1. Communicating Across Cultural and Language Barriers Ricky Winardi, MD, MPH Chief of Diversity and Multicultural Care, NVLY Primary Care Conference October 17, 2009

2. WELCOME Workshop agenda No affiliations to disclose Cultural and Linguistic Competency

3. Disclosure of Relevant Financial Relationships Dr. Winardi has disclosed that he has no relevant relationships with commercial or industry organizations. The CME Department has reviewed disclosure information for the planners and developers for this program and they do not have relationships that present a relevant conflict of interest.

4. OBJECTIVES * Sharing practical tips for effective communication across cultures * Introducing “red flags” that might indicate limited health literacy * Providing access to language and culture resources

5. Health Literacy October is Health Literacy Month Scope of the problem: 1 in 5 illiterate, average reading skills in 8 th -9 th grade Low health literacy leads to increased risk of serious health outcomes JCAHO study: 80% of medical errors are due to communication breakdown

6. Key risk factors for limited literacy Elderly Low income Unemployed Do not finish high school Minority ethnic group Recent immigration to the US US-born with English as second language

7. Behaviors that may signal limited literacy Incomplete forms Frequently missed appointments Non-compliance with medication regimens Lack of follow-through with tests/referrals They say that they are taking medications, but lab tests or other parameters do not change in the expected fashion

8. Responses that may signal limited literacy “I forgot my glasses. I’ll read this when I get home” or “Can you read this to me?” “Let me bring this home so I can discuss it with my children” Unable to name medications Unable to explain what medications are for Unable to explain dosing of medications

9. Suggested questioning “How happy are you with the way you read?” “What is the best way for you to learn new things?” “How confident are you filling out medical forms by yourself?” “How often do you need to have someone help you when you read instructions, pamphlets, or other written materials from your doctor or pharmacy?”

10. Tips to improve interpersonal communication Slow down Use plain, non-medical language Show or draw pictures Limit the amount of information provided and repeat it Use the “teach-back” technique Create a shame-free environment

11. Plain language alternatives to medical terms Anti-inflammatory Benign Enlarge Heart failure Lipids Monitor Referral Toxic Lessens swelling and irritation Not harmful Get bigger Heart not pumping well Fats in blood Keep track/an eye on Send to another doctor Poisonous

12. How to thrive in a multicultural world Hispanic Culture Video: http://www.aoa.org/x12933.xmlhttp

13. Important values in Latino/Hispanic cultures Familismo : family and community are the center of society Respeto : respect based on age, gender and status Personalismo : genuine concern for another person Esmero : attention to personal appearance

14. Resources Diversity Roundtables Diversity Conferences KP Diversity Provider Handbooks KP Multicultural Staff Associations Language Assistance Services

16. !Muchas gracias! Cultural competency is a journey throughout a lifetime, not a goal or an achievement. Please feel free to email or call me: Phone 8-416-6525 at Fair Oaks Email: ricky.z.winardi@kp.org