workforce development; health disparities; cultural sensitivity; cultural competence


Community Health | Community Health and Preventive Medicine | Health Services Research | Public Health | Public Health Education and Promotion


Objective: The purpose of this research is to analyze the association of attitudes and beliefs on engaging in culturally competent behavior.

Design: Explorational case study of individuals employed within an urban public health department.

Participants: Employees (n=90) from four metropolitan clinical sites of an urban public health department located in the southwest region of the United States were solicited and recruited during a monthly staff meeting. This sample is representative of 84% of the total employees which is comprised of 107 individuals.

Main Outcome Measures: The Cultural Competence Assessment is designed to explore individual knowledge, feelings and actions of respondents when interacting with clients in health service environments. The instrument is based on the cultural competence model, and measures cultural awareness and sensitivity; cultural competence behaviors and cultural diversity experience and training. For reporting purposes, participants were divided into subgroups, clinical and non-clinical. This was completed to account for the variation in respondents’ level of education, type of client/patient interaction and opportunities for professional development engagement.

Results: Respondents with increased levels of knowledge possessed attitudes which encompass dignity and respect of minority groups, potentially improving clinical interactions. African Americans and Hispanic/Latinos within the non-clinical subgroup displayed more culturally sensitive attitudes compared to their clinical peers within the same race/ethnicity classification. Non-clinical workers with Associate and Bachelors degrees displayed more culturally sensitive attitudes than their clinical counterparts. Clinical staff with graduate or professional degrees scored higher in the culturally sensitive attitudes analysis than non-clinical peers.

Conclusions: Knowledgeable individuals have the necessary foundation to develop beliefs and attitudes conducive to creating an effective clinical encounter. Educational programs must include components which increase participant awareness of diversity. In addition, training should encompass lessons to foster self-reflection of one’s own bias and beliefs, and its effect on how workers provide health services.