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Cultural competence lecture


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Cultural competence for health practitioners working with culturally and linguistically diverse communities

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Cultural competence lecture

  1. 1. Dr Beatriz CardonaUWS Office of EngagementUniversity of Western Sydney
  2. 2.  What we need to consider◦ Demographics (refugees and low socio economicmigrants in western sydney)◦ Disparities in Health Status◦ Health Practices and Beliefs◦ Barriers to Health Care
  3. 3. ◦ Culture informs our identity◦ Culture affects the roles played within a family, ethnicgroup and community◦ Culture defines family relationships, family structure,attitudes, beliefs, practices and styles ofcommunication◦ It also impact on our health practices and choices: forexample: use of complementary medicine, attitudestowards vaccinations, dress and food preferences,attitudes toward women, etc◦ However Culture is not he only or the most importantdeterminant of health: think of the 3 factors:demographics, environment and culture
  4. 4.  It reflects the ability to acquire and use knowledgeof health care related beliefs, attitudes, practicesand communication patterns of clients and theirfamilies to improve services, strengthen programs,increase community participation and close thegaps in health status among diverse populationgroups.
  5. 5.  Cultural competency is not static – you don’treally become but constantly becoming Fluid Culture as constantly being negotiated Multiple cultural identities No single formula but emphasis on processes andskills we use to negotiate interactions Cultures in negotiation _ cultural self-awareness
  6. 6.  Cultural Competence is a set of values,behaviors, attitudes and practices within asystem, organization, or among individuals thatenables them to work effectively across cultures. cultural competence focuses on the capacity ofthe health worker to improve health status byintegrating culture into the clinical context. the point of cultural competence is to maximisegains from a health intervention where theparties are from different cultures
  7. 7. Multicultural policy in NSW is administered by the Community RelationsCommission (CRC) for a multicultural NSW and is based on 4 principles ofmulticulturalism.Principles of Multiculturalism require that each publicauthority respect and accommodate the culture,language and religion of all individuals.Cultural diversity is defined as : people from a range ofcultural, ethnic, linguistic and religious background7
  8. 8. • “The healthy migrant effect”: Initial migrant healthadvantage often deteriorates over time as diet andexercise patterns change• Limited research into immigrant health in Australiainvisibility can undermine equity in healthcare provision• Immigrants face additional language and/or culturalbarriers not experienced by Australian-born patients• Poor engagement of older migrants to health systemundermines self-management of chronic conditions:effective communication is crucial to effective care
  9. 9.  • Humanitarian immigrants (refugees) are known to have poorer health than other immigrants (Khoo 2010) • Vitamin D deficiency common in newly arrived refugee children- consider rickets (Sheikh et al, 2011) • Afghanis may need written information in Dari and Pashtu, as well as interpreters (Omeri et al, 2006) • Ask Horn of Africa refugees about prior use of qaat (e.g. addictive - illegal in Aust.) (Bruce-Chwatt(2010)
  10. 10.  • inadequate vaccinations, nutritional deficiencies(vitamin D and iron) and dental disease • infectious diseases (gastrointestinalinfections,schistosomiasis, and latenttuberculosis) • musculoskeletal, social and psychological problems e.g. PTSD, anxiety, depression
  11. 11.  “I do not understand the health care system inAustralia. I have to rely on family and friends …” “It is difficult to find a service that provides aninterpreter …” “Because of my religion, I prefer to see afemale doctor … especially for reproductive issues”(Omeri et al, 2006)
  12. 12. Can you give any examples?12
  13. 13.  Interpreters Bilingual health workers Culturally appropriate food Non denominational quiet rooms Translated health information Cultural competence training Signage13
  14. 14. 14
