Transcript Presentation Slides with Transcript

In It Together:
National Health
Literacy Project for
Black MSM
Training of Trainers
Module 2: Culture in Health Literacy
Welcome
Trainer: Daniel Driffin
Email: [email protected]
Phone: 404.460.4792
This material was produced by John Snow Inc., under
Contract #HHSH25020140037I with the Health
Resources and Services Administration, U.S.
Department of Health and Human Services.
Review take-home assignment
Apply the universal precautions approach to health literacy
three times.
1. When did you try the universal precautions approach?
2. What was your experience implementing this approach?
3. What challenges did you face?
3
Goal of this module
Trainers will increase their
understanding of Black MSM
culture, and how these various
aspects of culture impact HIV
health literacy.
4
Objectives
At the end of this training, you
will:
 Understand the expanded
definition of culture as it
relates to health
organizations and individuals
 Discuss 3 specific aspects of
Black MSM culture that may
impact health literacy
 Identify 3 socioeconomic
aspects of life that can
impact Black MSM culture
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What does culture mean to you?
6
Overview
There are cultural factors that influence health literacy:
 Organizational culture
 Individual culture
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Organizational culture
Organizational culture is a set of shared assumptions that guide
what happens in organizations by defining appropriate
behavior for various situations.
Consists of broad guidelines rooted in organizational practices.
Ravasi, D and Schultz, M. (2006). Responding to
organizational identity threats: Exploring the role of
organizational culture. Acad Manage, 49(3), 433-458.
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Organizational culture
An organization’s culture is influenced by its founders and
leadership.
Organizational culture develops by:
 Hiring and retaining employees with the same beliefs and
values
 Demonstrating culture through behavior of leaders
 Familiarizing employees with organization’s thinking
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Organizational culture
Organizations must work to be:
 Attentive
 Respectful
 Responsive
For a health care organization, efforts to change culturally-based
values and beliefs around illness or disease must emerge from
an understanding of and a respect for both the organizational
culture and the individual culture of a patient.
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What is individual/group culture?
Culture: The shared values, social norms, mores, traditions,
customs, arts, history, folklore, sanctions, and institutions of a
people.
Orlandi, M. A. (1992). Defining cultural competence: An
organizing framework. Cultural competence for evaluators: A
guide for alcohol and other drug abuse prevention
practitioners working with ethnic/racial communities, 293299.
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What is individual/group culture?
Culture is the shared beliefs, values, social norms, traditions, folklore,
knowledge, systems, forms of expression, and history of a group
that:
 Provide the framework within which we define ourselves individually
or as members of one or more groups, including personal and social
roles, relationships, and structures we adopt or create
 Serve as the lens or filter through which we interpret and make
sense of the world, including how we see our place in it
 Guide how we interact with, respond to, influence, and are
influenced by people, events, circumstances and conditions (real or
perceived) in our environment
Hixson, JL, (1998). Developing Culturally Anchored Services: Confronting the Challenge of Intragroup Diversity. In F. L. Brisbane (ed.), Cultural Competence for
Health Care Professionals Working With African-American Communities: Theory and Practice (pp. 9-45). US Department of Health and Human Services,
Publication No: 98-3238. Accessed at ftp://ftp.hrsa.gov/bphc/docs/1999PALS/PAL99-10.PDF.
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Elements of culture
1. Identity development (including concepts of selfworth)
2. Rites of passage (characteristics of adulthood and
maturity), role of sex and sexuality
3. Images, symbols, and myths
4. Role of religion and spirituality
Hixson, JL, (1998). Developing Culturally Anchored Services: Confronting the Challenge of
Intragroup Diversity. In F. L. Brisbane (ed.), Cultural Competence for Health Care
Professionals Working With African-American Communities: Theory and Practice (pp. 9-45).
US Department of Health and Human Services, Publication No: 98-3238. Accessed at
ftp://ftp.hrsa.gov/bphc/docs/1999PALS/PAL99-10.PDF.
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Elements of culture
5.
6.
7.
8.
9.
View of, use of, and sources of power and authority
Art forms (visual, musical, literary)
Role and use of language
Ceremonies, celebrations, traditions
Learning styles, acquisition of knowledge and skills
Hixson, JL, (1998). Developing Culturally Anchored Services: Confronting the Challenge of
Intragroup Diversity. In F. L. Brisbane (ed.), Cultural Competence for Health Care Professionals
Working With African-American Communities: Theory and Practice (pp. 9-45). US Department
of Health and Human Services, Publication No: 98-3238. Accessed at
ftp://ftp.hrsa.gov/bphc/docs/1999PALS/PAL99-10.PDF.
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Elements of culture
10. Patterns of interpersonal interaction
11. Assumptions, prejudices, stereotypes, and
expectations of others
12. Reward/status systems
13. Concepts of sanction and punishment
