Outline of contents Culture and health/disease perception and reaction Culture and doctor-patient relationship Cultural differencies as a barrier in diagnostics, access and treatment Prepared by: Anna Szetela; Institute of Public Health, Jagiellonian University Medical College

Culture influencing the decision about contacts with health care Culture, beliefs play role when taking decision about: When (if) to contact the doctor, The choice of the therapy. Reasearch results show that in some minorities it is the common behaviour to visit the doctor only in the umtimate situation, especially in mental health cases. Extensive literature in the domain of health care seeking reveals that those from different socio-cultural backgrounds tend to differ in the extent to which they delay seeking medical help. Studies show that being a member of an ethnic minority group can add to delay IOM 2014.

The delay of health care seeking Cultural differences in delay in health care seeking are attributed to a diverse set of factors, ranging from knowledge and beliefs regarding causes of the disease (etiology related to religion), associated symptoms, curability, and consequences, to trust in physicians. The delay may be related to a shame and stigmatisation (especially in mental health issues).

Culture and doctor-patient relationship There is growing recognition of the need for culturally safe, patient-centered care in improving the health outcomes of minority populations. Cultural differences and the inability of health care providers to appropriately address these differences have contributed to high rates of noncompliance, reluctance to visit mainstream health facilities, and feelings of fear, disrespect, and alienation. Roundtable 2013.

Culture and doctor-patient relationship Some cultural norms heavily regulate gender relationships even in a health care setting such as a hospital. Studies show that female members of some cultural groups may be reluctant to be examined by male physicians and even the anticipation of this happening may contribute to delays in or complete avoidance of health care seeking. In these cultural groups, being examined by a female physician can mitigate the embarrassment. Some Asian women, although they had been in North America for a while and knew the language, indicated that they may choose to access traditional Chinese medicine because the traditional Chinese doctor examines the patient without asking her to take her clothes off. Uskul 2010. .

Cultural differences: Barriers in diagnostics, access and treatment Main barriers Comunication barriers (verbal, non-verbal). Cultural misunderstandings (e.g. dietary habits in other cultures). Unknown disease – culture-specific syndrome. Pathoplasticity - the variability in a symptom’s specific form and content, shaped by events in a patient’s life or culture (e.g. . Cultural misunderstandings can affect the ability of health professionals to assist their clients or patients in achieving optimal health. For example, health professionals may view clients or patients who are culturally different from themselves as unintelligent or of differing intelligence, irresponsible, or disinterested in their health. This can result in poor health status, marginalization within the health care system, increased risk, and experiences of racism (Roundtable 2013). .

Cultural differences: Communication barriers Main barriers Language – miscommunication related to different languages but also different meaning of „the same word” (linguistic differences). Cultural differences in gestures. Behaviour of patient and/or staff – related to differents habits, prejudices. .

You can use the Unit forum for questions … Thank you! You can use the Unit forum for questions … Pictures: Andalusian Childhood Observatory (OIA, Observatorio de la Infancia de Andalucía) 2014; Josefa Marín Vega 2014; RedIsir 2014; Morguefile 2014.

References Iwelunmor J, Newsome V, Airhihenbuwa CO. Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity & health. 2014;19(1):20-46. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589260/ (retrieved July 24, 2016). Lalonde M. A new perspective on the health of Canadians. A working document. Minister of Supply and Services Canada 1981. http://www.phac-aspc.gc.ca/ph-sp/pdf/perspect-eng.pdf (retrieved: July 20, 2016). Matsumoto D., Juang L. Culture and Psychology. Wadsworth, Cengage Learning, 2013: 179-205. Uskul, A. K. (2010). Socio-cultural aspects of health and illness. In D. French, A. Kaptein, K. Vedhara, and J. Weinman, (Eds.). Health psychology. Oxford: Blackwell Publishing. Final draft: https://kar.kent.ac.uk/32467/1/Uskul_culturehealth_finaldraft.pdf (retrieved: July 24, 2016). Ward C., Bochner S., Furnham A. The Psychology of Culture Shock, Rutledge 2005. http://s3.amazonaws.com/academia.edu.documents/43494013/_Colleen_Ward__Stephen_Bochner__Adrian_Furnham__ThBookZZ.org.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1470651227&Signature=UHDu%2FLdeW%2Bj3fKu6Ap9dmUiup%2BA%3D&response-content-disposition=inline%3B%20filename%3DColleen_Ward_Stephen_Bochner_Adrian_Fur.pdf (retrieved: July 22, 2016). Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities; Board on Population Health and Public Health Practice; Institute of Medicine. Leveraging Culture to Address Health Inequalities: Examples from Native Communities: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Dec 19. A, Culture as a Social Determinant of Health. Available from: http://www.ncbi.nlm.nih.gov/books/NBK201298/ (retrieved July 26, 2016).

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