Cultural and Linguistic Competence

Cultural competence is the ability of an individual or organization to interact effectively with people from different cultures.²⁸ Developing cultural competence is an evolving, dynamic process that takes time and occurs along a continuum.²⁸

For your efforts to prevent or reduce opioid misuse to be effective, you must consider cultural competence at each step of the SPF model—you must understand the cultural context of your target community and have the required skills and resources for working within this context.

Although some people think of culture simply in terms of race or ethnicity, there are many other elements to consider, including age, educational level, socioeconomic status, gender identity, language(s), and cognitive and physical abilities and limitations.³⁴ You must be respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of the diverse population groups in your target community. This means learning more about the community; drawing on community-based values, traditions, and customs; and working with persons from the community to plan, implement, and evaluate your strategies.

What is linguistic competence?

Linguistic competence involves more than having bilingual staff. The National Center for Cultural Competence defines linguistic competence as:³⁵

The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing. Linguistic competency requires organizational and provider capacity to respond effectively to the health and mental health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity.

Linguistic competence includes addressing the communication needs of various groups, including low-literacy groups and people with disabilities. Some approaches to consider:

• Hire bilingual/bicultural or multilingual/multicultural staff
• Offer services and supports in the preferred language and/or mode of delivery of the population served
• Provide foreign language interpretation and translation services that comply with all relevant Federal, state, and local mandates governing language access
• Print materials in easy-to-read, low-literacy, picture, and symbol formats
• Offer sign language interpretation services
• Use TTY and other assistive technology devices
• Offer materials in alternative formats (e.g., audiotape, Braille, enlarged print)
• Adapt how you share information with individuals who experience cognitive disabilities
• Translate legally binding documents (e.g., consent forms, confidentiality and patient rights statements), signage, health education materials, public awareness materials and campaigns
• Use media targeted to particular ethnic groups and in languages other than English—consider TV, radio, the Internet, newspapers, and periodicals
• Engage consumers in evaluating language access and other communication services

Note: Some information in this section was adapted from the guiding values and principles for language access created by the National Center for Cultural Competence.³⁶

Why Practice Cultural Competence?

Cultural and linguistic competence helps to ensure that the needs of all community members are identified and addressed, thereby contributing to the effectiveness of your strategies.

Consider the following examples:

• A community group wants to educate parents of high school students regarding the risks of prescription medications in the home. As Spanish is the primary language of many parents, the group asks a teacher to translate the take-home flyer. However, the teacher’s translation does not use vocabulary and idioms that match the parents’ ethnicity. When the flyer is given to a small group of parents for feedback, they make revisions that increase both the clarity and the usefulness of the information for the school’s Spanish-speaking families.
• A community group is working to reduce opioid overdoses by having outreach workers deliver messages to friends, family members, and individuals who are misusing opioids. At first, the group hires people who are not members of the user community, but these workers don’t connect well with the people they are trying to educate. The group then recruits members of the user community who are in recovery, and trains them to deliver outreach education. This strategy is much more successful.

National Culturally and Linguistically Appropriate Services (CLAS) Standards

In 2000, the Office of Minority Health developed a comprehensive series of guidelines to inform, guide, and facilitate practices related to culturally and linguistically appropriate health services.³⁴ After a public comment period, a systematic literature review, and input from a National Project Advisory Committee, in 2013 the standards were updated and expanded to address the importance of cultural and linguistic competence at every point of contact throughout the health care and health services continuum.³⁷

The 15 standards are organized into one Principal Standard and three themes:

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Resources for implementing the National CLAS Standards are available from the Office of Minority Health’s Think Cultural Health website.