1. CULTURAL COMPETENCY IN HEALTH CARE

2. 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.

3. Cultural Determinants
Ethnicity
Race
Age
Gender
Family
Language
Religion
Nationality

4. Factors Influencing Health
Genetic
Physiologic
Behavioral
Socioeconomic
Environmental

5. 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

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

7. 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.”

8. 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.

9. 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

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

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

12. 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

13. 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.

14. 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

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

16. 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

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

18. 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.

19. 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.

20. 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

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

22. 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”

23. 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

24. 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

25. 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

26. 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?

27. Questions?
“To know yourself is to know others”