Cultural competency
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  • J Human Lac – Rural –Urban Differenece human Lac – race, edu, bFinit. In LA


  • 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
    Practices that work
  • 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
    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
    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
    Practices that Work
  • 12. Breastfeeding Rates in the target area
  • 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
    • 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
  • 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
  • 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
  • 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
  • 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