Immigrants, Diabetes andCulturally-Responsive HealthcareSylvia Reitmanova, MD, PhDUniversity of Ottawasreitman@uottawa.ca
The lack of culturally-responsive careMisunderstanding and miscommunicationPatient general dissatisfactionPoor adherence t...
• Association of Faculties of Medicine of Canada:the Social Accountability Initiative to address and advocate thechanging ...
Ottawa (Census 2006):Population 835,470Immigrants 187,945men 85,920women 94,120visible minorities 109,080(Black, Chinese, ...
Two approaches to developingculturally-responsive careCultural competence modelculture = fixed patterns of learned beliefs...
Cultural safety modelculture = flexible system of values and world views that peoplelive by and recreate continuously depe...
Culturally-responsive diabetes care• Conceptions of health and disease• Variations in treatment approachesand responses• E...
Conceptions of health and disease“People are enmeshed within kinship structures and political,economic and religious syste...
Variations in treatment approachesand responses• Psychological therapy (meditation, imagining, problem solving)• Social th...
Expectations from healthcareprofessionals“For decades we understood the professions as a conventionalnuclear family, with ...
Social determinants of healthRacializationpoor health outcomes, undesired health behaviours and healthchoices are often bl...
The Starr County culturally-competentdiabetes self-management educationCommunity assessment• Understanding of diabetes• Pr...
Practical tips for developing culturally-responsive health services• Physical environment, materials & resources• Communic...
Canadian Diabetes Association:Diabetes GPS• an interactive microsite developed to help people with diabetesfrom the Chines...
References• Brown SA & Hanis CL. Culturally competent diabetes educationfor Mexican Americans: the Starr County Study. The...
Sylvia Reitmanova : Immigrants Diabetes and Culturally-Responsive Healthcare
Upcoming SlideShare
Loading in …5
×

Sylvia Reitmanova : Immigrants Diabetes and Culturally-Responsive Healthcare

1,208 views

Published on

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,208
On SlideShare
0
From Embeds
0
Number of Embeds
737
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Sylvia Reitmanova : Immigrants Diabetes and Culturally-Responsive Healthcare

  1. 1. Immigrants, Diabetes andCulturally-Responsive HealthcareSylvia Reitmanova, MD, PhDUniversity of Ottawasreitman@uottawa.ca
  2. 2. The lack of culturally-responsive careMisunderstanding and miscommunicationPatient general dissatisfactionPoor adherence to therapy and carePoor health outcomesHealth and care disparitiesRationale for the provision ofculturally-responsive health services
  3. 3. • Association of Faculties of Medicine of Canada:the Social Accountability Initiative to address and advocate thechanging needs of the communities• Liaison Committee on Medical Education:“… demonstrate an understanding of the manner in which peopleof diverse cultures and belief systems perceive health and illnessand respond to various symptoms, diseases, and treatments.”“… to recognize and appropriately address gender and culturalbiases in themselves and others, and in the process of health caredelivery.”Socially responsible healthcare
  4. 4. Ottawa (Census 2006):Population 835,470Immigrants 187,945men 85,920women 94,120visible minorities 109,080(Black, Chinese, South Asian, Arab)no knowledge of English/French 10,325Changing population demographics
  5. 5. Two approaches to developingculturally-responsive careCultural competence modelculture = fixed patterns of learned beliefs, values, practices,ways of interacting and communicating shared among groupsand passed between generations• all patients in one cultural group present the same health beliefsand behaviours• eliciting patients’ health beliefs, concepts of time, space andphysical contact, communication styles, the role of family andgender, social expectations, and decision-making preferences• a list of “do’s and don’ts”• tolerance, inclusion, and appreciationReinforces homogenizing, stereotyping and “othering”
  6. 6. Cultural safety modelculture = flexible system of values and world views that peoplelive by and recreate continuously depending on larger social,economic and political circumstances• the role of the social, economic, political and historical context inhealth outcomes and healthcare delivery (variations insocioeconomic status, employment, and housing patterns, theeffects of war, torture, and abuse)• intersectionality of culture, ethnicity, skin colour, gender, class,ability, age or sexual orientation in production of health• exploration of personal biases, fears, emotional reflexes, andpsychological defencesTwo approaches to developingculturally-responsive care
  7. 7. Culturally-responsive diabetes care• Conceptions of health and disease• Variations in treatment approachesand responses• Expectations from health professionals• Social determinants of health
  8. 8. Conceptions of health and disease“People are enmeshed within kinship structures and political,economic and religious systems which define who and what theyare” (Lawton, 2007, p.901)DiabetesExternalising responsibility = diabetes “happened to us” rather than“we brought it on ourselves”• Running in the family• All-pervading in the community (impossible escaping)• God’s will• Stress due to social roles and obligations• Stress due to unfamiliar lifestyles and values• Lack of control over one’s lifestyle• Medication
  9. 9. Variations in treatment approachesand responses• Psychological therapy (meditation, imagining, problem solving)• Social therapy (family involvement, social re-integration)• Physiological therapy (massage, acupuncture)• Supernatural therapy (prayers - traditional folk healers or religiousauthorities)• Own herbal and healing remedies• Drug therapySome patients (e.g. Hispanics and Nigerians) are more likely tohave low levels of Cytochrome P450 isoenzymes involved in theoxidation of many drugs resulting in poor metabolism of drugs
  10. 10. Expectations from healthcareprofessionals“For decades we understood the professions as a conventionalnuclear family, with doctor-father, nurse-mother, and patient-child. But our hope for total wisdom and protection from father isforlorn, our wish for total comfort and protection from motherunachievable, and the patient has grown up. A new three waypartnership should displace this vanishing family.”(Salvage & Smith, 2000, p.1019)Ontario’s Family Health TeamsThe roles and authority Compliance
  11. 11. Social determinants of healthRacializationpoor health outcomes, undesired health behaviours and healthchoices are often blamed on differences in biology, ethnicity,culture or religionSocial determinants of healthgender, income and social status, employment and workingconditions, social support networks, education, physical andsocial environment, healthy childhood development, healthservices
  12. 12. The Starr County culturally-competentdiabetes self-management educationCommunity assessment• Understanding of diabetes• Previous experiences• Suggestions for interventionIntervention• Language• Cultural beliefs• Diet• Family• Social emphasis
  13. 13. Practical tips for developing culturally-responsive health services• Physical environment, materials & resources• Communication styles• Social interaction• Cultural conceptions of health, illness, and end of life• Cultural assumptions, attitudes and values
  14. 14. Canadian Diabetes Association:Diabetes GPS• an interactive microsite developed to help people with diabetesfrom the Chinese, South Asian and African Caribbean communitiesaccess culturally appropriate information in their own languagehttp://www.diabetesgps.caResources
  15. 15. References• Brown SA & Hanis CL. Culturally competent diabetes educationfor Mexican Americans: the Starr County Study. The DiabetesEducator, 1999; 25(2):226-36• Lawton J et al. Contextualising accounts of illness: notions ofresponsibility and blame in white and South Asian respondentsaccounts of diabetes causation. Sociology of Health and Illness,2007; 29(6):891-906• Nova Scotia Department of Health. A Cultural Competence Guidefor Primary Health Care Professionals in Nova Scotia. Halifax, NS:Nova Scotia Department of Health, 2005• Salvage J & Smith R. Doctors and nurses: doing it differently. BMJ,2000; 320:1019-20

×