Cultural Competency in Health Coaching: Why Connection Comes Before Coaching

Cultural Competency in Health Coaching: Why Connection Comes Before Coaching

Culture is not something we add to health coaching. It is part of understanding the person we are coaching.

Health coaching is about supporting people to make meaningful, sustainable changes to their health and wellbeing. But behavior change doesn’t happen in isolation. It happens within the context of a person’s family, culture, beliefs, values, community, finances and lived experiences.

For health coaches, understanding this context is essential to building trust, creating meaningful connections and developing health goals that are realistic and sustainable.

Cultural competency isn’t about knowing everything about every culture. That’s impossible. Instead, it’s about developing awareness, curiosity and practical skills to work respectfully with people whose experiences and worldviews may differ from our own.

At its heart, culturally responsive health coaching begins with one simple principle: connect before you coach.

Why does culture matter in health coaching?

When someone comes to a health coach, we might initially focus on their diagnosis, health concerns or personal goals. But behind every health goal is a person with a unique story.

Their understanding of health and wellbeing may be shaped by:

• Family expectations and responsibilities.
• Cultural traditions and community connections.
• Spirituality, beliefs and personal values.
• Language and communication preferences.
• Financial circumstances and access to resources.
• Migration experiences and previous interactions with healthcare.
• Their experiences of identity, belonging and discrimination.

These factors can significantly influence how someone approaches their health and whether a collaborative action plan is achievable. The person might decide on an action plan during the consultation but struggle to implement them in everyday life due to various reasons.

Consider a person who wants to improve their nutrition. Focusing on changes to their meals without understanding their family’s eating habits, the foods that are culturally important to them, and who prepares the meals or what they can afford may result in a plan that is difficult to maintain.

This doesn’t necessarily mean they lack motivation or commitment. It may simply mean the plan doesn’t fit their circumstances or they did not understand the need for the change. Understanding a person’s health needs with cultural lens will support the person to make achievable behavior changes.

Sustainable behavior change requires us to understand the context in which behavior occurs.

Rather than expecting people to adapt their lives to our ideology we need to work collaboratively to find changes that fit within their lives.

Cultural competency is a journey, not a destination

Developing cultural competency is an ongoing process. It involves continually reflecting, learning and adapting our practice.

There are several interconnected aspects to this journey.

1. Cultural awareness

The first step is to recognise that cultural differences exist and that our own experiences influence how we see the world.

2. Cultural sensitivity

We begin to appreciate that these differences deserve respect and that our way of doing things is not necessarily the only or best way. Acknowledging their presence is key.

3. Cultural competency

We develop knowledge and practical skills to work more effectively with people from different cultural backgrounds.

4. Cultural safety

We move beyond considering our own intentions and ask how the person experiences the interaction and connection.

We might believe we are respectful and communicating clearly, but the person sitting in front of us may experience the interaction differently.

Cultural safety requires us to consider power imbalances, our assumptions and whether the person feels comfortable enough to express their needs, preferences or concerns.

5. Cultural humility

Finally, we recognise that learning never ends.

Even health professionals with decades of experience will encounter people who challenge their assumptions and teach them something new.

Cultural humility means acknowledging that we don’t know everything, remaining open to learning and recognising that each person is the expert in their own lived experience.

Start by understanding your own cultural lens

Cultural competency isn’t only about learning about other people’s cultures. It also requires us to understand ourselves.

We all bring our own upbringing, beliefs, values, experiences and professional training into a coaching conversation. These influence what we consider normal, healthy or appropriate.

For example, consider your assumptions about:

• What constitutes a healthy diet.
• What a supportive family looks like.
• How people should express motivation.
• What effective communication looks like.
• How people should interact with healthcare professionals.
• What makes someone a ‘good patient’.

These ideas haven’t appeared from nowhere. They have been shaped by our own experiences and the environments in which we have lived and worked.

Something that feels completely normal to us may be experienced very differently by another person or their families due to their cultural beliefs.

For one family, openly discussing personal matters may be a sign of closeness. For another, privacy may be highly valued, or because of the burden they may impose on others. Some things are to be shared with certain people, and some are not.

Some people may feel comfortable addressing a doctor by their first name, while others may consider formal titles an important sign of respect. The hierarchy approach is customary to many ethnicities.

Neither approach is inherently right or wrong. The important thing is to recognise that our own expectations are not universal.

A useful question for health coaches is: What am I assuming about this person, and how do I know that assumption is correct?

Developing this awareness helps us recognise unconscious bias and remain open to understanding the person in front of us rather than assuming them.

