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102.1 Cultural Humility and Bias
Learning from every person, checking our own bias, and language access
Your materials
Slides (PowerPoint) Handout (Word)
For instructors
Facilitator guide Printable pre and post tests Quiz (LMS import)
What you will learn
- Explain the difference between cultural humility and cultural competence
- Describe implicit bias and one way to check your own
- Arrange a qualified interpreter and explain why children never interpret
- Use plain language and teach-back to support health literacy
Start here
Think of a time someone made a guess about you because of how you looked or talked. How did it feel?
Lesson
Humility, not a finish line
Cultural competence
- Learn facts about groups of people
- Can feel like a skill you finish
- Risks turning people into stereotypes
- The worker is the expert
Cultural humility
- Learn from each person about their own life
- A lifelong practice that never ends
- Sees each person as one of a kind
- The client is the expert on their life
The parts of cultural humility
Tervalon and Murray-Garcia described these commitments:
- Look at yourself: Keep checking your own beliefs, habits and biases, your whole career.
- Share power: Notice the power gap between worker and client. Let the person lead their own story.
- Partner with community: Build fair partnerships where the community holds real expertise and gets real benefit.
- Hold institutions accountable: Agencies and hospitals must check themselves too, and let the community hold them to their goals.
In the authors' words
A lifelong commitment to self-evaluation and self-critique. Melanie Tervalon and Jann Murray-Garcia, 1998
Checking our own bias
Implicit bias is an attitude or stereotype that shapes what we think and do without our awareness.
- Expect it: Everyone has implicit bias. Having it does not make you a bad person.
- Slow down: Bias acts fast. Take a breath before you decide what a person needs.
- Ask, do not assume: Ask about language, food, faith, family and goals instead of guessing.
- Notice patterns: Who do you call back first? Who do you spend less time with?
- Talk in supervision: Bring a moment that bothered you to your supervisor or a trusted peer.
Language access done right
| Do | Do not |
|---|---|
| Ask what language the person prefers | Assume from a name or accent |
| Use a qualified interpreter, free of cost | Get by with your basic Spanish |
| Speak to the client, not the interpreter | Ask the client to bring their own interpreter |
| Write the preferred language in your notes | Use a child to interpret |
| Offer materials in the person's language | Rely on family unless the client privately requests it |
Upstream: when language becomes a wall
- What we see: Mrs. Nguyen in AsiaTown keeps missing follow-up visits. The clinic notes say she is not engaged.
- Why it happens (upstream): Reminder calls and letters come only in English. Her grandson read the last letter, and she felt embarrassed asking again.
- What we can build on (assets): Asian Services in Action, her temple community, bilingual neighbors, interpreter phone lines, and the clinic's own language access duty.
Our Cleveland communities
Greater Cleveland holds many cultures. Each person is still unique.
- Long-rooted neighborhoods: Black families in Hough, Glenville and Fairfax; Appalachian and Eastern European roots on the west side and Slavic Village.
- Latino communities: Puerto Rican, Mexican and Central American families in Clark-Fulton, Lorain and beyond, with many language preferences.
- Immigrants and refugees: Newcomers supported by groups like US Together, USCRI Cleveland and Catholic Charities Migration and Refugee Services.
- Many identities: LGBTQ+ neighbors, older adults, people with disabilities, and people of many faiths, often within one family.
Situation: the daughter who translates
Situation: At a home visit in Clark-Fulton, Mr. Ortiz speaks mostly Spanish. His 11-year-old daughter offers to translate his new medicine instructions. He says, it is fine, she always does it.
What do you do?
- Thank them both and kindly explain children should not interpret health news
- Call the agency's interpreter line or reschedule with a qualified interpreter
- Use teach-back through the interpreter to check understanding
- Note his preferred language and the interpreter used in your record
Talk it over
- What is one assumption you have caught yourself making about a client or neighbor?
- How might faith or family shape a health choice in your own life?
- What would make an agency in Cleveland more humble with your community?
Study sheet
The big idea: We never finish learning about people. We stay humble, check our bias, and make sure every person can understand and be understood.
Key points
- Cultural humility is lifelong: check yourself, share power, partner with communities, and hold institutions accountable.
