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Cultural Competency

Why Cultural Competence?
National CLAS Standards for Health Care Organizations
Transcend Services that Support CLAS
Cultural Competence in Action
Examples of Cultural Competence in Action

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Why Cultural Competence?

The 2011 American Community Survey, conducted by the U.S. Census Bureau, tells us that over 60 million people speak a language other than English at home, and over 25 million speak English less than “very well.” In California alone, there are over 220 distinct languages spoken. And 43% of California households speak a language other than English at home. In this diverse environment, cultural competence provides a framework through which we communicate. It starts with a recognition that customs, rules, ideas, values, religions, symbols, gender roles, and languages may vary from one culture to another. Once recognized, these differences form the basis of the standards and tools that allow us to interact effectively with people from other cultures in person, in writing, and via the Internet.

The motivation for culturally competent practices may vary: health plans want better outcomes for patients and the consequent savings; the justice system seeks to increase access for litigants, witnesses, and families. Some culturally competent practices are mandated; others are recommended.

In the health field, National CLAS Standards (Culturally and Linguistically Appropriate Services) established by the U.S. Department of Health and Human Services spell out what health care organizations must and should do to provide quality health care to an increasingly diverse population. For the courts and legal professionals, the American Bar Association has also set out National Language Access Standards that spell out what courts must and should do to ensure that limited English speakers have access to the court, court services and court-mandated services.

When the standards are enacted, agencies report that patients and court consumers are better able to understand and respond to their environment. Patients have better outcomes and pro se litigants can understand, participate in and comply with court proceedings and programs. These improvements lead to greater efficiencies, fewer appeals, and better outcomes.

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What are the National CLAS Standards?

The federal Office of Minority Health explains, “the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the United States.”

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Transcend Services that Support CLAS

At Transcend, we use our knowledge of cultural competency, readability, and translation to provide services that support best practices to achieve language access standards. Below, we set out a snapshot of the CLAS standards and the services Transcend provides to achieve them:

CLAS standards / Transcend services
CLAS Standard Transcend services to support the standard
Provide language assistance services, including bilingual staff and free, timely interpreter services at all points of contact.
  • Cultural competency training for health professionals
  • I-speak cards to identify the patient’s language
  • Language proficiency testing
Confirm interpreter and translator competency. Do not allow friends or relatives to interpreter for patient, unless requested by the patient.
  • Health Plan Translator Test – an online and in-person assessment tool to assess health organization staff language proficiency
  • Language access audits to aid organizations to identify areas of non-compliance
Provide easy to read patient materials.
Post signage in the most common languages in service areas.
  • Easy-to-understand bilingual and multilingual signage for public and private organizations
  • Patient materials written in plain language at the 4th-6th grade level to maximize readership, including patient education, consents, health instructions, and audio and video in all U.S. languages

Provide ongoing education and training for all staff about culturally and linguistically appropriate service delivery.

  • Cultural competency training for health professionals
  • Continuous updating of I-speak cards to identify the patient’s language
  • Plain language training
  • Plain translation services

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Cultural Competence in Action

The only way to know for sure if your readers will understand and respond to the important messages your documents contain is to field test!

Before going to final print, we can take a mock-up of your document to a group of typical consumers. We ask them about the text, graphics and what they like and dislike. Their answers help identify more effective language and graphics. And we learn what words and concepts are difficult for your audience.

Your field test includes preparing an instrument, recruiting participants, conducting the test and writing a report. We will also make suggestions based on the field test responses and incorporate changes to the documents.

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Here are some examples of how cultural competency improved the final product for Transcend’s clients:

Poster for Spanish-Speakers

To create a First 5 poster that would work well for Spanish-speakers in California, we did the following:

  • Translated the text using standard Mexican Spanish,
  • Lowered the reading grade level, without changing meaning,
  • Incorporated Mexican colors (red, white and green) in the design,
  • Changed ALL CAPS to lower case, and
  • Used a highly readable sans serif font.
Original and adpated versions of Children's Bill of Rights poster
Click to enlarge

The Spanish-language poster looked different than the English version, but it was more appealing and culturally appropriate for the intended audience. The client’s reaction: “This is absolutely fantastic!”

Website with Health Information for Teens

To create a website with health information for teens, we made modifications that research showed would appeal to this age group. [1] Published research and Transcend field testing demonstrated that teens really like:

  • cool graphics,
  • interactive features, and
  • visual information in vibrant colors and patterns.

They do not like a lot of text, clumsy or slow websites, or small size font. Armed with this information about teen culture, we were able to design a website that appeals to teens, and increases the chance of their getting and sharing the information at the site.

For more information on how teens use the web, click here.

Early Detection Strategies for Asian and Latina Women

When the Department of Health Services wanted to get more Asian and Latina women to go for regular breast and cervical exams, we conducted a community review with professionals who worked with women in the target groups.

For maximum appeal and readability, we incorporated the communities’ suggestions to:

  • include more photos of Asian/Latina women,
  • respond to issues of modesty,
  • strategize how to address the sensitivity of the topic, especially for older women, and
  • attract more female staff from these ethnic groups who speak their language.
Adapted Poster in Chinese, Spanish, Vietnamese
Click to enlarge

Visit link for more information about the community reviewer comments.

Dying in Different Languages

“Finding Your Way” is a lovely, English-language booklet that helps people prepare for end-of-life decisions. The Coalition for Compassionate Care of California (CCCC) wanted to make this information available to California residents who did not speak English. But a “straight translation” that did not embrace the unique ways in which each culture addressed death was not enough. CCCC and Transcend applied feedback from focus groups and community leaders to create Spanish and Chinese booklets that spoke to each group’s unique needs.

Finding Your Way booklet in English
Click to enlarge
Finding Your Way booklet in Chinese
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Finding Your Way booklet in Spanish
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English for Down Under

Hey mate!

Ya seen mee specs about?

When a global vision plan wanted to develop materials for English-speaking members down under (Aussies and Kiwis), Transcend evaluated key terms for compatibility with national language corpora and collected feedback from potential users from those key countries. We helped our client create materials that meshed well with their new audiences. For the American writers, this meant changes in:

  • Spelling
  • Writing style
  • Punctuation, capitalization, and numerical notation
  • Font type, font size, and other visual aspects
  • Word usage
  • References and citations

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References and Notes

[1] Norman Nielsen Group, 2005,

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Other Services:

Cultural Competency
Emergency Preparedness
Plain Language
Plain Language Training
Voice Talent
Web Accessibility