CULTURAL COMPETENCY IN HEALTH CARE. Cultural Definitions n Race - A socially defined population characterized by physical characteristics that are genetically.

CULTURAL CULTURAL COMPETENCY IN COMPETENCY IN

HEALTH CAREHEALTH CARE

Cultural DefinitionsCultural Definitions Race - A socially defined population Race - A socially defined population

characterized by physical characteristics characterized by physical characteristics that are genetically transmitted.that are genetically transmitted.

Ethnicity - Belonging to a common group Ethnicity - Belonging to a common group often linked by race, nationality, and often linked by race, nationality, and language with a common cultural heritage.language with a common cultural heritage.

Culture - Knowledge, skills, and attitudes Culture - Knowledge, skills, and attitudes learned and passed on from one learned and passed on from one generation to the next.generation to the next.

Cultural DeterminantsCultural Determinants EthnicityEthnicity RaceRace AgeAge GenderGender FamilyFamily LanguageLanguage ReligionReligion NationalityNationality

Factors Influencing Factors Influencing HealthHealth

GeneticGenetic PhysiologicPhysiologic BehavioralBehavioral SocioeconomicSocioeconomic EnvironmentalEnvironmental

DEMOGRAPHICSDEMOGRAPHICS

1990 1990 DistributionDistribution– 75%Anglo-75%Anglo-

European European AmericanAmerican

– 12% African 12% African AmericanAmerican

– 9% Hispanic 9% Hispanic AmericanAmerican

– 3% Asian American3% Asian American

2050 2050 DistributionDistribution– 53% Anglo-53% Anglo-

European AmericanEuropean American– 15% African 15% African

AmericanAmerican– 24% Hispanic 24% Hispanic

AmericanAmerican– 9% Asian American9% Asian American

By the year 2000, 4/10 By the year 2000, 4/10 Consumers of Health Consumers of Health

Care Will Be Nonwhite!!Care Will Be Nonwhite!!

Cultural CompetencyCultural Competency ““A set of academic and personal skills A set of academic and personal skills

that allow us to increase our that allow us to increase our understanding and appreciation of understanding and appreciation of cultural differences between groups.”cultural differences between groups.”

““The set of congruent behaviors, The set of congruent behaviors, attitudes, and policies, that come attitudes, and policies, that come together in a system, agency or among together in a system, agency or among professionals to work effectively in professionals to work effectively in cross cultural situations.”cross cultural situations.”

Culturally CompetentCulturally Competent We must first understand how we feel We must first understand how we feel

and will react to a pt to be able to and will react to a pt to be able to ultimately understand a pt. ultimately understand a pt. [--------------------------------------][--------------------------------------]Ethnocentric Ethno-RelativeEthnocentric Ethno-Relative

Most people lie in the ethnocentric Most people lie in the ethnocentric part of the continuum.part of the continuum.

Cultural CompetencyCultural Competency Developmental Model of Intercultural Developmental Model of Intercultural

Differences.Differences.– Stage 1 - DenialStage 1 - Denial– Stage 2 - DefenseStage 2 - Defense– Stage 3 - MinimizationStage 3 - Minimization– Stage 4 - AcceptanceStage 4 - Acceptance– Stage 5 - AdaptationStage 5 - Adaptation– Stage 6 - IntegrationStage 6 - Integration

Goals of Culturally Goals of Culturally Competent CareCompetent Care

1) Cultural Awareness1) Cultural Awareness 2) Cultural Knowledge2) Cultural Knowledge 3) Cultural Skill3) Cultural Skill 4) Cultural Encounters4) Cultural Encounters

The Road to Cultural The Road to Cultural CompetencyCompetency

• LEARNLEARN– L ListenL Listen– E ExplainE Explain– A AcknowledgeA Acknowledge– R RecommendR Recommend– N NegotiateN Negotiate• Assessment questions for patients.Assessment questions for patients.

Cultural Diversity in Cultural Diversity in Health CareHealth Care

Differences between high (collectivistic) Differences between high (collectivistic) and low (individualistic) context cultures and low (individualistic) context cultures in attitudes toward health and health in attitudes toward health and health care.care.

InterviewsInterviews– African-AmericanAfrican-American– HispanicHispanic– Asian-AmericanAsian-American– Native AmericanNative American

Cultural Diversity in Cultural Diversity in Health CareHealth Care

Related research Related research – Bekker et al. compared the cultural Bekker et al. compared the cultural

differences between the Dutch and differences between the Dutch and the Japanese and how they have an the Japanese and how they have an impact on the pt’s conception of impact on the pt’s conception of health and illness.health and illness.

