This Needs Assessment was conducted by graduate student Olivia Bowman as part of her practicum with SOS Public Health (SOSPH) in the Fall of 2022.  This needs assessment examines healthcare information access among the multinational English-speaking community living in South Korea, with a focus on the role that cultural dissonance may play in such access.

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The 2021 South of Seoul Public Health Survey found that putting effort into developing cultural competence may improve your perceptions of your own healthcare in South Korea. Let’s talk about this. Listen to the BlogCast Don’t want to read? Listen to the South of Seoul BlogCast which provides accessible content through the use of AI technology. We don’t have time to read each article but we do our best to make more of our content accessible. If you would like to join our Accessibility Team apply to volunteer with South of Seoul. Please note that the pronunciation of some Korean words may be inaccurate due to AI technology’s limitations. The Hard Parts of Ex-Pat Life Living in a foreign country can sometimes be difficult, frustrating, and lonely. It can feel like ‘everyone’ is working against you. Feelings of intense anger toward yourself and/or the culture around you may surface. You feel that you may never fit in or feel at home in the foreign country. You may find that this sentiment is common among ex-pats around the world and it has a name: culture shock. Culture shock might not be the only hurdle you face, but you can take action to overcome it. Therefore, addressing culture shock is a great place to start when tackling your integration journey. South of Seoul founder, Lanae Rivers-Woods, who has lived in South Korea for over a decade, detailed some tips she uses to overcome culture shock in her excellent blog (5 Tips for Conquering Culture Shock). Nobody needs to do it alone. The barriers that you face with culture shock can affect not only your day-to-day activity but also your ability to access healthcare in Korea. For this reason, building cultural competence is a vital skill to overcoming such barriers. What is ‘cultural competence’? Cultural competence. This technical term may invoke feelings of belittlement. Reading the term, ‘competence,’ in certain contexts may make you feel like your intelligence is being challenged. However, ‘competence’ is simply a term. If we remove the negative connotations that surround this term, we can be more open to understanding the full concept of cultural competence. Definition Many people have cultural knowledge, cultural awareness, and cultural sensitivity. These traits, however, should not be confused with cultural competence. Cultural knowledge, awareness and sensitivity make up only a part of the definition. They lack a key aspect that truly defines cultural competence: action and structural change. The CDC has a great definition of cultural competence. They define cultural competence as: “…a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.” Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and Human Services. Centers for Disease Control and Prevention. https://npin.cdc.gov/pages/cultural-competence. Human Services Edu has a more concise definition that reads: “The term cultural competence describes a set of skills, values and principles that acknowledge, respect and contribute to effective interactions between individuals and the various cultural and ethnic groups they come in contact with at work and in their personal lives.“ Admin. (2021, July 8). Cultural competency: Human services education. Human Services Edu. https://www.humanservicesedu.org/cultural-competency/. Both of these definitions imply that, to build cultural competence, you must take action or make structural changes to your belief system. Stepping outside your cultural beliefs for a moment to understand another’s allows you to have effective interactions with your community. This, however, doesn’t mean you need to give up your own cultural identity. Application Building cultural competence means taking a break from your personal thoughts and emotions to view your interactions from another perspective: putting yourself in someone else’s shoes, so to speak. Although it may come easily for some, building cultural competence takes time and practice. For instance, customer service differences between cultures remain one of the biggest points of contention for many foreigners in South Korea. Some foreigners have trouble practicing etiquette that seems rude in their home country but is not considered rude in Korea. Personally, I struggled with calling out across the room to waitstaff. This action felt horrifically rude until I took a second to look at the situation from the Korean waitstaff’s perspective. Korean restaurants (particularly small local ones) have very few waitstaff, if any. If the waitstaff had to check up on each table every five minutes (as they do in many U.S. restaurants), they would never get anything done. Calling to waitstaff when we need something allows them to efficiently do their jobs while serving their customers. Even now, I feel weird calling out, but I do it anyway because that is what the culture calls for, and I am able to get what I need more quickly. Why is cultural competence important for accessing healthcare in South Korea? Minor cultural adaptations such as my restaurant experience above can be handled fairly easily and improve the quality of daily life. Our recent SOS Public Health Survey confirmed a correlation between an individual’s level of cultural understanding, their level of integration into Korean society, and their accessibility to healthcare in Korea (shown in the below table). Where cultural competency gets spicy is when you have to deal with the high-stress experience of healthcare. In a healthcare setting, like a doctor’s visit, we deal with our own culture shock and cultural competence but also the Korean healthcare providers’ culture shock and gaps in their own cultural competencies. So, building cultural competence is a team effort. We will talk about our own cultural competencies in this blog since working on ourselves is