Notes about Terminology

“Cultural competence” and “cultural humility.” This toolkit uses “cultural competence” to refer to: increased understanding of individuals and families and their experiences; positive, affirming attitudes towards them; the skills to develop the provider-patient trust necessary for excellent health care, and the sustained provider and organizational behaviors that demonstrate continuous improvement.

The authors use the term “cultural competence” due to the widespread use of this terminology in the regulations governing health care training and medical education. – for instance, by the U.S. Department of Health and Human Services, Association of American Medical Colleges, and National Quality Forum.3 However, we embrace the “cultural humility” framework, which emphasizes the importance of maintaining an open attitude and curiosity about each individual and their circumstances, provider and staff self-awareness of their own biases, and a commitment to engage in ongoing self-reflection.In addition, true cultural competence requires providers and staff to appreciate the individual and intersectional differences that arise within communities with respect to race, ethnicity, gender, social circumstance, country of origin, religion, and other identity factors, and tailor their care appropriately. When a health provider assumes cultural competence to be a simple matter of mastering knowledge about characteristics shared by people, it may mislead the provider into thinking they know more than they actually do, and blind them to critical facts about their patient, undermining the provider-patient relationship and resulting in suboptimal care. Over-emphasis on provider “competence” also can blind a provider to racial, ethnic and cultural dynamics in the provider-patient relationship and reinforce racial, ethnic and cultural hierarchies.

In short, the authors of this toolkit have chosen to adhere to the language of “competence” – because of its general acceptance in health care professions and in the literature, and to emphasize that the knowledge, attitudes and skills emphasized here – including the skill of cross-cultural communication – are not optional or dispensable. However, the “humility” framework is equally important for good care.

Use of “LGBTQIA+”. The authors of this toolkit recognize that words matter and that the terminology used for self-identification of individuals and populations with minority sexual orientations, gender identities, gender expressions, and sex development continues to evolve. For example, some individuals may not be comfortable with the word “queer” while others may self-identify primarily as queer. In addition, some individuals may prefer to use the term “attractional” or “affectional” orientation instead of the term “sexual” orientation to describe their identities. Others may use “same-gender loving,” “gender queer” or “nonbinary” to define themselves. Diverse sub-populations within the community have their own preferred terms. For example, within the House/Ballroom culture there are such terms as “femme queen” and “butch queen,” which recognize a diversity of gender identities and gender expressions. While recognizing that any terminology used will not be inclusive of all, this toolkit will use the terms sexual orientation, gender identity, and gender expression (SOGIE), and sex development, to refer to broad domains of identity. This toolkit uses lesbian, gay, bisexual, transgender, queer, intersex, and asexual/ace spectrum to broadly refer to people with these diverse identities, while aware that there are more specific cultural, linguistic, and other self-identifications that, while not specifically named, are intended to be included. It is important for providers and staff to recognize the full range of sexual, attractional and gender identities and expressions, rather than make assumptions about their patients, and cultural competence/humility trainings should convey this message.

Additionally, the authors of these guidelines are acutely aware of the important historic, social, and political context for this work to improve health, as part of a larger movement towards health equity. Every person has multiple aspects of their identity in addition to their sexual orientation, gender identity, gender expression, and sex development. This toolkit is not intended to, and could not, adequately address the disparities and inequities based on sex, age, race, ethnicity, language, socioeconomic status, disability, national origin, immigration status, geographic location, and other factors. Any training on cultural competence should include discussion of these multiple lived experiences, with their compounding and cumulative impacts on access to services and health outcomes.

“Learners” vs. “trainees”. This toolkit uses ‘learners” rather than “trainees” to refer to providers and other staff who undergo trainings, in order to underscore the goal of continuous learning rather than a one-time communication of a defined set of facts. We also encourage the use of best practices in adult learning to optimize the effectiveness and impact of the trainings.