  15. 15. 15 Understand the importance of culture Recognise the dynamics of cultural differences Build cultural knowledge Adapt services to meet cultural needs
  16. 16. 16• LanguageDifferences• Culture• Non verbalcommunication• Stereotyping• Discrimination• Stress• Organisationalconstraints• The humanfactor• Resistance tochange
  17. 17.
  18. 18.  The Culture of Western Medicine◦ Meliorism – make it better◦ Dominance over nature – take control◦ Activism – do something◦ Timeliness – sooner than later◦ Therapeutic aggressiveness – stronger=better◦ Future orientation – plan, newer=better◦ Standardization – treat similar the same
  19. 19.  “Ours”◦ Make it Better◦ Control Over Nature◦ Do Something◦ Intervene Now◦ Strong Measures◦ Plan Ahead – Recent isBest◦ Standardize – TreatEveryone the Same “Others”◦ Accept With Grace◦ Balance/Harmony withNature◦ Wait and See◦ Cautious Deliberation◦ Gentle Approach◦ Take Life As It Comes –“Time Honored”◦ Individualize – RecognizeDifferences
  20. 20.  The Cultural Competence Continuum◦ Where Am I Now?◦ Where Could I Be?
  21. 21.  Cultural Competence Definitions◦ Cultural Destructiveness: forced assimilation,subjugation, rights and privileges for dominant groupsonly◦ Cultural Incapacity: racism, maintain stereotypes, unfairhiring practices◦ Cultural Blindness: differences ignored, “treat everyonethe same”, only meet needs of dominant groups
  22. 22.  Cultural Competence DefinitionsCultural Pre-competence: explore cultural issues, arecommitted, assess needs of organization andindividualsCultural Competence: recognize individual and culturaldifferences, seek advice from diverse groups, hireculturally unbiased staffCultural proficiency: implement changes to improveservices based upon cultural needs, do research andteach
  23. 23.  Acquiring Cultural Competence◦ Starts with Awareness◦ Grows with Knowledge◦ Enhanced with Specific Skills◦ Polished through Cross-Cultural Encounters
  24. 24.  Culturally sensitive approach to asking inquiringabout a health problem◦ What do you call your problem?◦ What do you think caused your problem?◦ Why do you think it started when it did?◦ What does your sickness do to you? How does itwork?◦ How severe is it? How long do you think you will haveit?(continued next page)
  25. 25.  Culturally sensitive approach to askingabout a health problem◦ What do you fear most about your illness?◦ What are the chief problems your sickness has causedyou?◦ Anyone else with the same problem?◦ What have you done so far to treat your illness: Whattreatments do you think you should receive? Whatimportant results do you hope to receive from thetreatment?◦ Who else can help you?
  26. 26. Listen to the patient’s perception of the problemExplain your perception of the problemAcknowledge and discuss differences/similaritiesRecommend treatmentNegotiate treatment
  27. 27. Pre interview sessionPre interview session Brief the interpreter about the session Obtain cultural background information from the interpreter Establish mode of interpretingDuring the interviewDuring the interview Introduce everyone and establish roles Establish ground rules – speaking THROUGH the interpreter TO theclient Maintain eye contact with the client, if culturally appropriate Speak slowly and clearly Summarize your discussion periodically throughout the interview With consecutive interpreting, use short sentencesPost interview sessionPost interview session De-brief the interpreter28
  28. 28.  Use simple, plain English Avoid jargon Don’t use slang or verbal jokes Speak slowly, but do not shout or raise yourvoice Be concise and clear Give instructions in a clear, logical sequence Ensure you have been understood Reinforce what you say Reduce the stress Be aware of your language all the time29
  29. 29.  Australian Bureau of Statistics, Census data 2006 ECC NSW, COPS NSW & DADHC (2006) CulturalCompetency & Case Management Training Package Multicultural skills for health staff, Cultural diversity trainingunit, University of Sydney, 1998 Cross cultural workshop, Macarthur health service Centre for culture, ethnicity & health Multicultural awareness, Corporate orientation program,SSWAHS Cultural competence, Facility orientation program, FairfieldHospital Sockalingum adapted from Hayes, Cultural CompetenceContinuum, 1993 and Terry Cross Cultural CompetencyContinuum30