Transcript Beloit Collaborative - UW Family Medicine & Community Health

Why Should Anyone Believe that
Cultural Competency Training Could Help Close
the Black-White Gap in Wisconsin Birth Outcomes?
Beloit LIHF Pathways to Healthy African American Families Project
Wisconsin Health Improvement and Research Partnerships Forum
September 14-16, 2011
Linda Denise Oakley, PhD
Professor
• Culture is often described as the
combination of a body of knowledge, a
body of belief and a body of behavior. It
involves a number of elements,
including personal identification,
language, thoughts, communications,
actions, customs, beliefs, values, and
institutions that are often specific to
ethnic, racial, religious, geographic, or
social groups.
•
NIH Health Literacy Initiative Clear Communication
Cultural competency has a positive effect
on patient care delivery by enabling
providers to deliver services that
respectful of and response to the health
beliefs, practices, and cultural and
linguistic needs of diverse patients.
NIH Health Literacy Initiative Clear Communication
Office of Minority Health
US Health and Human Services
National Standards for Culturally-Linquistically
Appropriate Services in Health Care 2001
• Defined 14 National Standards for Care
• Standard 1: Health care organizations
should ensure that patients/consumers
receive from all staff members effective
understandable and respectful care that
is provided in a manner compatible with
their cultural health beliefs and practices
and preferred language
Georgetown University National Center for Cultural
Competence Fetal-Infant Mortality Review Program
Organizational Self-Assessment to Plan Cultural
Competency 2009
• Self-Assessment addresses attitudes, behaviors, policies,
structures, and practices of an organization, including those
of its boards, advisory groups, staff, and volunteers
• Self-Assessment process can include structure instrument,
focus groups, structured interviews, analysis of community,
regional, and state demographic data, and review of the
organization’s values, mission, policies, procedures, budget,
and web/ print documents
• Four-Phase approach is establish a structure to guide the
work, create a shared vision and shared ownership, collect,
analyze, disseminate data, develop and implement a plan of
action
Beloit LIHF
Collaborative
A Wisconsin Partnership Program
(WPP) initiative to address the
disparity in the African American
infant mortality rate in Beloit
Collaborative Mission
The mission of the Collaborative is
to build a Beloit Community
Collaborative to close the
black-white gap in birth
outcomes by improving the
health and well-being of African
American Families and
communities, and addressing social
and economic inequalities.
.
Our Presentation Aims
We present the results
of the Collaborative selfassessment and cultural
competency training
and address the
following
implementation
question
Why should anyone
believe that cultural
competency training
could help close the
Black-White gap in
Wisconsin birth
outcomes?
Wisconsin Infant Mortality
2008
White
315 deaths for 53,561births
IM Rate is 5.9 per 1,000
Black
100 deaths for 7,236 births
IM Rate is 15.2 per 1,000
Hispanic
49 Deaths for 7,025 births
IM Rate is 6.5 per 1,000
Healthy People 2010 Goal
4.5
Wisconsin Black-White IMR Gap 2010
Black19.2 Deaths/1,000 Births
White 3.5 Deaths/1,000 Births
Tom Schlenker, MD
Dane County Department of Public Health
WSJ, 4/22/2011
Wisconsin Black Infant Mortality 2002-2006
Richard Allan Aronson, MD for WPP, 2008
City
IMR/ 1,000
Madison
7.15
Milwaukee
17.3
Kenosha
18.0
Beloit
19.2
Rock County
Black Prenatal Care
Start
2008 Births = 137
Start Prenatal Care 1st Trimester
109
Start Prenatal Care 2nd Trimester
17
Start Prenatal Care Unknown
11
Beloit Collaborative (N = 55)
Individual Self-Assessment
Aurora Chang, PhD
Beloit College
1. Returned Individual Surveys
(n= 36, rate of 65%)
2. Completed Individual
Interviews (n = 9)
3. Two Focus Groups (n = 6)
Beloit Collaborative
Self-Assessment Findings
•Cultural competency trainings don’t always leave a lasting
impact
•When talking about culture, it leads to talking about traditions,
not necessarily disparities between race and class
•People in power having the power to remove themselves
•Change happens by force, not voluntarily
•Lack of interracial interaction comes from lack of jobs
Beloit Collaborative
Cultural Competency Training
Program
• 1.5 days
Activities
• 3 Modules
•
Pre-Post Test (n = 33)
•
Individual Training Expectations
•
Individual Assessment Expectations
•
Domain Groups Initiatives Identified
•
Conversation with a Black infant
•
Conversation with Colleagues
•
Conversation with your values
•
Health and Racism
•
Social Determinants and Risk Factors
•
Cultural Competency
•
Post-Test (n = 28)
•
Evaluation Forms (n = 25)
Beloit Collaborative
Cultural Competency Training
“Incorrect” Pre-Test Items (2/10)
• Income level predicts the health of African
Americans and Caucasians,(n = 30, false)
• Researchers have shown that social stress can
produce unhealthy changes in amniotic fluid in
pregnant black women (n=9 don’t know, false)
Beloit Collaborative
Cultural Competency Training
Personal Training Expectations
• “To better understand how one
individual’s behavior can impact so
many lives”
Beloit Collaborative
Cultural Competency Training
“What Appreciative Inquiry Question would I ask
myself about the Beloit Black IMR?”