Areas of DissonanceAreas of Dissonance

Historical DistrustsHistorical Distrusts Interpretations of DisabilityInterpretations of Disability Concepts of Family Structure and Concepts of Family Structure and

IdentityIdentity Communication Styles and Views of Communication Styles and Views of

Professional RolesProfessional Roles Incompatibility of Explanatory Incompatibility of Explanatory

ModelsModels

Areas of DissonanceAreas of Dissonance

Disease Without IllnessDisease Without Illness Illness Without DiseaseIllness Without Disease Misunderstandings of Terminology, Misunderstandings of Terminology,

Language, or Body LanguageLanguage, or Body Language

Language BarriersLanguage Barriers

12% of US population speak a 12% of US population speak a language other than English.language other than English.

Strategies for working through a Strategies for working through a language barrier.language barrier.– Become a bilingual providerBecome a bilingual provider– Language banksLanguage banks– AT&T Language LineAT&T Language Line

Language BarriersLanguage Barriers

StrategiesStrategies– Professional Medical InterpreterProfessional Medical Interpreter– Family MembersFamily Members– Community Members/Traditional Community Members/Traditional

HealersHealers

Language BarriersLanguage Barriers

10 Guidelines for using an interpreter10 Guidelines for using an interpreter– Unless you are thoroughly fluent in the Unless you are thoroughly fluent in the

target language, always use an target language, always use an interpreter.interpreter.

– Try to use an interpreter of the same Try to use an interpreter of the same sex as the client.sex as the client.

– Emphasize by repetition and speak Emphasize by repetition and speak slowly but not loudly.slowly but not loudly.

– Be patient.Be patient.

Language BarriersLanguage Barriers

– Address the patient directly.Address the patient directly.– Be sure the interpreter knows what Be sure the interpreter knows what

you want.you want.– Provide instructions in list format.Provide instructions in list format.– Use short questions and comments.Use short questions and comments.– Use language the interpreter can Use language the interpreter can

handle.handle.– Plan what to say ahead of time.Plan what to say ahead of time.

Case Study: Lia LeeCase Study: Lia Lee

Hmong child with history of Hmong child with history of epileptic seizuresepileptic seizures

Family unable to speak EnglishFamily unable to speak English Clash of cultural beliefs and Clash of cultural beliefs and

practicespractices As of 1995 there were over As of 1995 there were over

110,000 Hmong living in US110,000 Hmong living in US

Case Study: Lia LeeCase Study: Lia Lee

How could Lia’s medical treatment How could Lia’s medical treatment have been more effective given have been more effective given the clash of cultures?the clash of cultures?

Incorporating Cultural Incorporating Cultural Competency Into Our Competency Into Our

LivesLives Resources AvailableResources Available

– AHECAHEC– Wisconsin ExpressWisconsin Express– Cultural Diversity Training Sessions and Cultural Diversity Training Sessions and

ExercisesExercises– Local Cultural OrganizationsLocal Cultural Organizations– Isaacs and Benjamin “Towards a Isaacs and Benjamin “Towards a

Culturally Competent System of Care: Culturally Competent System of Care: Vol II”Vol II”

SummarySummary

10 tips for improving the caregiver/ 10 tips for improving the caregiver/ patient relationship across culturespatient relationship across cultures– 1) Don’t treat patient the same way 1) Don’t treat patient the same way

you you would want to be treated would want to be treated– 2) Begin by being more formal with 2) Begin by being more formal with

patients of another culturepatients of another culture– 3) Don’t be insulted if patient does 3) Don’t be insulted if patient does

not look you in the eyenot look you in the eye

SummarySummary– 4) Don’t make assumptions about 4) Don’t make assumptions about

patient’s ideas about cause of illnesspatient’s ideas about cause of illness– 5) Allow patient to be open and 5) Allow patient to be open and

honesthonest– 6) Don’t discount the effects of beliefs 6) Don’t discount the effects of beliefs

of the supernatural in healthof the supernatural in health– 7) Inquire indirectly about the 7) Inquire indirectly about the

patient’s beliefspatient’s beliefs

SummarySummary

– 8) Ascertain the value of involving the 8) Ascertain the value of involving the entire family in the treatment entire family in the treatment

– 9) Don’t assume “the need to know”9) Don’t assume “the need to know”– 10) Incorporate the patient’s folk 10) Incorporate the patient’s folk

medicine and beliefs into treatment medicine and beliefs into treatment plan if not contraindicated plan if not contraindicated

Case Study: DiscussionCase Study: Discussion Case Study: Re-evaluating Ethics and Values Case Study: Re-evaluating Ethics and Values

From a Different Cultural PerspectiveFrom a Different Cultural Perspective DiscussionDiscussion

– What were the conflicting values about What were the conflicting values about which the three physicians disagreed?which the three physicians disagreed?

– Did the 3rd MD make a mistake and how Did the 3rd MD make a mistake and how might re-examining his ethics have helped might re-examining his ethics have helped him make a better decision?him make a better decision?

– What would you have done? How would you What would you have done? How would you justify your actions?justify your actions?

Questions?Questions?

““To know yourself is to know To know yourself is to know others”others”