4. 4
The lack of culturally-responsive care
Misunderstanding and miscommunication
Patient general dissatisfaction
Poor adherence to therapy and care
Poor health outcomes
Health and care disparities
Rationale for the provision of
culturally safe services
5. 5
Negative consequences
• stress-induced hormonal and immune responses make women
more vulnerable to pre-term labour, low birth weight, and
perinatal mortality and morbidity including gestational diabetes
and post-partum depression
(Patrick & Bryan, 2005; Van Eijsden, M. et al. 2006)
• destructive to women’s decisions to utilize services in the future
(Carlton, T. et al., 2005)
• healthy immigrant effect
(Beiser, 2005)
6. 6
• Association of Faculties of Medicine of Canada:
the Social Accountability Initiative to address and advocate the changing
needs of the communities
• Liaison Committee on Medical Education:
“… demonstrate an understanding of the manner in which people of
diverse cultures and belief systems perceive health and illness and
respond to various symptoms, diseases, and treatments.”
“… to recognize and appropriately address gender and cultural biases in
themselves and others, and in the process of health care delivery.”
Socially responsible healthcare
7. 7
Intersection of culture and health
• Conceptions of health and disease
• Treatment approaches and responses
• Expectations from health professionals
• Social determinants of health
9. 99
Cultural competence model
culture = fixed patterns of learned beliefs, values, practices, ways of
interacting and communicating shared among groups and passed
between generations
• all patients in one cultural group present the same health beliefs and
behaviours
• eliciting patients’ health beliefs, concepts of time, space and physical
contact, communication styles, the role of family and gender, social
expectations, and decision-making preferences
• a list of “do’s and don’ts”
• tolerance, inclusion, and appreciation
10. 1010
Cultural safety model
culture = flexible system of values and world views that people live
by and recreate continuously depending on larger social,
economic and political circumstances
• the role of the social determinants of health in health outcomes, choices
and behaviours (variations in socioeconomic status, employment, and
housing patterns, the effects of war, torture, and abuse, racism)
• intersectionality of culture, ethnicity, skin colour, gender, class, ability,
age or sexual orientation in production of health
• exploration of personal biases, fears, emotional reflexes, and
psychological defences
• advocacy
12. 1212
Barriers to mental healthcare
• Lack of information about mental illness and services
• Long wait times
• Financial constraints
• Linguistic concerns
• Cultural barriers
13. 13
Culture and mental health
spirituality, moral values, family ties, & non-materialistic life
internal strength, support, and understanding of the purpose of life
14. 14
Cultural barriers
Cultural differences and understanding
They [Canadian-born doctors] would never understand what I was
going to say. I know that. There are a lot of things that I say to
Canadian friends or neighbours and they just don’t know what I
am talking about.
Maybe understanding can be attained between the patient and the
mental health provider, but after the understanding, there is
treatment and help itself. I am not sure if there is a single recipe
for everyone from different cultures.
15. 15
Cultural validity of diagnostic methods
Psychological testing:
• Having fits, Blue spells, Raw deal
• Do you believe that the man should be the head of the family?
Cultural barriers
16. 16
Cultural barriers
Treatment approaches
• Psychological therapy (meditation, imagining, problem solving)
• Social therapy (family involvement, social re-integration)
• Physiological therapy (massage, acupuncture)
• Supernatural therapy (prayers, rituals - traditional folk healers or
religious authorities)
• Herbal remedies
• Drug therapy
Some patients (e.g. Hispanics and Nigerians) have low levels of
Cytochrome P450 isoenzymes involved in the oxidation of many
drugs resulting in poor metabolism of drugs
17. 17
Culturally appropriateness of activities promoting mental well-being
Dance or drink: these are things we are offered to do and they will criticize
us why we are not doing these things.
• Lack of gender-based sports, leisure and
social programs
Cultural barriers
18. 18
Cultural insensitivity
I am not expecting from my family doctor to ask me to go and pray.
One should admit it there is a difference [between cultures]. I do
not expect him to ask me to recite my Holy Book. But I remember
when I got cured from my condition and I said that “I want to thank
God and you,” he asked me “Why do you put God in this one?” I
told him that we always thank God for everything. It is a simple
thing you do. But he did not understand why I [first] thank God and
then to him. He expected maybe to thank only to him.
Cultural barriers
19. 19
Barriers to maternal healthcare
• Lack of information about maternity and services
• Lack of emotional and practical support
• Linguistic concerns
• Cultural barriers
20. 2020
Lack of women-only prenatal classes
Lack of room privacy
Lack of dietary accommodation
Lack of specific services (male circumcision)
Lack of female health professionals and staff
I want to say that there should be more female doctors here. And they
should be flexible to come for a delivery when any woman needs. It’s
the most important moment to have a female doctor during the
delivery… if she is not there as if I did nothing [to protect my
modesty].
Cultural barriers
21. 21
Cultural stereotypes, prejudice and insensitivity
She [a nurse] asked me, “And do you have cars in your country? Do you
have electricity?” I think she thought we ride on camels, so I told her
about my country
You see their faces, you feel it that they think you are stupid and you don’t
know anything about this world.
I asked nurses if they can knock before they enter so I can get dressed. I
also put a sign on the door but they didn’t respect it. This man came and
saw me [unveiled]. I was very upset and crying. One nurse came and
she said, “Oh, why you are crying? You are beautiful! You don’t need to
cover yourself.”
Cultural barriers
23. 23
Institutional support for cultural safety
• Policy and practice
• Service planning
• Hiring and retention of staff
• Professional development of staff
• Physical environment
• Health education materials
24. 24
• Diversity, gender, and social determinants of health
• Health beliefs and practices
• Personal self-reflection and advocacy
• Social interaction and communication
• Professional development activities
Personal support for cultural safety
