Conceptual framework for the provision of culturally competent services in public health settings.

Abstract: To develop a conceptual framework for the provision of culturally competent services in public health based on literature and expert panel reviews. Public health professionals conducted expert panel reviews for face and content validity of the conceptual framework. Results from the panel and theories from public health literature were used to strengthen the framework. Based on an ecological perspective, the framework consists of systems, sub-systems, concepts, and characteristics, including the context, individual provider, organization, service, and client. This framework is viable for the provision of culturally competent services in a variety of public health settings. Key Words: Cultural Competence, Racial and Ethnic Health Disparities, Service Provision, Public Health Settings, Conceptual Framework Although characterized in a variety of ways, cultural competence, here, is defined as the de sire, skills, and knowledge necessary to enable organizations, systems, and/or individual providers to work effectively and provide services consistent with the cultural context of the client (Thompson, 1998). Cultural competence has been well recognized as an integral part of efforts to reduce racial and ethnic health disparities (Betancourt, Green, & Carrillo, 2002; Brach & Fraserirector, 2000). Current models and frameworks of cultural competence have been developed outside of and applied to the fields of public health as well as health care in general (Suh, 2004; Frusti, Niesen, & Campion, 2003; Miller & Gaston, 2003; Spector, 2002; Purnell, 2002; Papdopoulos & Lees, 2002; Kim-Godwin, Clarke, & Barton, 2001; Callister, 2001; Campbell & Campbell, 1996; Campinha-Bacote, 1994, 1997, 2002, 2003; Davis & Voegtle, 1994; Green, 1995; Jones, Bond, & Cason, 1998; Center for Cross Cultural Health Care, 1997; McPhatter, 1997; Resnicow, Barabowski, Ahluwalia, & Braithwaite, 1999; Rogers, 1995; Siegel, 2000; Weaver, 1999; Wells, 2000; Willis, 1999; Cross, Bazron, Dennis, & Isaacs, 1989). In addition, these models and frameworks have primarily focused on the individual provider, and the Child and Adolescent Service System Program (CASSP) Model of Cultural Competence (Cross et al., 1989) incorporating the individual provider's organization. In public health, there are three core functions, which guide activities to promote and improve health. The first function, assessment, involves collecting, analyzing, and making available data and other information about the health status of clients and the community. In the second function, comprehensive public health policies based on science and knowledge are developed to protect and improve the health of clients and the community. The third function in public health is assurance, where service providers guarantee the necessary public health and healthcare services available to all clients and the community (Institute of Medicine Committee, 1988; Scutchfield & Keck, 1997). These functions reflect the contextual aspects of public health service provision outside of the individual provider and organization. A model of cultural competence for public health should reflect these contextual aspects. Many types of services may be provided across the different public health disciplines. The purpose of the conceptual framework described here is to propose the key systems, sub-systems, concepts, characteristics, and their relationships to each other and the degree to which they may impact service provision in a culturally competent manner within any public health setting. This framework will be useful in designing, implementing, and evaluating culturally competent services in public health settings. METHODOLOGY The literature related to cultural competence was reviewed to determine those aspects identified as being important to the provision and reception of good quality and culturally competent services. Specifically, the following items were reviewed and assessed for theoretical grounding and support from the literature: culturally competent services; guidelines for culturally appropriate services and care; working with culturally diverse clients; quality of services, customer service; customer satisfaction; cultural issues in the areas of nursing, social work, business, and mental health; and theories of health behavior and education. …