Cultural Competency Skills for Health Care Professionals

2 Cultural Competency Skills for Health Care Professionals: Community-Based Modules Developed by : Earle Waugh, PhD Olga Szafran, MSHA Jean A.C. Triscott, MD,CCFP

Acknowledgements: The research was funded by the Pallium 11 Project, Health Canada Funding for the videos from the Dr. Scott McLeod Family Medicine Fund, Department of Family Medicine and Centre for the Cross-Cultural Study of Health and Healing Manual development was provided from the Dr. Scott McLeod Family Medicine Fund

Learning Objectives Become aware of one’s own beliefs and attitudes toward individuals of different ethno-cultural groups To gain an increased understanding of how ethno- cultural attitudes influence patient-provider relationships; To gain an understanding of factors that can influence cultural principles, beliefs and values; To understand the meaning of cultural competency as it relates to providing patient care; To conduct a cultural competency self-assessment;

Learning Objectives: To describe and give examples of the six stages of the cultural competency continuum; To apply the LEARN Model for cross-cultural communication; To base the learning of cultural competency on filmed scenarios of four cultural groups in Northern Alberta

6 Developing Cultural Competency Skills for Health Professionals: Introductions and Learning Objective for the Session Fill out the Clinical Cultural Competency Questionnaire

7 Developing Cultural Competency Skills for Health Professionals: Research Presentation : “Toward Culturally Responsive Care in the Community: Views of five Cultural Communities on Dementia/End of Life Issues, (Consensus Group findings), Presentation on Definition and Tools of Cultural Competency

8 Developing Cultural Competency Skills for Health Professionals: Video presentations (2) and large group discussion using the Tools of Cultural Competency; (LEARN) and Cultural Competency Continuum. Small Groups and Cases Workshop evaluation

9 Definition: Cultural Competency ….a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations. (Cross, Bazron, Dennis,& Isaacs,1989)

10 Cultural competency is the: …acceptance and respect for differences, continuing self-assessment regarding culture, careful attention to the dynamics of differences, continuous expansion of cultural knowledge and resources, and a variety of adaptations to service models in order to better meet the needs of minority populations. (Cross, Bazron, Dennis,& Isaacs, 1989)

11 Definition: Cultural competency is the ‘The ability to think, feel and act in ways that acknowledge, respect, and build upon ethic, (socio) cultural, and linguistic diversity,” (Lynch & Hanson,1998)

12 Why is Cultural competency Important for Health Care Professionals?

13 Lack of cultural knowledge has been associated with improper diagnosis, lack of active compliance, social resistance and legal challenges.

14 Cultural orientation of health care providers Can influence assess and use of health services by various cultural groups Ethno-cultural factors affect the amount and type of care individuals belonging to various cultural groups receive Cultural competency has the potential to reduce inequities in access to health services and improve the health status of cultural communities

15 Why is Cultural Competency Important? Both quality of care and the detection of culturally- specific diseases have been shown to increase with the provision of culturally-sensitive health care Cultural competency improves both the patient-provider relationship and communication with patients.

16 Why is Cultural Competency Important? Cultural competence facilitates patient-provider interaction in a way that is consistent/with patient’s values, beliefs, and expectation. The development of cultural competence requires training and education

17 Cultural Competence Continuum A framework and model for understanding the process of becoming culturally competent and achieving cultural competence. (Cross, Bazron, Dennis, and Isaacs,1989)

18 Cultural Competence Continuum: There are six points on the continuum which represents possible ways of responding to cultural differences. (Cross, Bazron, Dennis, and Isaacs,1989)

19 Cultural Competence Continuum 1. Cultural Destructiveness (CD) 2. Cultural Incapacity (CI) 3. Cultural Blindness (CB) 4. Cultural Pre-competence (CP) 5. Cultural Competence (CC) 6. Cultural Proficiency (CP) CD____CI____CB____CP____CC____CP

20 Cultural Competence Continuum 1. Cultural Destructiveness (CD) 2. Cultural Incapacity (CI) 3. Cultural Blindness (CB) 4. Cultural Pre-competence (CP) 5. Cultural Competence (CC) 6. Cultural Proficiency (CP) CD____CI____CB____CP____CC____CP

21 Cultural Competence Continuum: 1.Cultural Destructiveness (CD) - attitudes and practices that are destructive to cultures and consequently to the individuals within the culture; 2.Cultural Incapacity (CI) – not intentionally seeking to be culturally destructive, lacking the capacity to help minority clients or communities, being extremely biased, believing in racial superiority of the dominant group, and assuming a paternal posture towards the “lesser” races;

