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A presentation about intercultural encounters within the healthcare relationship. This presentation was give, specifically, to allied health professional students.

A presentation about intercultural encounters within the healthcare relationship. This presentation was give, specifically, to allied health professional students.

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  • 1. ONE WORLD, MANY CULTURES Health Care Delivery In A Multicultural Environment The Importance of Cultural Competency Communication Strategies for Health Care Careers COM 125 C. Denise Clemmons, MS
  • 2. “ Physicians and other health care providers must become more sensitive and responsive to the cultural differences in their patients” Joint Center for Political and Economic Studies (JCPES), 1995 “ All health professionals should be educated to deliver patient-centered care that identifies, respects, and cares about patients’ differences, values, preferences and expressed needs…” Institute of Medicine of the National Academies Report (IOM), 2002
  • 3. Learning Objectives
    • By the end of this lecture, you will be able to:
      • Describe the relationship between the US changing demographics and the need for cultural competency;
      • Define ‘health disparity’ and give examples of where the differences occur;
      • Define ‘cultural competence’ and discuss its importance;
      • List the stages, domains, elements, and barriers related to cultural competency;
      • Describe how an awareness of diverse cultural backgrounds can improve understanding on what shapes an individual’s health practices and behaviors
  • 4. Learning Objectives, cont’d
      • Identify common origins of cultural misconceptions and how these misconceptions can impact the health beliefs, values, practices, and treatment efficacy of patients;
      • Define, identify, and apply strategies aimed at increasing awareness and improvement of skills related to the care of ethnically diverse patients; and
      • Describe how to cultivate a sense of empowerment in ALL patients regarding their health care and health care practices.
  • 5. The Changing Face of America… Source: Census Bureau 2001 (www.census.gov)
  • 6. The Changing Face of America… Source: Census Bureau 2001 (www.census.gov)
  • 7. The Changing Face of America… Source: Census Bureau 2001 (www.census.gov) (in millions)
  • 8. Latino Americans by Heritage 1990 Source: Census Bureau (www.census.gov)
  • 9. Think About…
    • What are the implications of the changing demographics of America?
  • 10. Health Disparities
    • Defined as racial or ethnic differences in the quality of healthcare
    • Result in worse clinical outcomes
    • Consistently found across a wide range of diseases, services, and settings
    • Differences persist after adjustment for know factors including:
      • Access to care
      • Health care
      • Stage of disease
      • Co-morbidities
      • Age
      • Other social factors
      • (Smedley et al. 2002)
  • 11. Evidence of Health Disparities
    • Cancer
    • Cardiovascular diseases
    • HIV
    • Diabetes
    • Maternal child health
    • Mental health
    • Women’s health
  • 12. The Existence of Racial and Ethnic Disparities
    • African Americans: 1 in 5 feel that they are not getting appropriate care because they are non-white
    • Source: Commonwealth Fund, 1994
  • 13.
    • Lack of insurance: 31% vs. 14% (42% of all uninsured)
    • Lack of health care choices: 29% vs. 16%
    • Employee health insurance coverage: 56% vs. 66%
    • Paying too much: 40% vs. 26%
    • Language difficulties: 21% (1/4 need interpreters)
    • Satisfaction with health care: 46% vs. 60%
    • Quality of life (high stress levels):
    • 36% vs. 26%
    • Difficulty obtaining specialty care: 18% vs. 8%
    The Existence of Racial and Ethnic Disparities Sources: Commonwealth Fund, 1995; Joint Center for Political and Economic Studies, 1995
  • 14. Biases and Assumptions
    • Inherent trait in humans
    • Shaped by society (socially constructed)
    • More likely to occur when time and information are limited
    • May occur subconsciously
  • 15. Think About…
    • What are stereotypes?
    • What are some stereotypes that you think people believe regarding the cultural group(s) you identify with?
    • How do these stereotypes make you feel?
  • 16. Some Common Ethnic Stereotypes
    • African-Americans over-utilize the ER.
    • Asians are compliant, deferential, and non-assertive.
    • Native Americans don’t show emotions.
    • European Americans starve themselves to be skinny.
    • Asians won’t complete prescription drug regimes.
    • Hispanics won’t lose weight or eat healthy diets.
