1. Chapter 8

2.  Many of the determinants of well-being span the boundaries of health care  and medicine; therefore, eliminating health disparities calls for new and  nontraditional partnerships across diverse sectors of the community.

3.  Background Information  Clear disparity with certain groups and races  Minorities ◦ Distrust health care ◦ Reluctant to participate as subjects in clinical research ◦ Need to build trust in the community

4.  Study 2003  Cultural proficiency to medical communities in Omaha  Instruments CAI and CCI  Community Assessment Instrument  Cultural Competency Instrument

5.  The purpose of this study was to assess the minority  patient/client perception of the cultural competency of their healthcare  providers within the Omaha, Nebraska, medical community and to have  healthcare providers self-assess their ability to provide culturally competent  care. Two instruments were developed, pilot tested, and administered during  the summer and fall of 2003 for this purpose: the Community Assessment  Instrument (CAI) and the Cultural Competency Instrument (CCI). The CAI  assessed the cultural competence of healthcare providers by the minority  community and the minority community’s knowledge of medical research  risks and benefits.

6.  1998Initiative to eliminate racial and ethnic disparities in health.  AA, Hispanics and NA higher morbidity and mortality in CVD, diabetes, infant mortality, HIV/AIDS, CA screening  Need to eliminate disparities: ◦ Policies, research, medical centers involvement, advocacy organizations

7.  Mistrust, lack of identifiable benefits, conflict in value and benefits, lack of relevance of research, methodology “at risk” population, lack of guidelines principals

8.  Research Design  Access of Omaha minorities  76 items  Physicians in Omaha are not cultural competent  IRB consent  30 minutes  Interpreters available  Different languages  Bias: no formal education

9.  Minority health care clients are not satisfied with health care in the Omaha community  Minority clients are not able to communicate with health care providers in the Omaha community  Minority clients prefer to be treated by health care providers who are of the same ethnic, racial, and/or cultural background  Minority clients practice folk medicine  Minority clients feel pressured to assimilate  Minority clients have never participated in a health care study and do not want to  Minority clients do not know the benefits of participating in a health care study and do not know anyone who has ever participated in one  Minority clients do not know the leading cause of death for people in their ethnic/racial group

10.  Ethnic/Racial Group  Date of Focus Group  Native American  August 20, 2003  Sudanese Men’s  September 10, 2003  Hispanic Men’s  September 17, 2003  African American  September 22, 2003  Sudanese Women’s  September 29, 2003  Hispanic Women’s  October 1, 2003  Vietnamese  November 9, 2003  White  November 24, 2003

11.  In 1998, the Initiative to Eliminate Racial and Ethnic Disparities in Health  (under the auspices of the U.S. Department of Health and Human Services)  addressed the problem of health disparities. Six areas in which African  Americans, Hispanics, and Native Americans have higher morbidity and/or  mortality rates and/or access to preventive health measures were identified:  cardiovascular disease, diabetes, infant mortality, HIV/AIDS, cancer screenings  and management, and child and adult immunizations.

12.  The goal of eliminating  these health disparities15 has been embraced by policy makers,  researchers, medical centers, managed care organizations, and advocacy  organizations. Models and programs have been developed and partnerships  have been formed by various advocacy groups, which include preventive  care, community education, and case and disease management.

13.  Mistrust: Some members of racially and ethnically diverse groups shun participation  in research studies because of historical mistrust due to past experiences  with racism, bias, or exploitation in healthcare delivery systems.  Lack of identifiable benefits: Some diverse communities have not equitably  benefited from their participation in research.  Conflict in values and benefits: Differing values and social, cultural, religious,  and spiritual beliefs related to health may inhibit or prevent certain  individuals and groups from participating in research protocols and studies.  Lack of relevance to research: Members of diverse racial and ethnic groups  that are fairly new to this country may be neither accustomed nor willing  to participate in research conducted according to traditional U.S. methodologies.

14.  Methodologies do not reflect the “at-risk” population: Many faculty members  within institutions of higher education neither use nor teach research  approaches and methodologies that are based on culturally competent and  participatory action.  Lack of guiding principles: Researchers have been slow to require principles  of cultural competence, participatory action research designs, and  advocacy-oriented approaches in the grants and contracts they support.

15.  Are there any questions? Thanks for attending!

16.  (2009). Kosoko-Lasaki, S., Cook, C.T., & O'Brien, R. L. Cultural Proficiency in Addressing Health Disparities. Sudbury, MA: Jones and Bartlett Publishers.