Cultural humility
Overview
In previous decades, many scholars and practitioners, in a variety of fields, advocated the concept of cultural competence—knowledge and skills that enable individuals to respond most helpfully to diverse peoples. More recently, however, many academics have raised concerns about this notion of cultural competence. Here are some examples of these concerns.
- The notion that you can be competent about a culture may erroneously imply that cultures are relatively homogenous. But culture shapes each person uniquely.
- The notion that you can be competent about a culture may erroneously imply that cultures do not change appreciably over time. But cultures do evolve over time in response to historical, social, economic, and political events.
- The notion that you can be competent about a culture may erroneously imply that people tend to belong to only one culture or community. But each person belongs to a dynamic blend of many ethnic, occupational, religious, and other communities.
The concept of cultural humility was partly developed to address these concerns. People who demonstrate cultural humility tend to
- recognise that many of their assumptions and knowledge about the culture of individuals may be limited, misguided, and biased,
- ask questions to understand diverse individuals better—such as their hopes, fears, and preferences— and to override misguided assumptions,
- develop a mindset in which they are mindful, attentive, and empathetic rather than presumptuous (Hook et al., 2017; Hook & Watkins, 2015).
A measure of cultural humility
To measure the extent to which individuals develop and exhibit cultural humility, Hook et al. (2013) designed and validated the cultural humility scale. This instrument was developed to measure the degree to which health practitioners exhibit cultural humility with diverse clients. The scale comprises 12 items that generate two clusters:
- Is respectful
- Is open to explore
- Is considerate
- Is genuinely interested in learning more
- Is open to seeing things from my perspective
- Is open-minded
- Asks questions when he or she is uncertain
- Assumes he or she already knows a lot
- Makes assumptions about me
- Is a know-it-all
- Acts superior
- Thinks he or she understands more than he or she actually does
The first seven items are deemed as positive, and the other items are deemed as negative and thus reverse scored. As this study demonstrated, cultural humility was positively associated with the degree to which therapists established a strong working alliance—as perceived by these clients. This working alliance increased the degree to which clients improved during these sessions.
The cultural humility and enactment scale
Some researchers have raised concerns about the cultural humility scale. Specifically, according to several researchers and scholars,
- the cultural humility scale does not encompass all the facets and nuances of cultural humility (Zhu et al., 2022; Zhang et al., 2022),
- the two dimensions of this cultural humility scale might not correspond to informative facets but may simply differentiate positively worded items from negatively worded items (Zhu et al., 2024).
The cultural humility and enactment scale, proposed and validated by Zhu et al. (2022), was designed to address these concerns. Like the cultural humility scale, this alternative instrument measures the cultural humility of health practitioners, often counsellors, from the perspective of clients. The scale comprises 29 items and assesses three facets. Zhu et al. (2024) replicated this factor structure but omitted 8 redundant items. The first facet, cultural teachability, measures the degree to which the practitioner seems willing to learn about cultures and to adjust their opinions and beliefs in response to additional information. Typical items include
- Is open to changing their views on cultural issues.
- Is open to corrective feedback for their cultural views.
- Enjoys discussing ideas of different cultures.
The second facet, cultural superiority and disrespect, assesses the degree to which health practitioners imply their culture is superior and imposes their values onto clients—an indication of low cultural humility. Sample items include
- Imposes their cultural views on me.
- Pretends to know something when they have no idea.
- Prioritizes their cultural views over mine.
The final facet, relational-oriented engagement, respectfully engages in conversations about diverse cultural values, epitomised by items such as
- Has authentic dialogue with me about our conflict.
- Makes room for me to have a different cultural perspective.
- Listens to my cultural views
- Makes me feel valued in our relationship
