3. Context

It is important to be able to put understandings of culture in context, and to understand the situation of an individual client or population group. Definitions of culture therefore need to consider the "complex combination of socio-historical factors and personal experiences that frame individual notions of 'cultural identity' and 'belonging'". Far too often, culture is poorly conceptualised and applied in health, resulting in dangerous immodesty and damaging stereotypes.

  • Culture is not static or homogenous: it is dynamic and can change over time and place, just as individuals change over time and place – that is, according to context.

  • Cultures are complex and dynamic and there can be a high degree of difference, and even discord, within a particular culture despite the existence of a set of dominant norms, values and beliefs. There is greater within group difference than between group difference.

  • Culture does not always or solely determine or explain behaviour. Cultural determinism is the belief that culture alone determines or predicts behaviour. The kind of thinking that says "it's because of his culture that he behaves this way ..." Considering the range of factors that influence behaviour, it is important to understand that culture is not always the most important. For example, the reason a CALD patient is not 'compliant' with a treatment plan may not be because of cultural differences; rather, it may be that socioeconomic constraints and other social, emotional and financial factors are at play.

To understand the situation of a client or population group the following contexts should be considered:

  • A person or community group's context includes, but is not limited to the following: employment, housing, income, dependents, access to transport and childcare, health status (social determinants of health); and the context of country of origin and the migration process. The social context may be a more critical factor in accessing health services.

  • There are a range of specific issues for refugees and humanitarian entrants that must be considered. In addition to complex and interrelated health issues, refugees (many now from sub-Saharan Africa, Middle-East and South-east Asia) have little experience with the Australian health care system.

  • From the moment a person from a CALD background arrives and settles in Australia, he or she is already in a different context and will undergo transformation from his or her cultural identity. The local Australian community also undergoes shifts in its identity (e.g. from Anglo-Celtic dominant to multicultural). This process is often referred to transculturation which is the dynamic and reciprocal exchange between cultures that results in the formation of something new.

  • Young people born to migrants often experience ambivalence and confusion about their cultural identity and sense of belonging. The desire to fit into the dominant Australian culture often overrides their sense of loyalty or belonging to their own cultural heritage. This can result in intergenerational conflict and stress.


Acculturation

  • Acculturation is the term given to describe the process of adopting the cultural traits or social patterns of another group.

  • Understanding where an individual consumer sits on this acculturation continuum can help predict their familiarity, and effective use of mainstream services.

Knowledge Skill Behaviour

1. Know that cultural considerations must be informed by context.

Able to consider contextual factors alongside cultural considerations in undertaking assessments, developing care plans and providing services.
 Avoids cultural determinism and stereotyping.
2. Individual factors such as gender, socioeconomic status, sexuality and social factors may be more important than considerations of cultural background. Individuals will therefore vary in terms of their cultural belonging and identity. There is greater within group difference than differences between groups.
 Can elicit contextual information about the client/client group that may impact on health care and consider in health care planning and delivery.

Never assumes that a belief or particular practice common to a particular culture is adopted by all its members.
3. Culture can change according to context. Historical factors can also contribute to new cultural norms and formations.
 Can access relevant and most up-to-date information about the client group. Can assess, prioritise and respond to greatest individual need or most critical factor in delivering individualised patient-centred care.
  
4. Migration is a major life change and likely stressor. Individuals vary in their capacity to gain cultural and linguistic capital. Country of origin, level of education, age, gender, existing community network and personal attributes all play a part.
 Able to take into consideration migration or asylum seeking status and processes in all assessments.

Exhibits awareness of, and responsiveness to, social, emotional and cultural factors.
5. Individuals may vary greatly in terms of their identification with their cultural background. Children of migrants, in particular, may experience stress and confusion relating to the pressure of 'fitting in' with Australian mainstream culture while maintaining their own cultural heritage. Being 'bi-cultural' brings with it a range of potential intergenerational and intercultural stresses particularly if young people distance themselves from their community or deny their cultural heritage.
 Able to facilitate links with communities and access other services when needed.

6. Refugees and humanitarian entrants may have endured social dislocation, severe trauma, famine, war and/or injuries. Post-traumatic stress disorder and other issues may not emerge in initial screening processes but complex health problems may emerge or worsen.

Skilled in establishing continuity of care plans with clients/ client groups (particularly refugees).