Introduction to Cultural Competency in Health Care Pharmacy Practice II

Definitions Culture: set of learned and shared beliefs and values that shape interactions and interpretation of experience; each of us can belong to many different cultures. Ethnicity: self-defined groups identity that is based on religion, nationality, and cultural patterns Race: a social and political construct having no scientific basis

US Census Data People Quick Facts 2000 OR%US% White, not Hispanic/Latino Black/African Americans American Indian/Alaskan Native Asian Native Hawaiian/Pacific Islander Hispanic/Latino

US Census Data: County Examples Multnomah County: Black/African American 5.7% Language other than English at home 16.6% Hood River County: Hispanic/Latino 25% Language other than English at home 24.7%

Health Disparities Racial or ethnic differences in the quality of healthcare Differences result in worse clinical outcomes Differences persist after adjusting for known factors: Socioeconomic factors Patient preferences Appropriateness of intervention

Examples of Health Disparities Cardiovascular Cancer Pain Asthma Diabetes Prenatal Care

Potential Sources of Disparities Patient variables: preferences, refusal, appropriateness of care Healthcare systems Care process: bias, stereotyping, uncertainty Cross-cultural education

Examining your own cultural background Review the questions provided Consider your own bias, stereotyping, uncertainty

Cultural influences Health Perception Treatment Preferences Communication Verbal Nonverbal

Federal Mandate: Title VI The US Department of Health and Human Services’ Office for Civil Rights (OCR) mandates that medical professions receiving federal funds must ensure limited English speaking persons can “meaningfully access” services.

National Standards for Culturally & Linguistically Appropriate Services in Health Care (CLAS) 14 standards Culturally competent care (Stds 1-3) Language access services (Stds 4-7) Organizational supports for cultural competence (Stds 8-14) Varying levels of stringency (mandates, guidelines, recommendations)

National Standards for Culturally & Linguistically Appropriate Services in Health Care (CLAS) Culturally competent care Care that is compatible with cultural health beliefs, practices, preferred language Diverse staff and leadership Education and training in CLAS

CLAS Standards, continued Language Access Services Offer and provide language assistance services at no cost, in a timely manner Verbal and written notice of right to receive language assistance services Family and friends should not be used except when requested by the patient Materials and signs in languages commonly encountered

CLAS Mandates Language Access Services Based on Title VI of the Civil Rights Act of 1964 with respect to services for limited English Proficiency (LEP) individuals Std 4: Offer and provide language assistance services at no cost and in a timely manner Std 5: Both verbal and written notice of their right to receive language assistance services

CLAS Mandates Language access services Std 6: Family and friends should not be used to provide interpretation services except when requested by the patient Std 7: Easily available materials and signage in languages commonly encountered or represented in the service area

CLAS Standards, continued Organizational supports for cultural competence Strategic plans Self-assessments Data collection Community profile Partner with community Conflict resolution Public information

Definitions of Disease Navajo Lack of harmony in and with the universe WHO Anything less than a complete state of physical, social, and mental well-being FDA Any deviation from impairment or interruption of the normal structure or function of any part, organ, or system (or combination thereof) of the body that is manifested by a characteristic set of one or more signs or symptoms, including laboratory or clinical measurements that are characteristic of a disease. Adapted from UC regents – School of pharmacy and center for the Health professions

Cultural influences Health Perception Treatment Preferences Communication Verbal Interpreters Language line Oregon Pacific AHEC Pay attention to your language Nonverbal

Taking Action: Improving Cross- cultural interactions Examine your own cultural background. Learn about the cultures in the community you serve. Show interest. Be aware. Don’t generalize. Ask open-ended questions to determine health beliefs and level of understanding.

LEARN MODEL Listen Explain Acknowledge Recommend treatment Negotiate agreement

Taking Action: Improving Cross- cultural interactions Use a trained interpreter. “Language Line” Be aware of and enlist culturally- based resources. Learn the language or phrases of the predominant non-English speaking population you serve.

References and Resources Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academy of Sciences National Standards for Culturally and Linguistically Appropriate Services in Health Care Executive Summary. U.S. Department of Health and Human Services, OPHS, Office of Minority Health. Washington, D.C. March 2001

References and Resources Fadiman, Anne. The Spirit Catches You and You Fall Down. New York: Strauss and Giroux National Center for Complimentary and Alternative Medicine U.S. Department of Health and Human Services, Office of Minority Health. US census data. Ethnic Medicine Information from Harborview Medical Center University of California San Francisco Primary Care Resource Links: Cross Cultural re.html APhA. Handbook of Nonprescription Drugs 14 th edition 2002