallos, 2017).
Many individuals believe that race is physical and biological differences between other groups and cultures (e.g., skin color).
Other individuals, such as sociologists, define race as a false construct that historically and currently conflates skin color and ancestry with behavior and culture.
This concept and perspective of race illustrate that the term evolved from an intent to create division.
Race, and its social existence, is widely held assumption and has real consequences for all people.
Romantic orientation is an affinity for someone that evokes the desire to engage in an emotionally intimate relationship.
Sex is a term used to refer to the chromosomal, hormonal, and anatomical characteristics used to classify individuals as male, female, or intersex.
Sexual orientation is the type of attraction one feels for others, often labeled based on the gender relationship between the person and the people to whom they are attracted.
Stereotypes are defined as oversimplified ideas we hold about a person based on their identity (Galanti, 2000).
Usually, stereotypes are based on assumptions, popular opinion, or misinformation, are generally negative, are sweeping and simple, and are often characterized by "always" and "never."
Defined as systems of power in a society that advantage certain groups over others and include ideologies such as racism, sexism, heterosexism, etc. (collectively "the isms") (Shlasko, 2015).
A transgender person's gender identity (and sometimes expression) does not align with the sex they were assigned at birth. "Trans" is an umbrella term that refers to various ways people transgress gender norms (University of Florida, 2017) .
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Hocking, C., Merritt, B., Patterson, M., & Thibeault, R. (2011). International advisory group: Human rights and educating occupational therapists. Poster presented at the Canadian Society of Occupational Science Conference.
Raypole, C. (2020, September 17). Yes, there’s a difference between ‘BIPOC’ and ‘POC’ — Here’s why it matters. Healthline. https://www.healthline.com/health/bipoc-meaning
Shlasko, D. (2015). Using the five faces of oppression to teach about interlocking systems of oppression. Equity & Excellence in Education, 48(3), 349-360. https://doi.org/10.1080/10665684.2015.1057061
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Wilcock, A. A., & Townsend, E. A. (2009). Occupational justice. In E. B. Crepeau, E. S. Cohn, & B. A. Boyt Schell (Eds.), Willard & Spackman’s occupational therapy (11th ed., pp. 192-199). Lippincott Williams & Wilkins
