One World Many Cultures For Health Commu


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

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  • One World Many Cultures For Health Commu

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