Transcript Culture, Cultural Competency, Sensitivity, Awareness and other

Training Providers
Who Serve Mono/Bilingual
Spanish-Speaking Clients
Tom Donohoe, MBA
Octavio Vallejo, MD, MPH
UCLA Pacific AIDS Education and
Training Center
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Member of the UCSF AIDS Research Institute
People living with HIV in the U.S., 2003
Infected without knowing
their HIV status (180-280K)
230,000
Know their HIV status
200,000
In medical care
With AIDS diagnosis
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130,000
340,000
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Minorities of Color and HIV
• Three of every five new AIDS cases in men were
among minorities (63.8 percent)
• Four of every five new AIDS cases in women
were among minorities (81.9 percent)
• Four of every five new AIDS cases in children
were among minorities (85.6 percent)
Ryan White Comprehensive AIDS Resource Emergency (CARE) Act. 2002
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Member of the UCSF AIDS Research Institute
Latinos: What have we learned?
• The percentage of new AIDS cases among
Latino/as has increased in the last 15 years
• In California Latino/as are the 30.8% of the total
population yet now account for 34.9% of the AIDS
cases.
• Latino/as receive an AIDS diagnosis at early ages
(< 30 year-old)
• HIV transmission occurs more frequently among
(MSM’s and women for heterosexual contact).
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Latinos and HIV
• Increase in number of new infections
• Increase in number of Latinos/as newly diagnosed
with AIDS
• Too late detection of HIV status
• Late access to health care
• Misperceptions and ignorance about the U.S. health
care system
• Language barriers
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Latinos and HIV
Translators
• Translations often conducted by office staff and
family, including children
• Even professional translators report difficulty
translating technical, medical, and personal (sexual,
drug/physical abuse) information
• Translators need training too!
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Culture and HIV
Culture and HIV: Introduction
• Culture as a body of learned behaviors common to
a given human society, acts rather like a template,
shaping behavior and consciousness within a
human society from generation to generation
- Systems of meaning (language)
- Ways of organizing society
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Culture involves at least 3 components:
• What people think
• What they do
• Material products they produce
Thus mental processes, beliefs, knowledge,
and values are parts of culture.
“Mental rules guiding behaviors”
(according to some anthropologists)
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We would like to . . .
• Increase awareness of cultural competence
• Understand the elements of cultural competence
in health care
• Apply cultural competence mindset to your
job/responsibilities
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Cultural Competency in the
Health Care Setting
• Set of attitudes, skills, behaviors, policies
– Enables organizations and individuals to work
effectively cross-culturally
– Understands importance of health-related
• beliefs, attitudes, and practices
• communication patterns of beneficiaries
– Eliminates disparities in health status
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When do we say that a health care
setting is culturally competent?
• When this setting has demonstrated awareness
and integration of three population specific
issues
– health-related beliefs and cultural values
– disease incidence and prevalence
– treatment efficacy
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Organizational Cultural Competence:
A journey, not a destination…
Unaware, Competent
Aware, Competent
Aware, Incompetent
Unaware, Incompetent
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Cultural Competence
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Awareness and acceptance of differences
Awareness of owns cultural values
Awareness of dynamics of differences
Development of cultural knowledge
Ability to work within other’s cultural context
Healthy self-concept
Free from ethnocentric judgment
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The AWARE Model
Communication Across Cultures
• Accept the other
person’s behavior
without judging it based
on what that behavior
means in your culture
• Wonder what the
person’s behavior means
in his/her culture, rather
than what it means in
your culture
• Ask what it means to
the person, showing a
respectful interest
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Member of the UCSF AIDS Research Institute
Noel Day, Polaris Research & Development
The AWARE Model
Communication Across Cultures
• Research and read
about other person’s
culture so you are able to
place their behavior in
the context of their
cultural word view
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• Explain what the
behavior means in
your culture.
Demonstrate and or
describe the
behaviors in your
culture that would
express similar
feelings or
meanings
Member of the UCSF AIDS Research Institute
Noel Day, Polaris Research & Development
Latinos and the US Health Care System
• The concept of developing relationships with
medical providers and becoming part of the team
care is a foreign concept
• First of all, it is necessary to encourage patients
to educate themselves about all his/her options,
how to express their opinions, concerns, doubts
and disagreements
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Member of the UCSF AIDS Research Institute
Latinos and HIV:
Treatment services must take into account:
• Latinos appreciate mutual respect in social
relationships, especially with authority figures. They
strive to preserve personal integrity in interactions with
others. A person receiving medical or drug treatment
must feel that he or she is treated with respect and
valued, or treatment will be rejected.
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Member of the UCSF AIDS Research Institute
Latinos and HIV:
Treatment services must take into account:
• Latinos have a different perception of time, with a more
flexible understanding of punctuality.
• Saving time is seen as less important than smooth,
warm social relationships. A Latino patient may see as
rudeness a hurried pace or focus on saving time on the
part of a caregiver.
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Member of the UCSF AIDS Research Institute
Latinos and HIV:
Treatment services must take into account:
• Familismo.- Emphasis on the family as the primary
social unit and source of support. “Strong ties within
Latino families.”
• Simpatia.- The importance in the culture of polite and
cordial social relations. (central cultural value and social
expectation).Shuns assertiveness, direct negative
responses and criticism. “Como Usted diga”
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Member of the UCSF AIDS Research Institute
Latinos and HIV:
Treatment services must take into account:
• Personalismo.- Latino preference for
relationships with others that reflect a certain
familiarity and warmth. Latino may be more likely
to trust and collaborate with someone with whom
they had pleasant conversations.
“We need a friend and support in the fight against
this disease”. “Sometimes the providers are
extremely cold and professional”.
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