Table 2.

Journey through the three zones of cultural safety, adapted from Jowsey.³

Depth of cultural safety	Definition	Examples	Risks
Surface cultural safety zone	Deployment of culturally specific knowledge	Provision of culturally appropriate services, such as an interpreter or prayer spaces in hospitals; greeting people in their native language; and being aware of certain taboos and cultural practices, for example, in the drawing and use of a patient's blood	May lead to overly simplistic interpretations of culture and in fact perpetuate stereotypes, hence reducing trust; surface-level approaches often do not examine underlying causes of inequity
Bias twilight zone	Supporting people to increase self-awareness of their own biases with a view to addressing health disparities	Moves away from learning specific cultural traits and uses more reflective strategies to understand the impact that individuals have on others; uses collaborative partnerships with indigenous people	With increasing ethnic and cultural diversity, biases and racism move beyond non-indigenous and indigenous paradigms; important to avoid tokenistic engagement with cultural groups
Confronting midnight zone	Realising that individuals live in relationships with others in the larger world and reflecting on the power, privilege and inequities in those relationships	Slow development of an awareness of cultural safety, which allows an understanding of existing power structures, including healthcare providers, and the effects of such power structures on the status quo and marginalisation of minority groups	Minority groups may find attempts at communication by those members in power to be meaningless or disingenuous; the realisations of cultural safety may also be threatening to those people in power