Beyond cultural competency: Bourdieu, patients and clinical encounters

Abstract

In response to widely documented racial and ethnic disparities in health, clinicians and public health advocates have taken great strides to implement 'culturally competent' care. While laudable, this important policy and intellectual endeavour has suffered from a lack of conceptual clarity and rigour. This paper develops a more careful conceptual model for understanding the role of culture in the clinical encounter, paying particular attention to the relationship between culture, contexts and social structures. Linking Bourdieu's (1977) notion of 'habitus' and William Sewell's (1992) axioms of multiple and intersecting structures, we theorise patient culture in terms of 'hybrid habitus'. This conceptualisation of patient culture highlights three analytical dimensions: the multiplicity of schemas and resources available to patients, their specific patterns of integration and application in specific contexts, and the constitutive role of clinical encounters. The paper concludes with a discussion of directions for future research as well as reforms of cultural competency training courses.

Cultural Competence in Action: “Lifting the Hood” on Four Case Studies in Medical Education

“…1 (Betancourt 2003(Betancourt , 2006Bromley and Braslow 2008;Crenshaw et al 2011;Eiser and Ellis 2007;Fung et al 2008;Green et al 2008;Guarnaccia and Rodriguez 1996;Hayes-Bautista 2003;Hershberger et al 2008; Kirmayer 2011Kirmayer , 2012aKripalani et al 2006;Kumaş-Tan et al 2007;Lié et al 2006;Lim and Lu 2008;Lo and Stacey 2008;Núñez 2000;Park et al 2006;Park et al 2009;Shapiro et al 2006;Smith et al 2007; South-Paul and Like 2008; Sue 1998Sue , 2003Sumpter and Carthon 2011;Teal and Street 2009;Tervalon 2003;Tervalon and Murray-Garcia 1998;Wachtler and Troein 2003;Wear 2003;Whitcomb 2003).…”

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

“…Since cultural health capital informs sense-making during interactions with formal treatment providers (Lo & Stacey, 2008), exposure to a shared culture of mistrust and skepticism toward formal health care providers in the individual's community network may reduce engagement, motivation, and compliance in treatment. Further, acting contrary to a shared health cultureeven if that action is putatively health promoting (e.g.…”

“…In particular, cultural health capital patterns conscious and unconscious beliefs about what behavior constitutes a possible and preferable response to a health crisis (Perry & Pescosolido, 2015). Importantly, individuals' orientations toward health and health care are developed through interaction with social network ties and exposure to the cultural capital made available by these ties (Lo & Stacey, 2008). Consequently, individual agency and behavior operates within the boundaries of the cultural health capital accessible through personal social networks and relationships, both past and present (Perry & Pescosolido, 2015).…”

“…Shim (2010) defines cultural health capital as "the repertoire of cultural skills, verbal and nonverbal competencies, attitudes and behaviors, and interactional styles" (p. 1) that influence relationships between providers and patients, as well as outcomes of health services. The particular set of preferences, beliefs, and attitudes about health and illness, help-seeking, and formal health care that a person holds structures behaviors around health and health care utilization (Bourdieu, 1977;1990;Lo & Stacey, 2008). In particular, cultural health capital patterns conscious and unconscious beliefs about what behavior constitutes a possible and preferable response to a health crisis (Perry & Pescosolido, 2015).…”

Clinical encounters and culturally competent practice: the challenges of providing cancer and infertility care

“…This flexibility partly explains the idea's popularity, as it simultaneously combines a post-modern concern with reflexive engagement and normative persuasion (Lo and Stacey, 2008) with a more long-standing, instrumental interest, which enables the State to use such insights to collectively manage complex social issues (Beck, 1992). As an illustration, this paper provides an analysis of how health and social care practitioners reflect on the 'messiness' (see Gunaratnam, 2008) of their everyday clinical encounters with patients of white and South-Asian backgrounds, while attempting to provide 'cultural competence' care.…”