Providing Culturally Appropriate Care

1. Introduction: What is Culturally Appropriate Care?

Culturally appropriate care (also called ‘culturally competent care’) is about understanding and being sensitive to people’s cultural identity or heritage, especially when arranging or providing care and support. It involves staff working in a person-centred way (see Personalisation chapter), to recognise, consider and respond sensitively to a person’s beliefs or conventions.

Cultural identity or heritage covers different things. For example, it might be based on a person’s ethnicity, nationality or religion, or it might be about their sexuality or gender identity. Lesbian, gay, bisexual and transgender people have their own cultures, as do Deaf people who use British Sign Language. However, it is important to note that people’s cultural identity or heritage may include a number of different cultures; they may identify with more than one.

In order to provide culturally appropriate care, staff must not provide standardised care – which involves giving the same service to everyone – instead they should always adapt their practice and interventions in line with the cultural values of the adult.

2. Why is Culturally Appropriate Care Important?

Care and support which reflects a person’s culture must be at the heart of person-centred care that is delivered by social care staff.

Providing culturally appropriate care will better meet people’s needs and is therefore more likely to achieve positive outcomes for adults and their families; their physical health and emotional wellbeing will also benefit.

When adults are not provided with care and support which is culturally appropriate, they can:

• feel marginalised and discriminated against;
• experience low self esteem and low self confidence;
• have restricted opportunities;
• feel stressed and anxious; and
• experience a loss of rights.

Providing care which recognises and responds to cultural differences also helps build better relationships between social care staff and the adult and their family.

3. Key Considerations in Providing Culturally Appropriate Care

Understanding and communicating well with people from different cultures is an important part of providing person-centred care (see Personalisation chapter).

Everyone is part of a culture, and sometimes a number of different cultures. People are more likely to receive the care and support they need, and experience positive outcomes if their culture is recognised and their cultural needs are met.

It is often easier for people’s cultural needs to be met if they are closer to cultural norms in an organisation, so staff should carefully consider the needs of those who are not so close to these cultural norms.

Providing culturally appropriate care does not require staff to be experts on different cultures, but it does need them to understand how culture can affect aspects of care, and to be open, respectful, and willing to learn.

4. Recognising Cultural Values

Cultural values are the core beliefs in a culture about what is good or right.

All cultures have values. They are informed by the cultures that each person most associates themselves with. These values are neither positive nor negative – they are just differences.

Cultural values can influence the way people treat each other and want others to treat them.

4.1 Differences between and within groups

While different groups can have different cultural values, there can also be differences within groups as well. Therefore, it is important not to make assumptions about people or stereotype them.

Cultural values are not just based on a person’s ethnic background. Other social contexts influence them too – for example profession, age, gender or faith.

4.2 Cultural values are not always visible

We are not always aware of a person’s cultural values. As a result, there may be bias or discrimination; this may be unconscious – when someone does not realise they are being biased or discriminatory.

It is not always easy to see our own cultural values because we take them for granted. But assumptions we may make can be based on them, and therefore can affect other people, especially those who have different cultural values.

4.3 Being sensitive to cultural values makes a difference

When staff are aware of their own cultural values and recognise other people’s, it can have a positive impact on:

• relationships between people using the service and the staff;
• whether people take part in activities;
• how likely it is that people will speak up if they are unhappy about something.

Staff should be aware of their own cultural values and how they might sometimes be different from other people’s. It can help them understand people better.

To ensure a good working relationship between staff and the people they are working with, they should:

• be curious about how people are feeling;
• ask people questions;
• listen without judgement;
• check their own thoughts – try to be aware of assumptions and judgements that could come from bias or stereotypes.

5. Providing Culturally Appropriate Care: Practice Guidance

There are many different aspects and variations in culture. Providing care should always be based on an assessment of a person’s individual needs.

5.1 Key points

Often, small changes make a big difference to people. The most important things for staff to do are:

• Spend time getting to know adults and their families; ask questions especially if you are unsure;
• be curious about what is important to the person, to help them live their fullest lives; every person is different.;
• try to understand and meet people’s preferences, and remember adults are the experts in their own lives;
• do not make assumptions; and
• be aware of your own cultural values and beliefs (see Section 4, Recognising Cultural Values).

 5.2 Providing person centred care which is culturally appropriate

• Look at people’s needs as a whole, including their cultural needs, and protect them from discrimination.

• People, their families and carers should be involved in developing their care plans, and these should  incorporate culturally appropriate care. Again, look at people’s needs as a whole, including identifying their needs on the grounds of equality characteristics (see Equality, Diversity and Human Rights chapter, Section 4.2, Protected characteristics) and looking at how they are met. It also includes finding out about their choices and preferences.

• Staff must support people in culturally sensitive ways. They should recognise when people’s preferences are not being taken on board or properly respected and take action accordingly, by raising it with managers for example.

• When carrying out strengths-based assessments, and developing and reviewing care and support plans, staff should support people to take part in activities that are culturally relevant to them, if they wish to do so.

• Cultural considerations may impact on a person’s decision to take medicines. Such issues should be recorded, and action taken as required.

• Cultural, ethical and religious needs should be taken into account when considering or discussing with diet and drinks. Cultural needs should also be reflected in how premises are decorated, for example.
• If someone lacks capacity for a particular decision, their cultural preferences should be taken into account when applying the Mental Capacity Act – for example, by consulting with people that know them and understand their cultural values, if the person is not able to fully respond.
• Staff should also ensure any cultural needs are also considered when working with carers and family members of an adult with care and support needs.

• In end of life care, people – and their families – should feel their cultural needs have been considered and provided for, as part of the planning process. Their religious beliefs and preferences must be respected.

5.3 Across the local authority

• Leaders, managers and staff should encourage people and their families, with whom they are working, to express their views and any concerns they may have. They should listen and act on such feedback to help shape the service and culture (see also Coproduction chapter).
• Staff should actively promote equality and diversity within the service in which they work.
• Staff should have access to training and learning and development opportunities to help them understand and meet people’s cultural needs. This should be considered as part of supervision and personal development appraisals.
• Staff should also feel that they are treated equally. The local authority should make sure it hears the voices of all staff and acts on them to help shape the service and culture.

See also Examples of Culturally Appropriate Care – Care Quality Commission for more detailed examples of ways care can be adapted to reflect cultural differences around:

• religious or spiritual practice, including planning care and support around religious festivals;
• food and drink;
• healthcare;
• clothes and personal presentation;
• personal and shared space;
• shared activities;
• relationships and community connections.

6. Further Reading

6.1 Relevant chapters

Personalisation

Equality, Diversity and Human Rights

6.2 Relevant information

Culturally Appropriate Care (Care Quality Commission)  

People’s Experience in Adult Social Care Services: Improving the Experience of Care and Support for People using Adult Social Care Services (NICE)