Transcript cultural competency

PRINCIPLES OF ORAL HEALTH
MANAGEMENT FOR THE HIV/AIDS
PATIENT
CULTURAL COMPETENCY
Elias J. Llerandi, DMD
Clinical Instructor, NY Medical College
Consultant, NYS Dept. of Health
Staff Dentist, Dept. of V.A.
Private Practice, Queens
Former Chief of Service, Spellman Dental Clinic, SVMH
OBJECTIVES
• Define and Recognize fundamental
characteristics of Culture
• Identify components of the process of
Cultural Competence
• Discuss the importance of understanding
cultural variation in the dental clinical
setting and how it influences our Tx plan
and its implementation
CULTURE
• What is it?
…acting, feeling, judging, perceiving, and organizing
(Shade, Kelly and Oberg, 1997)
• Why is it important?
-facilitates tx plans that can be followed by pts and
supported by their families
-enhances communication and clinical interaction
-helps Bottom line: Leads to retention of pts in a
competitive environment ($$$)
CHARACTERISTICS OF
CULTURE
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Learned Behavior
Shared
Ever-changing
No culture is better of worst than another, they
are just different
CULTURAL COMPETENCY
• A SET OF CONGRUENT BEHAVIORS,
ATTITUDES AND POLICIES THAT COME
TOGETHER IN A SYSTEM, AGENCY OR
AMONG PROFFESIONALS AND ENABLE
THAT GROUP TO WORK EFFECTIVELY IN
CROSS-CULTURAL SITUATIONS
SPECIAL POPULATIONS IN HIV
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Racial & Ethnic Minorities
Women
Substance Abusers
Gay/Lesbian/Bi-sexual/Transgender
MSM
Disproportionate Incidence of New Cases
of HIV/AIDS in People of Color in 2002
Total US Population
54%
Cases (%)
(n=288,369,000)
White*
69%
New HIV Cases
60
(n=40,000)
45
30
26%
19%
15
Black*
White*
Hispanic
New AIDS Cases
13%
5%
Other
Black*
Hispanic
Cases (%)
12%
60
(n=42,024)
50.4%
45
28.4%
30
19.6%
15
*Not Hispanic.
CDC: HIV/AIDS Surveillance Report. 12/2003.
Black*
White*
Hispanic
CULTURAL VARIATIONS
 Communication: Verbal, non-verbal, silence, eye contact
 Space: Degree of comfort, perception of space
 Social Organization: church, family
 Time: latinos/substance abusers
 Environmental controls: ‘I am undetectable’
CULTURAL VARIATIONS
 Communication: Verbal, non-verbal, silence, eye contact
 Space: Degree of comfort, perception of space
 Social Organization: church, family
 Time: latinos/substance abusers
 Environmental controls: ‘I am undetectable’
Incorporating Culture into Health
• Individual Pt-Provider & System Level
• Culture influences help seeking behavior and
attitudes toward HCP
• Communication must be clear
• Pt has personal experiences of biases within
the healthcare system
• HCP from culturally and linguistically diverse
groups are under represented
Recipe for Disaster
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Alcohol
Ether (starting fluid)
Benzene
Paint thinner
Freon
Acetone
Camp stove fuel
Ammonia
Red Phosphorous
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Toluene (brake cleaner)
Red Devil Lye
Drain cleaner
Battery Acid
Lithium from batteries
Ephedrine
Cold tablets
Diet aids
Energy boosters
Health Literacy
POTENTIAL FAILURES!!!
• HCP are reluctant to offer Tx plan option to
pts they believe will be non-compliant
• MDs are more likely to Rx HAART to those
perceived to be likely to be adherent
• MDs were more likely to tx African
Americans as non-adherent
( Bogart et al.,2001)
Do not limit tx plan choices based on
assumptions about a cultural group…
PT-HCP COMMUNICATION
CHALLENGES
• 40-80% OF MEDICAL INFORMATION IS
IMMEDIATELY FORGOTTEN
• HALF IS REMEMBERED INCORRECTLY
• THE MORE GIVEN, THE MORE FORGOTTEN
• SPEAKING INFO-17%
• SPEAK AND SHOW-84%
PROCESS OF CULTURAL
COMPETENCE
• Cultural Awareness: Front desk
appreciates/respects values and problem solving
strategies
• Cultural Knowledge: Seeking/obtaining factual info
on different cultures…’TWO MASK JOB’…
• Cultural Skill: Collect relevant data about health
hx/problems latinos HIV is taboo/’DL’ in aa
FROM DESTRUCTIVENESS TO
PROFICINECY
• Cultural Destructiveness: misinforming pt of
medical risks and benefits
e.g.: LA Co. DHS
measles study, sargenti
• Cultural Blindness: color or culture makes no
difference , all people are the same OR making
services so ethno centric as to render them useless to
other cultures
FROM DESTRUCTIVENESS TO
PROFICINECY
• Cultural Pre-Competence:
 hire staff that reflects different cultures
 Training
 Needs assessments
 Recruit diverse individuals to advisory committees
FROM DESTRUCTIVENESS TO
PROFICINECY
• Cultural Competence:
 Respect for difference
 Continue self-assessment
 Continue expansion
 Adapt
FROM DESTRUCTIVENESS TO
PROFICINECY
• Cultural Proficiency:
 Hold culture in high esteem
 Close cultural gaps and improve service delivery
 Positive tx outcome
 Minimize oral disease with systemic consequences
 Improve quality of life
MINORITIES AND HIV
• 63.8% of new AIDS cases in men (3/5)
• 81.9% of new AIDS cases in women (4/5)
• 85.6% of new AIDS cases in children (4/5)
• Latinos receive an AIDS diagnosis at early
ages(<30yrs old)
LATINOS AND HIV
• Latinos have different perception of time, more
flexible understanding of punctuality
• Saving time less important than a warm
relationship.
• May see as rudeness a hurried pace or focus on
saving time
TRANSGENDER
(LGBT)
• Bigender, MTF, FTM
• Identities change
• Hormones and Surgery
• Transgender=Gay
TRANSGENDER
(LGBT)
• The Office:
 ‘Scan’
 Train staff
 Forms
 Unisex bathroom
 Non discrimination policy poster visibly
HOW CAN WE BE EFFECTIVE
• Become familiar w/ pts culture
• Respect pt’s desires
• Modify teaching as necessary
• Involve family/significant other
• DO NOT BE JUDGEMENTAL