Communication is about more than words – so ask and don’t assume

Communication plays a central role in culturally safe health coaching, but it involves much more than the words we use.

Eye contact, silence, tone of voice, personal space, body language and the way we address others can all carry different meanings across cultures.

For example, a client who avoids eye contact may still be listening carefully and engaging with what is being said. A person who speaks very little may be taking time to consider the information rather than showing disinterest.

Similarly, expectations about personal space and professional hierarchy can vary.

If we interpret these differences through our own cultural lens, we risk misunderstanding the person and damaging the relationship.

Rather than immediately interpreting a behaviour as disengagement, we can remain curious and consider other explanations.

Make communication easier to understand

Health professionals regularly use medical terminology and abbreviations that may be unfamiliar to clients. Terms such as HbA1c, for example, may mean very little to someone who hasn’t encountered them before.

Culturally responsive communication means making information accessible without making assumptions about someone’s knowledge or abilities.

Practical strategies include:

• Using plain language rather than medical jargon.
• Keeping sentences short and introducing one concept at a time.
• Checking understanding throughout the conversation.
• Using visual resources where they may be helpful.
• Allowing enough time for people to process information and respond.
• Using a professional interpreter when required.

When working with an interpreter, continue to address the client directly rather than directing your questions to the interpreter. This reinforces that the conversation is about the client and their health, while the interpreter facilitates communication.

Professional interpreters are particularly important when discussing sensitive health matters. Relying on children or family members to interpret can compromise privacy and may make it difficult for clients to communicate openly.

Most importantly, don’t assume that a person understands simply because they nod or agree with you.

Checking understanding respectfully helps ensure that everyone has a shared understanding of the conversation and any agreed actions.

Connection comes before intervention

Health coaching is relational. The quality of the relationship can influence what becomes possible during a consultation.

When discussing personal health concerns, people need to feel safe enough to share their experiences, express uncertainty and tell us when something isn’t working.

Without that connection, even a well-designed coaching intervention may fall short.

This is particularly important when a client is navigating language barriers, unfamiliar healthcare systems or sensitive family circumstances.

A person may bring a family member to help with communication but still prefer to discuss certain aspects of their health privately. Another person may want a family member or trusted support person involved in developing their goals.

Neither preference should be assumed.

Meaningful conversations

Taking time to establish trust and understanding what the person needs can help create the conditions for more meaningful conversations, realistic goals and achievable action plans.

It can be tempting to focus on completing the coaching process: identifying a goal, exploring motivation and agreeing on next steps, however;

The process should never become more important than the person.

Sometimes, the most valuable thing we can do is slow down, listen and strengthen the relationship before moving towards an intervention.

Family can be part of the intervention — when the client chooses

Healthcare interactions are often framed as a relationship between a health professional and an individual patient. However, health decisions may involve a much wider network of family, community and spiritual relationships.

In Māori contexts, the concept of whānau recognises the importance of family and wider connections.

For some people, health decisions are closely connected to family responsibilities, shared meals, collective values and community expectations.

Recognising these connections can help health coaches understand the broader context of behaviour change.

But cultural responsiveness also means recognising individual choice.

We should create opportunities for clients to involve family or other support people if they wish, without assuming that this is necessary or desirable.

A simple question can open the conversation:

‘Is there anyone you would like to be involved in this conversation or in supporting your health goals?’

This gives the person control over the decision while acknowledging that their support network may be an important part of their health journey as well.

Develop health goals that respect culture and everyday life

Consider a client who says, ‘I need to lose weight.’

A health coach might immediately suggest stopping rice and curry or removing other culturally familiar foods from their diet based on their ethnicity. But what do we know about this person’s eating habits?

We may not know what they eat, how much they eat, who prepares their meals, whether they share food with extended family, what foods are important to them or what their budget allows.

By jumping straight to assumptions, we risk labelling culturally important foods as unhealthy without understanding the full picture. A more useful approach is to explore the person’s experience first and look at options from there.

We might ask:

• ‘Can you tell me what meals usually look like at home?’
• ‘Who normally prepares the meals?’
• ‘What foods are particularly important to you and your family?’
• ‘What changes do you think might work for you?’
• ‘Are there any challenges that could make those changes difficult?’

These questions allow us to work collaboratively rather than imposing a predetermined solution.

The aim is not to remove culture from a person’s life. It is to identify realistic health changes that work within their circumstances while respecting their traditions, preferences and priorities.

