1. Cultural Diversity in Health Care
It is a major influence in the health care arena today The world has become a global village especially the us a land of immigrants we are blessed with so many cultures But do we understand what is cultural diversity, how do we know how do we diagnose to address it we need to understand and recognize it when do you and I as health care providers conciously ask opurselves what cultural issues maybe influencing this encounter, because only then can we truly take care of the pt and not just a symptom or an abnormal chest xray
maybe a few clinical scenarios may highlight the points

2. What is the Goal of the American Medical System?
If the goal is
to provide optimal care for all patients
health care providers must understand cultural differences that create conflicts and misunderstandings and that can result in inferior medical care.
Caring for Patients from Different Cultures Geri-Ann Galanti

3. Role of Cultural Competence in Healthcare

4. What is Cultural Competence?
“…a set of academic and personal skills that allow us to increase our understanding and appreciation of cultural differences between groups.”
Archbold, 1996

5. Can We Achieve Cultural Competence?5

6. Continuum of Acculturation
Separation:
Individuals value
holding onto
their original
culture and avoid
interaction with
other cultural
groups.
Marginalization:
Low interest in
cultural
maintenance and
relationships with
individuals from
other cultures.
Integration:
Cultural integrity
is maintained
while the
individual
participates in the
larger social
network.
Assimilation:
Individual from a
non-dominant
group does not
wish to maintain
their original
culture and
actively
participates in
dominant culture.

8. Should We Achieve Cultural Awareness First……….?

9. Model of Cultural Competence

10. Why is Cultural Competence Important?
Cross-cultural misunderstandings may play a role in perpetuating health care disparities
Legislative, policy and accreditation mandates for the inclusion of cultural competence training in medical schools and health care institutions
Gregg, J, et al. Cultural Competence Training in Medicine: Should We? SGIM Task Force Recommendations 10 10

11. Why the concern with culture competence?
Increasing ethnic diversity of the United States
Health care inequities experienced by
non-white Americans

12. Current health care providers trained in a less culturally diverse environment and may be less prepared to deal with diversity
They may also be less likely to offer valuable therapies to certain patients
Over 600 disparities documented in the Institute of Medicine Report

13. Cultural Competence Fundamental Elements
Understand the dynamics of difference
Implement policies and procedures
Value diversity
Perform a cultural assessment
Question self-desire and motivation for positive change
Bigby, J. Cross-Cultural Medicine. 2003

14. Dynamics of Difference
Differences among patients and providers
Avoid cultural blindness
Belief that color or culture makes no difference
All people are the same
Difference in quality of care
Cardiovascular disease: Differential treatment after coronary arteriography, even controlling for disease severity
Cancer: Racial differences in mortality rates, analgesia, diagnostic tests and treatment
Pain Management
Elective procedures

15. Incorporating Cultural Competency into Healthcare Systems
Community engagement
Cultural perspectives
Reciprocal transfer of knowledge and skills
Healthcare organizations
Consensus statements
Call for action and research
Accreditation
Develop competencies and curricula
Taylor, 1997

16. Value Diversity Lack of Diversity in Leadership Workforce Diversity
Improve early education
Recruitment and retention
Mentoring
Workforce Diversity
Different perspectives
Improve communication
Comfortable environment

17. Cultural Assessment for Patients
What do you think caused your problems?
Why do you think it started it when it did?
What does your sickness do to you?
How severe is your sickness?
What problems has your sickness caused you?
What do you fear about your sickness?
What are the results you expect to receive?
Adapted from Kleinman, 1978

18. Internal Motivation and Self-Awareness
Recognize biases
Management decisions influenced by race and ethnicity
Physicians less likely to recommend catheterization for black females (Schulman)
Male physicians prescribed more analgesia for white patients vs. blacks (Wiesse)

19. What provider behaviors contribute to disparities?
What are the Consequences of Patient’s Experiences of Bias in Health Care Setting?

20. What provider behaviors contribute to disparities?
Provider perceptions of symptoms
Provider perception of worthiness of patient
Provider misunderstanding of racial and ethnic differences
Poor communication skills
Bigby, 2003

21. Consequences of Patient’s Experiences of Bias in Health Care Setting
Hold negative assumptions about providers
Interpret provider behavior from baseline of mistrust
Withhold important information
Delay presentation for care
Do not follow recommendations
Bigby, 2003

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