CULTURAL COMPETENCY IN HEALTH CARE

1. CULTURAL COMPETENCY IN HEALTH CARE

2. Cultural Definitions • Race - A socially defined population characterized by physical characteristics that are genetically transmitted. • Ethnicity - Belonging to a common group often linked by race, nationality, and language with a common cultural heritage. • Culture - Knowledge, skills, and attitudes learned and passed on from one generation to the next.

3. Cultural Determinants • Ethnicity • Race • Age • Gender • Family • Language • Religion • Nationality

4. Factors Influencing Health • Genetic • Physiologic • Behavioral • Socioeconomic • Environmental

5. 1990 Distribution 75%Anglo-European American 12% African American 9% Hispanic American 3% Asian American 2050 Distribution 53% Anglo-European American 15% African American 24% Hispanic American 9% Asian American DEMOGRAPHICS

6. By the year 2000, 4/10 Consumers of Health Care Will Be Nonwhite!!

7. Cultural Competency • “A set of academic and personal skills that allow us to increase our understanding and appreciation of cultural differences between groups.” • “The set of congruent behaviors, attitudes, and policies, that come together in a system, agency or among professionals to work effectively in cross cultural situations.”

8. Culturally Competent • We must first understand how we feel and will react to a pt to be able to ultimately understand a pt. [--------------------------------------] Ethnocentric Ethno-Relative • Most people lie in the ethnocentric part of the continuum.

9. Cultural Competency • Developmental Model of Intercultural Differences. • Stage 1 - Denial • Stage 2 - Defense • Stage 3 - Minimization • Stage 4 - Acceptance • Stage 5 - Adaptation • Stage 6 - Integration

10. Goals of Culturally Competent Care • 1) Cultural Awareness • 2) Cultural Knowledge • 3) Cultural Skill • 4) Cultural Encounters

11. The Road to Cultural Competency • LEARN • L Listen • E Explain • A Acknowledge • R Recommend • N Negotiate • Assessment questions for patients.

12. Cultural Diversity in Health Care • Differences between high (collectivistic) and low (individualistic) context cultures in attitudes toward health and health care. • Interviews • African-American • Hispanic • Asian-American • Native American

13. Cultural Diversity in Health Care • Related research • Bekker et al. compared the cultural differences between the Dutch and the Japanese and how they have an impact on the pt’s conception of health and illness.

14. Areas of Dissonance • Historical Distrusts • Interpretations of Disability • Concepts of Family Structure and Identity • Communication Styles and Views of Professional Roles • Incompatibility of Explanatory Models

15. Areas of Dissonance • Disease Without Illness • Illness Without Disease • Misunderstandings of Terminology, Language, or Body Language

16. Language Barriers • 12% of US population speak a language other than English. • Strategies for working through a language barrier. • Become a bilingual provider • Language banks • AT&T Language Line

17. Language Barriers • Strategies • Professional Medical Interpreter • Family Members • Community Members/Traditional Healers

18. Language Barriers • 10 Guidelines for using an interpreter • Unless you are thoroughly fluent in the target language, always use an interpreter. • Try to use an interpreter of the same sex as the client. • Emphasize by repetition and speak slowly but not loudly. • Be patient.

19. Language Barriers • Address the patient directly. • Be sure the interpreter knows what you want. • Provide instructions in list format. • Use short questions and comments. • Use language the interpreter can handle. • Plan what to say ahead of time.

20. Case Study: Lia Lee • Hmong child with history of epileptic seizures • Family unable to speak English • Clash of cultural beliefs and practices • As of 1995 there were over 110,000 Hmong living in US

21. Case Study: Lia Lee • How could Lia’s medical treatment have been more effective given the clash of cultures?

22. Incorporating Cultural Competency Into Our Lives • Resources Available • AHEC • Wisconsin Express • Cultural Diversity Training Sessions and Exercises • Local Cultural Organizations • Isaacs and Benjamin “Towards a Culturally Competent System of Care: Vol II”

23. Summary • 10 tips for improving the caregiver/ patient relationship across cultures • 1) Don’t treat patient the same way you would want to be treated • 2) Begin by being more formal with patients of another culture • 3) Don’t be insulted if patient does not look you in the eye

24. Summary • 4) Don’t make assumptions about patient’s ideas about cause of illness • 5) Allow patient to be open and honest • 6) Don’t discount the effects of beliefs of the supernatural in health • 7) Inquire indirectly about the patient’s beliefs

25. Summary • 8) Ascertain the value of involving the entire family in the treatment • 9) Don’t assume “the need to know” • 10) Incorporate the patient’s folk medicine and beliefs into treatment plan if not contraindicated

26. Case Study: Discussion • Case Study: Re-evaluating Ethics and Values From a Different Cultural Perspective • Discussion • What were the conflicting values about which the three physicians disagreed? • Did the 3rd MD make a mistake and how might re-examining his ethics have helped him make a better decision? • What would you have done? How would you justify your actions?

27. Questions? • “To know yourself is to know others”