1. CROSS- CULTURAL PERSPECTIVES
Craig Ernst MHS, PA-C
Professional Topics
LHUP PA Program

3. Empathy and Compassion
Imagine being in a foreign land and foreign culture.
How would you feel?
Vulnerable?
Scared?
Now imagine being sick in this same setting?
What would you want from your foreign health care provider?

4. What is Culture?

5. Culture
Shared way of life
Transmitted from generation
to generation

6. Way of Life Manners Dress Language Religion Rituals Values Norms
Beliefs
Assumptions
Expectations

7. Concept of Culture Ethnic Group: Ancestry Country of origin
Specific subgroup identification
Members of an ethnic group identify with each other through a common heritage, language, culture, religion, and ancestry.
Those human groups that entertain a subjective belief in their common descent because of similarities of physical type or of customs or both, or because of memories of colonization and migration; this belief must be important for group formation; furthermore it does not matter whether an objective blood relationship exists. –Max Weber
An ethnic group or ethnicity is a population of human beings whose members identify with each other, either on the basis of a presumed common genealogy or ancestry[1] or recognition by others as a distinct group,[2] or by common cultural, linguistic, religious, or physical traits.

8. What about Culture and Ethnicity in our society?
Country founded by immigrating groups
Migration continues
Ethnic Birthrates
Minorities account for 90 % of growth since 2000
Hispanics: 50 million (16% of population)
35 million in 2000
Asians: larger numeric gain than African Americans
Under 18 population: hispanics are 23%
William H. Frey with the Brookings Institution told the Post that, this has been a pivotal decade. "We're pivoting from a white-black-dominated American population to one that is multiracial and multicultural."

9. Acculturation
Process whereby attitudes and behaviors of people from one culture are modified as a result of contact with a different culture
Depends on…
Length of time
Age of individual on arrival
Socioeconomic status

10. Cultural Effects on Behavior and Decision Making
Remember that you are the product of your culture
As a provider you must avoid ethnocentric (eurocentric) bias
Approach your patients with an open mind
Recognize that they hold different beliefs, values, and assumptions than you
Their world view is not wrong, just different from your own

11. Comparison of Western and Non-Western Culture

12. Patient Care RESPECT is KEY
Probably the most comfortable patient care situation is where patient & provider share the same ethnic background & life experiences!
Mutual respect

13. Health Disparities? Cultural Factors Acculturation & Assimilation
Socioeconomic Factors

14. Cultural Factors Cultural beliefs & practices Birth Childrearing Diet
Perceptions of Death
Traditional definitions
Access to traditional healers

15. Acculturation & Assimilation
Number of years in the country
Language(s) spoken
Comfort with host culture
Integration with decision making process of dominant culture

16. Socioeconomic Factors
Poverty
Crowded living areas
Increased spread of communicable diseases
Delay in seeking treatment
Difficulty in getting meds/tests
Insurance…
Community environment

17. Clinical Case
Mrs. R is a 55 y/o Mexican-American woman with Type II Diabetes. She comes into your clinic with CC: of fatigue. Her glucose is 228. On exam she has diabetic retinopathy & decreased sensation on both feet.
On review of the chart, you note that she was last seen 18 months ago. At that time she was counseled on diet and exercise. She was also started on metformin. She was instructed to follow up in several weeks.

18. Clinical Case Continued
She is not currently taking the meformin and has not followed any of the other recommendations given.
Why is this patient noncompliant?

19. Possible Explanations…
Cultural beliefs & practices?
Acculturation?
Socioeconomic status?

20. Caring for Patients: Cross Cultural Perspective
How does the patient think about the illness…
…stems from the pts belief system which contains…
Their explanation of the illness based on spiritual, religious, or social circumstances
Explanatory Model

21. Explanatory Model Questions
What do you think has caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you? How does it work?
How severe is your sickness?
What kind of treatment do you think you should have?

22. Ask these questions with
L.E.A.R.N. L
Listen with sympathy & understanding
Explain your perception of the problem
Acknowledge & discuss the differences & similarities
Recommend treatment
Negotiate agreement E A R N

23. Exotic Cultures!