    • Source: A Toolbox for Teaching Communication Strategies
  • 17. Stereotype Avoidance
    • Assigning individuals to categories based on what is believed about the general group they belong to
    • Usually based on limited personal knowledge and/or experiences (closed-minded approach)
    • Any culture or ethnic group may possess similar characteristics
  • 18. Stereotype Avoidance, cont’d
    • Avoid defining characteristics as being unique to a specific group (or placing people into categories)
    • Cultural factors serve as guidelines and insights to assist in understanding others
    • No single method can be used to assist all people within the same ethnic population
  • 19. Culture
    • Patterned and integrated behavioral responses which develop over time
    • Influences and shapes:
      • values, thoughts, beliefs, customs, norms and practices, actions, and institutions of racial , ethnic , religious that are shared by members of the same group
      • (Office of Minority Health Resources Center, 2000)
      • thinking, doing, and being
    • Passed down from one generation to the next
  • 20. What is Does It Mean To Have “Competence”?
    • Having the capacity to function effectively
    • Possessing the required skill or knowledge
            • Random House Unabridged Dictionary, 2006
    • The state or quality of being adequately or well qualified
    • Possession of a specific range of skill, knowledge, or ability
            • The American Heritage Dictionary of the English Language, 2000
    • The quality of being competent or capable of performing an allotted function.
            • The American Heritage Stedman's Medical Dictionary, 2002
  • 21. A set of congruent behaviors, knowledge, attitudes, and polices that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations. (Office of Minority Health Resources Center, 2000) Cultural Competency
  • 22. Educational Assumptions
    • Cultural competency training…
    • will not change individual deeply held attitudes and beliefs;
    • is designed to raise awareness and impact behavior; and
    • with time, commitment and action, can foster change, growth and improvement in individuals and organizations.
  • 23. The Importance of Cultural Competency
    • Improve patient-provider relationships
    • Improve ability to deliver and achieve appropriate care
    • Improve communications
    • Improve therapeutic outcomes
    • Regulatory requirements
    • Increase patient satisfaction
    • Decrease liability
  • 24. Essential Elements of Competency
    • Values diversity
    • Capacity for cultural self-assessment
    • Consciousness of dynamics inherent when cultures interact
    • Institutionalization of cultural knowledge
    • Development of service delivery adaptation reflecting cultural diversity understanding
    • Source: http://cecp.air.org/cultural
  • 25. Domains of Competency
    • Values and attitudes
    • Communication styles
    • Physical environment, materials and resources
    • Policies and procedures
    • Population-based clinical practice
    • Community consumer participation
    • Training and professional development
    • Source: Cultural Competence: A Journey. HRSA, 1996
  • 26. Stages of Cultural Competency
    • Cultural Destructiveness
    • Cultural Incapacity
    • Cultural Blindness
    • Cultural Precompetence
    • Cultural Competency
    • Cultural Proficiency
    • Sources: Cross, 1988; http://web1.msue.msu.edu/intext/global/stages.pdf
  • 27. Cultural Competency Barriers
    • Lack of knowledge
    • Lack of cultural encounters
    • Self-protection/denial
    • Fear of the new or unknown
    • Fear of changing
    • Pressure due to time constraints
  • 28. Think About…
    • What role do cultural variations play in becoming culturally competent?
  • 29. Cultural Variations
    • Communication factors
    • Health literacy
    • Patient-provider discordance
    • Language barriers
    • Time orientation
    • Environmental Controls/Health Beliefs
    • Cultural Perceptions
  • 30. Communications
    • Most important variation
    • Includes written or oral language, eye contact, gestures, facial expressions, body language, use of interpreters
    • “ High-context” vs. “low-context”
    • Degree of directness
    • Loudness, pitch or silence
    • Appropriate conversational subjects
  • 31. Intercultural Communication Considerations
    • Personal space
    • Eye contact and feedback behaviors
    • Interruption and turn-taking behaviors
    • Gesturing
    • Facial expressions
    • Silence
    • Dominance Behaviors
    • Volume
    • Touching
    • Source: www.dshs.state.tx.us/thsteps/cultural/communicatio.shtm
  • 32. Intercultural Communication Strategies
    • Provide a safe environment
    • Focus on understanding
    • Explore the possibility that what is presented may not be the main issue
    • Acknowledge differences
    • Focus on similarities
    • Be aware of differences in nonverbal communication patterns
    • Treat all people with dignity
    • Respect all people as adults
