Cultural intelligence

Disclaimer: The term cultural competence is used frequently in academic texts, but is an outdated term that is being phased out of everyday culture. To accurately portray the concept of professionals being educated and aware of culture and its impacts on health care, we will be replacing the term ‘cultural competence’ in this article with ‘cultural intelligence’.

The Canadian health care system is witness to a variety of beliefs, values, religions, and social structures. Culture has an impact on our health care system and how we provide healthcare in our communities. It plays a large role in the understanding of illness, treatment, rehabilitation, and family involvement. It also contributes to a person’s decision to seek health care treatment at all.

With the knowledge we have about the role culture plays in a person’s health, there has been a major focus on understanding and implementing cultural intelligence in the delivery of care.

Topics in this section include:

What is cultural intelligence? 

Cultural intelligence (labeled as cultural competence in the following citation) is the “ability to understand and integrate [an individual’s values, beliefs, and behaviours about health and well-being, shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical, and mental ability, sexual orientation and occupation] into the delivery and structure of the health care system” [1].

Awareness of an individual’s cultural and intersectional background allows clinicians, physicians, and all health care providers to better understand a patient’s view on illness and health treatment. This facilitates the use of skills and strategies to develop and implement a rehabilitation plan, producing the best outcomes for the patient [2].

How does culture play a role in rehabilitation? 

An individual’s culture has a great impact on how they approach health care, disability, and rehabilitation. “People from different cultures have unique expectations of what it means to be ill or to have a disability” [3]. Some cultures believe an injury was an act of God while others may believe they have been cursed by an enemy [4].  Culturally specific beliefs regarding treatment also affect the rehabilitation process. Many cultures have traditional methods of healing that are poorly understood or aren’t acknowledged by others. By understanding a patient’s beliefs, values, and expectations, it is possible to “enhance treatment motivations and rehabilitation outcomes” [5].

In order for a health care or service provider to be successful in this aspect of care, they must commit to developing their cultural intelligence.

Cultural intelligence begins with awareness & knowledge

Health care providers can strengthen their cultural intelligence by acknowledging and taking inventory of one’s cultural values, attitudes, and potential biases [6]. By reflecting upon one’s potential biases, we can better understand the impact our culture has on our understanding and beliefs of illness and disability. Cultural intelligence is an ongoing, lifelong process, learned through educational training, and lived experiences [7].

Asking the right questions and seeking out information can assist a health care worker in determining what is important to the patient. This not only helps one understand the patient better, but it also builds a rapport and trust between both parties [8].

Cultural intelligence is not only educating oneself but educating the patient and their families on the illness and treatment options. “Providing tailored knowledge and psycho-education about TBI and rehabilitation to ethnic minorities and their families may be one of the most effective means of improving engagement in treatment and reducing outcome disparities” [9].

Due to different beliefs and interpretations, it is important to ensure the patient understands the treatments available and why they are being suggested or implemented. This education allows the patient to be better informed and make better decisions [10].

It is also important for the health care professional to listen to the patient and take the time to understand their concerns. Cultural intelligence includes taking into account a person’s history with systemic barriers and confronting one’s biases to make sure that a patient’s experience with you is not impacted in those regards.


Effective and simple communication is imperative in developing trust and building rapport [11]. There can be multiple barriers to communication, including languages and literacy. Additional barriers can include cognitive impairments, vision, auditory, or speech difficulties.

Addressing language and communication barriers has a direct impact on patient trust and health care outcomes [12]. This may include the availability of interpreters, translators, or providing documents available in Braille, with diagrams, or with large lettering.
In many cultures, family and community are extremely influential in a patient’s decision-making process and rehabilitation outcomes [13]. It is equally important to communicate with the patient’s family, friends, and traditional healers if this is requested by the patient.

Effective communication is also demonstrated through active listening. Listening and understanding the patient’s rehabilitation goals and interpretations of treatment is crucial as these may be very different to the westernized healthcare model. Cultural competence understands that rehabilitation is not provided through a template of providers and treatments; it is tailored to the individual, incorporating a mix of healthcare practices.

Individualized rehabilitation plans

Cultural intelligence includes understanding that one person’s experiences and related definitions of health care may be different than the provider’s. “Most cultures have different ideas of what being ill or disabled means, so it is likely the rehabilitation is going to look different depending on cultural background” [14]. It is important to understand “the goal of living an independent life is a westernized ideal and might not be the end goal of minorities from other cultural backgrounds” [15].

Cultural intelligence allows the healthcare worker to ask the right questions, address any concerns, and devise a mutually agreed upon treatment plan “including alternative and complementary therapies” [16], all of which will provide the best outcome for the patient.

A wide variety of therapies may be required in a brain injury rehabilitation plan. These can include physicians, surgeons, neurologists, occupational therapists, physiotherapists, speech-language pathologists, home health support workers, and traditional therapists, to name a few. Collaboration and clear communication between health care providers, the patient, families, and any additional members of the support team is essential in providing the best health outcomes, especially in culturally diverse populations.

Cultural intelligence is an ongoing process of learning and practice. As culture has a direct impact on a patient’s rehabilitation and healthcare outcomes, increasing one’s knowledge, awareness, and communication skills is imperative to developing trust and providing the best possible care.

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