2. Developed by
Office of Minority Health and Health Disparities
NC Department of Health and Human Services
Raleigh, NC
and
Forest Toms, PhD
Training Research & Development, Inc.
Hickory, NC
3. Goal of Training
To build the foundation for culturally
appropriate health services capable of
serving an increasingly diverse
population.
4. WORKSHOP OBJECTIVES
Participants will have an opportunity to:
♦ Increase awareness of their own cultural
understanding
♦ Increase awareness of cultural issues when
working with minority communities
♦ Learn about changing demographics which are
challenging health services
5. Training Overview
Changing demographics
Self awareness
Awareness of cultural differences
Socialization patterns
Role of value and beliefs
Overview of framework for developing cultural
competence
6. “When we think…
of Culture, we think of mainstream America; but
when we think of Diversity the tendency is to
think of minority groups.”
9. ASSUMPTIONS AND APPROACHES TO
DIVERSITY
DIVISIVE/PANDORA’S BOX
ONLY BLACK/WHITE
NOT AN ISSUE
SHOULD TREAT EVERYONE THE SAME
RESOURCES
ALREADY DEALT WITH
11. What’s In a Name?
African American – Black, Africans,
Carribeans
Hispanic/Latino – Mexican, Peurto Rican,
Cuban, Salvadorian, Equadorian,
Argentian, Honduran, Dominican, etc
European/Anglo – White
American Indian – Native American,
Alaska Native, Aleutian
Asian – Chinese, Filipino, Korean,
Japanese, Vietnamese, Cambodian,
Laotian, Hmong, Pacific Islander
(Polynesian, Melanesian, Mecronesian)
12. USUS Population Composition 1990 - 2050
75.6
60.5
52.8
11.8
13.1
13.6
9.1
18.9
24.5
2.8
6.7
8.2
0.7
0.8
0.9
0 10 20 30 40 50 60 70 80
American Indian
Asian/Pacific
IslandHispanic
Black
White
American Indian
Asian/Pacific Island
Hispanic
Black
White
Percentage of US Population
2050
2030
1990
Source: U.S. Census Bureau
American Indian
Asian/Pacific Island
Black
Hispanic
White
13. POPULATION PROJECTIONS for 2030
(US Census Bureau)
Population increases:
White Americans 25%
African Americans 68%
Asians Americans, Pacific Islanders,
American Indians 79%
Hispanic/Latinos 187%
14. North Carolina Racial and Ethnic Minority
Population, 2000 Census
Black
21.4%
American
Indian
1.2%
White
70.2%
Asian
1.4%
Hispanic
4.7%
Other
1.1%
15. North CarolinaNorth Carolina
Differences in Population by RaceDifferences in Population by Race
TRD,Inc. All Rights Reserved
0
10
20
30
40
50
60
70
80
White Afr. Am Hisp Asian Amer.
Ind
1990
2000
17. Dimensions of Diversity
Primary
– Largely unchangeable human differences
– Inborn
– Influence our early socialization
Secondary
– Can be changed
– Differences we acquire, discard and modify
throughout our lives
18. Primary Dimensions of Diversity
Sexual/AffectionalSexual/Affectional
OrientationOrientation
Unchangeable
Differences
AgeAge
RaceRace
PhysicalPhysical
Abilities/QualitiesAbilities/Qualities
GenderGender
EthnicityEthnicity
TRD,Inc. All Rights Reserved
19. Secondary Dimensions of Diversity
Educational
Background Geographic
Location
Income
Marital Status
Military
Experience
Household
Composition
Religious
Beliefs
Work Experience
TRD,Inc. All Rights Reserved
21. CultureCulture
Behavior patterns, arts, beliefs,
institutions, and all other products of
human work and thought American
Heritage Dictionary, 1991
A view of the world and a means of
adapting to the world Bilingual Health
Initiative Task Force, 1994
Is reflected in, and influences beliefs and
values, communication styles, health
beliefs and practices
27. Beliefs and Values
What we are used to thinking and doing
What we feel or know is right, good , important
Complex concepts with many dimensions
Influence all other area of life and activity
Affect how people think, feel, act
Can cause conflict if people’s beliefs and values
are not incorporated in health recommendations
28. Beliefs Concept Map
Views Of Truth
Religion
Supernatur
al
Beings
God
Human
Nature
Values
One
Redeemable
Many
Bad
Good
BeliefsBeliefs
Interpersonal
Relations
Time
Orientation
Focus Of
Human Activity
Relationship
With Nature
Influence
Include
Include
Include
May Be
Considered
May
Include
May Focus
On
May Be Perceived As
Include Influence
29. Overview of Beliefs
Comparison of Common Values
Anglo-Americans
– Mastery over nature
– Personal control over the
environment
– Doing-activity
– Time dominates
– Human equality
– Individualism/privacy
– Youth
– Self-help
– Competition
