Transcript No Slide Title

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
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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.
 The learner will understand the
effect of culture on health care
beliefs and practices.
 The learner will recognize the
importance of cultural competency
in providing effective health care.
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Culture
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Customary beliefs, social forms, and material
traits of a racial, religious, or social group
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A predominant force in shaping behaviors,
values and institutions
Cultural Awareness
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Cultural Awareness is developing sensitivity
and understanding of another ethnic group.
This usually involves internal changes in
terms of attitudes and values.
Cultural Competency
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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
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Values and attitudes
Communications styles
Community/consumer participation
Physical environment, materials and
resources
Policies and procedures
Population-based clinical practice
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Training and professional development
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Benefits of Cultural Competence
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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.
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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
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Listen to and understand to the patient’s perception
of the problem.
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Explain your perceptions of the problem and your
strategy of treatment.
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Acknowledge and discuss the differences and
similarities between these perceptions.
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Recommend treatment while remembering the
patient’s cultural parameters.
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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
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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
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Socioeconomic influences
Educational attainment
Family structure and dynamics
Ethnic origin and identification
Language preference
Questions To Ask:
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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:
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Knowledge
Skills
Ability
Culturally Effective Health Care:
Knowledge
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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.
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Recognition of the ways in which professional
values may conflict with or accommodate the
needs of patients.
Languages Spoken in Harlem
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Arabic
Chinese
English
French
German
Greek
Hebrew
Hindi
Hungarian
Italian
Japanese
Korean
Persian
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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
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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
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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.
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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
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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
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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.
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Reserve judgement about patient and family
personal behavior
Encourage patient and family members to
talk about themselves and their cultural
backgrounds.
Accommodating Differences
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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
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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.
Attributes of Traditional and
Modern
Societies
(Leff, 1988)
Modern
Traditional
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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
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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

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

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
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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
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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

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
Question 3

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
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Leff J: Psychiatry Around the Globe, 2nd Edition.
London, Gaskell Books, Royal College of
Psychiatrist, 1988