1. 135th Annual Meeting and Exposition
From Cultural Destructiveness to Cultural Proficiency: Increasing Cultural Competence in Working with African Americans
135th Annual Meeting and Exposition
November 3-7, 2007
Washington, DC

2. African American Cultural Competence to Eliminate Health Disparities
One-day interactive, skills building course
Based on cultural competence continuum that ranges from cultural destructiveness to cultural proficiency

3. Objectives
To provide healthcare workers with the necessary skills needed to recognize health-related beliefs and practices of African Americans
To improve the quality of services delivered
To understand the vital role cultural competence plays in reducing health care disparities among African Americans

4. Program Evaluation Data
Delivered to 7 community health care organizations
75 % of the participants strongly agreed they learned new skills
75% of the participants strongly agreed their awareness about cultural competence had increased due to the course
87.5% of the participants strongly agreed they could apply the cultural competence skills within the next three months

5. African Americans and Health Disparities
African American women, ages 35-44, have a breast cancer death rate more than twice the rate of White women in the same age group.
African American men have about a 60% higher incidence rate of prostate cancer than white men.
African Americans are far more likely to rely on hospitals or clinics instead of personal physicians for their usual source of care (16%), than are white Americans (8%).
Cancer Facts & Figures for African Americans

6. Barriers to Healthcare
Economic
Structural
Informational
Individual/Cultural

7. What is Culture? Patterns of human behavior that includes: Thoughts
Communications
Actions
Customs
Beliefs
Values
Institutions of racial, ethnic, religious, or social groups

8. What is Cultural Competence?
A set of congruent behaviors, attitudes, and policies that come together to enable health care providers to work effectively in cross-cultural situations.

9. Justification for Cultural Competence in Health Care
The perception of illness and disease and their causes varies by culture
Culture influences “health seeking behaviors” and attitude toward health care providers
Health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery system
The perception of illness and disease and their causes varies by culture
Diverse belief systems exist related to health, healing, and wellness
Culture influences “help seeking behaviors” and attitude toward health care providers
Individual preferences affect traditional and non-traditional approaches to health care
Patients must overcome personal experiences of biases within health care systems; and
Health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery system
National Center for Cultural Competence (1999)

10. Health Care Assumptions
Provider Assumptions
Uneducated
Don’t care about health
Lazy
Client Assumptions
Used as a guinea pig
Don’t care about my health
They don’t understand the challenges in my life

11. The Cultural Competence Continuum
Cultural Proficiency
Cultural Competence
Cultural Pre-Competence
Cultural Blindness
Cultural Incapacity
Cultural Destructiveness

12. Cultural Destructiveness
The blatant attempt to destroy the culture of a given group
The assumption that one group is superior to another
Acknowledges only one way of being and purposefully denies any other cultural approach
Trainer Notes:
Ask participants to give examples of historic events which mirror cultural destructiveness.
European ethnocentric attitudes that saw the Native American culture as primitive and actively sought to destroy their cultural values, beliefs and traditions
Recent events in Bosnia, Rwanda

13. Cultural Incapacity
An individual or organization lacks the capacity to be responsible to different groups, but this is not intentional.
Ignorance and unfounded fear are often the underpinnings of this problem.
Failure to recognize when mistreatment is due to cultural differences and thereby perpetuating its occurrence
Trainer notes:
Stress that this is done more so out of ignorance and is not purposeful
Example: an administrator who decides to have the agency's mentally ill clients (who happen to be black) enter through the back door to avoid upsetting other clients. Ignorance of emotional implications of blacks entering through the rear door may cause further isolation to black clients as well as black employees.

14. Cultural Blindness A blindness or ignorance of cultural differences
Individuals perceive themselves as “unbiased” because they feel that “culture makes no difference” in the way a person or group acts or reacts
Foster the assumption that we are all basically alike so what works with members of one group will work with all groups.
Trainers notes:
Cultural blindness occurs when service providers treat all clients/patients one way without recognizing differences affect the client/patient attitudes and perceptions about health and human services. Although well intended, the culturally blind service provider “treats everyone the same”. This sameness is often based on the provider’s own cultural experiences.

15. Cultural Pre-competence
Implies movement toward cultural sensitivity
The active pursuit of knowledge about cultural differences and the attempt to integrate this information into the delivery of health care services
Learning and understanding of new ideas is encouraged along with solution to improve performances or services
Trainer notes:
Explain to participants that a service provider who is culturally pre-competent will attempt to demonstrate their knowledge and acceptance of differences by making their work space more welcoming. They may incorporate pictures, magazines and music that represent the population being served into the décor of their workspace. On the organizational level, hiring practices may include ensuring that personnel reflect the makeup of the community being served.

16. Cultural Competence
The capacity to function in an effective manner within the context of the targeted group
Acceptance and respect of differences
Continual self-assessment
Actively seeks advice and consultation

17. Cultural Proficiency Culture is held in very high esteem
Cultural differences are regarded proactively
Improved cultural relations among diverse groups are promoted
Healthcare providers are regarded as specialists in developing culturally sensitive practices
Trainer notes:
Most health and human service organizations and programs providing services to individuals, children and families fall between the cultural incapacity and cultural blindness spectrum of the continuum.
Cultural proficiency is the ultimate goal for all service providers, however, as the final point of the cultural competence continuum, reaching this milestone requires tremendous effort.
Have participants write # 2 on the index card. Ask them to think about where they fall on the continuum and to write in down. Explain that they are not required to share this information unless they want to. Remind them that where they place themselves on the continuum and their ability to progress forward can be directly impacted by their cultural values, beliefs and societal and familial influences.

18. Achieving the Goal
The achievement of cultural competence assures that clients/patients are treated with dignity and that cultural traditions and values that can impact healthcare are identified and treated with respect.

19. Recommendation
Utilizing a developmental process to building cultural competence is recommended as the most effective means to increase cultural competence skills among healthcare providers.