Cultural Diversity, Cultural Competence, and Disparity: Issues

1. Cultural Diversity, Cultural Competence, and Disparity: Issues CHSC 433 Module 1/Chapter 2 UIC School of Public Health L. Michele Issel, PhD, RN

2. Learning ObjectivesWhat you ought to be able to do by the end of this module: • Develop a plan to determine the extent and nature of the diversity of a target population . • Assess program staff for their level of cultural competence. • Articulate ways in which diversity within a program affects of program development and evaluation . • Value the challenges inherent in developing a culturally competent health program

3. Outline of this ppt • Terminology • What is diversity • Culture, Health and Illness • Cultural competence • Sources of culture • Lessons about culture for program planning and evaluation

4. Terminology(Write your definitions, some in the text) Norms Values Cultural Sensitivity Cultural Competence Cultural Bound Enculturalation Multicultural Cross Cultural Acculturation Assimilation Cultural tailoring Culturally based

5. More terms and concepts • Stereotype • Xenophobis • Ethnocentrism • Stigma • Diaspera • Prejudice

6. What is your….? • Ethnicity • Nationality • Race • Culture

7. Diversity in other ways • Sexual orientation • Disability • Gender • Age • Economic status • Educational status • Religion

8. Other Sources of Culture • Culture related to profession(e.g., physicians v. nurses v. administrators v. social workers v. lay health workers) • Culture related to organization(norms and values within the organization) • Culture related to the program services delivery (norms and values within the program staff)

9. Culture and Illness “…this critical activity - the shaping of symptoms - by which sickness is saturated with specific meaning and cast as a particular configuration of human action and thereby made into a special cultural form. That cultural form is illness.” Kleinman, A. 1980.

10. Providers in the Health Care System • Professionals: modern scientific, professionalized group • Lay or Popular: Individuals or family members in social network • Folk: non-professional, sacred or secular

11. Continuum of 6 Typesof Culture Competency Least----------------------------------------------> Most Destructiveness Incapacity Blindness Openness Competency Proficiency

12. Dimensions of Cultural Sensitivity (Resnicow et al. 1999) • Surface structures ~ superficial, visible characteristics; increases acceptability of messages. How well does the program fit within their cultural experiences? • Deep structures ~ how history, values family affect behaviors ; conveys salience

13. Culture & Diversity affects Evaluation • Language and meaning issues in data tool development • Ethical perceptions regarding data collection

14. 10 Lessons for Program Planning • Specificity with which a cultural group is defined makes a difference • Reaching cultural groups requires designing strategies that match the values, norms, and expectations of the cultural group

15. Lessons… • Factor into the program design where people are currently going for help when faced with health, sickness, and illness problems. • The notion that illness is cultural, not just biological, will affect the degree to which individuals will accept professional explanations of health and illness.

16. Lessons… • When planning programs, the degree of acculturation needs to be considered because it affects health beliefs and behaviors. • When targeting groups or individuals who identify with more than one culture, their beliefs and behaviors need to be understood as a new culture.

17. Lessons… • The extent of cultural conflict being experienced will affect program participation, especially if programs do not address immediate concerns. • Structure into the program ways to modify the program based on what is learned about cultural nuances as a result of implementing the program.

18. Lessons… • Initiation and continuation of program effects may require different culturally appropriate interventions • Program objectives need to be culturally appropriate with correspondingly appropriate targets for achievements.

19. The Public Health Pyramid

20. Diversity across the Pyramid • Consider how diversity is different at each level of the pyramid • Consider how cultural competence of staff varies at each level of the pyramid