The Changing Context of Providing Inclusive Health Care in the 21st Century: New Directions for Cultural Competence Training

In the 21st century, cultural competence training of the clinical workforce has become a key approach in English-speaking countries to improve the health outcomes of its culturally and linguistically diverse (CALD) populations. Health care delivery has rests upon the shifting sands of migration, globalisation, environment, demography, morbidity and mortality. Core cultural competence training approaches from the disciplines of public health, allied health, nursing, medicine, psychology and psychiatry were reviewed. A new cultural competence model was developed due to these models: i) using numerous definitions; ii) describing different segments of the cross-cultural interaction between patients and health professionals; iii) lacking description, content and depth; and iv) conflating culture with race and ethnicity. The innovative Continuum Model advocates a 3-step approach to training the clinical health workforce that can be applied in any health care setting. The dynamics of health and ethnicity in the local CALD context are explored, then the mediating influences within and outside culture are examined, and finally strategies to achieving cultural competencies in the clinic are provided. This practical model, implemented since 2010, ultimately demonstrates on how providing patient-centred, culturally sensitive care at a health service in Queensland, Australia can be achieved in other cultural contexts and settings.