that differ, and they may accept a given type of service in a different way. If you are evaluating a program, you should ask if there is evidence that this program is effective with people of different cultures. You can also examine whether it is logical to assert that it would be effective with people of this culture, given what you know about this culture.
Cultural competence is reflected in the selection of your study sample. Is there adequate representation of persons of different cultures? If not, you will have a problem with the generalization of your findings to people of various cultures. In other words, you should not assume that your results will likely be achieved with members of the missing cultures.
Measurement of study variables is another task where culture is important. What tools will you use for this task? How bound are the words on your tools to a specific culture? Different words may have different meanings for people based on their culture.
When you analyze your data, you can examine cultural variables to see if people of different cultures were different regarding the variables in your study. Perhaps people of a certain culture did not achieve a significant gain in anxiety when given your treatment program, but people of other cultures did achieve a significant gain. Without this analysis, you would not know of this differential effect of your treatment.
Sometimes you will have immigrants in your caseload. A variable to include in your analysis is the length of time an immigrant has lived in this country. Those who have recently arrived may be different from those with many years of experience here.
Strategies for Culturally Competent Evaluation
According to the Office of Minority Health in the U.S. Department of Health and Human Services, culture and language may influence several aspects of the services system and the people who are served. One of these is the belief systems people have about health, healing, and wellness. What tells us we are healing? What is wellness? These are beliefs that may differ with regard to culture. Another aspect is how we perceive illness and disease and their causes. To what extent are causes potentially influenced by medical care? A third way in which culture may influence the system are the attitudes of patients toward health care providers. Are these attitudes positive, leading patients to have hope that health care will make a difference. A fourth influence of culture is on the providers who deliver the service, and their own particular values can compromise access to patients from cultures different from that of the providers (Centers for Disease Control and Prevention, 2014).
The Centers for Disease Control and Prevention has offered a set of practice strategies for culturally competent evaluation. These strategies are listed in six categories: (1) engage stakeholders, (2) describe the program, (3) focus on the evaluation design, (4) gather credible evidence, (5) justify conclusions, and (6) ensure use and lessons learned.
A strategy for engaging the stakeholders is to access cultural awareness. This means knowing ourselves and those who are different. Can we, for example, interact genuinely? In this regard, it is important to recognize multiple identities. A given culture does not totally define a given person. What are the different identities that help us understand someone?
Clarifying the nature of the program is a second strategy. In this regard, we need to clarify the stakeholders’ perception of the program. Can we highlight community strengths? Can we use models that resonate with the community?
After completing the program description, the evaluator needs to focus on the evaluation design. This is Step 3. What kind of information do the stakeholders trust? Do they understand the importance of some aspects of the evaluation design that are highly technical? Can these things be explained? Are they important to the stakeholders?
Step 4 is to gather credible information. What counts as credible evidence to the stakeholders? Perhaps the opinions of certain actors are more credible than scientific evidence. In this step, it is important to employ measurement tools that stakeholders understand and consider valid. Are these tools culturally appropriate?
Step 5 is to justify conclusions. This requires the engagement of the stakeholders in the determination of how data will be presented so that it has meaning to them. The technical experts and the stakeholders need to collaborate on this endeavor. This process needs to involve diverse stakeholders in the interpretation of the data.
The final step is to ensure the use of evaluation findings and to share lessons learned. Stakeholders will not use evaluation results that they do not understand or do not find to be useful to what they need to know. In this regard, you need to ensure that recommendations emanate from an inclusive process. You should involve various types of stakeholders in the determination of the recommendations that are warranted from the evaluation results.
Are Social Workers Culturally Competent?
While there are numerous sources of literature on what cultural competence means, why it is important, and how we can demonstrate it in our agencies, there is very little literature regarding the measurement of it. A question that arises for social work is whether social workers are culturally competent. The following paragraphs report on one such study.
Hall (2009) conducted a dissertation that focused on predictors of cultural competence among Masters of Social Work (MSW) students. While she found a number of studies showing that training in cultural competence achieves its learning objectives, she failed to find studies that answered the question of whether social workers (or students) are culturally competent at a reasonable level. This dissertation reported the results of a study of cultural competence among MSW students and recent graduates of MSW programs. A national sample of 186 persons participated. It was found that MSW students and recent graduates had high scores on cultural competence as measured by the Multicultural Competence Inventory. Students in various stages of matriculation (foundation year, advanced year, and recent graduates) were found to have similar levels of cultural competence. One might conclude from this discovery that schools of social work recruit people with high cultural competence.
Another discovery by Hall (2009) was that the personal characteristics of the MSW students were not related to the scores for cultural competence. Educational variables also failed to be related to this competence. One might conclude from the data that persons who enter social work education program tend to possess a high level of cultural competence and that this characteristic tends to be rather uniform, among different types of people.
Rethinking Cultural Competence
Reflecting on the evolution of our attention to the idea of cultural competence, Kirmayer (2012) offered the following observation:
In actual practice, cultural competence in the US has been largely approached through sensitization of clinicians to the social predicaments of these ethnoracial blocs or through efforts at ethnic matching of patient and practitioner. The cultural competence literature tends to treat culture as a matter of group membership (whether self-assigned or ascribed). This assumes that members of a group share certain cultural “traits,” values, beliefs and attitudes that strongly influence or determine clinically relevant behaviour. Unfortunately, this approach tends to reify and essentialize cultures as consisting of more or less fixed sets of characteristics that can be described independently of any individual’s life history or social context—hence the plethora of textbooks with chapters on specific ethnocultural groups. This is an old-fashioned view, now largely abandoned by anthropology. (p. 155)
Contemporary anthropology, according to Kirmayer (2012), emphasizes that culture is not a fixed characteristic of people, either as individuals or as groups. It is an ongoing process of sharing and using knowledge that depends on variables in communities that interface between ethnocultural communities and institutions of
