Embracing Cultural Humility and Community Engagement

Background

Everyone who works cross-culturally and cross-linguistically will make mistakes. In a world with diverse cultures and languages, it is crucial to be flexible and take responsibility for mistakes. It is also important to learn and adapt as cultures and languages evolve. Doing so helps build trust and relationships that are key to effective global public health efforts.

Global public health professionals, programs, and related communications belong to evidence-based public health and scientific agencies. Professionals in science-based agencies should demonstrate humility by learning from mistakes and adapting our approaches. Rigorous evaluation and community feedback often leads to better outcomes.

Cultural humility

To increase cultural humility...

1. Examine your personal history, background, and social position.

Evaluate how the factors below impact your interpersonal relationships:

• Gender.
• Ethnicity.
• Socio-economic status.
• Profession.
• Education.
• Assumptions, values, beliefs, and biases.
• Culture.

2. Reflect on how your professional organization impacts interactions and relationships with community members.

A health professional's affiliation with an organization can positively or negatively impact interactions and relationships. The organization's reputation, history, norms, and perceived power can influence how people perceive health professionals who represents that organization.

3. Understand and respect cultural differences.

To gain deeper understanding and respect of cultural differences, practice:

• Active inquiry and reflection.
• Openness to power-balanced relationships. It can also be accomplished through
• Appreciation of another person's or community's lived experience and social and cultural expertise.

4. Recognize when you are not the expert.

Everyone has gaps in their experience and expertise. Adopt a willingness to learn from local people and communities about their experiences and practices. Avoid judgment as much as possible.

Implement cultural humility

Emphasize mutually beneficial partnerships.

Global public health professionals should emphasize collaborative, mutually beneficial, and peer-to-peer approaches for solving shared challenges together. Avoid the posture, framing, and language of hierarchy, patriarchy, supremacy, and saviorism.

Make findings and products accessible.

Make findings and final products accessible to the communities and collaborators involved in the research, programs, or initiatives. Offer communication products in local languages and beyond written text, such as verbal presentations, group meetings, individual discussions, and infographics.

Avoid perpetuating harmful hierarchies and supremacies.

Actively identify and avoid markers of hierarchy and supremacy that are often seen in the global public health sector. The markers noted below can occur across different forms of hierarchy and supremacy rooted in: nationality and ethnicity, gender, income, education, ability, age, sexual orientation, etc.

Harmful hierarchies and supremacies to avoid:

• Assumptions that assistance is needed from people/groups who are not part of the population of focus and/or a lack of acknowledgement or discussion of how support is wanted or unwanted. If support is not wanted, respect the partner's/community's wishes and only engage in a mutually agreeable manner.

• Assumptions by visiting individuals and organizations that they know more about a country, community, or health issue than the people who are from that country or community. This can lead to a patronizing tendency of non-community members explaining to community members the very things they experience every day (lived experience).

• Greater value placed on the opinions, voice, or expertise of select experts from high-income countries (HICs) or experts who were educated in HICs or urban centers, that devalues the knowledge and expertise of those with lived experience or non-traditional education paths (e.g., birth attendants, doulas).

• A disregard for local knowledge and ability and/or an inflated sense of personal knowledge and ability.

• An assumption of power or domineering posture when speaking with representatives from local organizations/populations.

• Lack of willingness to share authority, credit for success, or responsibility for challenges and failures.

• A reluctance/refusal to discuss with, listen to, learn from, or partner with members of the population of focus in a manner that is culturally appropriate and that treats them as equals.

• A lack of flexibility/understanding that inhibits respect or patience for diverse local traditions, religions, beliefs, ideas, and expertise.

Community engagement

Global public health professionals should prioritize community engagement. Doing so builds foundational trust and relationships and strengthens collaboration. This helps ensure everyone involved has an equal opportunity to share their voices, opinions, or ideas for public health research, projects, and communications that impact their lives and livelihood.

Community engagement leads to more effective, sustainable, locally appropriate, and community-owned communication, programs, partnerships, and research.