14. Social groupings
Hixson, JL, (1998). Developing Culturally Anchored Services: Confronting the Challenge of
Intragroup Diversity. In F. L. Brisbane (ed.), Cultural Competence for Health Care
Professionals Working With African-American Communities: Theory and Practice (pp. 945). US Department of Health and Human Services, Publication No: 98-3238. Accessed at
ftp://ftp.hrsa.gov/bphc/docs/1999PALS/PAL99-10.PDF.
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Elements of culture
15. Perspective on the role and status of children and families
16. Patterns and perspectives on gender roles and relationships
17. Means of establishing trust, credibility, and legitimacy
18. Coping behaviors and strategies for mediating conflict or solving
problems
19. Sources for acquiring and validating information, attitudes, and
beliefs
20. View of the past and future, and the group or individual sense of
place in society and the world
Hixson, JL, (1998). Developing Culturally Anchored Services: Confronting the Challenge of Intragroup Diversity. In F. L. Brisbane (ed.), Cultural
Competence for Health Care Professionals Working With African-American Communities: Theory and Practice (pp. 9-45). US Department of
Health and Human Services, Publication No: 98-3238. Accessed at ftp://ftp.hrsa.gov/bphc/docs/1999PALS/PAL99-10.PDF.
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Recognizing diversity in Black MSM culture
Black MSM may
share demographic
characteristics:
 Sexual orientation
 Race
 Sexual behavior
But, Black MSM are
not a homogenous
group.
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A closer look at culture
Cultural humility: A willingness to accurately assess oneself and
one’s limitations, the ability to acknowledge gaps in one’s
knowledge, and an openness to new ideas, contradictory
information, and advice
Cultural competency: The ability to understand, appreciate, and
interact with persons from cultures and/or belief systems other
than one’s own, based on various factors
Tangney J.P. “Humility: Theoretical perspectives, empirical findings and directions for future research”Journal
of Social and Clinical Psychology. Vol 19, pp.70-82, 2000.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
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Black MSM Experiences: societal attitudes
Negative societal attitudes about homosexuality
 Experience of victimization and hatred specific to their sexual
orientation
Rosser, B. S., Bockting, W. O., Ross, M. W., Miner, M. H., &
Coleman, E. (2008). The relationship between
homosexuality, internalized homo-negativity, and mental
health in men who have sex with men. Journal of
Homosexuality, 55(2), 185-203.
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Black MSM experiences: homonegativity
Homonegativity: acceptance of societal anti-gay attitudes toward
oneself, leading to:
 Internalized conflict
 Devaluation of oneself
 Lack of concern for health and well-being
 Negative feelings about own sexuality
 Stress
 Shame of HIV status
Mayfield, W. (2001). The development of an internalized homonegativity inventory for
gay men. Journal of Homosexuality, 41(2), 53-76.
Meyer, I. H., & Dean, L. (1998). Internalized homophobia, intimacy, and sexual
behavior among gay and bisexual men. Stigma and sexual orientation:
Understanding prejudice against lesbians, gay men, and bisexuals, 4, 160-186.
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Small group activity
Prepare 1 example of each of the following:
1. A supportive statement that can be made to encourage Black
MSM patients to continue their health journey
2. Health information that can be useful for Black MSM seeking
HIV care/treatment
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Black MSM
experiences: stigma
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Black MSM experiences: stigma
Stigma: an attribute that is deeply discrediting
Stigmatizing social environments negatively affect healthrelated outcomes
Sexual stigma: negative regard, inferior status, and relative
powerlessness that society accords to any non-heterosexual
behavior, identity, relationship, or community
Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall, Englewood Cliffs, NJ.
Christensen, J. L., Milller, L. C., Appleby, P. R., Corsbie-Massay, C., Godoy, C. G., Marsella, S. C., and Read, S. J.
(2013). Reducing shame in a game that predicts HIV risk reduction for young adult MSM: A randomized
trial delivered nationally over the web. Journal of the International AIDS Society, 16,(Suppl 2) 18716
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Roots of stigma
Ethnocentrism: having or based on the idea that your own
group or culture is better or more important than others
Fear (of the unknown): to be afraid of (something or
someone)
Ignorance: a lack of knowledge, understanding, or education
Isolation: the state of being in a place or situation that is
separate from others; the condition of being isolated
LeVine, Robert A.; Campbell, Donald T. Oxford, England:
John Wiley & Sons Ethnocentrism: Theories of
conflict, ethnic attitudes, and group behavior. (1972).
ix 310 pp.
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When does stigma become cyclical?
 When it is internalized
 When it goes unchallenged
 When it is explicitly or implicitly taught to others
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Where Black MSM experience stigma
 Work environments and business establishments
 Family gatherings
 Friend groups and social settings
 Institutions of faith
 Institutions of learning
 Health care facilities
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Black MSM responses to stigma






