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Chapter 8
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Many of the determinants of well-being span the boundaries of health care and medicine; therefore, eliminating health disparities calls for new and nontraditional partnerships across diverse sectors of the community.
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Background Information Clear disparity with certain groups and races Minorities ◦ Distrust health care ◦ Reluctant to participate as subjects in clinical research ◦ Need to build trust in the community
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Study 2003 Cultural proficiency to medical communities in Omaha Instruments CAI and CCI Community Assessment Instrument Cultural Competency Instrument
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The purpose of this study was to assess the minority patient/client perception of the cultural competency of their healthcare providers within the Omaha, Nebraska, medical community and to have healthcare providers self-assess their ability to provide culturally competent care. Two instruments were developed, pilot tested, and administered during the summer and fall of 2003 for this purpose: the Community Assessment Instrument (CAI) and the Cultural Competency Instrument (CCI). The CAI assessed the cultural competence of healthcare providers by the minority community and the minority community’s knowledge of medical research risks and benefits.
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1998Initiative to eliminate racial and ethnic disparities in health. AA, Hispanics and NA higher morbidity and mortality in CVD, diabetes, infant mortality, HIV/AIDS, CA screening Need to eliminate disparities: ◦ Policies, research, medical centers involvement, advocacy organizations
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Mistrust, lack of identifiable benefits, conflict in value and benefits, lack of relevance of research, methodology “at risk” population, lack of guidelines principals
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Research Design Access of Omaha minorities 76 items Physicians in Omaha are not cultural competent IRB consent 30 minutes Interpreters available Different languages Bias: no formal education
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Minority health care clients are not satisfied with health care in the Omaha community Minority clients are not able to communicate with health care providers in the Omaha community Minority clients prefer to be treated by health care providers who are of the same ethnic, racial, and/or cultural background Minority clients practice folk medicine Minority clients feel pressured to assimilate Minority clients have never participated in a health care study and do not want to Minority clients do not know the benefits of participating in a health care study and do not know anyone who has ever participated in one Minority clients do not know the leading cause of death for people in their ethnic/racial group
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Ethnic/Racial Group Date of Focus Group Native American August 20, 2003 Sudanese Men’s September 10, 2003 Hispanic Men’s September 17, 2003 African American September 22, 2003 Sudanese Women’s September 29, 2003 Hispanic Women’s October 1, 2003 Vietnamese November 9, 2003 White November 24, 2003
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In 1998, the Initiative to Eliminate Racial and Ethnic Disparities in Health (under the auspices of the U.S. Department of Health and Human Services) addressed the problem of health disparities. Six areas in which African Americans, Hispanics, and Native Americans have higher morbidity and/or mortality rates and/or access to preventive health measures were identified: cardiovascular disease, diabetes, infant mortality, HIV/AIDS, cancer screenings and management, and child and adult immunizations.
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The goal of eliminating these health disparities15 has been embraced by policy makers, researchers, medical centers, managed care organizations, and advocacy organizations. Models and programs have been developed and partnerships have been formed by various advocacy groups, which include preventive care, community education, and case and disease management.
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Mistrust: Some members of racially and ethnically diverse groups shun participation in research studies because of historical mistrust due to past experiences with racism, bias, or exploitation in healthcare delivery systems. Lack of identifiable benefits: Some diverse communities have not equitably benefited from their participation in research. Conflict in values and benefits: Differing values and social, cultural, religious, and spiritual beliefs related to health may inhibit or prevent certain individuals and groups from participating in research protocols and studies. Lack of relevance to research: Members of diverse racial and ethnic groups that are fairly new to this country may be neither accustomed nor willing to participate in research conducted according to traditional U.S. methodologies.
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Methodologies do not reflect the “at-risk” population: Many faculty members within institutions of higher education neither use nor teach research approaches and methodologies that are based on culturally competent and participatory action. Lack of guiding principles: Researchers have been slow to require principles of cultural competence, participatory action research designs, and advocacy-oriented approaches in the grants and contracts they support.
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Are there any questions? Thanks for attending!
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(2009). Kosoko-Lasaki, S., Cook, C.T., & O'Brien, R. L. Cultural Proficiency in Addressing Health Disparities. Sudbury, MA: Jones and Bartlett Publishers.
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