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Cultural Competency and Health Education
1. Cultural Competency and Health
Education: A Window of
Opportunity
Raffy R. Luquis, Ph.D., MCHES
Penn State Harrisburg: rluquis@psu.edu
Miguel A. Pérez, Ph.D. MCHES
Fresno State: mperez@csufresno.edu
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3. Demographic Shift
• The numbers and characteristics of the US population have
been changing since the turn of the century.
• Census Bureau projects that in the next four decades the
nation:
• Will be more diverse and
• The majority of the population will be concentrated in urban
areas
• Immigration will continue to drive demographic shifts
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4. Demographic Shift
• The number of people 60 and older will continue to increase
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6. Demographic Shifts
• Non-White population are expected to become the majority
• The Hispanic and Asian populations will continue to grow
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7. Demographic Shift
• The racial and ethnic diversification of the U.S. population
establishes the need for cultural and linguistic competence.
• In order to be effective, health education and prevention
strategies must: address each group ’s unique:
• culture,
• experiences,
• language,
• age,
• gender, and
• sexual orientation
In a culturally and linguistically appropriate manner.
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8. Health People 2020
• In the US, not all men [and women] are created equal which is
denoted in their health status.
• Healthy People 2020 goal to achieve health equity, eliminate
disparities, and improve the health of all groups”, expands on
previous goals for the nation.
• Health disparities are caused by a myriad of factors
• lack of health information;
• lack of health insurance;
• individuals’ beliefs and attitudes;
• a shortage of diverse health care providers;
• comorbidity involving other serious health problems; and
poverty.
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9. Definitions
• Diversity is a dynamic philosophy of inclusion based on
respect for cultures, beliefs, values, and individual differences
of all kinds. It respects and affirms the value in differences in
ethnicity and race , gender, age, sexual orientation,
socioeconomic status, linguistics, religion, politics, and special
needs
• Race refers to the biological variation including phenotypical
differences in stature, skin color, hair color, facial shape and
other inherited characteristics that may or may not be
mutually exclusive in each individual
• Although the concept of race is socially meaningful, it is of limited
biological significance.
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10. Definitions
• Ethnicity refers to a group or individual ’s concept of cultural
identity which includes a wide variety of learned behaviors
that a human being uses in his or her natural and social
environment to survive, which may result in cultural
demarcation between and within societies
• An ethnic group consists of people who share a common
orientation toward the world, whose members identify with each
other on the basis of a real or a presumed common genealogy or
ancestry, and who are perceived by others as having a distinctive
culture
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11. Definitions
• Culture comprises values and beliefs
• it is learned, shared, and transmitted from one generation to next
• it helps organize and interpret life
• it includes thoughts, styles of communicating, ways of interacting,
views on roles and relationships, values, practices, and customs
• It includes socioeconomic status,
• physical and mental ability,
• sexual orientation, and occupation
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12. Cultural & Linguistic Competence
• Six reasons why we need cultural and linguistic competence
• To respond to current and projected demographics changes.
• To eliminate long-standing disparities in the health status of
people of diverse racial, ethnic, and cultural background.
• To improve the quality of service and health outcomes
• To meet legislatives, regulatory, and accreditation mandates.
• To gain a competitive edge in the marketplace.
• To decrease the likelihood of liability or malpractice claims.
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Cohen & Goode, 1999; Goode & Dunne, 2003
13. Cultural Competence & Confidence
• Cultural Competence
• A developmental process defined as a set of values, principles,
behaviors, attitudes, and policies that enable health professionals
to work effectively across racial, ethnic, and linguistically diverse
groups.
• At the organization level requires a comprehensive and
coordinated plan, including for the individual
• Cultural confidence
• A lifelong process based upon individuals' self-reflection on
biases and prejudices as well as a motivation to expand their
limited understanding of complex issue.
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2011 Joint Committee on Health Education and Promotion Terminology
14. Cultural Competence
• Cultural competence is a journey
• It is characterized by the awareness and acceptance of
difference.
• Includes awareness and acceptance of one’s own cultural
values.
• Includes the commitment to honor and
respect beliefs and values of other cultures.
• Does not mean you agree with everything.
• Includes the ability to develop, adapt, and implement practice
skills to fit the cultural context of the person.
• It is a dynamic, ongoing, developmental process that requires
a long-term commitment and is achieved over time.
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16. The Ongoing Journey of Cultural
Competence
• Assessing culture by being aware of your own culture
• Value diversity by developing a community of learning with
students
• Manage the dynamics of difference by appreciating the power
of conflicts
• Resolve the conflicts
• Adapting to diversity by committing to continuous learning
• Institutionalizing cultural knowledge
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17. Linguistic Competence
• The capacity of an organization and its personnel to
communicate effectively, and convey information in a manner
that is easily understood by diverse audiences.
• Includes a myriad of strategies to accomplish proper
communication with diverse audiences.
• It requires that individuals and organizations have the capacity
to respond effectively to the health literacy needs of the
populations served.
