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Strategies for Working
With Culturally Diverse Communitiesand Clients


Elizabeth Randall-David


Table of Contents


Chapter 1: Setting the Stage

Chapter 2: Assessing your Own Cultural Heritage

Chapter 3: Learning About the Community

Chapter 4: Guidelines for Working With Culturally Diverse Community Groups and Clients

Chapter 5: Guidelines for Using Interpreters to Enhance Cross-Cultural Communication

Chapter 6: Relevant Information on Specific Cultural Groups




The Community Outreach Demonstration Project (COPD) was initiated, guided, and funded by the Department of Health and Human Services, Office of Maternal and Child Health (OMCH), under the direction of Sharon Barrett, Director, Hemophilia Program. The major goal of the project is the identification of ethnic minority patients with hemophilia in order to provide this often difficult-to- reach population with relevant education and comprehensive hemophilia treatment. Through a collaborative relationship with the National Hemophilia Foundation (NHF), OMCH has been instrumental in providing training and technical assistance to local NHF chapters involved with outreach to culturally diverse communities and clients.

Although this manual was originally designed to guide project participants, most of the principles can be effectively utilized by a variety of community groups engaged in a broad range of educational, medical and social service outreach efforts. It is hoped that these principles will be applicable for working with families caring for children with a variety of chronic illnesses and disabilities. It is also hoped that an increased awareness of the importance culture plays in shaping our attitudes, values, and practices will lead to more culturally appropriate community outreach and culturally sensitive health care.

Members of the Community Outreach Demonstration Project Task Force who provided techical assistance throughout the project and who reviewed and critiqued earlier drafts of this manual include: Lisa Flam, M.P.H.; Claire Garceau; Donald Goldman, Esq.; Mary Gooley; Natalie Sanders, M.D.; Jeanette Stehr-Green, M.D.; Ashaki Taha; Mirielle Tribie, M.D.; and Ron Walker, Ph.D. In addition, Sharlene Simpson, Ph.D., and Manny Laureano-Vega, M.D., offered greatly appreciated input and critical comments. A special thanks goes to each of them for their willingness to share their expertise and individual perspectives. April Mackenzie and Sara Jarvis provided assistance with the technical aspects of typing and assembling the manual. And, finally, we gratefully acknowledge Christine Johnson, M.D., for providing a funding mechanism through the OMCH Region IV Hemophilia Grant for completion of this manual. Truly this project is a team effort.

Betsy Randall-David, Ph.D.

Chapter 1


In the history of human thinking, the most fruitful developments frequently occur at those points where different lines of thought meet. These lines may have their roots in different cultures, in different times, in different religious traditions. If these are allowed to meet...a new and interesting way of being will emerge. (Heisenberg, 1974)

Like a quilt rich in colors, textures, and patterns, the United States is a nation made up of many ethnic, racial, religious, and cultural groups. The concept of the melting pot, now outmoded, has been replaced by the recognition that this diversity lends strength and uniqueness to the fabric of our society. With the broad range of experience that the various parts of our population bring to everyday life in America comes the need for increased efforts at understanding and valuing our differences as well as our similarities. Since the culture in which we are raised greatly influences our attitudes, beliefs, values, and behaviors, it is important to gain an awareness of the cultural determinants of our own, as well as our clients',* thoughts, feelings, and acts.

This manual is designed to help you, as a health care provider, increase your understanding of the cultural aspects of health and illness so that you can work effectively with individual clients and with families from culturally diverse communities. Information contained in each chapter will guide you in providing culturally sensitive and appropriate health education, counseling, and care in your various roles within the health care system. Just as all parts of a culture fit together and support one another, so, too, do the chapters of this manual reinforce succeeding ones. The information will be most useful if read in the order set forth.


*Throughout this manual the term "client" is used to refer to any individual or group of individuals with whom the service provider is working. A client may be an adult, a child, or a family.

Chapter 2


The culture in which you are raised greatly influences your attitudes, beliefs, values, and behaviors. In order to provide sensitive and effective care to clients from cultures that are different from your own, two things must occur.

  1. An awareness of your own cultural values and beliefs and a recognition of how they influence your attitudes and behaviors.
  2. An understanding of the cultural values and beliefs of your clients and how they influence their attitudes and behaivors.

This chapter is designed to help you assess your own cultural heritage. Take a few minutes to do the following exercises. They will help you clarify your attitudes and beliefs and how these influence your ability to work with clients from diverse cultural backgrounds. There are no right or wrong answers to these questions. They are intended only to facilitate an acknowledgment of your own cultural heritage.

Chapter 3


Now that you understand more about how your own cultural heritage influences your world view, you are ready to learn about the cultural values, beliefs, and practices of the community you are trying to reach.

How does one get started on what seems like an overwhelming task? The following suggestions are excerpted from a variety of courses, including texts designed for health care providers working in developing countries as well as from manuals targeted for those working in our own country. There are three components of the process:

Chapter 4


Once upon a time a monkey and a fish were caught up in a great flood. The monkey, agile and experienced, had the good fortune to scramble up a tree to safety. As he looked down into the raging waters, he saw a fish struggling against the swift current. Filled with a humanitarian desire to help his less fortunate fellow, he reached down and scooped the fish from the water. To the monkey's surprise, the fish was not very grateful for this aid. (Old Chinese fable, quoted in Foster, 1962).

You are armed with an awareness of your own cultural heritage. You understand a lot more about the sociocultural aspects of the community you're trying to reach. You genuinely want to be helpful. Everything is going great. Right? Not great, actually. You sense some resistance on the part of the community in general and from certain clients in particular. Where does this resistance come from?

Chapter 5



If you are working with clients who speak a different language from your own, there can be problems in cross-cultural communications. To facilitate communication, consider the use of an interpreter or translator.

Chapter 6


Every community is unique. Even communities with a similar ethnocultural makeup may vary depending on geographic region, whether the community is in an urban or rural setting, or a host of other factors. Thus, there are no standard blueprints to address the needs of each ethnic community. One must work with the community to understand its values, attitudes, strengths, weaknesses, perceptions, and behaviors, and to learn how to work effectively within that context. There are, however, some general characteristics that can be used to describe particular cultural groups.

This chapter will discuss some cultural issues relevant to working with clients who are Amish, Asian American, Black American, Hispanic or Latino, and Haitian. Again, it cannot be emphasized too strongly that members of your community may or may not think, behave, or feel in the ways described for their ethnic group. The importance of conducting your own community assessment with the tools described in Chapter 3 and evaluating each client's cultural belief system using the tools described in Chapter 4 cannot be overstated.

There is always the danger of overgeneralizing or stereotyping when cultural information such as this is described. It is vitally important that none of these groups be seen as a monolith, but rather as a collection of individuals who share a common cultural heritage. There are many intragroup differences as well as intergroup dissimilarities and similiarities. Please be aware of these caveats as you read and use the cultural information presented on the following pages.

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