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Word Association

Word Association. What Do All Of The Following Words Have In Common?. Word Association Continued. Commission Corp Officers Federal Staff Civilian Personnel Tribal Staff. The Common Association Between All Of The Personal Is Healthier Nation.

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Word Association

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  1. Word Association What Do All Of The Following Words Have In Common?

  2. Word Association Continued • Commission Corp Officers • Federal Staff • Civilian Personnel • Tribal Staff

  3. The Common Association Between All Of The Personal Is Healthier Nation

  4. In the United States, Immigrant Health Is A Challenge That all health care providers Face.

  5. As Medical Doctors, Nurse Practitioners, Physician Assistants, Nurses… We All Must Work Towards

  6. Reaching Immigrant Populations on Health Promotion and Disease Prevention LCDR Linda Egwim, DNP, ANP-BC, GNP-BC USPHS COF 2011

  7. Learning Objectives • At the end of the presentation, participants will be able to: • Identify 2 modifiable immigrants’ barriers to HPDP • Describe cultural myths & beliefs that hinder immigrants’ participation in HPDP • Utilize knowledge gained to individualize patient care plans • Increase cultural sensitivity as it relates to immigrant patient population

  8. Introduction/Case presentation • An elderly Nigerian female presented to the clinic for a follow-up with her primary care provider for hypertension management. The patient was in the company of her daughter who acted as the interpreter. During the clinic encounter, the physician asked the patient, as part of routine health maintenance, when she had her last well-woman exam. The patient looked at the physician bewildered, and to the daughter for interpretation. The physician further attempted to clarify by asking specifically, when the patient’s last mammogram was completed. Again, the patient could not understand the term mammogram, due to lack of familiarity with the terminology. The physician explained that it was a breast-screening exam used for early detection of breast cancer. The daughter, who understood the cultural conflict with mammograms, was at a loss for words to explain to the patient. Surprisingly, the patient heard and understood breast cancer. She jumped down from the exam table in a hospital robe and forbade the physician from making such a statement. She walked out of the clinic and swore never to return to that physician.

  9. Evidence • Studies identified the growing increase in the immigrant population in the US, and Minnesota is home to the largest immigrant refugee population from African countries (U.S. Census Bureau, 2007). • Studies have identified evidence of the disparities in health and access to health services among ethnocultural minorities in the United States and Canada (Dunlop, Coyte, & Melsaac, 2002; Groeneveld, Laufer, & Garber, 2005; Moy, Dayton, & Clancy, 2005; Williams, 2005).

  10. Evidence • Minority elders in the United States tend to face more barriers than the general older adult population and report a lower level of use of services designed for aging adults than the general population (Woodruff, 1995).

  11. Needs Assessment • Healthy people 2020, nation’s goals and objectives for health promotion and disease prevention • USPHS Mission to protect, promote, and advance the health and safety of our nation. • Immigrant community and families • Healthcare providers that serve the immigrants • Literature review

  12. scope • This presentation is about increasing participation of immigrants on HPDP measures, which include basic physical activity, healthy food choices, age appropriate screening, and immunization, through health education on the benefits of HPDP. Also, collaborate with healthcare providers and PHS Officers who serve immigrants to promote participation in HPDP measures.

  13. Goal • To increase Immigrants’ participation in the recommended age appropriate HPDP through health education on the benefits of HPDP while remaining culturally sensitive to their beliefs, values and norms.

  14. Methodology • Develop a trusting working relationship • Establish contact with interpreters familiar with the healthcare system and terminology • Assess baseline level of understanding

  15. Cultural myths and beliefs • The belief that mentioning a terminal or deadly disease is forbidden. • The mere mention of a disease such as cancer or AIDS is perceived as inviting the spirit of the disease from an evil spirit and witchcraft. • The spirit of the disease must be warded off through spiritual healing and traditional medicine.

  16. Cultural myths and beliefs, cont. • It is believed that seeing a physician or healthcare provider confirms the presence of a terminal illness or disease. • This population does not routinely screen for diseases that are initially asymptomatic like cancer, AIDS, hypertension, and diabetes. • It is believed that what an individual does not know will not kill the individual.