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Denial
Shame
Isolation
Deceit
Defensiveness
Depression





Guilt
Withdrawal
Fear
Self-harm
Loss of self-worth
Black MSM experiences: homonegativity and stigma
 Deeply rooted in the Black community
 More than half of Black MSM themselves believe that
homosexuality is always wrong
 Black MSM are likely to encounter stigma and homonegativity,
even in social settings with other Black MSM
Ahrold, T. K., & Meston, C. M. (2010). Ethnic differences in sexual attitudes of US college students: Gender,
acculturation, and religiosity factors. Archives of sexual behavior, 39(1), 190-202.Glick & Golden, 2010
Glick, S. N., & Golden, M. R. (2010). Persistence of racial differences in attitudes toward homosexuality in the
United States. Journal of acquired immune deficiency syndromes (1999), 55(4), 516.
Lewis, G. B. (2003). Black-white differences in attitudes toward homosexuality and gay rights. Public Opinion
Quarterly, 67(1), 59-78.
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Black MSM experiences: faith and religion
The Black church:
Is an integral part of the community
Plays a significant role in defining
attitudes toward same-sex behavior
and relationships
Black MSM in the church
Often fundamental Protestant
Likely to believe in a God who
sends misfortunes as punishments
Amirkhanian, Y.A.., Broaddus, M. , Dickson-Gomez , J., DiFranceisco, W., Kelly, J.A., Quinn,
K., & Lawrence, J.S.S. (2015) Correlates of internalized homonegativity among black
men who have sex with men. AIDS Education and Prevention, 27(3), 212–226.
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Black MSM experiences: masculinity
 Real/perceived anti-gay attitudes from Black community affect
Black MSM perceptions of masculinity and sexual identity
 Black male social and cultural environments may inhibit MSM
expression and identity
 Black MSM may portray a hyper-masculine public image to hide
their homosexuality (viewed as inconsistent with traditional
masculine gender roles)
Fields, E. L., Bogart, L. M., Smith, K. C., Malebranche, D. J., Ellen,
J., & Schuster, M. A. (2015). “I always felt I had to prove my
manhood”: homosexuality, masculinity, gender role strain,
and HIV risk among young black men who have sex with
men. American Journal of Public Health, 105(1), 122-131.
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How does culture impact health literacy?
Culture impacts how health information is:
Received
Understood
Valued
Applied
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Specific cultural factors influencing health literacy of
Black MSM
 Country of origin
 Medical mistrust
 Region
 Reluctance to disclose personal information
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Country of origin
There are Black MSM from various countries
around the world living in the United States.
All Black MSM do not necessarily:
 Speak the same language
 Use the same dialect
 Share the same ideas and experiences that
help to shape health literacy
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Medical mistrust
 Results in negative attitudes against prescribed medications,
prophylaxis, and suggested health practices recommended by
physicians and public health professionals
 Black MSM doubt that they can live long and healthy lives,
despite information about treatment received from providers
 Leads to misunderstanding of disease, which impacts health
literacy
St. Lawrence, J. S., Kelly, J. A., Dickson-Gomez, J., Owczarzak, J.,
Amirkhanian, Y. A., & Sitzler, C. (2015). Attitudes Toward HIV
Voluntary Counseling and Testing (VCT) Among African American
Men Who Have Sex With Men: Concerns Underlying Reluctance to
Test. AIDS Education and Prevention, 27(3), 195-211.
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Other medical misinformation
In a recent study:
 About 22% of gay and bisexual men believed that infection
rates are actually decreasing, and the remainder believed that
infections have remained constant.
New HIV infections increased 12% among gay and bisexual
men overall and 22% among young (aged 13-24) gay and
bisexual men.
 Most were not aware of current treatment recommendations,
and only 25% had heard about PrEP.
Hamel, L., Hoff, T., Kates, J., Levine, S., & Dawson, L. (2014). HIV/AIDS In The
Lives Of Gay And Bisexual Men In The United State. Retrieved from The
Henry J. Kaiser Family Foundation website:
http://kff.org/hivaids/report/hivaids-in-the-lives-of-gay-and-bisexualmen-in-the-united-states/.
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Region
Black MSM from various regions of the
United States may have subtle
differences based on the nuances of
the environments they live in.
Rural settings:
 Have fewer health care providers
 Residents average fewer medical
appointments
 Create distance and time-related
barriers to care
 People living with AIDS report
crippling levels of stigma
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Reluctance in disclosure of personal information
Few Black gay and bisexual men
report talking about HIV in any of
their social circles.
In a recent study, 61% of Black MSM
reported rarely discussing HIV
with their physicians.
Hamel, L., Hoff, T., Kates, J., Levine, S., & Dawson, L. (2014).
HIV/AIDS In The Lives Of Gay And Bisexual Men In The United
State. Retrieved from The Henry J. Kaiser Family Foundation
website: http://kff.org/hivaids/report/hivaids-in-the-lives-ofgay-and-bisexual-men-in-the-united-states/.
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Socioeconomic factors that impact Black MSM health
literacy

