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Week 6M1L6.1-3
Cross- Cultural Competence:
A Developmental Approach
From Winkelman CASC Ch 5
Supplemental Reading Culture andHealth Chapter 3
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Overview
Describe bases for developing cultural competence in
health care
Present anthropological approaches and personal and
interpersonal strategies for intercultural adaptation Present cultural frameworks for adapting to effects of
culture on health behavior
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Introduction: Cultural
Competence in Health Care Basic Issues
Clinical Relations & Effectiveness
Communication and Relations
Personal DevelopmentCultural Competence
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Cross- Cultural Competence
General Orientation: Major DimensionsKnowledge of the general dynamics of culture,
psychology and cross-cultural relations
General Skills in intercultural relationsAwareness of onesown cultural influences
Specific cultural competencies
Culture specific knowledge of behaviors and
beliefs of group(s)
Personal and social abilities in relating toparticular cultural groups
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Factors in Cultural Competence
Castro (1998) Three-factor model
capacity level
Gross ethnocentrism thru proficiency
specific cultures, subcultures and segments
specialty area
E.g, clinical, community, research, teaching
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Developmental Approaches Ethnocentrism/Denial
Develop cultural awareness of others
Defense
Learn value of cross-cultural relations
Minimization/Universalism Limits of biological explanations
Acceptance
Acquiring another cultures perspectives
Adaptation Developing cultural competency
Integration
Shifting cultural perspectives
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General Levels of Cross-Cultural
Competence
Awareness
Sensitivity (Acceptance)
Responsiveness (Adaptation) Competence (Everyday life)
Proficiency (Teach Others)
Organizational Cultural Competence
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M1 L6.2
Tools for Cross-cultural AdaptationAnthropological Perspectives on Cultural Adaptation
Personal Skills &Attitudes for Cross-cultural Adaptations
Interpersonal Skills for Intercultural Relations
Adapting to General Dynamics of Intercultural Attribution
Interview as Relationship Building and Negotiation*
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Anthropological Perspectives
Culture and Emic Perspectives
Cultural Relativism
Cross-cultural or Etic Perspectives.
Intracultural Variation: Cultural
Characterizations versus Stereotypes
Racial Concepts vs. Ethnicity and Culture
Social versus Cultural Effects
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Personal Skills & Attitudes
Cognitive-Behavioral Approach
Emotional Maintenance:
Culture Shock Adaptation
Personal Change and Transformation
Cultural Self-Awareness
Cognitive Re-organization:
Cultural Attribution
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Interpersonal Skills for Inter-
cultural RelationsAchieving communication competence
Adjusting to the other culture's behavioral
expectations Developing and maintaining interpersonal
relationships.
Interpersonal skills for expressing empathy and
cultural understanding Language Skills
use of Translators and Interpreters
Social Interaction Rules & Communication Styles
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Hmong Social Interaction Rules
Deserve services
Respect & compassion, esp. for elders
Allowing & Respecting their decisions Eye contact and touch
Yes as acknowledgement not acquiescence
Emotional meanings
Passive sick role behaviors Family involvement in care planning
Indirect questioning styles and communication
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Adapting to General Dynamics of
Cross-Cultural Relations
Managing Conflict Managing Cultural Differences
Personal Reactions to Cultural Shock
Personal Projections: Attributions
Prejudice and discrimination
Managing Defense Mechanisms
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Personal Reactions
Culture ShockPhases/Stages of Cultural Shock
Honeymoon, Crises, Adjustment & Adaptation
Causes of Cultural Shock
Cultural Differences
Stress, Fatigue, Personal and Role Shock
Multiple dimensions of shock
Cognitive adaptations
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Meaning: Attribution and Interpretation
Reality as Meaning makingAttribution
Ethnocentrism as most basic
Types of Causal Social Attributions
Personal vs Situational
Dynamics of Attribution: Ingroup vs Outgroup
Interaction of Causes and Group Dynamics
Im Good, Youre Bad
Cultural Attribution Development: Managing Projections
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Classic and Modern Views of
Prejudice and Discrimination
Prejudice
negative stereotyped attitudesabout a group.
Discrimination
negative and damaging behaviors.
Modern View
Prejudice and Discrimination as Universals
Normative (culturally expected) behaviors
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PREJUDICE
Prejudice-- tendency to prejudge normal part of
relating to world through our prior expectations
Reduce through suspending judgmental approach
Normative Perspectives
People develop prejudices & discriminate as a normal partof cultural learning and values
Social and Psychological Causes
Cultural, social & situational targets
Addressing institutional discrimination
norms, structures and organizations that perpetuate
discrimination
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Psychodynamic Process in
Intercultural Relations
Projection
Attribution to others: prejudice, discrimination, stereotypes
Ethnocentric and Stereotypes vs.
Cultural/Contextual-- Emic and Situational Perspectives
Managing Transference and Counter-transference
Transferred effects of previous experiences
Defense Mechanisms
reactions to maintain psychological stability in the face of stress
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Minority Defense Mechanisms
Self-Hatred
Denial
Acceptance
Obsessive Sensitivity
Ego Enhancement
Aggression
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Majority Defense Mechanisms
Stereotyping
Prejudice
Denial and Displacement
Minimization
Everybodys the sameHistoricizing
Not learning about cultural and social influences
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Considerations of client culture Salience of cultural identity & background;
Idioms of illness and illness and treatment beliefs;
Explanatory models for conditions, symptoms,significance of condition and proposed treatments;
Clients level of functioning within the cultural-psychosocial environment;
Cultural effects on presentation and client-physician relationships and communication; and
Overall assessment of significance of culture indiagnosis, care preferences and treatmentadherence
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Guidelines for addressing the potential
role of culture in pathology and care Self-assessment by providers of own cultural
biases;
Consultation with family members to determinecultural significance (culture-bound syndromes)and psychosocial functioning of client;
Ask questions using culturally sensitive and
appropriate styles; Determine expectations regarding adherence using
explanatory model;
Identify and resolve conflicts
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Negotiation (cont)
Provider offers compromises to conflicts
and attempts to implement them
Provider as expert advice, patient as finalarbiter
Providers ongoing monitoring of agreement
and participation
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OConnors (1995) strategies to support
the negotiation of treatment plan Providers expression of an attitude of openness
and willingness to cooperated
Giving explanation in everyday language of theproviders recommendations
explication of the reasons for disagreement withthe patients beliefs or preferences
Providers acceptance of patients preferredtreatments not in conflict with patients interest
an ability to engage in shared decision making
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Summary: Cultural Responsiveness as
Enhancing Clinical Relations
Enriching the Provider-Patient Relationship
with Patient Perspectives
Reduce conflict and non-compliance
Enhanced comfort and well-being for both
Using culture to care for providers
Help with coping with culture
Managing communication styles
Enhancing emotional support