TMT Cairns, 2013

1. Cultural Awareness
Training
Achieving Cultural Competency
Dr. Hung The Nguyen
hunguyen250369@gmail.com
TMT, Cairns 07/02/2013
1Monday, 4 February 2013

2. A word on stereotyping
Stereotyping Generalising
unconscious
judgemental
fixed perspective
conscious
descriptive
flexible, adaptable
2Monday, 4 February 2013

3. What we expect from each other
!join in the discussion
!be willing to receive and give feedback
!participate, engage and volunteer
!respect each others views
!maintain confidentiality - what is said here,
stays here
3Monday, 4 February 2013

4. Outline
"a warm up
"culture and its dimensions
"identification and patient diversity
"communication and connecting
"last comments and questions
4Monday, 4 February 2013

5. Warm-up
5Monday, 4 February 2013

6. An approach to cultural
competence
Awareness + Reflection
(know yourself, know them)
Sensitivity +Safety
(trust yourself, trust them)
Competence + Structural change
(working together, organisation change)
6Monday, 4 February 2013

7. Being culturally aware
• culture is a blueprint for action
- Laksiri Jayasuriya
• a cultural group can be understood through
the group’s rituals, customs, heroes and
values
• cultural blindness occurs when we
don’t accept or perceive people’s
behaviours are guided by their culture
7Monday, 4 February 2013

8. Being culturally
sensitive
• culture is complex but not chaotic.
• we perceive the values of out culture in
moral terms and therefore we tend to view
other peoples values as morally inferior
• Cultural dimensions through the cultural
lens
8Monday, 4 February 2013

9. “With the education they get, this is all we can expect.”
“They are just not used to working hard – look at their
history.”
“They really don’t seem to care about their health. Life is not
valued as much in their country.”
“As soon as you take your eyes off them, they stop working.
They haven’t been taught responsibility.”
! Explanation 1. People from some other nations/
cultures are stupid, lazy, amoral, and/or
obstructionist.
9Monday, 4 February 2013

10. " Explanation 2. People from some other nations/
cultures differ in cognition in ways that result in
different perceptions, judgments, decision making and
behaviours.
10Monday, 4 February 2013

11. Culture confers a survival advantage.
If it does not that cultural component
would be extinct.
National
Culture
Physical ecology
Social ecology
acceptable
behaviours
emotional
expression
communication
tendencies and
preferences
11Monday, 4 February 2013

12. People can only see their culture when they
encounter a mismatch b/w their lifelong
patterns of thinking and that of other people.
Klein, 2004
12Monday, 4 February 2013

13. Klein, 2004
People cannot adjust mismatches by altering
their underlying cognitive processes i.e. how
they think about the world.
13Monday, 4 February 2013

14. The lens filters and organizes incoming
information, makes sense of the information,
structures planning and adaptation activities, and
guides interactions and communication.
Klein, 2004
14Monday, 4 February 2013

15. Applying the Cultural
Lens
• know about the cognitive differences ie
cultural dimensions
• know how and why cultural dimensions
sustain a culture trait
• observations and perspective taking
• cultural immersion and experiential
learning
15Monday, 4 February 2013

16. Cultural dimensions
high vs low power distance
short vs long term time orientation
mastery vs fatalism
masculinity vs femininity
high vs low tolerance for uncertainty
hypothetical vs concrete reasoning
root cause vs systems approach
individualist vs collectivist
16Monday, 4 February 2013

17. Individualism
Individualism Collectivism
17Monday, 4 February 2013

18. Power Distance
Low PD High PD
18Monday, 4 February 2013

19. The Weekend Australian Magazine (11/12/07) Richard Guiliatt ʻBeautiful mindsʼ (Terry Tao)
ʻI skipped year 5ʼ Nigel notes, ʻbut I donʼt try to
make a big deal out of it and I donʼt let that define
me. Maybe thatʼs an Australian thing, where you
admire someone for being a good bloke rather
than something theyʼve achieved. If weʼd grown
up in the US it might have been different. In
Australia you can be tremendously good at
something but if youʼre a whacker, people still
arenʼt going to like you.ʼ
19Monday, 4 February 2013