Educational level

Emotional state

Housing status

Incarceration

Physical/mental capacity

Poverty

Situational context
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Educational level
 There is no direct correlation
between educational level attained
and literacy level.
 A person may be embarrassed
about his lack of health literacy if
the individual considers himself
highly literate or highly educated.
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Emotional state
 The emotional state of an
individual can impact not only
what he hears, but also how he
interprets and acts upon what he
hears from a health professional.
 Studies show that when people
are anxious or overwhelmed with
too much information, their ability
to absorb, recall, and use health
information can decline,
compromising their ability to
manage their health.
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Housing status
 People living with AIDS are often in danger of losing their jobs
due to discrimination or as a result of frequent health-related
absences, which can lead to unstable housing.
 Housing instability makes it difficult to:
Attend medical appointments
Establish a relationship with a medical care team
Regularly fill prescriptions
 Homelessness can have an impact on the prioritization of
medical adherence and options for care.
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Incarceration
 Almost 1 in 4 Black MSM
reported recent
incarceration.
 There is heightened risk for
contracting HIV when
incarcerated.
 Black men who have been
incarcerated may show
desensitization to the
importance of health due to
other challenges that are
more immediately pressing
Brewer, R. A., Magnus, M., Kuo, I., Wang, L., Liu, T. Y., & Mayer, K. H. (2014). Exploring the relationship between incarceration and HIV among Black men who have sex
with men in the United States. Journal of Acquired Immune Deficiency Syndromes (1999), 65(2), 218.
Brewer, R. A., Magnus, M., Kuo, I., Wang, L., Liu, T. Y., & Mayer, K. H. (2014). The high prevalence of incarceration history among Black men who have sex with men in the
United States: associations and implications. American Journal of Public Health, 104(3), 448-454.
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Physical/mental capacity
Physical or mental impairment due to illness or injury can affect
health literacy, and can impact:
 Understanding information that is presented
 Being physically capable of meeting the medical instructions
related to adherence
 Being able to mentally process medical options for treatment
and care
 Having adequate representation of another capable adult
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Poverty
 Limits access to health care
 Impacts the quality of health care
received
 Affects health outcomes
46
Situational context
Situational contexts
include:
 Stress
 Fear
 Intimidation by
medical
environments
47
Review
You should now:
 Understand the expanded
definition of culture as it
relates to health organizations
and individuals.
 Be familiar with 3 specific
aspects of Black MSM culture
that can impact health
literacy.
 Be comfortable identifying 3
socioeconomic aspects of life
that can affect Black MSM
culture and health literacy.
48
Next steps
In Module 3, you will increase your understanding of the
attributes that are associated with health literate organizations
and the steps you can take to create a health literate
organization.
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Take home
 Make 3 attempts to apply
what you have learned about
culture’s impact on health
literacy.
 Consider how merging cultural
humility and cultural
competence can improve your
organization.
50
Contact information
Trainer: Daniel Driffin
Email: [email protected]
Phone: 404-460-4790
This material was produced by John Snow Inc., under Contract
#HHSH25020140037I with the Health Resources and Services
Administration, U.S. Department of Health and Human
Services.
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