CULTURAL COMPETENCY IN HEALTH CARE

Cultural Definitions Race - A socially defined population characterized by physical characteristics that are genetically transmitted. Ethnicity - Belonging to a common group often linked by race, nationality, and language with a common cultural heritage. Culture - Knowledge, skills, and attitudes learned and passed on from one generation to the next.

Cultural Determinants Ethnicity Race Age Gender Family Language Religion Nationality

Factors Influencing Health Genetic Physiologic Behavioral Socioeconomic Environmental

DEMOGRAPHICS 1990 Distribution 2050 Distribution 75%Anglo-European American 12% African American 9% Hispanic American 3% Asian American 2050 Distribution 53% Anglo-European American 15% African American 24% Hispanic American 9% Asian American

By the year 2000, 4/10 Consumers of Health Care Will Be Nonwhite!!

Cultural Competency “A set of academic and personal skills that allow us to increase our understanding and appreciation of cultural differences between groups.” “The set of congruent behaviors, attitudes, and policies, that come together in a system, agency or among professionals to work effectively in cross cultural situations.”

Culturally Competent We must first understand how we feel and will react to a pt to be able to ultimately understand a pt. [--------------------------------------] Ethnocentric Ethno-Relative Most people lie in the ethnocentric part of the continuum.

Cultural Competency Developmental Model of Intercultural Differences. Stage 1 - Denial Stage 2 - Defense Stage 3 - Minimization Stage 4 - Acceptance Stage 5 - Adaptation Stage 6 - Integration

Goals of Culturally Competent Care 1) Cultural Awareness 2) Cultural Knowledge 3) Cultural Skill 4) Cultural Encounters

The Road to Cultural Competency LEARN L Listen E Explain A Acknowledge R Recommend N Negotiate Assessment questions for patients.

Cultural Diversity in Health Care Differences between high (collectivistic) and low (individualistic) context cultures in attitudes toward health and health care. Interviews African-American Hispanic Asian-American Native American

Cultural Diversity in Health Care Related research Bekker et al. compared the cultural differences between the Dutch and the Japanese and how they have an impact on the pt’s conception of health and illness.

Areas of Dissonance Historical Distrusts Interpretations of Disability Concepts of Family Structure and Identity Communication Styles and Views of Professional Roles Incompatibility of Explanatory Models

Areas of Dissonance Disease Without Illness Illness Without Disease Misunderstandings of Terminology, Language, or Body Language

Language Barriers 12% of US population speak a language other than English. Strategies for working through a language barrier. Become a bilingual provider Language banks AT&T Language Line

Language Barriers Strategies Professional Medical Interpreter Family Members Community Members/Traditional Healers

Language Barriers 10 Guidelines for using an interpreter Unless you are thoroughly fluent in the target language, always use an interpreter. Try to use an interpreter of the same sex as the client. Emphasize by repetition and speak slowly but not loudly. Be patient.

Language Barriers Address the patient directly. Be sure the interpreter knows what you want. Provide instructions in list format. Use short questions and comments. Use language the interpreter can handle. Plan what to say ahead of time.

Case Study: Lia Lee Hmong child with history of epileptic seizures Family unable to speak English Clash of cultural beliefs and practices As of 1995 there were over 110,000 Hmong living in US

Case Study: Lia Lee How could Lia’s medical treatment have been more effective given the clash of cultures?

Incorporating Cultural Competency Into Our Lives Resources Available AHEC Wisconsin Express Cultural Diversity Training Sessions and Exercises Local Cultural Organizations Isaacs and Benjamin “Towards a Culturally Competent System of Care: Vol II”

Summary 10 tips for improving the caregiver/ patient relationship across cultures 1) Don’t treat patient the same way you would want to be treated 2) Begin by being more formal with patients of another culture 3) Don’t be insulted if patient does not look you in the eye

Summary 4) Don’t make assumptions about patient’s ideas about cause of illness 5) Allow patient to be open and honest 6) Don’t discount the effects of beliefs of the supernatural in health 7) Inquire indirectly about the patient’s beliefs

Summary 8) Ascertain the value of involving the entire family in the treatment 9) Don’t assume “the need to know” 10) Incorporate the patient’s folk medicine and beliefs into treatment plan if not contraindicated

Case Study: Discussion Case Study: Re-evaluating Ethics and Values From a Different Cultural Perspective Discussion What were the conflicting values about which the three physicians disagreed? Did the 3rd MD make a mistake and how might re-examining his ethics have helped him make a better decision? What would you have done? How would you justify your actions?

Questions? “To know yourself is to know others”