Cultural Definitions
 Race - A socially defined population
  characterized by physical characteristics
  that are genetically transmitted.
 Ethnicity - Belonging to a common
  group often linked by race, nationality,
  and language with a common cultural
 Culture - Knowledge, skills, and
  attitudes learned and passed on from
  one generation to the next.
    Cultural Determinants
   Ethnicity
   Race
   Age
   Gender
   Family
   Language
   Religion
   Nationality
Factors Influencing Health
  Genetic
  Physiologic
  Behavioral
  Socioeconomic
  Environmental
   1990 Distribution        2050 Distribution
    – 75%Anglo-European       – 53% Anglo-European
      American                  American
    – 12% African             – 15% African
      American                  American
    – 9% Hispanic             – 24% Hispanic
      American                  American
    – 3% Asian American       – 9% Asian American
 By the year 2000, 4/10
Consumers of Health Care
   Will Be Nonwhite!!
    Cultural Competency
 “A set of academic and personal skills
  that allow us to increase our
  understanding and appreciation of
  cultural differences between groups.”
 “The set of congruent behaviors,
  attitudes, and policies, that come
  together in a system, agency or among
  professionals to work effectively in
  cross cultural situations.”
    Culturally Competent
   We must first understand how we feel
    and will react to a pt to be able to
    ultimately understand a pt.
       Ethnocentric                 Ethno-Relative

   Most people lie in the ethnocentric part
    of the continuum.
    Cultural Competency
   Developmental Model of Intercultural
    – Stage   1   -   Denial
    – Stage   2   -   Defense
    – Stage   3   -   Minimization
    – Stage   4   -   Acceptance
    – Stage   5   -   Adaptation
    – Stage   6   -   Integration
       Goals of Culturally
        Competent Care
 1)   Cultural   Awareness
 2)   Cultural   Knowledge
 3)   Cultural   Skill
 4)   Cultural   Encounters
The Road to Cultural
– L Listen
– E Explain
– A Acknowledge
– R Recommend
– N Negotiate
• Assessment questions for patients.
     Cultural Diversity in
         Health Care
   Differences between high (collectivistic) and
    low (individualistic) context cultures in
    attitudes toward health and health care.
   Interviews
     – African-American
     – Hispanic
     – Asian-American
     – Native American
     Cultural Diversity in
         Health Care
   Related research
    – Bekker et al. compared the cultural
      differences between the Dutch and the
      Japanese and how they have an impact on
      the pt’s conception of health and illness.
    Areas of Dissonance

 Historical Distrusts
 Interpretations of Disability
 Concepts of Family Structure and
 Communication Styles and Views of
  Professional Roles
 Incompatibility of Explanatory Models
    Areas of Dissonance

 Disease Without Illness
 Illness Without Disease
 Misunderstandings of Terminology,
  Language, or Body Language
     Language Barriers
 12% of US population speak a language
  other than English.
 Strategies for working through a
  language barrier.
    – Become a bilingual provider
    – Language banks
    – AT&T Language Line
      Language Barriers
   Strategies
    – Professional Medical Interpreter
    – Family Members
    – Community Members/Traditional Healers
      Language Barriers
   10 Guidelines for using an interpreter
    – Unless you are thoroughly fluent in the
      target language, always use an interpreter.
    – Try to use an interpreter of the same sex
      as the client.
    – Emphasize by repetition and speak slowly
      but not loudly.
    – Be patient.
 Language Barriers
– Address the patient directly.
– Be sure the interpreter knows what you
– Provide instructions in list format.
– Use short questions and comments.
– Use language the interpreter can handle.
– Plan what to say ahead of time.
    Case Study: Lia Lee
 Hmong child with history of epileptic
 Family unable to speak English
 Clash of cultural beliefs and practices
 As of 1995 there were over 110,000
  Hmong living in US
     Case Study: Lia Lee
   How could Lia’s medical treatment have
    been more effective given the clash of
Incorporating Cultural
Competency Into Our
   Resources Available
    – AHEC
    – Wisconsin Express
    – Cultural Diversity Training Sessions and
    – Local Cultural Organizations
    – Isaacs and Benjamin “Towards a Culturally
      Competent System of Care: Vol II”
   10 tips for improving the caregiver/
    patient relationship across cultures
    – 1) Don’t treat patient the same way you
      would want to be treated
    – 2) Begin by being more formal with
      patients of another culture
    – 3) Don’t be insulted if patient does not look
      you in the eye
– 4) Don’t make assumptions about patient’s
  ideas about cause of illness
– 5) Allow patient to be open and honest
– 6) Don’t discount the effects of beliefs of
  the supernatural in health
– 7) Inquire indirectly about the patient’s
– 8) Ascertain the value of involving the
  entire family in the treatment
– 9) Don’t assume “the need to know”
– 10) Incorporate the patient’s folk medicine
  and beliefs into treatment plan if not
Case Study: Discussion
   Case Study: Re-evaluating Ethics and Values
    From a Different Cultural Perspective
   Discussion
     – What were the conflicting values about
       which the three physicians disagreed?
     – Did the 3rd MD make a mistake and how
       might re-examining his ethics have helped
       him make a better decision?
     – What would you have done? How would
       you justify your actions?

   “To know yourself is to know others”

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