Cultural Humility

Definitions

The term cultural humility was first coined in 1998 by Dr. Melanie Tervalon and Dr. Jann Murray-García, who originally described it as a tool to educate physicians to work with culturally, ethnically, and racially diverse populations in the United States. Originally developed to address health disparities and institutional inequities in medicine, cultural humility is now applied in a variety of health services fields. Three Things to Know: Cultural Humility

Cultural humility has been defined as “a lifelong process of self-reflection and self-critique whereby the individual not only learns about another’s culture, but one starts with an examination of her/his own beliefs and cultural identities.”
(Yaeger & Bauer-Wu, 2013)

Other definitions of cultural humility include the following:

The “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person].”
(Hook et al., 2013)

“A practice of self-reflection on how one’s own background and the background of others, impact teaching, learning, research, creative activity, engagement, leadership, etc.”
What is Cultural Humility: The Basics

According to Tervalon and Murray-Garcia (1988), cultural humility has three aspects (a) a lifelong commitment to self-evaluation and self-critique; (b) a desire to fix power imbalances; and (c) a wish to develop partnerships with people and groups who advocate for others.

A lifelong commitment to self-evaluation and self-critique is based on understanding that one is never finished learning; therefore, one must be willing to look at oneself critically and then act on the knowledge gained. This involves self-reflection on how one’s own background affects one’s feeling, attitudes, and behaviors. A desire to fix power imbalances involves recognizing that each person brings something different to an interaction and has something valuable to contribute; therefore, individuals must collaborate and learn from each other for the best outcomes. It means committing to work both individually and with others to end unjust power imbalances. Attaining cultural humility also includes developing partnerships with people and groups who advocate for others; thus, it is necessary to become aware not only of one’s own values, beliefs, and social position, but also of the historic context in which people operate. It means holding institutions accountable to end oppression and discrimination. Reflections on Cultural Humility

The key attributes of cultural humility are

  • Openness
  • Self-Reflection/Awareness
  • Lifelong learning
  • Institutional accountability
  • Empathy and compassion
  • To be “other oriented”
  • Acknowledging power imbalances and balancing power imbalances

Thus, cultural humility is not an outcome; rather, it is a process that involves a “way of being” and necessitates a growth mindset and lifelong learning. Cultural humility can foster inclusivity, empowerment, respect, collaboration, and lifelong learning, as well as counter stereotyping, marginalization, and stigmatization. Fostering Cultural Humility in the Classroom

Relation to cultural competence

Cultural competence is a related, but not identical concept. Cultural competence has been defined as the ability to understand, communicate with, and effectively interact with people across cultures. Cultural competence encompasses (a) being aware of one’s own world view; (b) developing positive attitudes towards cultural differences; (c) gaining knowledge of different cultural practices and world views; and (d) developing skills for communication and interaction across cultures.

Project Ready described the relation between cultural competence and cultural humility as a pyramid with cultural competence as the foundation on which cultural humility is built. They stated that both cultural competence and cultural humility require developing cultural self-awareness and acquiring cultural knowledge; however, cultural humility also requires understanding and redressing power imbalances and holding institutions accountable for providing inclusive and equitable and programs and services.

Tervalon and Murray-Garcia (1998), created a table that compares the two concepts on goals, values, shortcomings, and strengths.

Cultural competence Cultural humility
Goals To build an understanding of minority cultures to better and more appropriately provide services To encourage personal reflection and growth around culture in order to increase service providers’ awareness
Values ·       Knowledge

·       Training

·       Introspection

·       Co-learning

Shortcomings ·       Enforces the idea that there can be ‘competence’ in a culture other than one’s own.

·       Supports the myth that cultures are monolithic.

·       Based upon academic knowledge rather than lived experience. Believes professionals can be “certified” in culture.

·       Challenging for professionals to grasp the idea of learning with and from clients.

·       No end result, which those in academia and medical fields can struggle with.

Strengths ·       Allows for people to strive to obtain a goal.

·       Promotes skill building.

·       Encourages lifelong learning with no end goal but rather an appreciation of the journey of growth and understanding.

·       Puts professionals and clients in a mutually beneficial relationship and attempts to diminish damaging power dynamics.

Yaeger and Bauer-Wu (2013) expanded this differentiation, with a table that represents these differences along additional dimensions.

Attributes Cultural Competence Cultural Humility
View of culture •Group traits •Unique to individuals
•Group label associates group with a list of traditional traits and practices •Originates from multiple contributions from different sources.
•De-contextualized •Can be fluid and change based on context
Culture definition •Minorities of ethnic and racial groups •Different combinations of ethnicity, race, age, income, education, sexual orientation, class, abilities, faith and more
Traditions •Immigrants and minorities follow traditions •Everyone follows traditions
Context •Majority is the normal; other cultures are the different ones •Power differences exist and must be recognized and minimized
Results •Promotion of stereotyping •Promotion of respect
Focus •Differences based on group identity and group boundaries •Individual focus of not only of the other but also of the self
Process •A defined course or curriculum to highlight differences •An ongoing life process
•Making bias explicit
Endpoint •Competence/expertise •Flexibility/humility

 

Implementation

According to the Kent State University Center for Teaching and Learning, the process of developing the skills and attitudes for cultural humility can be divided into three categories: personal reflection, interpersonal or group discussion, and immersive experiences. Fostering Cultural Humility in the Classroom