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19. Linguistic Competence
• Includes, but is not limited to, the use of:
• bilingual/bicultural or multilingual/multicultural staff;
• cross-cultural communication approaches;
• foreign language interpretation services including distance
technologies;
• sign language interpretation services;
• multilingual telecommunication systems;
• print materials in easy to read, low literacy, picture and symbol
formats;
• materials in alternative formats (e.g., audiotape, Braille, enlarged
print );
• materials developed and tested for specific cultural, ethnic and
linguistic groups;
• translation services;
• ethnic media in languages other than English (e.g., television, radio,
newspapers). 19
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20. Standards for Cultural and
Linguistic Appropriate Services
• CLAS serves as a blueprint for individuals, health and health
care organizations to implement culturally and linguistically
appropriate services
• CLAS are structured:
• Principal Standard (standard 1),
• Governance, Leadership, and Workforce (standards 2–4),
• Communication and Language Assistance (standards 5–8), and
• Engagement, Continuous Improvement, and Accountability
(standards 9–15)
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https://www.thinkculturalhealth.hhs.gov/Content/clas.asp
21. Program Planning Models and
Cultural Diversity
• Planning models provide structure, direction, and sequence to
the planning process.
• The concepts of cultural competence help to direct the focus
of the planning model toward programs appropriate for the
diverse population.
• Community-based participatory research models are useful in
development of culturally and linguistically appropriate
programs to address health disparities.
• As part of CBPR, it is important to recognize the collaboration
of community-based leaders and academic communities in
this process.
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22. Planning, Implementation,& Evaluation
of CulturallyAppropriatePrograms
• When working with diverse groups, health educators must get
a clear picture of how cultural issues influence a health
problem and related risk behaviors.
• Needs Assessment
• Tool to help get the bid picture of the health problem.
• Allow for the identification of community capacities and needs
• Qualitative methods and secondary data gathering are useful in
needs assessment with diverse groups.
• Careful attention should be given when using population based
surveys.
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23. Planning, Implementation,& Evaluation
of CulturallyAppropriatePrograms
• Culturally appropriate evaluation
• Requires a balance of the program goals and objectives, the
target population, and the resources available.
• Collaboration of all program staff and representatives of the
target population is key.
• Several factors must be consider when determining how to
design, adapt, or collect data with diverse groups.
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24. Planning, Implementation,& Evaluation
of CulturallyAppropriatePrograms
• Education
• formalized education is a mechanism by which individuals are
taught how to function within the organization of society.
• education provides opportunities to learn and practice
assessment constructs that are commonly used in planning and
measuring program outcomes.
• lack of formal Western education can compromise the use of
standard assessment constructs when working with diverse
groups.
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25. Planning, Implementation,& Evaluation
of CulturallyAppropriatePrograms
• Language
• When translating evaluation assessments, the translation must
accurately reflect a specific target population’s language,
standards, traditions, and culture.
• Lack of written language or the inability to read is also a
significant challenge in evaluation design.
• Cultural protocol
• These are culturally sanctioned behaviors acceptable to a specific
population.
• These patterns of behaviors pose considerable challenges in the
planning, implementation, evaluation of community-based
programs.
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26. Cultural Appropriateness and
Diverse Individuals and Groups
• Trust and sensitivity are pillars in building positive working
relationships and interactions between the health professional
and cultural groups.
• Cultural desire and cultural awareness are exemplified in the
selection and design of health education program approaches
and materials.
• Health professionals can develop the personal sensitivity,
trust, and credibility that are pivotal for integrating cultural
competence into health education programs.
• Cultural appropriateness in working with diverse individuals
and groups requires a collaborative partnership that
recognizes and respects the skills of all parties.
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27. Strategies to Incorporate CLC
into Health Education
• Health educators must
learn to recognize the
importance of culture and
respect diversity.
• Maintain a Current Profile
of the Cultural Composition
of the Community
• Consider the language of
both younger and older
generations.
• Provide Ongoing Cultural
and Linguistic Competence
Training to Health
Educators and other Staff.
• Involve cultural brokers
from the targeted racial
and ethnic groups during
the development of health
education programs.
• Ensure that health
education programs and
services are culturally and
linguistically appropriate.
• Assess and evaluate the
program’s level of cultural
and linguistic competence.
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28. Standards for C&LC in Health
Education and Health Promotion
• Health Education and
Promotion Programs
• Needs assessment &
appropriate assessment
tools
• Work with and include
members of the target
group
• Use target group preferred
language
• Empower racial/ethnic and
cultural communities
• Ensure that programs are
accessible, appropriate and
equitable
• A Trained Workforce
• Professional preparation
programs
• Continue education for
practitioners
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29. Points to Remember
• Health educators need to understand that cultural and
linguistic competence are an integral part of the development,
implementation, and evaluation of health education and
promotion programs.
• Health educators need to promote cultural and linguistic
competence in order to work effectively with the individuals
or communities served by their organizations and to address
these individuals’ or communities’ health needs.
• We already know a number of good strategies for
incorporating cultural and linguistic competence into health
education.
• It is time for our profession to develop standards that address
cultural and linguistic competence in health education
programs and in the preparation of health education
professionals.
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