Structural Competency: Toward Antiracism in Healthcare

Our current featured article in ANS is titled “A Concept Analysis of Structural Competency” authored by Katerina Melino, MS, PMHNP-BC; Joanne Olson, PhD, RN, FAAN; and Carla Hilario, PhD, RN. We welcome you to download this article at no cost while it is featured on the web! This message from Katerina Melino gives background about her work:

My interest in structural competency was born out of my professional experience as a registered nurse and psychiatric mental health nurse practitioner, and the tensions and gaps I grew increasingly aware of in my practice and the health care system over the course of my career. For the last 13 years, I have worked as a nurse in acute and emergent mental health care, substance use treatment, and HIV mental health care. My clinical work in each of these settings has been with people with mental health challenges who are disproportionately Indigenous, Black, and people of colour; LGBTQ+ identified; and living in poverty. Many of my clients struggled to access appropriate treatment, experienced challenges in maintaining engagement with care, and were hampered in their mental health recovery by factors that could not be addressed by the biomedical model of care in which I was working. Structural competency offered a way to conceptualize what I was seeing in practice, as well as possibility in how to move forward in addressing these gaps.

Structural competency is a nascent concept in the health professions literature and has only been published on in the discipline of nursing since 2018. It represents an evolution of cultural competency and incorporates understandings of the social determinants of health, structural violence, and critical race theory in conceptualizing how factors far outside the individual locus of control influence individual health. This concept analysis uses Rodgers’ evolutionary method to examine how disparate meanings and uses of this concept across medicine and nursing can be synthesized to broaden our multidisciplinary conceptual approach to addressing health inequity. I am excited by the promise of structural competency to transform our approach to clinical mental health care.

Many thanks to my mentors, Dr. Joanne Olson and Dr. Carla Hilario, who guided me in doing this research.