Commentary
Teaching health care students about disability within a cultural competency context

https://doi.org/10.1016/j.dhjo.2013.05.002Get rights and content

Abstract

The training of health care providers has been identified as key to resolving the health disparities experienced by persons with disabilities. We contend that: 1) cultural competency provides a useful conceptual framework for teaching disability-related content to health professions students; 2) educational experiences can be structured to reflect the socio-cultural complexity of the ‘disability culture;’ 3) desired competencies associated with culture can be defined with regard to professionals' approach to patients with disabilities; 4) exposure to persons who have disabilities in their homes allows the student to make connections between the nuances of daily life with a disability and one's health care needs; 5) the framework allows the disability culture to be integrated with other cultural contexts, including race and ethnicity; and 6) the framework acknowledges the potential impact of providers' conscious or unconscious recognition of their potential membership in the disability culture on their approach to patients with disabilities.

Section snippets

Application of cultural competency principles

There has been considerable progress in the incorporation of cultural competency curricula and experiences into health care training programs. Over 90% of medical schools in the United States now include cultural competence training in their curricula. The American Association of Colleges of Nursing (AACN) has established cultural competencies for baccalaureate, master's and doctoral nursing programs.22, 23 Such training has been found to improve health care provider students' knowledge,

Disability-related competencies

Eddey and Robey5 applied an existing multidimensional model of cultural competency, proposed by Flores,36 in delineating competencies that are necessary to serve persons with disabilities effectively. Specifically, they called for medical schools to incorporate into their curricula the means to build competencies with regard to the “culture of disability” in the areas of communication issues, patient and family beliefs about health care, “folk” or nontraditional treatments, provider practices,

Cultural exposure

In order to develop and foster an understanding of other cultures, proponents of cultural competency training often prescribe the need for direct and substantial exposure to members of those cultures for meaningful one-on-one exchange with the cultures' members.55 The same holds true for building the skills in cultural competence in practice with persons with disabilities. Studies suggest that exposure to persons with disabilities does change attitudes that might contribute to poor health care,

Multiple cultural influences

As with any cultural training, students should be encouraged to consider multiple simultaneous cultural influences, viewing the culture of disability as only one of a number of sources of cultural influence on the individual. The culture of disability cuts across all other cultural boundaries and, as such, the individual will also be influenced by cultural memberships based on gender, race and ethnicity, socioeconomic background, age, and/or sexuality and sexual orientation.64

In describing the

Disability culture and the “possible me”

Unlike membership in cultures based on ethnicity or race, membership in the disability culture is not necessarily attributable at birth. For some individuals, it is one that is acquired at some later point in life, either suddenly or gradually, and incorporated over time into an already existing set of cultural memberships. As some degree of disability is typically associated with the aging process, its addition to one's set of cultural memberships is likely. Health care providers may be aware,

Conclusion

While we have argued that a cultural competency approach is well suited as a framework for teaching students about disability, we also recognized earlier that the predominant view of cultural competency at present is that it is a framework for teaching students about cultural influences associated with race and ethnicity. This well-entrenched view of cultural competency might, in some instances, be an obstacle to the educator who lobbies to have disability-related experiences formally

Summary of key points

  • Cultural competence provides one conceptual framework through which disability-related content and experiences can be understood and presented in health care education.

  • Competencies can be identified with regard to the health care professional's approach to the individual who has a disability.

  • Exposure to persons with disabilities in their homes or other “natural” settings is critical to an understanding of the “culture of disability,” of the nuances of daily life with a disability, and of the

Acknowledgments

The authors wish to acknowledge the comments and suggestions that were provided by the members of the Alliance for Disability in Health Care Education on various drafts of this paper. In particular, the authors acknowledge the contribution of Alliance member Ingrid Masterton, P.T., M.S.P.T. whose thoughtful critique prompted the inclusion of the “possible me” section of the paper. The Alliance for Disability in Health Care Education is a collaborative network of health care educators promoting

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    The authors have no conflicts of interest associated with this manuscript, and no funding is associated with this work.

    Some of the concepts in this paper were presented at the 2011 Conference on Inequity to Equity: Health Care and Women with Disabilities, American Psychological Association, Washington, DC, USA.

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