• Why is the black IM rate important to me? How
can I be part of the solution?
• I watched my sister bury her 3-month old son. She
did everything right in her pregnancy and with him
after he was born. We are white. I don’t
understand. I’m sorry. I try. Why Anyone wouldn’t
do everything they could for the health of their
child. Yes there are barriers-Fight them! So my
question for myself, am I prejudice?”
Beloit Collaborative
Cultural Competency Training
One reason I doubt that racism affects the
health of African Americans is:
• “I know healthy African Americans in communities
with much racism”
• “Free healthcare is provided for African Americans
to access health care”
• “One reason I doubt racism affects health of
African Americans is that sometime we do not get
the same treatment and care as another race
would”
WPP Risk Factors
Risk Factors: Non-Modifiable
(LIHF WPP)
1. African-American Race
2. Prior Preterm Birth
3. Maternal Age <18 or >40 Years
4. Poor Nutrition
5. Poor Vitamin Intake Prior to Pregnancy
6. Low Socioeconomic Status
7. Cervical- Uterine Anomaly
8. Premature Cervical Dilatation or Effacement
9. Multiple Pregnancy
10. Polyhydramnios (excessive amniotic fluid)
Risk Factors: Modifiable
(LIHF WPP)
1. Use of tobacco, alcohol, medications, recreational drugs
2. Short interpregnancy interval
3. Absent prenatal care
4. Anemia
5. Infection [bacteriuria/urinary tract infection (UTI), Sexually-transmitted
infection (STI)], such as gonorrhea, Chlamydia, bacterial vaginosis, Group B
β-hemolytic streptococcus, HIV/AIDS; Periodontal Disease)
6. Chronic Disease (diabetes, hypertension/ preeclampsia/ eclampsia, asthma,
and obesity)
7. Depression (prenatal and post-partum), other mental-health conditions
8. Strenuous work
9. High environmental stress
What does the research say?
Cytokines
4. Cytokines
(Kunz-Ebrecht, Mohamed-Ali, Feldman, Kirschbaum, Steptoe, 2003)
• Repeated episodes of acute stress and chronic stress affect
immune system
• Stress can cause chronic release of pro-inflammatory
cytokines
• Inflammatory response to stress increases risk of infection
• Cytokines in vaginal fluid and infection are associated with
PTB in black women
3. Pro-inflammatory Immune Response
(Woodworth, Grenache, Gronowski, 2011)
• Corticosteroid (anti-inflammatory medication) given 48+
hours prior to PTB decreases the risk of infant morbidity and
mortality
• Biomarkers in vaginal fluid are used to predict time to PTB
• Two biomarker s Fetal Fibronectin and Pro-inflammatory
cytokine IL-6. This study tested both markers in 343 black
women and 324 white women
• Cytokines in fluid is associated with vaginal bacterial
infection and chorioamninonitic –membranes
• Study found cytokines associated with delivery in black
women--with and without symptoms of preterm labor– no
cytokine association with delivery in white women.
• Conclusion: Cytokine test “markedly improved” prediction of
delivery in black women
…Question
•
Why should anyone believe that cultural competency training could help
close the Black-White gap in Wisconsin birth outcomes?
…Answer
The data supports “competency” models
aimed at make effective treatment,
effective for black women
Thank you