1. Culturally Sensitive Care Beyond the Doctor-Patient Visit Aurora Galindo-Simental B.S. C.H.E.S Health Educator/Promotora June 27, 2014

2. Cultural Sensitivity and Health Care Cultural Sensitivity Cultural sensitivity means being aware that cultural differences and similarities exist and have an effect on values, learning, and behavior. Stafford, Bowman, Eking, Hanna, & Lopoes- DeFede (1997) Cultural Sensitivity: respect and empathy to people of various nationalities. Our Spanish speaking team to understand cultural influences, appreciate adaptation skills, and tailor culturally competent approaches for at-risk Latino/Hispanic patients.

3. Caring for Hispanic/Latino Diabetic Patients Building trust Overcoming language barriers Nutrition management Addressing myths and facts of diabetes Family dynamics 3

4. Culturally Sensitive Methods I Establish trust and rapport Give a warm greeting; put patient at ease Improve communications Overcome language barriers Provide culturally sensitive nutritional management Healthy breakfast/food demonstration Sensitive to financial concerns Missing work, transportation Consider family dynamics support and encouragement, or lack of. 4

5. Culturally Sensitive Methods II Courteous welcome with a positive attitude. Listen with sympathy and understanding to patients’ perspective of the problem. Decrease physical distance and increase contact with patients Shake hands with patients, or place a hand on their shoulder when speaking. Show interest in patients’ lives. Brief conversation about their family. Use of appropriate titles and greetings. Address patients by their proper name (surname), rather than first name. 5

6. Overcoming Language Barriers Spanish language DGA’s are offered to better engage patients and empower them to self-manage their diabetes. Understanding physicians' instructions Improved family shared decision making Adherence to treatment Decrease missed appointments Increased of patient satisfaction Long term behavior modification 6

7. Nutrition Management I Understanding Cultural Beliefs Regarding Weight Excess weight in Latino/Hispanic culture is tolerated and many times celebrated. Overweight children may indicate that they are well take care of. --Thin children may be viewed as unhealthy Mealtime is an especially social activity and serves as a link with the homeland and family Taught not to be wasteful--“Clean your plate.” 7

8. Nutrition Management II Incorporating Latino/Hispanic healthier meal options in the DGA All Breakfast items bought in local grocery stores Label reading Creating meal plans with recipes Food demonstration Meeting with our bilingual RD CDE Group outings to local grocery stores Comparing items for a healthier selection 8

9. Addressing Myths of Diabetes Eating too much sugar causes diabetes. You should never eat carbs if you have diabetes. If you have pre-diabetes, there is nothing you can do to prevent Type II diabetes. You can catch diabetes from someone else. Insulin will cause blindness. Being punished with insulin for not following doctor’s orders. Having diabetes makes you less of a man. 9

10. Conclusion Culturally sensitive group appointments are effective for improving clinical outcomes and reducing diabetes risk in our Latino/Hispanic populations. 10

11. 11 DGA Highlights