Cultural Competence The increasing population growth of racial and ethnic communities and linguistic groups, each with its own cultural traits and health profiles, presents a challenge to the health care industry in this country. The U.S. Department of Health and Human Services

Cultural Competence The provider and the patient each bring their individual learned patterns of language and culture to the health care experience which must be transcended to achieve equal access and quality health care. The U.S. Department of Health and Human Services

The Influence of Culture and Language Culture and language may influence  health, healing, and wellness belief systems.  how illness, disease, and their causes are perceived.  the behaviors of patients who are seeking health care and their attitudes toward health care providers.  the delivery of services by the provider who looks at the world through his or her own limited set of values, which can compromise access for patients from other cultures. The U.S. Department of Health and Human Services onii.htm onii.htm

Culture Defines How Health Care Information is Received How rights and protections are exercised. What is considered to be a health problem. How symptoms and concerns about the problem are expressed. Who should provide treatment for the problem. What type of treatment should be given. The U.S. Department of Health and Human Services

The Patient Health care providers must work with and provide care to many different people. This requires understanding and appreciating the differences between people. Try to respect the individuality of each person.

Fulfilling our Missio n As health care providers we must give the same level of care regardless of any other factors. A patient’s culture can often drive their expectations. What are the cultural customs of your patients? Is there a cultural disconnect? We need to build trust and try to establish a good rapport. © Joint Commission Resources: (Cultural Sensitivity- A Pocket Guide for Health Care Professionals). Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations, (2007) Reprinted with permission.

Cultural Considerations Language Religious Beliefs Age Disability ( both physical and mental) Sexual Orientation Gender Socio-economic status 7

What Is Cultural Competency? Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. The U.S. Department of Health and Human Services

Cultural Competence Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. The U.S. Department of Health and Human Services

Why is it Important? Cultural competency is one the main ingredients in closing the disparities gap in health care. It’s the way patients and healthcare providers can come together and talk about health concerns without cultural differences hindering the conversation, but enhancing it. The U.S. Department of Health and Human Services

Improving Health Outcomes Health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes. Oftentimes health professionals think that if they just treat each patient with respect, they will avoid cultural problems, but that may not always be the case. The U.S. Department of Health and Human Services

Health Resources and Services Administration The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. The U.S. Department of Health and Human Services

Health Resources and Services Administration Many health care professionals agree that cultural competence is a critical factor in providing relevant services to the nation’s growing culturally and ethnically diverse patient population. The HRSA has preliminarily identified nine areas that are important to developing a plan for cultural competence in health care settings. These areas are referred to as domains. The U.S. Department of Health and Human Services

The Domains 1. Values and attitudes 2. Cultural sensitivity 3. Communication 4. Policies and procedures 5. Training and staff development 6. Facility characteristics, capacity, and infrastructure 7. Intervention and treatment model features 8. Family and community participation 9. Monitoring, evaluation and research The U.S. Department of Health and Human Services

1. Values and Attitudes Values and attitudes refer to the set of beliefs and mindsets possessed by providers, administrative staff, health care organizations and others involved in service delivery. Provider values and attitudes toward other cultures can change through cross-cultural interactions with clients and by developing knowledge about and adaptation to this diversity. The U.S. Department of Health and Human Services

Cultural Imposition It is common for some healthcare providers to either consciously or unconsciously impose their cultural beliefs on someone else. It is important to avoid this transference. Culturally competent care adapts care to the client’s cultural needs. This doesn’t mean that you must abandon your beliefs.

Values and Attitudes The beliefs and mindsets of organizations, professionals, and consumers influence direct care encounters, shaping the interaction between the consumer and the provider, the provider’s delivery of care, and the way in which consumers perceive care. The U.S. Department of Health and Human Services

2. Cultural Sensitivity Cultural sensitivity manifests itself in a provider’s ability to accurately interpret and respond to non-verbal or other cultural cues or in the way in which health care organizations provide information to their clients. The U.S. Department of Health and Human Services

Cultural Sensitivity Cultural sensitivity generally refers to heightened awareness and complements several other domains, most notably communication. Cultural sensitivity is a regard for a consumer’s beliefs, values, and practices within a cultural context and awareness of how a provider’s background may influence professional practice. The U.S. Department of Health and Human Services

3. Communication Communication encompasses a wide range of activities, both oral and written, that describe the flow and exchange of information among those involved in the provision and receipt of care. Providers must assess the patient’s communication style to learn about cultural-specific cues that are used. The U.S. Department of Health and Human Services

Communication Language services for those consumers with limited English proficiency or for whom English is not the primary language is of growing importance in making treatment decisions and ensuring appropriate care. The U.S. Department of Health and Human Services

Eye Contact Many cultures utilize eye contact as a way of assessing if a patient is listening to us or truly hearing what is being said. What does it mean if a patient is not making eye contact? Is the patient ignoring you or are they shy? In some cultures a lack of eye contact be a sign of respect.