– Future orientation
– Informality
– Directness/openness/honesty
– Practicality/efficiency
– Materialism
Other Ethnocultural Groups
– Harmony with nature
– Fate
– Being
– Personal interaction dominates
– Hierarchy/rank/status
– Group welfare
– Elders
– Birthright inheritance
– Cooperation
– Past or present orientation
– Formality
– Indirectness/ritual/”face”
– Idealism
– Spiritualism
31. Health Status – Minority Groups
High risk for :
– Heart disease, diabetes,
cancer, homicides, infant
mortality – African Americans
– Stroke/diabetes, MVA, infant
mortality American Indian
– Diabetes, MVA, homicide -
Hispanics
– Diabetes - Asians/Pacific
Islanders
Teen pregnancy
– African Americans
– American Indians
– Hispanics
32. Barriers to Health Services
High rates of poverty
Unemployment
Cost of care
Lack of insurance
Location and hours of
services
Lack of transportation
Lack of information
Language
Cultural differences between
providers and clients
33. Visions of a Culturally Competent
Healthcare System
34. Definition of Cultural Competence
The process is ongoing and continuous.
Cultural competence is a dynamic, developmental
process and a state towards which we should strive, it
takes a long-term and consistent commitment to achieve.
It is not something that comes to the individual,the
agency, or the system through a one-shot, quick-fix
approach.
35. MOVING TOWARDS THE GOAL
In order to move towards cultural competence, there must
be a willingness and courage to confront all the feelings and
attitudes that cultural competence and change indicate for
the individual, the agency, and society in general.
As Pinderhughes (1989) states, the multicultural staff
engages in dialogue about their differences in perceptions
and experiences.
36. OUTCOMES
Failure to provide the opportunity to understand and process
these differences among a multicultural staff can produce two
outcomes:
staff will cover over the conflict in perceptions
and orientation and block off the confusion,
frustration, and strong feelings.
conflict can erupt and staff will become burned
out and fatigued.
37. BEFORE TAKING ACTION
Before developing programs and policies, agencies should
understand cultural dynamics and the significance of
cultural identify for themselves, their clients, and their work
together.
Opportunities for sharing and dialogue must be built into the
structure of the agency or organization seeking to become
more culturally competent.
38. UNDERSTANDING THE
AGENCY ENVIRONMENT
As part of the agency’s commitment, it should be
recognized that cultural diversity and cultural
competence require an understanding of the
sociopolitical environment in which an agency
operates.
39. Cultural Competency Continuum
Cultural destructiveness -- attitudes, policies, and
practices that are harmful to cultures and hence to
individuals within the culture.
Cultural incapacity -- the system or agencies lack(s) the
capacity to help minority clients or communities. There is
much bias.
Cultural blindness -- the system and agencies provide(s)
services with the belief that they are unbiased. The
premise is that services are universally applicable.
40. Cultural Competence Continuum continued
Cultural pre-competence -- agency recognizes its limitations
in serving minorities and tries to improve services for a specific
population.
Cultural competence -- agencies are characterized by
acceptance and respect for difference, continuing self-
assessment regarding culture, careful attention to the dynamics
of difference, continual expansion of cultural knowledge and
resources, and various adaptations to service models to better
meet the needs of minority populations.
Cultural proficiency -- advanced cultural competence.
Characterized by holding culture in high esteem.
41. Quiz
QUIZ
1. T or F Race, age, gender and ethnicity are primary diversity differences that
cannot be changed.
2. T or F Cultures have the same beliefs and values.
3. Thought, artifacts _________ and ___________ are integrated patterns of
culture behavior.
4. T or F High poverty rates is not a barrier to health services.
5. T or F This agency should recognize that cultural diversity and cultural
competence require an understanding of the socio-political environment in
which it operates.
Name:_________________________________ Date:__________________
(Fax Quiz to Crystal Hoggard, HR Assistant at 358-7869)