Boundary Crossing: Resituating Cultural Competence
Since 1997, Professors Mary Lawlor and Cheryl Mattingly have been conducting a longitudinal study of health care trajectories in 30 African-American children with illnesses and/or disabilities, their families, and practitioners who serve them. In total, this research program has been supported with over five million dollars in federal funding; it currently operates through a four-year NIH 2R01 grant. In this study, cross-cultural health care encounters with families are being examined and situated in broader temporal and developmental trajectories as well as sociocultural contexts including family, home, community, and institutional sociocultural worlds. The research aims are to identify, describe and situate how families contribute to the production of culturally responsive care, and to reveal the strategies families and practitioners employ to establish commonality, bridge differences, and effectively "partner up."
Although an overwhelming body of literature documents health care disparities for ethnic minorities, there is a striking paucity of strategies to address this significant public health issue. Much research on cultural competence radically underestimates how much work families do to achieve culturally competent care. Longitudinal and learning aspects are underdescribed, as are the strengths and resources families bring to healthcare encounters. Using an approach that is both event-centered and longitudinal, this study leads to information about how discrete moments of healthcare encounters produce effects across both context and time. It is expected that the findings of this study will facilitate a reconsideration of dominant models of cultural competency and health literacy at multiple policy levels.