New York State Department of Health

1
WELCOME

• New York State Department of Health
• HIV Oral Health Regional Resource Center
• Cheryl Stolarski, DMD
• Dental Co-Director
• 914-391-4883
• crs03_at_health.state.ny.us
• Howard Lavigne
• Program Director
• 315-477-8479
• hel01_at_health.state.ny.us

2
Oral Health Cultural Competency for HIV/AIDS 2010

• Cheryl R. Stolarski,DMD
• Co-Dental Director
• NY/NJ AIDS Education Training Centers
• Elias J. Llerandi, DMD
• Staff Dentist, U.S. Dept. of Veterans Affairs
• Consultant, NYS Dept. of Health
• Attending Dentist, The Brooklyn Hospital Center

3
OBJECTIVES

• Define and Recognize Fundamental Characteristics
  of Culture
• Identify Standards and Steps Towards Cultural
  Competence
• Discuss the Importance of Understanding Cultural
  Variation in the Dental Setting

4
Definition of Culture

• Integrated patterns of human behavior that
  include language, thoughts, communications,
  actions, customs, beliefs, values and
  institutions of racial, ethnic religious or
  social groups
• Cross et al (1989)

5
Why is it Important that Oral Health Care
Providers be Culturally Competent?

• Closes disparities between patient and provider
• Respect of culture and language can bring about
  positive treatment outcomes
• Patient behaviors/attitudes
• Lack of minority providers

6
Oral Health Care for HIV/AIDS Patients can
include these Populations

• Racial Ethnic Minorities
• Women
• Substance Users
• Gay/Lesbian/Bisexual/Transgender
• Adolescents
• Female
• MSM

7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
Cultural Competence Standards and Steps

• National Standards on Culturally and
  Linguistically Appropriate Services (CLAS)
• http//minorityhealth.hhs.gov/templates/browse.asp
  x?lvl2lvlid15
• Cultural Competence Continuum
• http//nccc.georgetown.edu/projects/sids/dvd/cont
  inuum.pdf
• LEARN Model
• http//www.diversityrx.org/html/MOCPT2.htm

11
Cultural Competence Continuum
Cultural Destruction
Cultural Incapacity
Cultural Blindness
Cultural Pre-Competence
Cultural Competence
Cultural Proficiency
12
LEARN MODEL

• LISTEN Identify Yourself
• Is Interpreter needed
• Ask Open ended questions
• EXPLAIN- Clear and easy language
• Pictures
• ACKNOWLEDGE- Find Common Ground
• RECOMMEND- Tx that involves both Doctor
  and Patient
• NEGOTIATE- Decide on a Plan that is
• Agreeable to both Doctor and Patient
  
• BerlinFowkes1989

13
Dental Providers should remember

• Cultural factors may influence a patients and/or
  providers views
• Communication must be on the patients level
• -Language barriers
• -Examples and illustrations might
• be needed

14
Examples of Cultural Views at the Provider Level

• HCP are reluctant to offer Tx plan option to pts
  they believe will be non-compliant
• MDs are more likely to Rx HAART to those
  perceived to be likely to be adherent
• MDs were more likely to tx African Americans as
  non-adherent
• (Bogart et al 2001)

15
DO NOT LIMIT TREATMENT PLAN CHOICES BASED ON
ASSUMPTIONS ABOUT A CULTURAL GROUP
16
Body Language Speaks Volumes

• Verbal vs. Non-Verbal
• Touch (What is Appropriate?)
• Personal Space
• Eye Contact
• Be Direct
• Sit at the Patients height or below
• Shaking Hands
• Avoid crossing your arms and legs

17
(No Transcript)
18
Cultural Factors Limiting Compliance

• Language
• Limited Health Literacy
• Indigenous Beliefs
• Trust in the Medical/Dental Profession
• Burroughs,et al National Pharm Council National
  Medical Assoc. 2002.

19
Health Literacy
20
Dental Providers should

• Respect differences
• Expand Cultural Knowledge
• Adapt service modifications
• -language barriers
• -use appropriate terminology
• -use illustrations when necessary
• -seek staff who represent the community
• -develop good patient rapport

21
Linking Communication to Outcomes

• Communication leads to
• Patient Satisfaction
• Adherence
• Better Health Outcomes
• Joseph Betancourt MD. Harvard University

22
Final Thoughts

• If you miss being understood by laymen and fail
  to put your hearers in this condition, you will
  miss reality.
• Hippocrates
• Ancient Medicine
• Adapted from Rose Jones PhD, Medical
  Anthropologist
• TX/OK AETC

23
Additional References

• CULTURE AND CLINICAL CARE EDITED BY JULIENE G.
  LIPSON/SUZANNE L. DIBBLE UNIVERSITY OF
  SANFRANCISCO Nursing press
• ACHIEVING CULTURAL COMPETENCY A CARE-BASED
  APPROACH TO TRAINING HEALTH PROFESSIONALS, EDITED
  BY LISA A. HARK, HORACE M. DELISSER.
  WILEY-BLACKWELL PUBLISHING
• GUIDE TO CULTURALLY COMPETENT HEALTH CARE, SECOND
  EDITION, LARRY D. PURNELL