Cultural Competency & Health Coaching

By Elizabeth Bechard, BA, RYT

What does cultural competency have to do with health coaching?

Cultural competence describes the ability to communicate effectively and respectfully with individuals from different backgrounds. While we often think of “culture” as referring to a person’s ethnic or geographic origin, it also encompasses a wide spectrum of other characteristics, such as gender and/or gender identity, sexual orientation, age, disability, income, and education level.

If we’re lucky, we’ll have the opportunity as health coaches to interact with a wide variety of clients, many of whom may have backgrounds that are different than ours. The diversity of our clients’ life experiences may also mean that we’ll serve individuals facing challenges we haven’t faced ourselves. A young, able-bodied coach may work with an elderly client who’s been wheelchair bound for decades with a disability. A white coach may work with an African American client whose health is directly affected by the ever-present stress of racism. A straight, cisgendered female coach may serve a transgender client who faces discrimination every time they go to the doctor.

In our role as supportive partners in the work of health behavior change, it’s essential that we cultivate an awareness of the ways that culture, in its broadest sense, intersects with health. Without this awareness, we may unintentionally run into blind spots that impact our ability to connect respectfully, meaningfully, and skillfully with our clients.

What can coaches do to increase their cultural competency?

The work of becoming culturally competent is lifelong, and requires both an open mind and an open heart. There’s no certification or ten-step process that will deem you “culturally competent” for life, but there are steps you can take to increase your knowledge, awareness, and capacity to serve individuals whose life experience may be different than your own. Here are some ideas to get you started:

• Bring an open, curious mind to the process of learning about cultural competency. Mindfulness is an invaluable skill when diving into learning that may be uncomfortable and challenging at times.
• Educate yourself about unconscious biases and blind spots: we all have them, and increasing our awareness of this can help us shed light on the hidden beliefs and assumptions we may hold ourselves. The book Blind Spot is a good place to start.
• Research has shown that healthcare professionals demonstrate the same levels of implicit bias as the wider population.^[1] Consider taking an implicit bias test online to assess your own implicit bias, such as this Racial Implicit Association Test – you may be surprised at the results.
• Participate in racial bias training, such as that offered by the Racial Equity Institute. Many large organizations offer diversity or equity training; ask your employer if such a training is available in your workplace, and if not, consider coordinating such a training for yourself and your colleagues.
• Create space in your professional development to learn about health disparities, and if you are working with a population or individual whose life experience differs significantly from your own, make an effort to learn about the particular challenges they may face. For example: learn about microaggressions, watch a documentary on health disparities, consider taking a class on health disparities at a local university, or check out books on health disparities from your local library; the possibilities for learning are endless.
• Weave an intentionally inclusive approach into your health coaching intake process. For example, you could:
  • Ask your client what pronouns he/she/they prefer to use.
  • If your intake form contains demographic categories, make sure that there is space for individuals to self-identify an identity that may fall outside of cultural norms.
  • Use language like “partner” or “significant other,” rather than “husband” or “wife.” If the client does have a partner and chooses to talk about them, follow their lead in choosing language moving forward.
  • Consider leaving space on an intake form for clients to identify any disabilities that may affect their wellness (and remember that not all disabilities are visible).
• Be open to learning a new vocabulary with which to talk about issues relating to race, gender/sexuality, and other realms of social inequity, and be mindful of words or issues that may be personally triggering for you. Words like “privilege,” and “racism” may be emotionally charged for many of us. If you noticed yourself feeling triggered, take it as an opportunity to breathe deeply and engage in an inquiry: what beliefs or assumptions might be behind your reaction? What deeper learning might this reaction be inviting you into?
• Take inventory of your own identities – particularly those that may be “invisible” to you. For example, I identify as a white, cisgendered, able-bodied, U.S.-born adult female in a heterosexual relationship – and all of these identities influence the kind of health care I receive and how well I’m supported (or not supported) by my culture. What identities shape your own experience of life and healthcare?
• If your identities include those of a dominant cultural group (such as white, male, straight, cisgendered, able-bodied, or young), use your privilege to work towards justice and equity for marginalized groups. Do the ongoing work of dismantling your own biases and assumptions, learn about the ways marginalized groups are affected by health disparities and systemic oppression, and actively participate in educating others in dominant groups about these issues.
• Allow yourself to make mistakes: the work of dismantling our assumptions and biases is often uncomfortable and painful, and it’s nearly impossible not to make missteps along the way. If you unintentionally say the “wrong” thing, learn how to apologize sincerely, forgive yourself, and move on (on the apologies front, here’s a great primer: Getting Called Out: How to Apologize.
• Find a partner whose background is similar to your own to process your learning with. For example, if you’re a white coach learning about racial bias in the healthcare system, find another white coach to debrief and discuss your learning with. It’s normal for topics like health disparities and implicit bias to feel uncomfortable and deeply challenging at times, but you don’t have to go it alone.

Want to learn more about cultural competency?

What steps will you take next to deepen your cultural competency as a health coach? For an in-depth series of discussions of these issues, join us for the Cultural Competency for Health Professionals course: this 5-session webinar training will educate health professionals about several marginalized populations, and offer considerations for effectively working with diverse clients and patients. We hope to see you there.

^[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333436/