20. Uncertainty Avoidance
Tolerance of ambiguity Need for certainty
20Monday, 4 February 2013

21. Masculinity
Feminine Masculine
21Monday, 4 February 2013

22. Time Orientation
Short term Long Term
“Mankind differs from
the animals only by a
little, and most people
throw that away.”
“The superior man is
modest in his
speech but exceeds
in his actions.”
22Monday, 4 February 2013

23. • What about your national cultural
dimensions?
23Monday, 4 February 2013

24. Applying the Cultural
Lens
• know about the cognitive differences ie
cultural dimensions
• know how and why cultural dimensions
sustain a culture trait
• observations and perspective taking
• cultural immersion and experiential
learning
24Monday, 4 February 2013

25. Being Culturally Safe
Cultural safety is define by the patients not the
health service. Nguyen, 2008
25Monday, 4 February 2013

26. Identification of Aboriginal and
Torres Strait Islander Status
• Why identify?
26Monday, 4 February 2013

27. What we know...
• Most Aboriginal and Torres Strait Islander
people seek medical advice from their
mainstream GP - from 80% in urban setting
to 6% in remote locations.
27Monday, 4 February 2013

28. What we know...
Indigenous patient presenting to private
general practice were:
• younger,
• seen in rural and remote areas,
• problems managed per encounter
was similar,
• types of problem managed were
different
Indigenous patient presenting to ACCHS
(Townsville, Darwin) were:
• younger,
• new to practice,
• had complex problems,
• more new problems,
• more problems managed per encounter,
• problems managed were different to GP
presentation,
• more consultation leading to admission to
emergency
28Monday, 4 February 2013

29. • RACGP Standards for general practices (4th edition)
Criterion 1.1.7 Indicator E: ʻOur practice can demonstrate that we
routinely record Aboriginal and Torres Strait Islander status in our
active patient health recordsʼ
29Monday, 4 February 2013

30. Who is Aboriginal or
Torres Strait Islander?
Bob Gallagher
Simone
Petersen
Jack Thorpe
Patricia Brown
Thomasina
Cook
30Monday, 4 February 2013

31. Incentives?
• For the patient and the GP...
• For the GP and practice...
31Monday, 4 February 2013

32. ʻEfforts to close the life expectancy gap must
be based on rock solid data, not estimates that
can fluctuate.ʼ
Tom Calma, Social Justice Commissioner
๏< 1/3 GPs routinely ask
๏ Low take-up of specific health services
๏ Poor quality Indigenous data
32Monday, 4 February 2013

33. ʻIt is not credible to suggest that one of the
wealthiest nations in the world cannot solve a
health crisis affecting less than 3% of its
citizensʼ
Tom Calma, Social Justice Commissioner
60
65
70
75
80
85
Males Females
Total Indigenous
Total Non-
Indigenous
33Monday, 4 February 2013

34. What is the question?
ʻAre you of Aboriginal or
Torres Strait Islander origin?ʼ
Responses:
No
Yes, Aboriginal
Yes, Torres Strait Islander
1. ASK
2. RECORD
3. RESPOND
34Monday, 4 February 2013

35. Being Culturally
Competent
Inala (Hayman, 2009)
"Indigenous staff
No indigenous person working there
"Culturally appropriate waiting
room
Nothing to identify with
"Staff cultural awareness
Staff perceived as unfriendly, uncaring
Staff talk down at you, “shame”
Treated poorly at reception
Staff intolerance towards children’s behaviour
"Inform local indigenous
community
"Promote inter-sectorial
collaboration
Majellan (Johanson and Hill, 2011)
"Bulk billing
Lack of bulk billing
"The clinic
Lack of indigenous awareness
One session a week
Attended by AHW from ACCHS – recalls, cultural broker
"Transport
Transport issues to clinic and ACCHS
Bus operated by ACCHS, petrol subsidized by DGP
"Consult Elders, Qld Dept. Health,
DGP
35Monday, 4 February 2013

36. Awareness + Reflection
(know yourself, know them)
Sensitivity +Safety
(trust yourself, trust them)
Competence + Structural change
(working together, organisation change)
36Monday, 4 February 2013

37. 38Monday, 4 February 2013