  17. Cultural myths and beliefs, cont. • The belief is that ignorance of a disease by avoiding early detection through screening grants an individual the ability to live and enjoy life without fear. • Breast cancer, as an example, is perceived to be as a result of an injury to the breast. • Cervical cancer is erroneously believed to be a disease of sexual promiscuity.

  18. Cultural myths and beliefs, cont. • Treatment is believed to be rendered in the form of medication that will help them live healthy and longer. • They have a myth that oral medication is not as potent and effective as an intramuscular (IM) or intravenous (IV) medication. However, in the event they cannot get an IV or IM medication, they will settle for an oral medication. • They do not believe that health education without medication is worth their time.

  19. Barriers Administrative problems in service delivery: (a) long physician appointment waiting list (b) inconvenient office hours (c) complicated procedures. Immigrants perceive the American healthcare system of making a clinic appointment as complex, and they would rather show up at the clinic when they are sick than make a clinic appointment. Solutions Establish a trusting relationship, flexible clinic schedule, assure them of the importance of their culture, valves and norms Ethical Threats/Barriers & Solutions

  20. Barriers Cultural incompatibility: (a) language barriers between professionals and patients. (b) healthcare providers are not able to speak the same language as the patients. (c) the healthcare providers do not understand the patients’ culture, and programs are not specific or specialized for the immigrant elderly Africans (Lai & Chau, 2007). Solution Reassurance regarding confidentiality of patient information. Culturally sensitive training of healthcare providers/personnel Ethical Threats/Barriers & Solutions, Cont.

  21. Barriers Personality attitude (a) individual’s nonadherence to free preventive medicine. (b) refused to be vaccinated because of cultural beliefs for fear of harm. (c) identified autonomy issues (d) ashamed of their lack of knowledge Solution An understanding of their unique characteristics. Ethical Threats/Barriers & Solutions, Cont.

  22. Barriers Circumstantial challenges Solution Provide them with information on the services and resources available to them at no cost, connect them to caseworker Ethical Threats/Barriers & Solutions, Cont.

  23. Theoretical Framework: Pender's HPM

  24. Discussion • There is no doubt that the benefits of immigrants’ participation in HPDP grossly outweighs non participation. The benefits are not limited to the patients, families on land, on sea and overseas. There are extensive cost savings on healthcare for the third party payers, and tax payers. More so, to improve the quality of life within the community, through increased public awareness and understanding of HPDP and the opportunities for progress; while supporting the PHS Mission and Healthy People 2020 vision, mission and goals.

  25. References • Dunlop, S., Coyte, P. C., & Melsaac, W. (2002). Socio-economic status and the utilization of physicians’ services: Results from the Canadian National Population Health Survey. Social Science & Medicine, 51, 123-133. • Groeneveld, P. W., Laufer, S. B., & Garber, A. M. (2005). Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000. Medical Care, 43, 320-329. • Lai, D. W., & Chau, S. B. (2007). Effects of service barriers on health status of older Chinese immigrants in Canada. National Association of Social Workers, 52(3), 261-269. • Moy, E., Dayton, E., & Clancy, C. M. (2005). Compiling the evidence: The National Healthcare Disparities reports. Health Affairs, 24, 376-387. • U. S. Census Bureau. (2007). 2006 American community survey. Available from http://factfinder.census.gov/servlet/DatasetMainPageServlet?_program=ACS&submenuId=&_lang=en&_ys=

  26. References • Willems, S., De Maesschalek, S., Deveugele, M., Derese, A., & De Maeseneer, J. (2005). Socio-economic status of the patient and doctor-patient communication: Does it make a difference? Patient Education and Counseling, 56, 139-146. • Williams, D. R. (2005). The health of U.S. racial and ethnic population. Journals of Gerontology Series B: Psychological Sciences and Social Services, 60b, S53-S62. • Yee, D. L. (1992). Health care access and advocacy for immigrant and underserved elders. Journal of Health Care for the Poor and Underserved, 2(4), 148-464.

  27. THE END • THANKS FOR YOUR TIME AND ATTENTION • QUESTIONS????

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