22 Cultural Competence Continuum: 3.Cultural Blindness (CB) – expressing a philosophy of being unbiased, believing that culture/ethnicity/race makes no difference and all people are the same, believing that approaches traditionally used by the dominant culture are universally applicable; 4.Cultural Pre-Competence (CP) – becoming aware of weaknesses in serving minorities and attempting to improve some aspects of their services to a specific population;

23 Cultural Competence Continuum 5.Cultural Competence (CC): accepting and respecting differences, continual self-assessment regarding culture, being attentive to the dynamics of difference, continually expanding cultural knowledge, and adapting service delivery in order to better meet the needs of minority populations; 6.Cultural Proficiency (CP) – holding culture in high esteem, seeking to add to the knowledge base of culturally competent practice, and developing new approaches based on culture.

24 Cultural Competence Continuum 1.Cultural Destructiveness (CD) 2.Cultural Incapacity (CI) 3.Cultural Blindness (CB) 4.Cultural Pre-competence (CP) 5.Cultural Competence (CC) 6.Cultural Proficiency (CP) 7.CD____CI____CB____CP____CC____CP

25 In order to move along the cultural competency continuum professionals must: Value diversity Understand cultural biases; Be conscious of the dynamics of cultural interactions; Internalize cultural knowledge; and Develop adaptations to diversity. Each conditions must function at every level of the health care system in order for that system to provide culturally competent care

26 “Learn” Model for Cross- Cultural Communication The LEARN process enables health providers to elicit, discuss, and negotiate relevant cultural, social, and personal information relevant to an illness episode. (Berlin and Fowkes 1983) The Guidelines are: L Listen with sympathy and understanding to the patient’s perception of the problem E Explain your perceptions of the problem A Acknowledge and discuss the differences and similarities R Recommend treatment N Negotiate agreement

27 Use of the Learn Model Improves cross-culture communication Increases awareness of cultural issues Obtains better patient acceptance of treatment plan The primary focus is a suggested process for improved communication, which is seen as the fundamental need in cross-cultural patient-physician interaction (Berlin & Fowkes, 1983)

28 Community-Based Modules Learning Modules are based on research finding from the cultural communities Research was based on end-of-life and dementia care which involved the elderly, and senior members of the respective communities in Northern Alberta, Canada.(Waugh E, Szafran O, Triscott JAC, 2010) ---Aboriginal (Cree)----Chinese -(Cantonese, Mandarin) ---Francophone ---Lebanese Muslim

29 Community-Based Modules The modules should not be regarded as being the norm for all such communities, as variability exists even within a cultural group. During the research process, it became evident that which health care professionals were aware of issues surrounding cultural competence in patient care, they had received little or no training in cultural competence. Health care professionals expressed a need for formal culturally-sensitive training.

30 Community-Based Modules Films were developed as teaching tools to give some real-life depth to cultural issues in dementia and end- of-life care. The professional script writer, Mary-Ellen Perley, Directors, Omar Moaullem and Michael Olsen. The cases were based on important issues related to the the respective communities.

31 Module 1: Cultural Competency Skills In Aboriginal Community –Cultural Awareness

32 Module 2: Cultural Competency Skill in Development in the Chinese Community – Cultural Perceptions of Medical Intervention

33 Module 3: Cultural Competency Skill Development in the Franco-Albertans- Communication & Cultural Understanding

34 Module 4: Cultural Competency Skill Development in Lebanese Muslin Community – Caregiving & End-Of-Life Issues

35 References: Cross TL, Bazron BJ, Dennis KW, Isaacs MR.(1989) Towards a Culturally Competent System of Care, Volume 1. Washington, DC: CASSP Technical Assistance Centre, Centre for Child Health and Mental Health Policy, Georgetown University Child Development Centre. Lynch EW, Hanson MJ,(1998) Developing Cross-Cultural Competence: A Guide for Working with Children and Their Families. Baltimore: Paul H Brookes. Berlin EA, Fowkes W.(1983)A teaching framework for cross- cultural health care. Application in family practice. The Western Journal of Medicine 139(6):

36 References: Book Manuscript:” At the Interface of Culture and Medicine: Contemporary Canadian Studies: University of Alberta Press: Two chapters: Waugh E, Triscott J, Szafran O., “Towards Culturally Responsive Care in the Community: views of five Cultural Communities on Dementia/End of Life Issues, (Consensus Group findings), Triscott J, “Language and Culture”. In the University of Alberta Press: November 2010.