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Cultural Competency in Medical Research

Cultural Humility

 

Cultural Competency in Medical Research

 In order to understand cultural competency, we should first come to some agreement on a definition. Unfortunately, there is no single, easy to express, definition.  It is of primary importance to realize that the scope of cultural competency is vast and its application not universal. You are not going to be able to attend a lecture, read this blog post, some scholarly articles, and then declare yourself to be culturally competent. All of these things are, however, good starting points to understanding what cultural competency is.  Cultural competency is a journey that will be ongoing throughout your career. It is a discipline that will vary over time. Your levels of competency are influenced by your own personal situation as well as by the populations involved in your research.

Taking all this into account, let’s begin by defining cultural competency. Cultural competency is the process with which we deliberately think about our own cultural influences and the cultural influences of those with whom we will be working. In research it is also the establishment of accommodations that respect cultural diversity and promote autonomy.

Self-reflection & Cultural Humility

This definition lacks the ability to provide a true understanding of what is necessary to become a culturally competent researcher. In order to clarify, we shall begin where every researcher should. A prerequisite to cultural competency is gaining cultural humility. Creating cultural humility should begin long before the onset of a research project.  Researchers begin by reflecting on their own cultural identity and reality. This allows them to honestly assess their own beliefs, practices, and implicit biases. This process of self-reflection is crucial in determining how our personal culture might impact the research process.

Racial Literacy

A large part this identification is for researchers to develop racial literacy. This begins with a recognition of the power inequalities inherent to belonging to a dominant culture. The role of researcher already places you in a higher status than  that of the volunteer subject, even if you share the same or similar culture. This introspective process requires ample amounts of humility and empathy — one cannot hope to gain a deeper understanding of how culture influences others until they are able to understand how racial, social, and cultural norms effect their own behavior. Cultural competency cannot begin without accountability for this first step by each member of a research team.

My Personal Journey

Each individual is going to have a different path to take in gaining cultural competency. My personal journey begun when I had the opportunity to live outside of the US. Embedded in a foreign culture, I often felt awkward and out of place. Personally, as a White, cisgender female, I had not previously had the opportunity to understand what it feels like to be the other. Living in a foreign culture helped me to understand the struggles, frustrations, and anxieties inherent to living outside of the dominate group. This experience helped to open my eyes to the privileges I had grown up with. Through self-reflection, I began to see how this privilege affected my outlook on the world.

Returning to the US, I made a conscious effort to continue to broaden my cultural viewpoint. In the first year of my graduate studies, I volunteered to work with a professors on his research project. This project addresses the concentration of high rates of infant mortality in certain zip codes in and around Indianapolis. The communities are composed of a majority Black/African American and/or lower-income families. This professor has been a wonderful illustration of someone who practices cultural competence. He has displayed this in both the classroom and in research. He incorporates multiple strategies to support participant autonomy. His focus is to minimize the power dynamic inherent to research with vulnerable population. Beginning with the consent process, he has established a dynamic that aims to shift the power balance back toward participants. Working with him and the participants has taught me a great deal about cultural humility. I have learned from them some of the actual impacts of racism on the lives and health of real people.

Cultural Diversity & Implicit Bias

Taking advantage of further opportunities to broaden my knowledge, I participated in a course on culturally responsive teaching. This course is offered here at IUPUI by the Center for the Integration of Research, Teaching, and Learning (CIRTL). It is designed for graduate and post-doc students who will be working in classrooms. The course began by asking us to reflect critically on our own culture.  We then dove into topics that included diversity, equity, and inclusion in the classroom setting. This course helped me to challenge the way I think about cultural diversity. It helped me to recognize how cultural diversity relates to pedagogical practices.

This course also allowed me to gain a better understanding of implicit bias. I learned how a failure to identify and address implicit biases can seep into my interactions with students. I highly encourage everyone reading this post to participate in the Harvard project on implicit bias. Clicking through the surveys the project has posted online are quick, but very insightful. Finding out where your biases are is a key aspect to establishing culturally competent research practices.

Unfortunately, I was witness to an illustration of a professor who lacked understanding of his own implicit biases. He did not appreciate his own privilege privilege or the history of institutionalized racism. (I will not recount the specifics here to protect individuals involved) This lack of insight contributed to actions that demeaned a student of color in a classroom setting. It was a horrifying and absolutely unacceptable depiction of how a lack of knowledge challenges cultural competency.

The intent of this post is to highlight the importance for researchers and educators to begin their own journeys into culturally competency. Following the links provided in the text will provide some starting points. However, the responsibility lies within each individual. Begin with self-reflection. Develop cultural humility. Identify implicit biases. Find a role-model. Be a culturally competent researcher and human!

 

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Author

Heather Anderson

Graduate Assistant, IUSM Center for Bioethics

Heather is currently pursuing a graduate degree of bioethics at IUPUI. She is also a GA in the IUSM Center for Bioethics and the Brand Fellowship for Bioethics recipients for 2019-20.