The next step in the process of developing culturally safe practice is cultural appraisal or assessment. This is the process of identifying and valuing differences as cultural strengths rather than barriers which somehow have to be 'overcome'.
Cultural appraisal is a process of learning about domains or constructs of a culture that are pertinent to cancer control. It's also about recognising and respecting cultural strengths as an important focal point for developing appropriate interventions and cancer control strategies.
Identifying the cultural strength of any group cannot be done at a distance or by using a formula; it requires a relationship approach of learning from people and understanding the context of their world. Cultural strengths are the positive qualities, values, beliefs and traditions of a culture. In health care, these are likely to influence decision making about treatment and modes of care.15
Conceptual framework for identifying cultural strengths
Collins Airhihenbuwa15, 19, 34 offers a complex framework called the PEN-3 model for analysing and appraising cultures. This conceptual framework comprises three subcomponents listed below from which the acronym PEN-3 is formed.
Domains of the PEN-3 model for appraising different cultures
Relationships and expectations
- Extended family.
The ICC framework
The Intercultural Cancer Council (ICC) in the USA has developed a practical tool for health care professionals involved in reducing the inequities of cancer outcomes for 'minority racial/ethnic patients and families'.35
The ICC framework is applied as a method of cultural appraisal, and is recommended for all cross-cultural encounters where the culture of the individuals requiring cancer care differs from those providing the care.
Components of the ICC Framework35 for identifying and appraising cultural differences include:
- greeting and introductions
- communication mores and styles
- ethnicity - regional values/practices
- non-verbal communication styles
- religion and spirituality
- belief/values associated with death and dying
- social distance and spacing.
Describe how you define the cultural strengths of your cancer nursing practice.
Discuss how you could learn about the cultural strength of a local Indigenous community.
Access the resources below and describe examples of how the PEN-3 model has been applied in cancer control.
- Recruiting African American men for cancer screening studies: Applying a culturally based model. Health Education and Behavior 32(4): 441- 451.36
- Developing a culturally responsive breast cancer screening promotion with Native Hawaiian women in churches. Social Work in Health Care. 2008;33(3):169-7737
Using the components of the ICC Framework,34 describe an Indigenous culture in your region. Your engagement with the local Indigenous community, including Indigenous health care providers, is crucial for completing this learning activity.
Understanding the roles of stakeholders
In the interest of protecting the cultural integrity of the Indigenous population it is important for outsiders (non-Indigenous people) to follow protocols of cultural respect. Protocols for engaging with Indigenous organisations and communities can be accessed in many jurisdictions.
Establishing culturally appropriate cancer control requires the development of collaborative relationships with Indigenous health providers and their organisation.
Indigenous health workers
Indigenous health workers in a variety of health related occupations are an important part of the health workforce involved in cancer control activities. However, there is no uniformity across Australia in their roles, title, training, conditions of employment, and the ways they interact with other members of the workforce.
Access the Indigenous health workers webpage on the Australian Indigenous HealthInfoNet website38 for more information.
The roles of Indigenous health workers can include:
- clinical functions (often as the first point of contact with the health workforce, particularly in remote parts of the country)
- liaison and cultural brokerage
- health promotion
- environmental health
- community care
- administration, management and control
- policy development and program planning.
Video 12: Cindy (0.34 min)
Cindy discusses the role of the Indigenous health worker, & how one aspect of their job is to ensure the patient's cultural safety.
Video 13: Catherine (0.43 min)
Catherine talks about the benefits of the Indigenous health worker as someone who immediately understands Aboriginal & Torres Strait Islander culture.
Video 14: Catherine (0.34 min)
Catherine talks about how Indigenous health workers can support Aboriginal & Torres Strait Islander peoples in practical ways.
The Council of Aboriginal and Torres Strait Islander Nurses (CATSIN) was founded to formally represent Indigenous nurses. CATSIN recognises the unique contributions and commitment of Indigenous nurses in the area of health, and acknowledges the cultural expertise/knowledge that Indigenous nurses contribute to the health industry and nursing profession.
CATSIN's core business role is to increase the recruitment and retention of Aboriginal and Torres Strait Islander people into nursing. More information about CATSIN can be found by visiting their website.39
- Review the summary information about Indigenous health workers.
- Identify Indigenous health workers in your local area.
Access the cultural respect frameworks developed by your State/Territory government and/or other protocols for engaging with Indigenous organisations and communities such as Our Lungs, Our Mob community education resource80, and list the key principles involved in engaging with Indigenous communities.