  1. Personal Reflection: Fostering cultural humility should begin with introspection regarding the foundations for one’s own cultural identity, beliefs, perceptions, attitudes, and behaviors. This can be done using survey instruments and prompts.
    1. Scales: One option includes cultural humility (Hook et al., 2013) or related constructs such as intercultural sensitivity (Bennett, 2011). These scales can provide both instructors and students a clearer sense of their attitudes, beliefs, and behaviors regarding culture.
    2. Reflection Papers: A second option is an awareness-raising “one-minute” paper based on the following prompt: “How does the material you’ve heard thus far connect or conflict with your prior knowledge, beliefs, or values?” (Nilson, 2019). This brief reflection can be integrated into lectures during class or assigned to students engaged in course readings. The goal is to increase awareness of the relation of material on topics having to do with cultural humility to their previously held perspectives.
    3. Journaling:  A third option involves journal writing prompts tied to videos, readings, guest speakers, course lectures, interviews, and other structured learning activities. Students could also be asked to reflect on cultural humility by engaging in creative work (e.g., creating or locating collage, music, video clips) to encourage innovative connections and enhance critical thinking (Anderson Juarez et al., 2006).
  2. Interpersonal or Group Discussion: Students can benefit from comparing their own reflections on issues related to cultural humility with those of their peers. Several techniques may be used to encourage meaningful interaction and dialogue.
    1. Discussion Boards: Use of an online discussion board can highlight the relevance of cultural humility to the academic content of the course. Research has shown that students engage in online discussion boards to more when challenged to answer questions creatively (e.g., including a GIF, cartoon, and/or song lyrics in their posts; Dagistan, 2020). Such techniques could also enhance cultural humility by increasing perceived social presence on the learning platform by allowing students to express their identities, be open to the contributions of their peers, and contribute to a respectful communication dynamic (Sellers & Kirven, 2019).
    2. Standing Surveys: The standing survey activity involves students expressing their opinions via their movement across the room regarding issues that have been selected by the instructor and presented as declarative statements. The instructor may read the statement and then tell students to “Stand on the left if you agree with the statement, on the right if you disagree, and in the middle if you are undecided.” (Shapiro et al., 2014, p. 74). This activity allows for students to share views, opinions, and interests in ways that allow for deeper contemplation of the sources of their own perspectives.
    3. Think-Pair-ShareThis technique ensures that instructors give students the necessary time to contemplate a response to a question posed in class. Following a brief period for solitary thinking, students pair with another student in the class to discuss their thoughts. Then the pair shares with the entire class the common themes or new insights of their discussion (Lyman, 1981). This approach can assist students in developing cultural humility by promoting critical self-reflection as well as respectful interaction with others who have different points of view.
  3. Immersive Experiences: Self-reflection and discussion strategies can also be employed in conjunction with more hands-on learning experiences and opportunities.
    1. Role Play/SimulationsInteractive assignments involving role play scenarios, simulation, or applied theater techniques can allow students to reflect on their own cultural identities as well as communication barriers associated with cultural differences (Ivory et al., 2016). Students can learn to recognize and adjust their emotional reactions and behaviors by solving problems, working on relationship-building skills, or confronting challenging situations (Anderson Juarez et al., 2006; Ivory et al., 2016).
    2. Field Experiences/Site Visits: Teachers can intentionally address diversity and power dynamics through the lens of cultural humility. According to Fisher (2019) instructors can use reflective questions along with close guidance, training, and supervision to support students’ development of critical awareness of cultural and sociopolitical factors impacting marginalized communities and of students’ own biases and beliefs. Instructors can also help students bridge cultural humility with social justice and advocacy work by urging them to identify potential actions to facilitate change (Fisher, 2019).
    3. Event Attendance: Speakers on topics related to culture and diversity can assist students in gaining an understanding of cultural differences. McCleary and Weaver (2008) suggested that it is helpful to prepare students for speakers by tying attendance to a class assignment and following up with a class discussion regarding the speaker.

Sources

University of Texas Hogg Foundation
Three Things to Know: Cultural Humility

University of Oregon Division of Equity and Inclusion
What is Cultural Humility: The Basics

Kent State University Center for Teaching and Learning
Fostering Cultural Humility in the Classroom

Project Ready: Reimagining Equity & Access for Diverse Youth
Cultural Competence & Cultural Humility

The Social Work Practitioner
Cultural Humility Part I: What is cultural Humility?

American Psychological Association
Reflections on Cultural Humility

References

Tervalon, M., Murray-García, J. (1998). Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training in Multicultural Education. Journal of Health Care for the Poor and Underserved9 (2): 117-125.

Yeager, Katherine A., and Susan Bauer-Wu. (2013). Cultural Humility: Essential Foundation for Clinical ResearchersApplied Nursing Research 26 (4): 251-256

Hook, J. N., Davis, D. E., Owen, J., Worthington Jr., E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology®. doi:10.1037/a0032595

Additional Resources: Videos

Cultural Humility
https://www.youtube.com/watch?v=SaSHLbS1V4w&t=482s

Conversations about Culture: The importance of cultural humility
https://www.youtube.com/watch?v=SaSHLbS1V4w&t=482s