Culturally competent health services: trends and perspectives in the Italian context. An explorative study

Author/s Giuseppina Dell’Aversana, Andreina Bruno
Publishing Year 2018 Issue 2018/2
Language Italian Pages 22 P. 115-136 File size 240 KB
DOI 10.3280/PDS2018-002010
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Italy has one of the most inclusive policy in Europe for the protection of migrants’ health rights. However, the development of health services to meet the needs of an increasingly diverse population, despite best practices, remains largely fragmented. To tackle health inequalities for migrants and ethnic minorities, cultural competence (CC) for professionals and organizations is emerging internationally as a synonym for best practices. Its definition is currently debated, being affected by the influence of the specific historical-geographical contexts in which it is used. The aim of the study is to explore in the Italian context: 1) the critical issues in the development of culturally competent services; 2) the perception of best practices in comparison with the European guidelines; 3) the use and understanding of the CC construct. 8 experts with different backgrounds and renowned for their professional expertise in the promotion of migrants health were interviewed. The analysis of the results allows to compare the national trends with the European ones and to deepen internal differences. The use of the term cultural competence does not appear widely diffused and is interpreted using different perspectives, with approaches suggesting to overcome the categorical vision of culture. Overall, the data recommend the importance of a research-based health service to hinder discriminative practices, foster equity and contextualize strategies to local needs.

Keywords: Cultural competence, health inequalities, migrants, best practices, equity, healthcare organizations