- Implicit bias lives in everyone. We slow down, ask instead of assume, and talk it through in supervision.
- Use a qualified interpreter, free to the client. Never use a child to interpret except in a true emergency stopgap.
- Health literacy is also the agency's job: organizations must make information easy to find, understand and use.
- Use plain language, focus on one to three key points, and check with teach-back.
- Faith, family and culture shape health choices. Ask with respect what matters to each person.
Remember
- Cultural humility: Tervalon and Murray-Garcia, 1998
- Do you understand? is not a teach-back question
- Federal Section 1557 rule: no relying on minor children to interpret
- Record each client's preferred language
Ask yourself
- Which groups do I know least about, and how will I learn from people instead of guessing?
- When did my own culture shape a health choice I made?
Vocabulary
| Word | What it means |
|---|---|
| Culture | The shared ways of life of a group, including language, beliefs, food, faith, customs and values. |
| Cultural humility | A lifelong practice of checking yourself, learning from each person, sharing power and partnering with communities. |
| Cultural competence | Knowledge and skills for working across cultures; useful, but it can wrongly feel like something you finish. |
| Implicit bias | Attitudes or stereotypes that shape our thoughts and actions without our awareness. |
| Stereotype | A fixed idea about a whole group that gets applied to one person. |
| Power imbalance | When one person in a relationship, such as a worker, has more control than the other. |
| Qualified interpreter | A trained person who accurately turns spoken words from one language into another and keeps it private. |
| Limited English proficiency | When a person does not speak, read or understand English well enough for health conversations. |
| Health literacy | How well people can find, understand and use health information and services to make decisions. |
| Teach-back | Asking a person to explain in their own words what you shared, to check that you explained clearly. |
| Plain language | Short sentences and common words, with medical terms explained. |
Real-life situations
The quiet nod
Ms. Carter, age 70, in Glenville nods yes to everything you say about her new diabetes visit. When you ask her to tell you the plan, she cannot.
What to do
- Thank her and say it was your job to explain it more clearly
- Explain again with one to three key points in plain words
- Ask her to tell it back in her own words, a little at a time
- Write down the plan with large print and the clinic phone number
Why: Teach-back checks how well we explained, not how smart the client is. Many adults struggle with health information, so we use plain language with everyone.
The family that needs a newcomer guide
The Haddad family arrived from Syria last year and lives near West Boulevard. The mother tells you, through an interpreter, that forms from the school and clinic are confusing.
What to do
- Ask which language each family member prefers to speak and to read
- Offer help through a qualified interpreter, not the children
- Connect the family with a refugee service group such as US Together or USCRI Cleveland
- Follow up to see if the connection worked
Why: Newcomer families often face language and system barriers at the same time. Local refugee groups are strong assets that know these systems.
The assumption at intake
A coworker sees that a new client in Fairfax lists a same-sex partner and says, I will skip the family questions. You know the partner drives the client to every visit.
What to do
- Gently remind your coworker that every client gets the same full intake
- Ask the client who they consider family and who supports them
- Include the partner in the plan only with the client's consent
- Raise the moment with your supervisor if bias seems to be a pattern
Why: Bias can lead us to skip people or their supports. Asking every person the same respectful questions protects fairness and care.
Activity: My culture, my health
About 20 minutes.
- Write three parts of your own culture that shape your health, such as food, faith, family roles or language.
- Write one assumption someone once made about you and how it felt.
- Write one question you can ask clients to learn about their culture without guessing.
- Share your question with a partner or post it in the course discussion.
Post-test
Ten questions. You need 75% to pass, with one retake. Your result is saved in this browser.
Sources
- Tervalon and Murray-Garcia (1998), Cultural humility versus cultural competence, Journal of Health Care for the Poor and Underserved 9(2)
- Yeager and Bauer-Wu (2013), Cultural humility: essential foundation for clinical researchers
- Kirwan Institute, State of the Science: Implicit Bias Review
- 45 CFR 92.201, Meaningful access for individuals with limited English proficiency (Section 1557)
- Healthy People 2030, Health Literacy
- AHRQ Health Literacy Universal Precautions Toolkit, 3rd edition
- Case Western Reserve University, Resource Sheet: Refugee and Immigrant Services