Practicing Cultural Humility in Community Health Centers

At AAPCHO, we believe that communities are the experts on their own health. We acknowledge that communities are rich in diversity of language, cultural heritage, spirituality, history, experience, health beliefs, and practices.

Why is cultural humility important for community health centers?

Community health centers provide essential care for underserved, uninsured, and increasingly multicultural communities across the United States and its territories. We believe that it is imperative for all community health center providers, staff, and administrators to provide culturally and linguistically appropriate care — starting with the practice of cultural humility.

In response to the growing need for cultivating inclusivity among the communities health centers serve across the United States and territories, this resource is divided into the following sections:

  1. Understanding Cultural Humility
  2. How is Cultural Humility Practiced?
  3. Resources
  4. Training Opportunities
  5. References

We are proud to partner with Solutions Training and Assistance for Recruitment & Retention (STAR2) Center, Association of Clinicians for the Underserved, and National Health Care for the Homeless Council to provide resources for cultural humility.

For any questions, please contact us at training@aapcho.org.

Understanding Cultural Humility

What is cultural humility?

Cultural humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes. It does not require a mastery of lists of different cultures and particular health beliefs and behaviors (Luluquesen et al., 2009).

The values of cultural humility include openness, appreciation, acceptance, and flexibility. Humility is marked by modesty in behavior, attitude, or spirit. It entails showing patience, gentleness, and moderation about one’s own abilities and values (Lobos & Reyes, 2019).

The principles of cultural humility are 1) lifelong learning and critical self-reflection, 2) recognizing and challenging power imbalances for respectful partnerships, and 3) institutional accountability (Tervalon & Murray Garcia, 1998).

 

How is cultural humility different from cultural competence? 

Cultural humility entails developing a respectful partnership with diverse individuals, groups, and communities. This is different from cultural competence, which is defined as mandates, laws, rules, policies, and “standards” used to increase the quality of interactions (Luluquesen et al., 2009).

While cultural competence is important, it can be difficult to master knowledge of every person’s culture, and sometimes. This can lead to stereotypes, automatic assumptions, and implicit biases.

How is Cultural Humility Practiced?

Community health center providers, staff, and administrators can adopt the following framework and example strategies.

Cultural Humility Framework

Principle #1: Lifelong learning and critical self-reflection

  • Motivational interviewing training for providers and staff
  • Assessments for leadership staff to establish a baseline of personal biases, how patients are viewed, and how staff view leadership

Principle #2: Recognizing and changing power imbalances

Principle #3: Developing institutional accountability

  • Hiring for diversity for clinical and enabling services providers
  • Attracting, recruiting, training, mentoring, and rewarding a diverse workforce to provide culturally aware health care services

Health center participants in the 2019 Building an Inclusive Organization Learning Collaborative hosted by the Solutions Training and Assistance for Recruitment & Retention (STAR2) Center and the Association of Clinicians for the Underserved developed some of the aforementioned example strategies were provided by.

What are your current strategies for each principle in this framework? Send your suggestions to training@aapcho.org and be featured on AAPCHO’s national training resources.

Resources

AAPCHO recommends community health centers to review the following resources to develop and implement policies and procedures that support the practice of cultural humility at the individual and organizational level:

Training Opportunities

AAPCHO offers in-person and virtual “Practicing Cultural Humility in Community Health” workshops for community health centers and community-based organizations. The training program focuses on addressing healthcare workers’ implicit biases through exploration of one’s own lived experiences, resulting in the development of stronger communication skills, empathy, and ability to build respectful partnerships with diverse patient populations. For more information, please contact training@aapcho.org.

Resources

Association of Asian Pacific Community Health Organizations (2009, March). Guiding principles and values. http://www.aapcho.org/wp/wp-content/uploads/2011/07/AAPCHO_GPV_March2009-revlogo.pdf 

Chavez, V. (2012, August 9). Cultural humility: People, principles and practices. YouTube. https://www.youtube.com/watch?v=SaSHLbS1V4w&t=678s 

Lobos, F., & Reyes, K. (2019). Cultural humility: Working in partnership with individuals, families and communities [PowerPoint Slides]. San Mateo County Health, Behavioral Health & Recovery Services. 

Luluquisen, M., Schaff, K., & Galvez, S. (2009). Public health 101 module II: Cultural competency and cultural humility [PowerPoint slides]. Alameda County Public Health Department, Community Assessment Planning & Education Unit. http://www.acphd.org/media/133120/modii_slides_cultural_competency.pdf

Miyagawa, L.A. (2020, March 16). Practicing cultural humility when serving immigrant and refugee communities. EthnoMed. https://ethnomed.org/resource/practicing-cultural-humility-when-serving-immigrant-and-refugee-communities/

Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125.

Tervalon, M. (2013). Cultural humility: People, principles and practices. Melanie Tervalon Consulting. https://melanietervalon.com/wp-content/uploads/2013/08/Cultural-Humility-A-Video.pdf