Introduction to Cultural Competency in Health Care

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Introduction to Cultural Competency in Health Care

• Pharmacy Practice II

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Definitions

• Culture set of learned and shared beliefs and
  values that shape interactions and interpretation
  of experience each of us can belong to many
  different cultures.
• Ethnicity self-defined groups identity that is
  based on religion, nationality, and cultural
  patterns
• Race a social and political construct having no
  scientific basis

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US Census Data
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US Census Data County Examples

• Multnomah County
• Black/African American 5.7
• Language other than English at home 16.6
• Hood River County
• Hispanic/Latino 25
• Language other than English at home 24.7

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Health Disparities

• Racial or ethnic differences in the quality of
  healthcare
• Differences result in worse clinical outcomes
• Differences persist after adjusting for known
  factors
• Socioeconomic factors
• Patient preferences
• Appropriateness of intervention

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Examples of Health Disparities

• Cardiovascular
• Cancer
• Pain
• Asthma
• Diabetes
• Prenatal Care

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Potential Sources of Disparities

• Patient variables preferences, refusal,
  appropriateness of care
• Healthcare systems
• Care process bias, stereotyping, uncertainty
• Cross-cultural education

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Examining your own cultural background

• Review the questions provided
• Consider your own bias, stereotyping, uncertainty
  

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Cultural influences

• Health Perception
• Treatment Preferences
• Communication
• Verbal
• Nonverbal

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Federal Mandate Title VI

• The US Department of Health and Human Services
  Office for Civil Rights (OCR)
• mandates that medical professions receiving
  federal funds must ensure limited English
  speaking persons can meaningfully access
  services.

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National Standards for Culturally
Linguistically Appropriate Services in Health
Care (CLAS)

• 14 standards
• Culturally competent care (Stds 1-3)
• Language access services (Stds 4-7)
• Organizational supports for cultural competence
  (Stds 8-14)
• Varying levels of stringency (mandates,
  guidelines, recommendations)

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National Standards for Culturally
Linguistically Appropriate Services in Health
Care (CLAS)

• Culturally competent care
• Care that is compatible with cultural health
  beliefs, practices, preferred language
• Diverse staff and leadership
• Education and training in CLAS

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CLAS Standards, continued

• Language Access Services
• Offer and provide language assistance services at
  no cost, in a timely manner
• Verbal and written notice of right to receive
  language assistance services
• Family and friends should not be used except when
  requested by the patient
• Materials and signs in languages commonly
  encountered

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CLAS MandatesLanguage Access Services

• Based on Title VI of the Civil Rights Act of 1964
  with respect to services for limited English
  Proficiency (LEP) individuals
• Std 4 Offer and provide language assistance
  services at no cost and in a timely manner
• Std 5 Both verbal and written notice of their
  right to receive language assistance services

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CLAS MandatesLanguage access services

• Std 6 Family and friends should not be used to
  provide interpretation services except when
  requested by the patient
• Std 7 Easily available materials and signage in
  languages commonly encountered or represented in
  the service area

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CLAS Standards, continued

• Organizational supports for cultural competence
• Strategic plans
• Self-assessments
• Data collection
• Community profile
• Partner with community
• Conflict resolution
• Public information

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Definitions of Disease

• Navajo
• Lack of harmony in and with the universe
• WHO
• Anything less than a complete state of physical,
  social, and mental well-being
• FDA
• Any deviation from impairment or interruption of
  the normal structure or function of any part,
  organ, or system (or combination thereof) of the
  body that is manifested by a characteristic set
  of one or more signs or symptoms, including
  laboratory or clinical measurements that are
  characteristic of a disease.
• Adapted from UC regents School of pharmacy and
  center for the Health professions

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Cultural influences

• Health Perception
• Treatment Preferences
• Communication
• Verbal
• Interpreters
• Language line
• Oregon Pacific AHEC
• Pay attention to your language
• Nonverbal

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Taking Action Improving Cross-cultural
interactions

• Examine your own cultural background.
• Learn about the cultures in the community you
  serve. Show interest.
• Be aware. Dont generalize.
• Ask open-ended questions to determine health
  beliefs and level of understanding.

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LEARN MODEL

• Listen
• Explain
• Acknowledge
• Recommend treatment
• Negotiate agreement

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Taking Action Improving Cross-cultural
interactions

• Use a trained interpreter.
• Language Line
• Be aware of and enlist culturally-based
  resources.
• Learn the language or phrases of the predominant
  non-English speaking population you serve.

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References and Resources

• Institute of Medicine. Unequal Treatment
  Confronting Racial and Ethnic Disparities in
  Healthcare. National Academy of Sciences. 2003
• National Standards for Culturally and
  Linguistically Appropriate Services in Health
  Care Executive Summary. U.S. Department of
  Health and Human Services, OPHS, Office of
  Minority Health. Washington, D.C. March 2001

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References and Resources

• Fadiman, Anne. The Spirit Catches You and You
  Fall Down. New York Strauss and Giroux. 1997
• National Center for Complimentary and Alternative
  Medicine http//nccam.nih.gov
• U.S. Department of Health and Human Services,
  Office of Minority Health. http//www.ohmhrc.gov
• US census data. http//quickfacts.census.gov
• Ethnic Medicine Information from Harborview
  Medical Center http//www.ethnomed.org
• University of California San Francisco Primary
  Care Resource Links Cross Cultural
  http//medicine.ucsf.edu/resources/guidelines/cult
  ure.html
• APhA. Handbook of Nonprescription Drugs 14th
  edition 2002