This principle applies to many aspects of health, including physical activity, sleep, stress management, medication routines and social connection. When we understand the person’s context, we are better placed to support changes that can be sustained over time.

What happens when we get it wrong?

Even experienced health coaches will sometimes make incorrect assumptions or unintentionally cause discomfort.

Cultural humility doesn’t mean never making a mistake. It means being willing to recognise and repair mistakes when they occur.

If a client corrects us, we can acknowledge their feedback, apologise and thank them for helping us understand their perspective.

For example, we might say:

‘I’m sorry. I assumed that, and I appreciate you correcting me. Would you be comfortable explaining what would work better for you?’

This response demonstrates respect and a willingness to learn.

Avoid becoming defensive or withdrawing from the conversation because you feel uncomfortable about getting something wrong.

Instead, use the experience as an opportunity to reflect and adapt your approach.

Cultural responsiveness also extends beyond individual consultations. Health coaches may encounter systems, policies or workplace practices that create barriers for people from different cultural backgrounds.

These challenges may involve access to interpreters, culturally appropriate services, communication around ageing and end-of-life care, or assumptions about how families should participate in healthcare.

Where possible, health coaches can advocate for better processes, raise concerns with colleagues and help identify resources that make services more accessible.

Reflection, discussion, supervision and ongoing learning can help us improve our practice over time.

A practical cultural curiosity toolkit for health coaches

You don’t need to ask every question in every consultation. Instead, use these questions as prompts when you need to better understand a client’s perspective.

Six questions to support culturally responsive conversations

1. What’s important for me to understand about you?

This gives the person an opportunity to share information they consider relevant, without requiring them to explain or represent an entire culture.

2. What does being healthy mean to you?

Our definitions of health and wellbeing can differ. Understanding the client’s perspective helps ensure that the conversation reflects what matters to them.

3. Who are the important people involved in your health decisions?

This explores the person’s support network without assuming that family or community involvement is necessary.

4. Are there any cultural, family or spiritual practices you would like me to understand?

This creates space for the person to share practices that may influence their health goals or preferences.

5. What might make this plan difficult in your everyday life?

This encourages an honest discussion about barriers, including financial constraints, family responsibilities, work, access to resources and other practical considerations.

6. How can we make this plan work for you and your family?

This invites collaboration and helps translate health recommendations into realistic actions that fit the person’s circumstances.

The purpose of these questions is not to collect cultural information for its own sake. It is to develop a better understanding of the individual and use that understanding to support meaningful, person-centred care.

Prepare to work with the community you serve

Cultural responsiveness also requires health coaches to understand the communities in which they practice.

• When starting in a new clinic or healthcare setting, it is worth asking:
• Which communities do this service support?
• What languages are commonly spoken?
• How can I access professional interpreters?
• Which culturally appropriate healthcare services and community organisations are available locally?
• Are translated resources available?
• Is there a cultural advisor or colleague I can approach when I need guidance?
• How does the practice support clients who want family involved in their care?
• What opportunities are available for cultural supervision and further learning?

Health coaches don’t need to hold every resource in their heads. They do, however, need to know where to find reliable support. Building a directory of local interpreter services, community organisations, culturally appropriate healthcare providers and translated resources can save time and help ensure clients receive appropriate support.

It also helps health coaches become more connected to the communities they serve, rather than relying solely on what they learn during consultations.

Bringing cultural responsiveness into everyday health coaching

Cultural competency is not a checklist to complete or a body of knowledge that we eventually master. It is an ongoing commitment to understanding people, reflecting on our own assumptions and adapting our practice.

When we bring cultural awareness and humility into health coaching, we are better equipped to build relationships based on trust, respect and collaboration.

Five simple principles you can adopt for your next coaching conversation are:

1. Be curious. Approach each person with an openness to learning about their experiences and perspective.
2. Be humble. Recognise the limits of your own knowledge and remain willing to learn.
3. Build connection. Prioritise the relationship rather than rushing to an intervention.
4. Ask, don’t assume. Let the person tell you what matters to them.
5. Adapt your coaching. Work with the person to develop an approach that fits their life, values and circumstances.

These principles are relevant whether you work in a general practice, an allied health setting, a community organisation or a private health coaching practice.

Ultimately, culturally responsive health coaching is about recognising that people are more than their diagnoses or health goals. They bring their whole lives into the coaching relationship.

When we take the time to understand that context, we create better opportunities for meaningful conversations, shared decisions and sustainable behaviour change.

Culture is not something we add to health coaching. It is part of understanding the person we are coaching.