Cultural competence in ethnically diverse healthcare: A case of a district health board in New Zealand

Abstract

With increasing migration taking place globally, there has been a corresponding increase in cultural diversity among populations in receiving societies worldwide. Health services which are not responsive to the needs of culturally diverse populations have led to health disparities between ethnically diverse groups and the dominant population groups. This study investigated how health disparities can be reduced by determining the components of cultural competence which are needed in healthcare organisations which serve increasingly multicultural populations. This is a mixed-methods qualitative case study consisting of a two-stage sequential research design that took place at Waitematā District Health Board (WDHB), one of the twenty DHBs in New Zealand that plan, fund and deliver health services to the population in its region. The first stage of data collection was the preunderstanding stage, which consisted of having informal conversations with industry members in addition to secondary data collection. The second stage of data collection consisted of conducting semi-structured interviews with fourteen staff of WDHB. Various barriers in accessing adequate health services faced by culturally diverse population groups were conveyed in this study. Eight components of cultural competence have been proposed along with focus areas within each one, for where action can be taken by healthcare organisations as part of an attempt in moving along the cultural competence continuum. The eight cultural competence components are cultural awareness, cultural competence education, models of care, cultural representation, workforce capability, primary health organisation enrolment and health literacy, interpreting services and ethnicity-based data collection. The findings of this study can be used as a preliminary guide for healthcare organisations in New Zealand to better meet the health needs of an increasingly ethnically diverse population via appropriately responding to the obstacles conveyed in the study. This can consist of developing indicators and quantifiable baseline targets and values specific to the health needs of their population. The study has also highlighted the importance of the Treaty of Waitangi, where further exploration is required to determine how the unique position of the indigenous Māori population can be acknowledged in healthcare organisations' attempt in moving along the cultural continuum.