Cultural Competency Doris Pastore MD Director Adolescent SBHC

Cultural Competency Doris Pastore, MD Director, Adolescent SBHC Mount Sinai Adolescent Health Center Beth Techow, MED Program Coordinator Mount Sinai Adolescent Health Center Elet Howe, H. Ed. Health Education Coordinator Mount Sinai Adolescent Health Center

Goal n Health Care Delivery- Core Content Area – The learner will demonstrate an awareness of and respond to unique opportunities and challenges of health care delivery in the SBHC setting.

Objectives The learner will define culture, cultural awareness and cultural competency. n The learner will understand the effect of culture on health care beliefs and practices. n The learner will recognize the importance of cultural competency in providing effective health care. n

Culture n Customary beliefs, social forms, and material traits of a racial, religious, or social group n A predominant force in shaping behaviors, values and institutions

Cultural Awareness n Cultural Awareness is developing sensitivity and understanding of another ethnic group. This usually involves internal changes in terms of attitudes and values.

Cultural Competency n n Cultural Competency is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices and attitudes, to increase the quality of health care; thereby producing better health outcomes. Culturally competent providers: – Appreciate family ties and realize that they are defined differently for each culture. – Welcome collaboration and cooperation

Seven Domains of Cultural Competence n Values and attitudes Communications styles Community/consumer participation Physical environment, materials and resources Policies and procedures Population-based clinical practice n Training and professional development n n n

Benefits of Cultural Competence n n Leads to improved diagnoses and treatment plans Allows clinicians to obtain more specific and complete information to make an appropriate diagnosis Facilitates the development of treatment plans that are followed by the adolescent patient and supported by the family Reduces delays in seeking care and allows for improved use of health services.

Benefits of Cultural Competence cont. n n Enhances overall communication and the clinical interaction between the patient and the provider. Enhances the compatibility between Western and traditional cultural health practices.

Becoming Culturally Competent LEARN n Listen to and understand to the patient’s perception of the problem. n Explain your perceptions of the problem and your strategy of treatment. n Acknowledge and discuss the differences and similarities between these perceptions. n Recommend treatment while remembering the patient’s cultural parameters. n Negotiate agreement. It is important to understand the patient’s explanatory modes so that medical treatment fits in their cultural framework.

Patient’s Health Care Beliefs n n Physicians’ training focuses on illness and symptoms. It is important to remember that patients comprehend their symptoms and illness experience differently. Patients also rely on multiple sources during their illness, other than their professional health care provider. Popular, folk and other professional medical practitioners can all or in part, impact on a patient’s health care beliefs and behaviors.

Key Cultural Factors n n n Socioeconomic influences Educational attainment Family structure and dynamics Ethnic origin and identification Language preference

Questions To Ask: n n n n What do you think caused your problem? Why do you think it started when it did? What do you think your sickness does to you? How severe is your sickness? Do you think it will last a long time, or will it be better soon in your opinion? What are the chief problems your sickness has caused for you? What do you fear most about your sickness? What kind of treatment do you think you should receive? What are the most important results you hope to get from treatment?

Culturally Effective Health Care Requires: n n n Knowledge Skills Ability

Culturally Effective Health Care: Knowledge n n n Culture, history, traditions, values and family systems of patients. Impact of race/ethnicity on health status, behavior, attitudes and values of patients. Help-seeking behaviors of patients. Roles of language, speech patterns and communications styles of patient population. Resources (e. g. Agencies, persons, networks) that can be utilized on behalf of patients.

Culturally Effective Health Care: Knowledge cont. n Recognition of the ways in which professional values may conflict with or accommodate the needs of patients.

Languages Spoken in Harlem n n n n Arabic Chinese English French German Greek Hebrew Hindi Hungarian Italian Japanese Korean Persian n n n Polish Portuguese Russian Serbo-Croatian Spanish Tagalog Thai Urdu Vietnamese Yiddish African languages Other Indic languages Other Indo-European languages

Culturally Effective Health Care: Skills n n Personal qualities that reflect genuineness, empathy, warmth and capacity to respond to a range of possible situations. Acceptance of racial/ethnic differences between and among people. Understanding of personal values, stereotypes and biases about one’s own and others’ race/ethnicity. Techniques for learning and adapting to the personal and cultural patterns of patients and their impact on adherence to prescribed treatment regimens.