what we have the most power over at any given moment. If we can increase cultural competence among patients and healthcare providers alike, we can increase equitable access to healthcare. In other words, if you build trust and respect regardless of the differences between you and your healthcare provider and vise versa, then you each will feel more comfortable interacting with each other. If you and your physician are able to work beyond your cultural differences, this can lead to: Cultural Competence in the West Countries designated as part of the “Western World” such as Australia, England, and the U.S. have very diverse populations. These countries have had quite some time to adapt to diversity and cultural issues (though many places in the Western World still have some ways to go on this). Due to the high levels of diversity among demographic populations (i.e. race/ethnicity, socioeconomic status, etc.) in the ‘West,’ healthcare providers have adapted cultural competence trainings as part of their onboarding process for new employees. Now, not all healthcare providers require this training which is unfortunate. Nonetheless, the implementation of cultural competence training continues to grow and evolve in the ‘West.’ Cultural Competence in South Korea Before we dive into cultural competence in Korea, we need to understand the makeup of the international population living here. In Korea, globalization is still a fairly new thing. Korea has experienced enormous growth among its international population over the last 20 years. In 2000, the foreign population count was at 491,234. By 2020, the population reached over 2 million. It can be difficult to keep up with the growing health needs of the international population with this kind of growth rate. Furthermore, the diversity that we see in Korea cannot be compared with the diversity seen in the West. In Western countries, diversity is high, but the majority of cultural groups tend to be members of the same nationality (i.e. Korean American, Black American, Mexican American). The culturally ethnic groups may differ, but each group shares some sort of base understanding of American culture as a whole. Therefore, Korea has to deal with not only people of varying racial/ethnic backgrounds but also people of varying nationalities. Each country has its own healthcare culture. The difficulty of managing patients from all these different cultural backgrounds can be overwhelming. Although it may not be fun or easy for any of us, it will take time for the South Korean healthcare system to learn how to manage this social shift; we all have to still manage our healthcare through this difficult time. Korea is known for making great strides for the growth of the country. I have no doubt that Korea will find ways to adapt to the cultural changes. However, they can’t do it alone. Healthcare workers need our patience and understanding. It is up to us to make the first move by building on our personal cultural competence about Korea and advocating for our health needs. When we practice conscious, cultural competence it allows others around us to more easily reciprocate. The fact of the matter is that this sounds easier than it is. Being present and aware of our own cultural competencies during vulnerable interactions, such as healthcare, feels overwhelming, and often we will fall off the wagon. The feeling of anger may overwhelm us. Fear may lead to our perceptions being skewed. Frustration may make us unwilling to observe things objectively. However, all is not lost when you find yourself buried by culture shock. Feel those feelings. Address those feelings. Explore what experiences caused those feelings. Advocate for yourself by learning what cultural differences could have caused this, and advocate for change where change is needed. In short, build up your cultural competence a little at a time. How do I build cultural competence to improve my comfort level in South Korea? You can build cultural competence in a variety of different ways. Here are a few tips on how I started when I first moved to Korea. Tip # 1 Learn the language Learning a new language, especially one like Korean which uses characters that look nothing like that of your native language, can be daunting. However, don’t let the Korean language scare you. It is more straightforward than you might expect. You also don’t have to become fluent. Just learning how to read can change how you view the world around you. Many people are able to get by in Korea using translating apps and interpreters. Even knowing how to speak Korean, I still use Papago occasionally for more difficult language exchanges. However, this method of communication is less personal. When you learn the local language, even if only a couple of useful phrases, it shows that you are making an effort to understand the community. When the local community can see your efforts, they may be more open to connecting with you and lending a helping hand. Furthermore, in a health setting, learning a few technical health-related words and phrases can help you navigate your hospital visits with more ease. Even in your native language, medical terms can be difficult to understand and explain, right? Understanding a few Korean medical phrases can help reduce some of the stress that results from misunderstanding. I know I feel more comfortable visiting a doctor when I at least know some of the basic medical terminology my doctor uses. As a testament to the importance of language, our SOS Public Health survey revealed that a high level of language proficiency is correlated with a high level of integration and access to healthcare. The survey results are listed below. More to come on language barriers and healthcare access in a future blog. Tip # 2 Make at least one local friend This tip is a major one that I will always recommend no matter where in the world you live or travel. Making local friends opens up so many doors. A local friend can show you their culture from a “behind-the-scenes” perspective by giving you the exclusive scoop on how to interact with other Koreans. Moreover, learning about...

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