1. TriLHIN Integrated Cancer Screening (ICS) Orientation Cultural Competency Dharshi Lacey, London Intercommunity Health Centre

2. Cultural Competence “What is required goes beyond mere tolerance or sympathy or sensitivity- emotions which can be willed into existence by a generous soul. True cultural sensitivity (competence) is something far more rigorous and even intellectual than that. It implies readiness to study and learn across cultural barriers, an ability to see others as they see themselves” - Aga Khan

3. Festivals Clothing Music Food Literature Language Rituals Iceberg Concept for Culture

4. The Health of New Immigrant

5. Community Evidence-Based Barrier Language Information is not in their language Information is not easy to understand – meaning is lost in translation…. Not having physicians who speak the same language Negative connotation of “cancer” as word - that advertising depicts

6. Community Evidence-Based Barrier Lack of knowledge What types of cancer can be screened What the tests are for cancer screening Tests need to be done regularly How to access screening No cost with OHIP

7. Community Evidence-based Barrier Accessibility “it is a long process” “understanding the health care system” “clinics are available only during office hours” Information not from family physicians Not having a female doctor Fear to know

8. The Importance of Communication “People don’t get along because they fear each other. People fear each other because they don’t know each other. People don’t know each other because they don’t communicate.” Dr. Martin Luther King Jr.

9. Things to Consider Power Dynamics Experience and Expertise Communication Styles

10. What it means to me What it might mean to another Not making eye contact Often saying “YES” Spending time on small talk Arriving late for an appt Needing to consult family Assigning Meaning

11. Common Assumptions is Everyone who looks & sounds the same... is the same Being aware of cultural commonalities is useful as a starting point BUT… Drawing distinctions can lead to stereotyping Making conclusions based on cultural patterns can lead to desensitization to differences within a given culture (Garcia Coll et al., 1995; Greenfield, 1994; Harkness, 1992; Ogbu, 1994)

12. Cross-Cultural Communications Strategies Assume differences Acknowledge your own ethnocentrism Listen to stories Share your intent, your purpose, your thinking Ask for clarification Take risks and be prepared to apologize Be sincere and respectful

13. Actions that Support Cultural Competence Examine your own values, beliefs and assumptions Recognize conditions that exclude people such as stereotypes, prejudice, discrimination and racism Reframe thinking to better understand other world views

14. Actions that Support Cultural Competence Develop a relationship of trust by interacting with openness, understanding and a willingness to hear different perceptions Create a welcoming environment that reflects and respects the diverse communities that you work with and that you serve

15. “I had no idea she did not understand until I asked her to teach it back to me. I was so wrapped up in delivering the message that I didn’t realize it was not being received." Provider from the University of Washington Medical Center

16. Costs of Not Providing Interpretation in Healthcare A literature review described inequitable care with regard to three specific factors: Adverse events - Patients who do not speak English are more likely to experience serious medical errors Inappropriate tests and procedures Lack of or inappropriate hospital utilization (Access Alliance, 2009)

17. The Goal is Health Equity Creating the same opportunity for positive health outcomes for all

18. Conclusion Cultural Competency is an integral component of service excellence as it acts to: Create organizational flexibility and change and improve organizational climate Continuously reduce costs and improve productivity by enhancing patient safety Create an attitude toward improving information services Improve the quality of care

19. Acknowledgement to Sick Kids Hospital, Toronto By providing Cultural Competence Train the Trainer Manua l

20. Thank you