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Book Review
Transcultural health and social care: Development of culturally competent practitioners
Irena Papadopoulos (ed)
ISBN: 0-443-10131-0 2006 351 pages Churchill Livingstone Elsevier
Jeffrey Fuller
Northern Rivers University Department of Rural Health
University of Sydney and Southern Cross University
Lismore Australia
As suggested in the title, Transcultural Health and Social Care: Development of Culturally Competent Practitioners sets out to help health care workers develop cultural competence. The basis of this edited text is a staged model of cultural competence articulated by the editor (Irena Papadopoulos) and two colleagues (Mary Tilki and Gina Taylor), who are academic nurses from Middlesex University.
The content is presented across twenty chapters in four sections with clear content and learning objectives at the beginning of each chapter and reflective questions at each end. This structure is a useful guide to learning. There are plenty of concept definitions and explanations throughout to provide an adequate understanding of the terms and frameworks used in transcultural health care, which is useful for student health practitioners new to the field.
The first section is theoretically oriented (5 chapters), with chapters covering the Papadopoulus, Tilki and Taylor model of developing cultural competence; UK and European policies related to culturally competent care; and issues pertaining to refugees, ethics and research. Although the theoretical concepts covered are not new, a welcome emphasis is to stress the importance of social and organisational factors on health and health care, in addition to cultural group influences. The staged model of cultural competence presented (awareness, knowledge, sensitivity and competence), is not unique, and others have proposed similar developmental stages, such as in the USA by Campinha-Bacote (1995). The other chapters in this first section, on human rights and policies in the UK and Europe, on refugee issues, on ethics and on research, all provide thoughtful description of relevant concepts, such as on the stages of refugee resettlement and on the limits on autonomy in relation to cultural preference. The focus here is largely towards the UK and Europe, even though many of the concepts covered are universal and currently topical. While the coverage is broad, a student health practitioner would still have to go elsewhere to find tools, such as how to conduct a culturally responsive health care assessment, how to work with interpreters, and how to deal with social, organisational and political factors: such as through working with cultural intermediaries (ethnic health workers) and immigrant community organisations.
Section two is comprised of five chapters pertaining to the work of the editor and colleagues across descriptive research projects with different cultural groups in the UK. The focus of these projects appears to have explored either the meaning and experiences attached to illness of these groups (e.g. about cancer), or how the health needs of these groups might more responsively be met (e.g. for Ethiopian refugees, Welsh minorities, etc.). The content in this section is broadly labelled as cultural-specific competencies, which relate to the specific information needed to work effectively with a particular client. There is a broad range of theoretically useful material in these chapters to stimulate student thinking, such about cancer beliefs, variations in acculturation and adaptation and culturally responsive strategies for the delivery of health information. What remains unclear for the student practitioner, however, is how to move from a set of cultural-generic competencies towards the cultural specific-competencies needed to work with a particular client or group. This is because the cultural specific information mentioned in each chapter was derived from the authors’ research with these groups and it could not be expected that a health care practitioner would be able to obtain this specific information in this way. The chapter on culturally competent health promotion that is needed for minorities in Wales provides some insight into the social and environmental barriers to health care faced by these groups, beyond only cultural explanations, although discussion of relevant institutional and social responses to these barriers is brief.
The final two sections present four chapters on 'European perspectives' (Finland, Germany, Greece and Spain), and four chapters on 'Global perspectives' (Muslim/Arab, Israel, Australia and Canada). These chapters provide historical, political and some religious perspectives on health care in the respective national and cultural contexts. As such, these chapters would be informative to student practitioners who might care for people from such backgrounds. At a basic level, these chapters describe how selected nations have responded at a policy level to population cultural diversity; however, there is no integrative or comparative analysis of the material across these chapters.
References are made throughout the text to seminal works in the fields relevant to transcultural health care (such as Leininger, Good, Hofstede), and in social epidemiology (Marmot, Kawachi); however this material is not readily located, because the chapters are somewhat discrete and, except for the first section, labelled according to cultural or national groupings rather than according to concept themes. Perhaps this is the inevitable limitation of an edited text, but it does make it difficult for a student practitioner to systematically see and work through a range of competencies (as the text set out to do), such as has been done in texts on welfare and health leadership (Cox 1989; Dreachslin 1996), and also in describing specific national health care contexts (Reid and Trompf 1990). The value of the text is that it provides, in one volume, a broad coverage of the topic of transcultural health care with descriptive accounts of various cultural groups and some different national contexts. This gives it suitability as an undergraduate text for student practitioners (such as nursing). With this breadth, however, students will need to search further (as they should), for practical tools (such as culturally responsive health assessment), and for strategies to deal with organisational and institutional responses to cultural diversity.
References
Campinha-Bacote, J. (1995) ‘The quest for cultural competence in nursing care’ Nursing Forum 30(4):19-25.
Cox, D. (1989) Welfare Practice In A Multicultural Society Prentice Hall: Sydney.
Dreachslin, J. (1996) Diversity Leadership Health Administration Press: Chicago.
Reid, J. and Trompf, P. (eds) (1990) The Health of Immigrant Australia. A Social Perspective Harcourt Brace Jovanovich: Sydney.
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