Culturally Effective Health Care: Abilities n n Communicate accurate information on behalf of patients to their health plans. Discuss racial/ethnic differences and issues openly, and in response to culturally-based cues. Assess the meaning race/ethnicity has for individual patients. Interpret the implications of symptoms as they are expressed by individuals from different cultures.

Culturally Effective Health Care: Abilities cont. n n n Work effectively with an interpreter to interview patients and provide health care. Evaluate new techniques, research and knowledge regarding their acceptability in working with your patient population. Secure an appropriate level of adherence and/or cooperation with prescribed treatment regimens.

Developing a Rapport n n n Listen carefully to patients and family members especially when they discuss cultural differences that may influence health care Affirm importance of patient by asking questions about their health practices Take patients’ and families’ beliefs, ideas, and values in to account when developing a management plan

Facilitating Open Communication n n Use a conversational tone Recognize and accept feelings that accompany health problems Share your own similar experience, if appropriate Learn which family members can discuss what health issues and respect those relationships Establish times to meet separately with patients and with parents when possible.

Facilitating Open Communication cont. n n Reserve judgement about patient and family personal behavior Encourage patient and family members to talk about themselves and their cultural backgrounds.

Accommodating Differences n n Etiquette rules include specific ways to greet others, whom to address and what form of address to use. Some conversation topics maybe taboo Communicating emotions may vary by culture, some cultures are more restrained than others Silence, physical distance, eye contact and body movements or gestures vary among different groups of people.

Some Beliefs About Medications n n n In Japan, a drug’s safety profile is stressed. Hispanics, Chinese and Asians often expect quick relief from symptoms and want to avoid minor side effects. Chinese rely on traditional medicine for long-term illness because they believe can remove illness permanently. Women from Islamic and African cultures may prefer oral drugs vs. vaginally inserted medications for vaginal yeast infections. Mexican and Puerto Rican patients’ concern about the addictive effects of medications can lead to reluctance to take long-term medications. Vietnamese patients have taken only half of their prescribed medication, believing it’s too strong. (ISMP, Medication Safety Alert, Sept. 4, 2003)

Attributes of Traditional and Modern Societies (Leff, 1988) Modern Traditional n n n n n Group-oriented Extended family Income-producing linked to kinship ties Economic functions nonspecialized High mortality, high fertility Status determined by age & position in family Relationships determined by role & position in family Individuals can be replaced by others filling the same roles Extensive classification terminology for distant relatives n n n n n Individual-oriented Nuclear family Income-producing independent of kinship ties Economic functions specialized Low mortality, low fertility Status achieved by own efforts Relationships determined by individual choice Individuals unique and irreplaceable Restricted classification terminology for close relatives only

Question 1 n Developing sensitivity and understanding of another ethnic group. This usually involves internal changes in terms of attitudes and values. This is called: a. Culture b. Cultural Awareness c. Cultural Competency

Question 1 n Developing sensitivity and understanding of another ethnic group. This usually involves internal changes in terms of attitudes and values. This is called: b. Cultural Awareness

Question 2 n Your patient informs you that she is currently using an herbal remedy. Which is the most cultural sensitive: a. State: “Herbal remedies don’t work. You need to take this prescription. ” b. Ask the patient about the herbal remedy and why they taking it and discuss the benefits of a prescription medication instead. c. Give your patient a prescription and leave the room.

Question 2 n Your patient informs you that she is currently using an herbal remedy. Which is the most cultural sensitive: b. Ask the patient about the herbal remedy and why they taking it and discuss the benefits of a prescription medication instead.

Question 3 n Which is a benefit of cultural competency: a. Leads to improved diagnoses and treatment plans b. Allows clinicians to obtain more specific and complete information to make an appropriate diagnosis c. Reduces delays in seeking care and allows for improved use of health services d. All of the above

References n Leff J: Psychiatry Around the Globe, 2 nd Edition. London, Gaskell Books, Royal College of Psychiatrist, 1988