2 Cultural DefinitionsRace - A socially defined population characterized by physical characteristics that are genetically transmitted.Ethnicity - Belonging to a common group often linked by race, nationality, and language with a common cultural heritage.Culture - Knowledge, skills, and attitudes learned and passed on from one generation to the next.
3 Cultural Determinants EthnicityRaceAgeGenderFamilyLanguageReligionNationality
4 Factors Influencing Health GeneticPhysiologicBehavioralSocioeconomicEnvironmental
5 DEMOGRAPHICS 1990 Distribution 2050 Distribution 75%Anglo-European American12% African American9% Hispanic American3% Asian American2050 Distribution53% Anglo-European American15% African American24% Hispanic American9% Asian American
6 By the year 2000, 4/10 Consumers of Health Care Will Be Nonwhite!!
7 Cultural Competency“A set of academic and personal skills that allow us to increase our understanding and appreciation of cultural differences between groups.”“The set of congruent behaviors, attitudes, and policies, that come together in a system, agency or among professionals to work effectively in cross cultural situations.”
8 Culturally CompetentWe must first understand how we feel and will react to a pt to be able to ultimately understand a pt [ ] Ethnocentric Ethno-RelativeMost people lie in the ethnocentric part of the continuum.
9 Cultural Competency Developmental Model of Intercultural Differences. Stage 1 - DenialStage 2 - DefenseStage 3 - MinimizationStage 4 - AcceptanceStage 5 - AdaptationStage 6 - Integration
10 Goals of Culturally Competent Care 1) Cultural Awareness2) Cultural Knowledge3) Cultural Skill4) Cultural Encounters
11 The Road to Cultural Competency LEARNL ListenE ExplainA AcknowledgeR RecommendN NegotiateAssessment questions for patients.
12 Cultural Diversity in Health Care Differences between high (collectivistic) and low (individualistic) context cultures in attitudes toward health and health care.InterviewsAfrican-AmericanHispanicAsian-AmericanNative American
13 Cultural Diversity in Health Care Related researchBekker et al. compared the cultural differences between the Dutch and the Japanese and how they have an impact on the pt’s conception of health and illness.
14 Areas of Dissonance Historical Distrusts Interpretations of Disability Concepts of Family Structure and IdentityCommunication Styles and Views of Professional RolesIncompatibility of Explanatory Models
15 Areas of Dissonance Disease Without Illness Illness Without Disease Misunderstandings of Terminology, Language, or Body Language
16 Language Barriers12% of US population speak a language other than English.Strategies for working through a language barrier.Become a bilingual providerLanguage banksAT&T Language Line
17 Language Barriers Strategies Professional Medical Interpreter Family MembersCommunity Members/Traditional Healers
18 Language Barriers 10 Guidelines for using an interpreter Unless you are thoroughly fluent in the target language, always use an interpreter.Try to use an interpreter of the same sex as the client.Emphasize by repetition and speak slowly but not loudly.Be patient.
19 Language Barriers Address the patient directly. Be sure the interpreter knows what you want.Provide instructions in list format.Use short questions and comments.Use language the interpreter can handle.Plan what to say ahead of time.
20 Case Study: Lia Lee Hmong child with history of epileptic seizures Family unable to speak EnglishClash of cultural beliefs and practicesAs of 1995 there were over 110,000 Hmong living in US
21 Case Study: Lia LeeHow could Lia’s medical treatment have been more effective given the clash of cultures?
22 Incorporating Cultural Competency Into Our Lives Resources AvailableAHECWisconsin ExpressCultural Diversity Training Sessions and ExercisesLocal Cultural OrganizationsIsaacs and Benjamin “Towards a Culturally Competent System of Care: Vol II”
23 Summary10 tips for improving the caregiver/ patient relationship across cultures1) Don’t treat patient the same way you would want to be treated2) Begin by being more formal with patients of another culture3) Don’t be insulted if patient does not look you in the eye
24 Summary4) Don’t make assumptions about patient’s ideas about cause of illness5) Allow patient to be open and honest6) Don’t discount the effects of beliefs of the supernatural in health7) Inquire indirectly about the patient’s beliefs
25 Summary8) Ascertain the value of involving the entire family in the treatment9) Don’t assume “the need to know”10) Incorporate the patient’s folk medicine and beliefs into treatment plan if not contraindicated
26 Case Study: Discussion Case Study: Re-evaluating Ethics and Values From a Different Cultural PerspectiveDiscussionWhat were the conflicting values about which the three physicians disagreed?Did the 3rd MD make a mistake and how might re-examining his ethics have helped him make a better decision?What would you have done? How would you justify your actions?