“Cultural safety puts the woman at the centre of care by identifying her needs and establishing a partnership built on trust.” (Phiri et al 2010)
Cultural safety is based on the basic human rights of respect, dignity, empowerment, safety and autonomy (Phiri et al 2010). The concept of ‘cultural safety’ comes from an approach that incorporates culture within a wider structural framework, focusing on social position to explain health status rather than on the ‘values, beliefs and traditions’ of a particular group (Williamson & Harrison 2010). This approach considers the dynamic nature of culture and the diversity within groups, avoids stereotyping and identifies the needs of the individual receiving care.
Cultural safety is defined by the individual attending health care. It builds on the concepts of cultural awareness (appreciating cultural, social and historical differences and reflecting on one’s own culture, biases and tendency to stereotype) and cultural sensitivity (acknowledging differences and exploring self attitudes) (Thomson 2005). For example, if a woman prefers to see a female health professional, identifying this need is culturally aware, planning the woman’s care around that need is culturally sensitive and ensuring that the woman is not seen by a male health professional is culturally safe (Phiri et al 2010). Embedding this into routine care may contribute to a culturally responsive service (Reibel & Walker 2010).
Strategies to ensure culturally safe care include optimising communication (eg through the use of interpreters), building sound relationships, acknowledging women’s cultural preferences (Phiri et al 2010) and reflecting on and analysing how power relationships and history have affected the health of individuals (Kruske et al 2006). It is also important to acknowledge that the interaction between the ‘culture’ of the health professional and the culture of the woman (regardless of ethnicity) may result in a power imbalance (Kruske et al 2006). Women from vulnerable and marginalised groups may feel particularly disempowered in healthcare settings. This can be reduced through (Kruske et al 2010):
- mindfulness about symbols of power (eg uniform, stethoscope) and the way the room is structured (eg avoiding sitting behind a desk);
- positioning — sitting alongside, not opposite, quiet or shy women and families; and
- showing genuine respect for the woman — the woman will be more likely to feel trust, tell more of her experience and accept advice.