Threshold Concepts

THRESHOLD CONCEPTS FOR DEVELOPING INTERCULTURAL & INDIGENOUS HEALTH COMPETENCE draft

1. Ideas about health, illness and wellbeing are shaped by our cultural influences. What we regard as normal, correct or effective about health care can vary a lot between different cultures. Exclusively Western biomedical models of health care can limit quality and reduce safety for many cultures. Often more holistic models are appropriate, ones that recognise the important influence of spiritual, emotional and cultural dimensions. To be effective health care professionals, we need to balance respect for different cultural health perspectives, while maintaining high professional standards of quality and safety.

2. The current health and wellbeing of some cultural groups, particularly Aboriginal and Torres Strait Islander peoples, is profoundly disadvantaged by current and historical practices. This includes trauma and intergenerational transmission of trauma resulting from practices such as racism, invasion, colonialism, destruction of culture and population, repression of cultural identity, forced dislocation from country and community.

3. Access to health care is a universal human right. Institutional policies or practices that are more suited to dominant cultures can systematically make barriers for some people to access health care. Targeted policies and actions are needed to redress this disadvantage. Our responsibilities as health professionals includes upholding these human rights, by attending to community wellbeing and development, and social determinants of health- as well as immediate individual needs.

4. The attitudes, skills and knowledge needed for intercultural health care largely overlap with 'intracultural' care for the mainstream. Improving competence in intercultural health care will benefits for practitioners (in reducing stress) and cultural groups, not just specific ethnicities.

5. All cultural groups have similarities and differences with other cultures. There are always subgroups that, while sharing some values and practices with the larger group, also having distinctive differences that may be unique to that subgroup's identity. An important example is the diversity of Aboriginal and Torres Strait Islander peoples particularly in terms of culture, language and history.

Quick Quiz 2
{Evidence-based health care is culture free, that is, the dominant Western scientific model applies universally across different cultures. - True. + False.
 * type=""}
 * Not really. What we may call 'evidence-based' health care is the product of a series of culturally influenced decisions. Therefore, culture needs to be acknowledged on both sides of the equation.
 * Good, correct answer! Ideas about health, health care and wellbeing can vary widely according to cultural background. Effective health professionals take cultural factors into account when making decisions.

{Ensuring quality and safety means correcting clients' 'irrational' cultural beliefs about their health. - True. + False.
 * type=""}
 * Sorry, not really. Cultural values tend are very hard to shift, especially in the short term. Therefore the best path is usually to try to work with the client's cultural worldview, wherever possible, while respectfully seeking to persuade them of the best evidence-based approach.
 * Well done! This is the correct answer. Please see above.

{Clients who complain about the effects of historical injustices to their cultural group should just look to the future and stop being so negative. - True. + False.
 * type=""}
 * Incorrect, sorry, this is an unhelpful choice. Please see below.
 * Excellent, this is the correct answer. There is ample and solid evidence to show that historical disadvantages such as cultural decimation and discrimination can have profound continuing effects over generations and impact negatively on current health status.

{Developing awareness and respect for the Human Right to access good health care should be part of every health professional's training. + True. - False.
 * type=""}
 * Yes, you've got it! Often health professionals are the only personal interface between clients and the 'system'. They may not even be aware of their rights, and if we don't represent their interests, there may be no one else in a position to do so.
 * Uh, uh, sorry. Unfortunately there are many instances where this Human Right is not respected in Australia.

{Australian citizens do not have to worry about the human right to access good health care, that is a third world problem. - True. + False.
 * type=""}
 * Bad luck, please see below.
 * Good choice. Many Indigenous Australians do not have adequate access to good quality health care. Highlighting this breach of the UN's Human Rights Declaration is a valid and powerful way to seek positive change to address such health disparities. Human Rights breaches is also a real health concern for immigrants such as asylum seekers.

{Sometimes cultural and spiritual concerns can be just as important as physical symptoms in promoting intercultural health. + True. - False.
 * type=""}
 * Great, you're doing well. While Western scientific medicine has tended to discount such 'intangible', there is growing awareness that these dimensions often interrelate with physical and psychological wellbeing.
 * Not really. Even Western health professionals caring for Western clients increasingly recognise the importance of cultural and spiritual beliefs.

{Becoming an interculturally competent health professional will also have benefits for clients in 'mainstream' Australian culture. + True. - False.
 * type=""}
 * Great, you're doing well. Many intercultural health competencies overlap with general advanced professional abilities such as emotional intelligence.
 * Afraid not. There is a big overlap in the skill sets and insights involved.

{In-depth learning about the Indigenous Australian culture will help health professionals understand how to work with Indigenous people all over Australia. - True. + False.
 * type=""}
 * Not necessarily- but don't worry, this one is a bit more complex and 'grey'. While some cultural features of Indigenous Australians are shared across the country, there are in fact many cultures with highly distinctive identities, languages and stories. Please also see below.
 * This is probably a better response. It will help to know some general, shared cultural values, but there will always be a need to also learn about local or regional values, beliefs and practices. It can be a real trap, for example, to think that an approach that works in Broome will necessarily work in Tasmania. Please also see above.