  1. Papps E. and Ramsden I. (1996). Cultural safety in nursing: the New Zealand experience. International Journal for Quality in Health Care, 8 (5): 491-497.
  2. Barbour R. (2001). Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ, 322 (7294): 1115-1117.
  3. Betancourt J.R., Green A.R., Carrillo J.E. and Park E.R. (2005). Cultural competence and health care disparities: key perspectives and trends. Health Affairs, 24 (2): 499-505.
  4. Braun V. and Clarke V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2): 77-101.
  5. Bruno A. and Dell’Aversana G. (2018). ‘What shall I pack in my suitcase?’: the role of work-integrated learning in sustaining social work students’ professional identity. Social Work Education, 37(1): 34-48. DOI: 10.1080/02615479.2017.136388
  6. Bruno A., Dell’Aversana G. and Zunino A. (2017). Customer Orientation and Leadership in the Health Service sector: the role of Workplace Social Support. Frontiers in Psychology, 8: 1920.
  7. Cattacin S., Chiarenza A. and Domenig D. (2013). Equity Standards for Health Care Organisations: a Theoretical Framework. Diversity and Equality in Health and Care, 10 (4): 249-258.
  8. Chiarenza A. (2012). Developments in the concept of cultural competence. In: Ingleby D., Chiarenza C., Deville W. and Kotsioni I., eds., COST Series on Health and Diversity. Antwerp: Garant Publishers, pp. 66-80.
  9. Ciancio B. (2014). Sviluppare la competenza interculturale. Il valore della diversità nell’Italia multietnica. Un modello operativo. [Developing intercultural competence. The value of diversity in multiethnic Italy. An Operational Model]. Milano: FrancoAngeli.
  10. Crenshaw K.W. (1991). Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43: 1241-1299.
  11. Cross T., Bazron B., Dennis K. and Isaacs M. (1989). Towards a culturally competent system of care: a monograph on effective services for minority children who are severely emotionally disturbed. Vol. 1. Washington, DC: Georgetown University Child Development Center.
  12. Dauvrin M. and Lorant V. (2017). Cultural competence and social relationships: a social network analysis. International Nursing Review, 64 (2): 195-204.
  13. Dell’Aversana G. and Bruno A. (2017). Different and similar at the same time. Cultural competence through the lens of healthcare providers. Frontiers in Psychology, 8: 1426.
  14. DelVecchio Good M.J.D. and Hannah S.D. (2015). “Shattering culture”: perspectives on cultural competence and evidence-based practice in mental health services. Transcultural Psychiatry, 52 (2): 198-221. DOI: 10.1177/136346151455734
  15. Devillé W., Greacen T., Bogic M., Dauvrin M., Dias S., Gaddini A., Jensen N.K., Karamanidou C., Kluge U., Mertaniemi R., Riera R.P., Sárváry A., Soares J.J., Stankunas M., Strassmayr C., Welbel M. and Priebe S. (2011). Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study. BMC Public Health, 11: 699. DOI: 10.1186/1471-2458-11-69
  16. Domenig D. (2007). Das Konzept der transkulturelle Kompetenz [The concept of transcultural competence]. In: Domenig D., ed., Transkulturelle Kompetenz: Lehrbuch für Pflege-, Gesundheits- und Sozialberufe. Bern: Verlag Hans Huber, pp. 165-189.
  17. Fassin D. (2000). Repenser les enjeux de santé autour de l’immigration. [Rethinking Migrants’ Health Issues]. Hommes et Migrations, 1225: 5-12.
  18. Goode T. and Like A. (2012). Advancing and sustaining cultural and linguistic competence in the American health system: challenges, strategies, and lessons learned. In: Ingleby D., Chiarenza C., Deville W. and Kotsioni I., eds., COST Series on Health and Diversity. Antwerp: Garant Publishers, pp. 49-65.
  19. IDOS (2017). Immigrazione e presenza straniera in Italia. Scheda di sintesi. [Immigration and foreign presence in Italy. Factsheet.]. Retrieved -- From:
  20. Ingleby D. (2011). Good practice in health service provision for migrants. In: Rechel B., Mladovsky P., Devillé W., Rijks B., Petrova-Benedict R. and McKee M., eds., Migration and health in European Union. Maidenhead, UK: Open University Press McGraw-Hill, pp. 227-242.
  21. Ingleby D. (2012). Ethnicity, migration and the ‘social determinants of health’ agenda. Psychosocial Intervention, 21 (3): 331-341.
  22. Jirwe M., Gerrish K., Keeney S. and Emami A. (2009). Identifying the core components of cultural competence: findings from a Delphi study. Journal of clinical nursing, 18 (18): 2622-2634.
  23. Johnstone M.J. and Kanitsaki O. (2007). An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context. Journal of Transcultural Nursing, 18 (3): 247-256. DOI: 10.1177/104365960730130
  24. Kirmayer L.J. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49 (2): 149-164. DOI: 10.1177/136346151244467
  25. Kleinman A. and Benson P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoSMedicine, 3 (10): 1673-1676.
  26. Mladovsky P., Ingleby D. and Rechel B. (2012). Good practices in migrant health: the European experience. Clinical medicine, 12 (3): 248-252.
  27. Nelson A.R., Stith A.Y. and Smedley B.D., eds. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
  28. Nørredam M. and Krasnik A. (2011). Migrants’ access to health services. In: Rechel B., Mladovsky P., Devillé W., Rijks B., Petrova-Benedict R. and McKee M., eds., Migration and health in European Union. Maidenhead, UK: Open University Press McGraw-Hill, pp. 67-78.
  29. O’Donnell C.A., Burns N., Mair F.S., Dowrick C., Clissmann C., Van Den Muijsenbergh M., ... and De Brun T. (2016). Reducing the health care burden for marginalised migrants: the potential role for primary care in Europe. Health Policy, 120 (5): 495-508.
  30. OMH (Office of Minority Health) (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report, Washington, DC: Department of Health and Human Services.
  31. OMH (Office of Minority Health) (2013). National standards for Culturally and Linguistically Appropriate Services in health and health care: A blueprint for advancing and sustaining CLAS policy and practice. Washington, DC: Department of Health and Humans Services.
  32. OIM (Organizzazione Internazionale per le Migrazioni). (2016). Global Migration Trends Factsheet 2015. -- Retrieved From:
  33. Rechel B., Mladovsky P., Ingleby D., Mackenbach J.P. and Meckee M. (2013). Migration and health in an increasingly diverse Europe. Lancet, 381: 1235-1245. DOI: 10.1016/S0140-6736(12)62086-
  34. Renschler I. and Cattacin S. (2007). Comprehensive “Difference Sensitivity” in health systems. In: Cuadra C.B and Cattacin S., eds., Migration and health: difference sensitivity from an organizational perspective, pp. 37-41.
  35. Rinaldi A., Civitelli G., Marceca M. e Paglione L. (2013). Le politiche per la tutela della salute dei migranti: il contesto europeo e il caso Italia. [Policies to protect migrants’ health: European context and the Italian case]. Revista Interdisciplinar da Mobilidade Humana, 21(40): 9-26.
  36. Seeleman C., Essink-Bot M.L., Stronks K. and Ingleby D. (2015). How should health service organizations respond to diversity? A content analysis of six approaches. BMC health services research, 15 (1): 510.
  37. Suphanchaimat R., Kantamaturapoj K., Putthasri W. and Prakongsai P. (2015). Challenges in the provision of healthcare services for migrants: a systematic review through providers’ lens. BMC health services research, 15 (1): 390.
  38. Tognetti Bordogna M. (2013). Nuove disuguaglianze di salute: il caso degli immigrati [New inequalities in health: the case of immigrants]. Cambio, 5: 59-72.
  39. Tervalon M. and Murray-Garcia J. (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9 (2): 117-125.
  40. Thackrah R.D. and Thompson S.C. (2013). Refining the concept of cultural competence: building on decades of progress. Medical Journal of Australia, 199 (1): 35-38.
  41. Williams D.R. and Mohammed S.A. (2013). Racism and health: pathways and scientific evidence. American Behavioral Scientist, 57 (8): 1152-1173. DOI: 10.1177/000276421348734

  • Servizi sanitari, migrazione e diversità. Prospettive sull'implementazione della competenza culturale Giuseppina Dell’Aversana, Andreina Bruno, in RICERCHE DI PSICOLOGIA 1/2020 pp.275
    DOI: 10.3280/RIP2020-001013

Giuseppina Dell’Aversana, Andreina Bruno, Servizi sanitari culturalmente competenti: prospettive emergenti nel contesto italiano. Uno studio esplorativo in "PSICOLOGIA DELLA SALUTE" 2/2018, pp 115-136, DOI: 10.3280/PDS2018-002010