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Cultural Competency

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  • http://web.ebscohost.com.libproxy.tulane.edu:2048/ehost/pdfviewer/pdfviewer?hid=105&sid=cfa83e79-8c51-443a-b735-72c0501a8fca%40sessionmgr113&vid=2
  • http://www.marchofdimes.com/peristats/printer.aspx?dv=co&reg=28&stop=46&top=4&lev=4&obj=1&cmp=22&copy=1http://www.marchofdimes.com/peristats/printer.aspx?dv=co&reg=05&stop=46&top=4&lev=4&obj=1&cmp=22&copy=1
  • J Human Lac – Rural –Urban Differenece http://jhl.sagepub.com.libproxy.tulane.edu:2048/content/26/2/118.longJ human Lac – race, edu, bFinit. In LA http://jhl.sagepub.com.libproxy.tulane.edu:2048/content/24/2/175.long
  • http://web.ebscohost.com.libproxy.tulane.edu:2048/ehost/pdfviewer/pdfviewer?hid=105&sid=cfa83e79-8c51-443a-b735-72c0501a8fca%40sessionmgr113&vid=2
  • http://www.fns.usda.gov/wic/Breastfeeding/breastfeedingmainpage.HTM
  • http://www.nal.usda.gov/wicworks/Learning_Center/bfshowcase.pdf
  • http://www.nal.usda.gov/wicworks/Learning_Center/support_bond.html
  • http://vimeo.com/13649529
  • Transcript

