1. Cultural Awareness Issues in Chiropractic Faculty Development Day July 15, 2002 Cheryl Hawk, DC, PhD Director of Chiropractic Sciences Dept. of Graduate Studies

2. Definitions Culture: shared beliefs & values affectingCulture: shared beliefs & values affecting  social interactions  interpretation of experience Race: biological conceptRace: biological concept Ethnicity : self defined group identity inEthnicity : self defined group identity in  religion  nationality  culture

3. Examples of different cultures of chiropractic patients SexSex  male/female  sexual orientation AgeAge  children  adolescents  elderly Income/education Race/ethnicity Religion

4. What is “cultural competency”? Set of skills, knowledge & attitudes related to a clinician’s Set of skills, knowledge & attitudes related to a clinician’s  understanding and respect for patients’ values, beliefs, expectations  awareness of his/her own assumptions and value system  ability to adapt care to be congruent with patients’ expectations and preferences.

5. WHY should DCs be “culturally competent”? US population is increasingly culturally diverseUS population is increasingly culturally diverse Different cultures have different health behavior and health risksDifferent cultures have different health behavior and health risks Doctor-patient communication and rapport are affected by cultural differencesDoctor-patient communication and rapport are affected by cultural differences  This affects outcomes!

6. US population is increasingly culturally diverse

7. Racial Distribution of US Population 2000 White (72%) Hispanic Afr-Am Asian Am. Indian

8. Are we keeping pace with these changes?

9. US population vs chiropractic patients % non-white/Hispanic General population (1998)28% DC patients (1974-82) 4% DC patients (1997-98) 5%

10. Ethnic diversity in the US MD and DC workforce % Non-white/Hispanic General population 28%General population 28% MDs 7%MDs 7% MD students (2000) 34%MD students (2000) 34% DCs 7%DCs 7% DC students (PCC 2002) 9%DC students (PCC 2002) 9%

11. US DCs 1991 1998 1991 1998 Female 13.3% 19.2% 51% Asian 0.81.8 4 Hispanic 1.61.713 African American 0.50.612 American Indian 0.2 0.8 1 Gen. pop.

12. and… why should we care? Only 11% of all Americans see a chiropractor annuallyOnly 11% of all Americans see a chiropractor annually Minority populations are not benefiting from chiropractic careMinority populations are not benefiting from chiropractic care Chiropractic is not helping eliminate health disparitiesChiropractic is not helping eliminate health disparities Bottom line: it’s the right thing to do!Bottom line: it’s the right thing to do!

13. Different cultures have different health behavior and health risks

14. Examples of US Health Behavior Differences: Reduced Physical Activity WomenWomen Lower income/educationLower income/education African-Americans and HispanicsAfrican-Americans and Hispanics Older adultsOlder adults  by age 75, 33% men, 50% women have no physical activity at all Source: Healthy People 2010

15. Examples of US Health Behavior Differences: overweight/obesity* ALL: 50%!!ALL: 50%!! Lower income women and adolescentsLower income women and adolescents African American/Mexican American womenAfrican American/Mexican American women  25; obese: BMI  30 *overweight: BMI  25; obese: BMI  30

16. Examples of US Health Behavior Differences: smoking Among adolescents:Among adolescents:  39% white  33% Hispanic  20% African American Among adults:Among adults:  Highest in Am. Ind., blue collar and military  HS dropouts 3x rate of college grads

17. Examples of US Health Risk Differences: Chronic LB Disability Activity limitation, rate per 1000 adults:Activity limitation, rate per 1000 adults:  Asian15  Hispanic28  White32  African American36  American Indian68 by race

18. Examples of US Health Risk Differences: Chronic LB Disability by income and education poormid/high 28 hs drop hs grad some coll Activity limitation, rate per 1000 adults 77 24 54 35

19. Examples of US Health Risk Differences: Diabetes White 8% 14% 16% 18% Afr-Am Mex-Am Am. Ind. a g e s 5 0 - 5 9

20. Examples of US Health Risk Differences: Unintentional Injury leading COD ages 1-44leading COD ages 1-44 ages 65+ higher rate for fireages 65+ higher rate for fire all non-whites higher rate for fireall non-whites higher rate for fire Males 2x-4x rate for drowningMales 2x-4x rate for drowning American Indians 3x higher rate overallAmerican Indians 3x higher rate overall

21. Examples of US Health Risk Differences: Intentional Injury Homicide 3rd COD ages 5-14Homicide 3rd COD ages 5-14 Homicide 2nd COD ages 15-24Homicide 2nd COD ages 15-24 Homicide rate for Afr. Am. aged 15- 24 2x rate for Hispanics and 14x rate for whitesHomicide rate for Afr. Am. aged 15- 24 2x rate for Hispanics and 14x rate for whites Suicide 3rd COD ages 15-24; whites higher although Af. Am. rate risingSuicide 3rd COD ages 15-24; whites higher although Af. Am. rate rising

22. Doctor-patient communication and rapport are affected by cultural differences

23. Cross-Cultural Communication Barriers on BOTH sides: doctor and patient Stereotypes affecting perceptionsStereotypes affecting perceptions RolesRoles  authority figures  gender  family Personal vs. impersonal stylePersonal vs. impersonal style Non-verbal cuesNon-verbal cues LanguageLanguage Respect (it’s a two-way street!)Respect (it’s a two-way street!)

24. Communication issues Language (spoken and written)Language (spoken and written)  Non-English speakers  Educational level  Acceptable topics VoiceVoice  Loudness/pitch  Silence Body languageBody language  personal space  touch  gestures/facial expressions  eye contact