    • Keep a sense of humor
    • Sources: www.dshs.state.tx.us/thsteps/cultural/communicatio.shtm ; Office of Minority Health and Cultural Competency, 2001
  • 33. Health Literacy
    • Ability to read, comprehend, and act on written/numerical information received
    • To achieve optimal drug therapy outcomes, patients must:
      • Understand the diagnosis
      • Be interested in their health
      • Correctly assess the impact of the diagnosis
      • Believe in the efficacy of the prescribed treatment
      • Be assessed for their ability and readiness to manage their care
      • Have adherence strategies that are easier to manage than the health condition
  • 34. Health Literacy
    • Source: http://kerriesmyres.typepad.com/label.gif
  • 35. Patient-Provider Discordance
    • Can occur when the provider and patient :
      • Are ethnically and/or culturally different
      • Appear ethnically and/or culturally similar
    • Due to differences in:
      • Acculturation to western medical practices
      • Dialects (terminology/word meanings)
      • Educational attainment and literacy
  • 36. Language Barriers
  • 37. Language Diversity in America
    • Top 20 OTHER languages spoken in American homes include:
    • Spanish
    • Chinese
    • French
    • German
    • Tagalog
    • Vietnamese
    • Italian
    • Korean
    • Russian
    • Polish
    • Arabic Portuguese
    • Japanese
    • French Creole
    • Greek
    • Hindi
    • Persian (Farsi)
    • Urdu
    • Gujarathi
    • Armenian
    18% of U.S. homes speak language other than English
  • 38. Use of Interpreters
    • Can enhance or deter communications
    • Interpreting vs. translating
    • Make eye contact with patient
    • Carefully evaluate use of family members
    • Professionally trained preferred
    • Assess patient’s nonverbal communication
    • Use short, clear sentences and multiple approaches
    • Avoid jargon and idioms
    • Ask open-ended questions
    • Ask the patient to repeat information given
    • Ask interpreter to provide feedback
    • AT&T language line
    • Pictures (pictograms)
      • www.usp.org
    • Adapted from: McDonagh, 2000
  • 39. Time Orientation
    • Social time vs. clock time
    • Health provider time vs. patient time
    • Past orientation:
      • holds onto old values and beliefs
      • resistance to change possible
    • Present orientation:
      • holds little reality of the future nor promise of future benefits
    • Future orientation
      • future is dominant factor
      • is essential to preventative care
  • 40. Environmental Control/Health Beliefs
    • Individual perception of disease, illness and the ability to direct factors within their environment
    • May involve luck, chance, fate, magic, mysticism, spirituality
    • Influence patient by shaping
      • Control and empowerment over health issues
      • Interpretation of healing, disability and quality of life
      • Attitudes about survival and death
  • 41. Cultural Perceptions of Disease and Illness
    • Aging
    • Invasion of foreign bodies
    • Body imbalances
    • Punishment from God
    • Curses (individual or supernatural)
    • Result of breaking from traditions
    • Taking drugs means I am sick
  • 42. Cultural Perceptions of Healing
    • Restoring/repairing body parts or systems
    • Fighting the intruder
    • Restoring balance
    • Making atonement to God
    • Adhering to traditions
    • Receiving proper/successful cure
  • 43. Cultural Perceptions of Health Practices
    • Efficacious
      • viewed as beneficial
    • Neutral
      • has no physiological benefit
      • may have psychological benefit
    • Dysfunctional
      • may be harmful
    • Uncertain
      • unknown effects
    • Includes folk medicine and healers
  • 44. Some Common Causes of Misunderstandings
    • Conventions of Courtesy
    • Sequence
    • Phasing
    • Objectivity
    • Specificity
    • Assertiveness
    • Candor
    • Simplicity
    • Accents
    • Telephones
    • Walking on eggs
    • Hot buttons
    • Source: National Institute of Corrections, 1995
  • 45. Tips for Delivering Culturally Competent Care
    • Know where your patient was born and the implications;
    • Know what language your patient speaks at home;
    • Know if your patient has cultural dietary habits;
    • Know your patient’s religion and the implications;
    • Know your patient’s independence level;
    • Know your patient’s support system and any associated cultural issues;
    • Know how health issues are handled at the patient’s home;
    • Know the role family plays in patient’s life
    • Individualize each situation based on the patient’s cultural issues
    • Evaluate the patient’s emotional state and the implications
    • Allow the patient to assist you in learning cultural words used to describe his/her illness
    • Sources: www.dshs.state.tx.us/thsteps/cultural/communicatio.shtm ; Malone, 2000
  • 46. There may be one world with many cultures, but you can make sure that all patients receive equal health care, ONE PATIENT AT A TIME!