Personal Contact - Touch The sense of touch is often considered important to healing in many cultures. Please be aware that cultures can regard touch in very different ways.

Personal Space It is important to consider one’s physical position relative to a patient when interacting with them in professional situations that require effective communication. Establishing an appropriate professional distance, and positioning oneself at the same height as the patient to allow comfortable eye contact can often defuse patient defensiveness or anxiety.

Health Literacy Health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness. The U.S. Department of Health and Human Services

Health Literacy Do your patients understand you? Do they speak your language? Do you speak theirs? Is an interpreter available?

Health Literacy Can they read the pamphlet that you are giving them? Are they able to fill out the health and insurance forms that you have given them? Can they read and comply with the information written on the prescription bottle? Try to provide health information written at the appropriate level respecting the cultural norms.

4. Policies and Procedures As an agency or professional moves toward cultural competence, they begin to understand the interplay between policy and practice and are committed to policies that enhance services to diverse clientele. The U.S. Department of Health and Human Services

5. Training & Staff Development Training and staff development concentrates on how to provide health care professionals the knowledge and skills required to supply culturally competent care. Health professionals should be trained to collect relevant cultural data when conducting health histories and assessments. The U.S. Department of Health and Human Services

Training and Staff Development The objective of training is that providers will reach a state of “cultural knowledge.” Cultural knowledge means the “student begins to show familiarity with the broad differences, similarities, and inequalities in experience, beliefs, values, and practices among various groupings within society.” The U.S. Department of Health and Human Services

6. Facility Characteristics, Capacity, and Infrastructure Facility characteristics, capacity, and infrastructure refer to issues related to the access and availability of care and the environment in which it is provided, including location, hours of operation, physical resources, and information systems. The U.S. Department of Health and Human Services

7. Intervention and Treatment Model Features Intervention and treatment model features focus on aspects of patient evaluation, diagnosis, treatment, and referral services. Diagnoses should be based on an assessment that is sensitive to the cultural needs and beliefs of the patient. The U.S. Department of Health and Human Services

Intervention and Treatment Model Features Sharing diagnoses with consumers in a culturally sensitive manner can contribute to increased understanding of diagnoses and treatment. Obtaining an understanding of whether consumers are using traditional healers or other non-conventional care is important, particularly in the context of managed care where access to such services is often restricted The U.S. Department of Health and Human Services

8. Family and Community Participation Family and community participation refers to family- centered, family-focused, and family-oriented care that recognizes the important role of the family and the larger community in the provision of health care. Community participation in assessments and community outreach efforts represent means for providers to develop an understanding of consumers’ cultural backgrounds and support structures. The U.S. Department of Health and Human Services

Family Who makes the health care decisions? Who is the main health care provider? Are there important gender issues? Is there a strong family network? Is this person’s care being compromised because of their family obligations?

Religious and Spiritual Beliefs Religious and spiritual beliefs often influence the health practices and attitudes of many people. In the United States most healthcare providers practice what would be considered “traditional Western Medicine” based on scientific methods and research for diagnosing and treating illness. Other cultures may use alternative medical approaches to treat illness, such as faith healing, herbal medicines, care provided by a Shaman or Medicine Man, or other alternative approaches.

9. Monitoring, Evaluation and Research Efforts to become culturally competent include monitoring and evaluating current efforts in order to assess the extent to which cultural competence is present, is maintained, and contributes to desired results with respect to health and health care. The U.S. Department of Health and Human Services

Applying What You Have Learned Listen to your patients. Is there a language barrier? Ask respectful and non-judgmental questions. Do your homework. Try to learn more about the cultures that you see frequently. Recognize and avoid prejudice and stereotyping. Allow patients to practice and express their beliefs as much as possible.

Resources The U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C