    • 1. Valuing diversity
      Identifying and addressing barriers to healthcare and their connection to breastfeeding through culturally sensitive practices
    • 2. Purpose
      This tutorial is designed to
      Identify the barriers minorities in Louisiana, Mississippi and Arkansas face when accessing healthcare services
      Identify avenues for public health agencies to promote breastfeeding with minorities while keeping in mind the barriers they face while accessing healthcare
      These ideas are presented to spark the thought processes. Theories, practices and ideas can be adapted to fit many different situations
    • 3. Outline
      Disparities in Healthcare Access for minorities
      Addressing the Gap
      Breastfeeding Among Minorities
      Barriers
      Trends
      Practices that work
      WIC
      3
    • 4. Disparities in the Target Area
      In Louisiana, Mississippi, and Arkansas:
      poor quality of healthcare
      High minority population
      Rate of low birth weight high among minorities
      The following slides show some of the disparities in the target region.
      These challenges are specifically relevant for Maternal and Child Public Health workers
    • 5. 5
      States with the largest percentage of white residentshave the highest Medicare quality rankings.
      Percentage of population that is non-Hispanic white according to2000 census by Medicare Quality Ranking for 2000–2001
      The target area has the lowest quality ranking and lower percentage of white residents
      Note: Medicare rankings are shown for the top 12 and the bottom 12 states only.
      Sources: S. F. Jencks et al., “Change in the Quality of Care Delivered to Medicare Beneficiaries,1998–1999 to 2000–2001,” Journal of the American Medical Association, Jan. 15, 2003 289(3):305–12; United States Census Bureau, Census 2000. Chart 6-3
    • 6. Low birth weight percentage in the target area for minority populations
      March of Dimes Peristats
    • 7. Transportation
      Childcare
      Language
      Cultural Barriers
      Financial barriers
      Lack of social supports
      Lack of Insurance
      These factors limit minority populations from accessing care.
      Evidence shows that these factors cause some Hispanic populations to not even seek care.
      Disparities in US Healthcare
      The Commonwealth Fund Chartbook March 2008
    • 8. Addressing the Gap
      Insurance coverage for vulnerable minority populations
      Interpreter services for those with English as a second language
      Providing more permanent solutions to racial and ethnic disparities is key
      The Commonwealth Fund Chartbook March 2008
    • 9. Addressing the Gap
      Providing a Medical Home
      Culturally Competent Training
      Developing a relationship with a primary care provider is associated with better overall healthcare
      Regular source of care gives the patient access to more services and resources
      (see next slide)
      Training for Healthcare workers
      Educational materials for minorities that are culturally competent
      Language
      Respectful of beliefs and practices
      The Commonwealth Fund Chartbook March 2008
    • 10. 10
      Racial and ethnic differences in getting neededmedical care are minimal for adults with medical homes;disparities decline substantially compared with adults withno regular source of care.
      Percentage of adults ages 18 to 64 reportingalways getting care they need when they need it
      Note: Having a medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone, or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time.
      Source: The Commonwealth Fund. Health Care Quality Survey. 2006. Chart 7-4
    • 11. Breastfeeding Among Minorities
      Barriers
      Trends
      Practices that Work
    • 12. Breastfeeding Rates in the target area
      http://www.cdc.gov/breastfeeding/data/reportcard.htm
    • 13. Barriers to Breastfeeding
      Rural Populations
      African American Populations
      Lower income populations
      Higher rates of poverty
      Lack of resources that promote breastfeeding
      Lack of specialized services in hospitals or clinics to support Maternal and Child Health (Sparks 2010)
      Lack of individual and generational education about breastfeeding
      Lack of social support
      Lack of support from the work environment
      Cultural norms that support formula feeding and early feedings with solid foods(Chin, Myers, Magnus 2008)
    • 14. Barriers to Breastfeeding
      Latin American Populations
      Lack of support from extended family
      Lack of support services that understand Latin American culture or traditions
      US cultural norms that support formula feeding through availability and marketing of formula
      Lack of communication with providers
      Language barriers
      (Denman-Vitale & Murillo, 1999)
    • 15. Practices that work
      WIC
      • Incentives for breastfeeding mothers
      • 16. Loving Support Project
      • 17. Other Initiatives
    • Women, Infants and Children
      Although research by Chin, Myers and Magnus (2008) associated participation in WIC with lower rates of breastfeeding; WIC has initiated a strong campaign to promote breastfeeding
      The following highlight the practices WIC uses to promote breast feeing among minority populations. Their methods include : incentives, peer support, and targeted cultural campaigning
    • 18. WIC Incentives
      WIC mothers choosing to breastfeed are provided information through counseling and breastfeeding educational materials.
      Breastfeeding mothers receive follow-up support through peer counselors.
      Breastfeeding mothers are eligible to participate in WIC longer than non-breastfeeding mothers.
      Mothers who exclusively breastfeed their infants receive an enhanced food package.
      Breastfeeding mothers can receive breast pumps, breast shells or nursing supplementsto help support the initiation and continuation of breastfeeding
      By using incentives, WIC promotes breastfeeding and offers support for mothers who face financial challenges or work related barriers
      http://www.fns.usda.gov/wic/Breastfeeding/breastfeedingmainpage.HTM
    • 19. WIC “Loving Support Makes Breastfeeding Work” Campaign
      Campaign sponsored by WIC and Best Start Social Marketing
      Used to promote breastfeeding in States
      Provides information on how other states have successfully implemented or expanded peer support breast feeding programs
      Provides information about training workers .
      Breastfeeding Peer Support – Implementation and Expansion Resource
      This document created by WIC shares the successes of several States WIC supported breastfeeding peer counseling programs
      Use the above link to access the document
      Also see the presentation on Peer Counseling
      http://www.nal.usda.gov/wicworks/Learning_Center/bfshowcase.pdf
    • 20. Breastfeeding a Magical Bond of Love
      WIC initiative specifically designed to promote breastfeeding in Hispanic families.
      Created from a study that looked at the perceptions that Hispanic women have of breastfeeding in the United States
      Provides educational materials for mothers, fathers, and grandmothers in English and Spanish
      http://www.nal.usda.gov/wicworks/Learning_Center/support_bond.html
    • 21. Promotional videos
      Video by Mississippi WIC is highly representative of minority populations in the State
      Highlight minorities populations breastfeeding
      Teenage mothers
      Single mothers
      Black, Hispanic and Asian mothers
      http://vimeo.com/13649529
    • 22. Conclusions
      Using a diverse approach to addressing health disparities is an effective way to target programing
      Culturally competent training and practices help provide services that are sustainable and effective
      Barriers to Breastfeeding among minority populations may be seeded in cultural norms, lack of resources or lack of support services.
      WIC provides various services that could be replicated or improved upon to promote breastfeeding among diverse populations
      Key programs provides education, support and incentives

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