Find resources that include principles and recommendations with global context.

Defining communities and representatives.

Questions to consider

• Is the community or intended audience the people who reside within specific geographic boundaries? Or is the community/intended audience a group of people with common ethnicity, income, age, gender, language, country of origin, migrant or refugee status, belief or faith, etc.?

• Is the community/intended audience based on institutions, such as faith communities, schools, or healthcare facilities? Or a group of people with similar interests or hobbies?

• Is the community/intended audience a combination of the above?

• How can the community be involved to ensure fair representation from populations experiencing disadvantage due to factors such as:
  • Poverty and income status.
  • Living in rural areas or peripheral urban settlements.
  • Discrimination.
  • Migrant or refugee status or country of origin.
  • Language, culture, or faith.
  • Age.
  • Gender.

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Leverage existing relationships

Leverage existing relationships with local partners and community members to proactively identify, listen to, and incorporate a range of people. This broader range of people will bring additional perspectives, experiences, and knowledge. Additional insights can benefit projects and programs throughout the planning, development, implementation, and evaluation phases.

If a relationship with the community does not yet exist, work with and follow the lead of trusted intermediaries who do have existing relationships.

Availability and accessibility

Ensure platforms and safe spaces are available and accessible for people from all involved parties to raise their voices throughout the project. Ideally, each involved party should have equal speaking time during discussions. At each stage of the project, note who is or is not speaking and who was included or excluded.

Using the local language fosters inclusive engagement.

Global public health professionals who are not familiar with the local language should work closely with partners or translators who are fluent.

Identify if social or cultural norms prevent participation.

Identify whether any social or security constraints exist that could hinder community members' participation. If constraints exist, identify how engagement, planning, and implementation can be adapted. For example, some women might have limited mobility or farmers tend to be busy during the day or seasonal workers are unavailable at certain times of the year.

Ensure everyone can get the information that is shared.

Assess the appropriateness of descriptive video, close caption, teletypewriter (TTY), and other accommodations for individuals with disabilities. When these options are not available, consider recording or transcribing meetings and allowing members extra time to review materials. Translate materials if language barriers exist.

Active community participation

Ensure that communities are encouraged and have the opportunity to actively participate throughout the project. Community members should be actively engaged in designing, implementing, leading, evaluating, and improving the public health research, projects, and communications that impact them. Identify potential gaps in participation and implement the most inclusive processes possible before moving to the next stage. Ideally, community members should determine priorities and lead subsequent action and initiatives.

If some participants are present during a discussion but are not active participants, consider whether any power dynamics impact their willingness to speak. For example, people perceived to be at a lower social caste may be unwilling, hesitant, or barred from speaking in front of people in a perceived higher social caste.

In some cases, it might be necessary to convene participants in separate groups. For example, a women's group and a men's group or an adult group and an adolescent group might need to meet separately.

Support people in sharing their own story.

Especially for communication activities that involve storytelling, engage all parties to tell their own story. Try to ensure that the overall narrative is from the community, not merely about the community.

The person with lived experience is the expert on their own story. Ideally, the power to write or dictate the story should rest with the person or community with lived experience. In such an arrangement, a professional communicator should be in a support role, offering input and advice as appropriate.

When a professional communicator is developing the story, use quotes and expand on the surrounding context. Focus the narrative and action on the person or community's own ideas about what is needed for them to live healthy and secure lives.

When storytelling across languages, ensure that translation is high quality so that key nuances are not lost.

Ensure that stories incorporate a range of experiences to represent the diversity of the population.

Invite and include community members in research and publications.

Encourage and invite local partners to contribute as authors of research publications. Any authors from local institutions who contribute and meet authorship criteria must be included as authors in the final, published version.

While abiding by institutional and journals' authorship criteria, engage in open discussion to clarify contributions, negotiate authorship, and publish with an accurate/adequate order of authorship.

Encourage and promote local authors as first and senior authors. Local authors are often underrepresented in key authorship positions in literature about their own countries.

Additional resources