Cult Comp Combined and Revised 3

8/4/2019 Cult Comp Combined and Revised 3

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Cultural CompetencyLisa Z. Killinger, DC

Palmer CollegeDiagnosis/Research


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What is

cultural competency?


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What is cultural competency?

Set of skills, knowledge & attitudes related to aclinicians:

understanding and respect for patients values,beliefs, expectations

awareness of his/her own assumptions andvalue system

ability to adapt care to be congruent withpatients expectations and preferences.


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Definitions

Ethnicity: self-defined group identity in religion

nationality

cultureCulture: shared beliefs & values affecting

social interactions

interpretation of experience

Race: A biological concept (Cannot change)


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Examples of different cultures of

chiropractic patients Sex

male/female

sexualorientation

Age

children adolescents

elderly

Income/education

Race/ethnicity

Religion


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WHY should DCs be culturally

competent? US population is increasingly culturally

diverse

Different cultures have different healthbehavior and health risks

Doctor-patient communication and rapport

are affected by cultural differences

This affects outcomes!


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When we improve cultural

competency, we... Reach patients more effectively

Enhance the quality of the

doctor/patient interaction

Improve patient compliance

Achieve better health outcomes!!

And

We enrich ourselves...


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Racial Distributionof US Population

2000

Caucasian

(72%)

Hispanic

Afr-Am

Asian

Native Am.


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Racial Distributionof US Population

2020

Caucasian


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Are we keeping pace with

these changes?


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Interesting Factoids: The mixed

ethnicity category is the fastestgrowing sub-population in the US.

Hispanics are the fastest growingspecific ethnicity in the US

(aside from mixed ethnicity).


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Our societys growing diversity

is not a problem

(& its certainly not going away!)

Its an opportunity for us all to gain

from each otherscultural wealth.


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So.how does diversity affect us here at

Palmer, (and in practice)

and how doWE

become more culturally competent?


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Diversity:US population vs. chiropractic patients

(% Non-Caucasian)

General population (2000) 35-45%

DC patients (1974-82) 4%

DC patients (1997-98) 5%


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Ethnic diversity in the US

MD and DC workforce

% Non-Caucasian

General population ~40%

MDs 7%

MD students (2000) 34%

DCs 7% DC students (PCC 2002) 9%


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U.S. Chiropractors

1991 1998Female 13.3% 19.2% 51%

Asia n 0.8 1.8 4

Hispanic 1.6 1.7 13

African American 0.5 0.6 12

Native Amer. 0.2 0.8 1

Gen.

pop.


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Some keys to cultural competency:

Fight your fear ofthe unknown

Learn aboutsomeone different

Dont let time

pressures rob you

of patience andtolerance

Ask questions, andLISTEN!

Recognize thatdifferent does not= inferior.

Let your heart

lead; (your headjust wouldnt

understand!)


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Cultural Communication Issues

Language (spoken and written)

Non-English speakers

Educational level

Acceptable topics

Voice

Loudness/pitch

Silence

Body language

personal space touch

gestures/facial expressions

eye contact


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Hot Tip:An African American patient may make great use offacial expressions to show approval or disapproval,

or to influence the behavior/attitudes of others.

Be aware of your patients facial expressions!


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Hot Tip:Arab, Asian, or Indo-Pakistani students

(and others) may show respect for you bylowering their gaze (not making eye

contact). Such behavior does not reflect a

lack of interest or respect.


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Cultures

in the clinical setting.

The challenges

The great communication divide

Crossing the divide with grace

The right match


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Hot Tip:A practicing Muslim or Orthodox Jewish femalepatient or student may be unwilling to be partnered

with a male student/doctor, and may not wish touncover her hair, arms, legs or torso due to the

value placed in these faiths on modesty.


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Case Study: Hispanic Culture

Family overindividual

Respect forhierarchy

Belief in spirits,and the evil eye

Includes family inhealth decisions

Patient may expect

Dr. to wear a whitecoat, (and toperform miracles!)

Provider, while

respecting beliefs,may need to stressthe importance ofadhering to care

plan


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WARNING!!!

Since every patient (of any ethnicityor faith) is an individual, NEVERassume anything about their beliefs.

(See next slide)

Remember all minority persons areBi-Cultural (at least!). They meld 2 or

more value systems every day! Identify strengths in your

patient/students cultural orientation

and build on them.


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Different cultures and ethnicitieshave different health behaviors

and health risks


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US Health Disparities (Behavior):Reduced Physical Activity

Women

Lower income/education

African-Americans and Hispanics

Older adults

by age 75, 33% men, 50% women

have no physical activity at all

Source: Healthy People 2010


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US Health Disparities (Behavior):

Smoking Teens: 39% Caucasian

33% Hispanic 20% African American

Adults:

Highest in Native Amer, blue collar andmilitary

HS dropouts 3x rate of college grads


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Health Disparities (Behavior):

Overweight/obesity* >60% of Americans are

overweight/obese!!

Esp. low income women and teens

African American/Mexican Americanwomen have highest rates of obesity

*overweight: BMI 25; obese: BMI 30


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Chronic Low Back Disability

Activity limitation, rate per 1000 adults:

Asian 15 Hispanic 28

Caucasian 32

African American 36

Native American 68

(by race)


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Health Disparities:Chronic Low Back Disability

by income and education

poor mid/high

28

hsdrop

hsgrad

somecoll

Activity limitation, rate per 1000 adults

77

24

54

35


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Health Disparities:Diabetes

0

5

10

15

20

25

Cauc.

8%

14%

16%

18%

Afr-Am Mex-Am Native

Am.

a g e s 5 0 - 5 9


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Disparities in Health Risk:Intentional Injury

Homicide 3rd COD ages 5-14

Homicide 2nd COD ages 15-24

Homicide rate for Afr. Am. aged 15-242x rate for Hispanics and 14x rate forCaucasians

Suicide 3rd COD ages 15-24;Caucasians highest


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OK, OK, I GET IT.There are differences

between cultures!

So, what should I do?


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Developing Cultural Competencyin Yourself:

Turn pre-conceived notions into questions

Use or develop empathy

Tread lightly, and if you dont know, ask

Express respect for the patientsvalues/culture/faith

Become familiar with your own attitudes about

cultures/faiths. Do you stress assimilation orvalue maintenance of patients/students

cultural traditions?


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To gain information about a

patients health beliefs,ASK! What do you think caused your problem?

Why do you think it started when it did?

How severe do you think it is? What are the main problems this has

caused for you?

What kind of care do YOU think youshould receive?

What results do you hope to receive?


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Read all about it.

Kiss, bow , or shake hands? (Morrison)

Cultural Health Assessment-MosbysPocket Guide (DAvanzo and Geissler)


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Try not to be

a cultural klutz.

Your patients

will thank you!

Documents

Cult Comp Combined and Revised 3