Emerging Populations and Culturally Competent Care

1. Emerging Populations and Culturally
Competent Care
Fall 2018
Jacey Mitchell, RDH, MS

2. Objectives
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 2
1. Define cultural competence and analyze its importance in
dental hygiene.
2. Identify health issues relevant to cultural/ethnic groups and
identify barriers to dental hygiene care with different
minority groups.
3. Relate the dimensions of ADPIE to culturally competent
care.

3. Cultural Competence
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 3
• What is cultural competence?
A set of congruent behaviors, attitudes, and policies that…enables that system,
agency, or those professionals to work effectively in cross cultural situations”
• By 2035, 40% of the U.S. population will be composed of minorities

4. Goals of Culturally Competent Care
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 4
Cultural
knowledge
Cultural
Awareness
Cultural
Sensitivity

5. Cultural Knowledge
5
• Emerging Populations
• Ethnic Minorities
• Asian Americans/Pacific Islanders
• Blacks/African Americans
• Latinos/Hispanic Americans
• Native Americans
• Arab Americans
• Persons with HIV/AIDS
• Homeless Persons

6. Cultural Awareness: Race vs. Ethnicity
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 6
Race
• Categorization of
people based on
physical properties
and biological heredity
• Social construct—not
useful to identify
populations for
health/research
purposes
Ethnicity
• Sense of collective
identity;
distinctiveness
• Sharing of customs,
food, dress, language

7. Your Experience
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 7
• Write down one experience you had with a patient who was of a
minority race or culture. Was treating that patient different than
treating a patient of the same race as your own? Was it the same?
What assumptions might you have made based on their race or
culture?

8. Cultural Knowledge
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 8
• Voluntary migration
• Immigrants- come for positive experience
• Permanent vs. sojourner
• Involuntary migration
• Refugees- Fleeing or being forced out of homeland

9. Ethnic Diversity
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 9
• Ethnic group
• Group set apart on basis of cultural/national origin characteristics
• Values/perceptions about health/illness
• Socialization process within ethnic group
• Minority group
• People who receive disproportionately less wealth, power, social status

10. Culture, Values, and Value Orientation
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 10
• Culture
• Shared patterns of values/behaviors—shaped by cultural group
• Cultural values
• Unique cultural beliefs of what is valued that guide decisions and behavior (such as
health values)
• Value orientation
• Values learned by socialization by group and that reflect overall beliefs of that group

11. MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 11

12. Folk Healing vs. Professional Care
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 12
• Self-care: 70% to 90% population; mild illnesses
• Professional health care system
• Specialized training; remuneration for services
• Folk healing practices
• Reflect beliefs, values, treatment of cultural group
• Ethnocentrism
• Practice of viewing other ways as inferior or unnatural
• Obstacle in therapeutic provider-patient relationships
• Holism
• Incorporates family and support system in care
• Considers patient viewpoint

13. Ethnic minority groups-Health
Disparities
13

14. Arab Americans

15. Background
• Three major waves of immigration
from late 1800s to 1960s
• Three largest groups: Lebanese,
Syrians, Egyptians
• Religions: Christianity, Judaism, Islam
Barriers to care
• Religious belief and practices
• Cultural norms/modesty
• Gender issues regarding providers
• Communication difficulty
• Folk remedies
• Lack of culturally competent providers
Selected health-related cultural aspects
• Importance of family; male-dominated
family structure
• Present-oriented
Health concerns and care issues
• Adult-Onset Diabetes Mellitus
• Coronary artery disease
• Role of acculturation
• Mental health
• Teenage smoking

16. 16
Asian Americans/Pacific Islanders

17. Background
• Two waves of migration
• Largest groups: Chinese, Koreans,
Filipinos
• Diverse origins, cultures, lifestyles
• Value education
Health concerns and care issues
• Hesitancy to seek early
diagnosis/screening
• Higher rate of tuberculosis
• Mental health problems due to
adjustment issues
• Lower rate of obesity, hypertension
• Poverty
• Cultural norms that prevent health
• Loss of social networks
• Poor access to services
Selected health-related cultural aspects
• Value of collectivism vs.
individualism
• Family most important social
institution; respect for elders
• Cultural value of passivity to avoid
conflict
• Taoism: Foundation of Chinese
medicine “achieving harmony”
• Use of folk medicine/alternative
treatment modalities common

18. 18
Latinos/ Hispanic Americans

19. Background
• Largest ethnic group; relatively young
population
• Mexican, Puerto Ricans, Cubans
most common
• Large diversity within Latino
population
Health concerns and care issues
Higher incidence of
• Stomach cancer
• Diabetes mellitus
• Cardiovascular disease
• HIV
Barriers to care
• Highest uninsured rate of any U.S.
racial/ethnic group
• Lack of interpreter services in health
care
• Lack culturally appropriate health
care services
• Reliance on folk systems of healing
Selected health-related cultural aspects
• Family supersedes individual needs
• Spiritual strength important
• Hot and cold concept of disease
• Disease attributed to supernatural or
psychological causes
• Folk remedies used in combination
with Western medicine

20. 20
Blacks/African Americans

21. Background
• Involuntary migration history
• American slave system facilitated
racism/alienation
• Recent substantial progress;
inequities remain
Health concerns and care issues
• Higher cancer deaths
• HIV
• Hypertension
• Obesity
• Mental health concerns
Barriers to care
• Poverty
• Lack of health insurance
• Inadequate or unsafe environments
• Centered on family and religion
• Family needs to be involved in care
• Churches important in promoting
health
• Use traditional healing approaches

22. 22
Native Americans

23. Background
• Native to North/South America for
thousands of years
• Experience minority group status;
lower education and income levels
compared to other groups
Health concerns and care issues
• Linked to social and economic
conditions
• Smoking, substance abuse
• Deaths: unintentional injuries,
cirrhosis, homicide, suicide,
pneumonia, diabetes
Barriers to care
• Difficult access to care
• Underserved population
Selected health-related cultural aspects
• Present-oriented; take one day at a
time
• Value cooperation over competition
• Share resources
• Value families—form kinship
systems
• Believe health exists when person is
in harmony with nature
• Traditional health practices important
(shaman)

24. Persons With HIV/AIDS
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 24
• Overview
• Over 1 million persons in United States affected
• Affects all ethnic groups, sexual orientations
• Adults over 50 years old fastest growing cohort
• HIV strategies
• Prevention—Most Important!
• Rapid diagnosis
• Symptom management

25. Persons With HIV/AIDS
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 25
• African Americans most severely affected population
• Barriers to treatment
• Communication gap between health care professionals and at-risk populations
• Socioeconomic factors such as poverty
• Cultural values, stigma
• Personal values and attitudes, behaviors
• Political influences

26. Responses to Health Challenges of Emerging
Populations
26
• The nation’s response
• NIH is devoting significant resources to reducing health disparities
• Congress created National Center on Minority Health and Health Disparities
in 2010
• Healthy People 2020 lists as one of primary goals to reduce/eliminate health
disparities
• Dental profession’s response
• Professional organizations: Commitment to development of culturally
competent care
• Professional journals with transcultural and cultural diversity focus
• Educational materials for dental professionals
• Continuing education/staff development

27. References
MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 27
• Edelman, C., Mandle, C. “Health Promotion throughout the Life Span” Seventh
Edition. St. Louis, MO: Mosby, Elsevier, 2010
• Darby, M., & Walsh, M. (2015). Dental hygiene theory and practice. (4th ed.). St.
Louis: Elsevier.