BESAFE Cultural Competency
NMAETC has developed the BESAFE Cultural Competency Model to help health care providers gain a greater understanding and awareness of how culture may influence their attitudes, behaviors, and policies on health care. NMAETC conducts highly interactive BESAFE workshops to increase cultural competency among providers when diagnosing and treating patients. In addition BESAFE workshops build organizational capacity by developing cultural competency plans. The culturally competent health care provider will develop the needed skills and interpersonal capacity to better respond to a diverse patient population.
The BESAFE framework is based on research conducted by Campinha-Bacote (1998) that uses culturally pluralistic content and perspectives based on the 6 core elements to guide providers in caring for patients of all races.
Barriers to Care address real and perceived gaps to providing quality care and the impact of race and ethnicity on each of them. Barriers to Care include:
- Mistrust of medical systems, HIV programs
- Lack of access, no insurance
- Stigmas, lack of awareness about HIV transmission
- Lack of support systems; poverty, crime, violence
- Drug abuse; risk behaviors
- Clinician bias, lack of objectivity
- Stereotyping, racism, homophobia
Ethics addresses the morality of beliefs, values, and behavior. Providers must give priority to professional duty; valuing of different cultures; and issues relevant to honesty, confidentiality, research, death and dying as they relate to HIV/AIDS. Ethics cover:
- Morality, values
- Belief systems
- Behaviors driven by individual experiences and social influences
- Professionals ethic is “to do no harm”
- Truth telling; honoring patient’s perspective and autonomy
- Confidentiality
Sensitivity of the Provider addresses the need for providers to examine their own prejudices and biases toward other cultures and determine where they are along a continuum that ranges from unconscious to conscious competence. It is important that they conduct an in-depth exploration of their own cultural background and work so as to avoid engaging in the phenomena of cultural imposition – the tendency to impose their values on another culture (Leninger 1978). Sensitivity to:
- Examine ones own biases and prejudices: race, ethnicity, sexual orientation, language, gender, etc,
- Explore/know ones cultures
- Avoid cultural imposition
- Create shared understandings and shared context
Assessment addresses the need to be able to collect relevant data regarding patient’s health history and problems in the context of the patient’s cultural background and understanding that patients have a right to have their specific cultural beliefs, values, and practices. Assessment:
- Collects relevant patient information
- Uses systemic appraisal approach
- Presents to the patient in the context of the patients own cultural background
Facts acknowledge that full assessment requires the understanding of physiology, behavior, and the patient’s perception or his/her illness. Providers must design treatment regimens based their mastery of facts such as:
- Biologic variations based on ethnicity, worldviews (metaphorical explanations), and culturally specific behavioral patterns; variations in virologic and immunologic interpretations, HIV sub types
- Variations in drug interactions and efficacy
- Influence of spirituality, discrimination and stigmas, support systems
Encounters address the fact that providers have a duty to achieve effective encounters with all of their patients. When providers are unsure how to proceed, factors such as language, cultural norms, the role of spirituality and concepts of personal space should be discussed during patients’ first visit. Encounters are characterized by:
- Face to face, personal space, eye to eye contact, touch
- Norms, language
Training in the area of Cultural Competency/Fluency may be obtained from NMAETC by accessing our Training Request Form, indicating the particular areas of service desired.