1. Culturally Responsive Health Care: How to Meet the Challenge Jeffrey Ring, Ph.D. Director of Behavioral Sciences and Cultural Medicine White Memorial Med. Ctr. Family Medicine Los Angeles, California

2. Presenter Disclosure Information Speaker’s Bureau: Merck & Co., Inc. Speaker’s Bureau: Merck & Co., Inc. (not product division) (not product division) Other: Author of a book for Radcliffe Other: Author of a book for Radcliffe Oxford Publishing Oxford Publishing In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants: Name of Presenter: Jeffrey Ring, Ph.D.

3. Objectives By the conclusion of this presentation, participants will: Be able to articulate a strong rationale for providing culturally responsive care Be able to articulate a strong rationale for providing culturally responsive care Deepen their capacity for self-reflection Deepen their capacity for self-reflection Enhance their understanding of health disparities Enhance their understanding of health disparities

5. Culturally Responsive Care Patient-centered care with an attention to the patient’s culture, beliefs, health behaviors and world view.

6. Why provide culturally responsive care?

7. Exploring Similarities and Differences

8. Imagery Exercise

9. Exploring Health Inequities

10. U.S.Diabetes Mortality Rates (2007) White Non-Hispanic White Non-Hispanic African American African American Latino/a Latino/a Am. Indian/Alaska Native Am. Indian/Alaska Native Asian/Pacific Islander Asian/Pacific Islander

11. U.S.Diabetes Mortality Rates* (2007) White Non-Hispanic22.3/100,000 White Non-Hispanic22.3/100,000 African American48 African American48 Latino/a32.1 Latino/a32.1 Am. Indian/Alaska Native43.7 Am. Indian/Alaska Native43.7 Asian/Pacific Islander16.6 Asian/Pacific Islander16.6 * Age adjusted www/cdc/gov/nchs/data/hus07.pdf

12. Sources of Health Inequities Patient Factors Patient Factors Health Care System Factors Health Care System Factors Society Factors Society Factors Practitioner Factors Practitioner Factors

13. Culturally Responsive Communication Strategies Q2 (A. Kleinman) Q2 (A. Kleinman) How do you believe you got sick? How do you believe you got sick? What do you believe will help you heal? What do you believe will help you heal? LEARN (Berlin and Fowkes, 1983) LEARN (Berlin and Fowkes, 1983) Listen with empathy and understanding Listen with empathy and understanding Explain your perception of the problem Explain your perception of the problem Acknowledge and discuss similarities/differences Acknowledge and discuss similarities/differences Recommend treatment Recommend treatment Negotiate agreement (Getting to Yes, Fisher and Ury, 1983) Negotiate agreement (Getting to Yes, Fisher and Ury, 1983)

14. Motivational Interviewing (Miller and Rollnick, 2002) Patient-Centered Model Patient-Centered Model Identify and Resolve Ambivalence/Barriers Identify and Resolve Ambivalence/Barriers Diagnose the Patient’s State of Mind/Change Diagnose the Patient’s State of Mind/Change Precontemplation Precontemplation Contemplation Contemplation Action Action Maintenance (Relapse) Maintenance (Relapse) Resist the Righting Reflex Resist the Righting Reflex

15. QUICK CASE Patient with high sugars is obese, depressed, does no exercise… Patient with high sugars is obese, depressed, does no exercise… Advice? Advice? “…people almost never change without first feeling understood.” (Stone, 1999)

16. QUICK CASE Patient with high sugars is obese, depressed, does no exercise… Patient with high sugars is obese, depressed, does no exercise… Motivational Interviewing Questions? Motivational Interviewing Questions? What are the benefits of not exercising? What are the benefits of not exercising? If your heart was failing, might you change then? If your heart was failing, might you change then? Have you thought about what exercise you might try? Have you thought about what exercise you might try? What are the sources of strength and support in your life? What are the sources of strength and support in your life?

18. Commitment to Act List two commitments/covenants to further your capacity to provide culturally- responsive care, based on today’s discussions

19. Resources Ring, Nyquist et al. (2008) Curriculum for Culturally Responsive Health Care, Radcliffe Ring, Nyquist et al. (2008) Curriculum for Culturally Responsive Health Care, Radcliffe www.vimeo.com/15822032 Addressing Culture and Language for Medical Assistants www.vimeo.com/15822032 Addressing Culture and Language for Medical Assistants www.vimeo.com/15822032 www.diversityrx.org www.diversityrx.org www.diversityrx.org http://minorityhealth.hhs.gov/ http://minorityhealth.hhs.gov/ http://minorityhealth.hhs.gov/ Medscape.com (Health Diversity Resource Center) Medscape.com (Health Diversity Resource Center) Jeffrey Ring, Ph.D. ring@usc.edu Jeffrey Ring, Ph.D. ring@usc.eduring@usc.edu