El Poder Sin Ver:

Ability Without SightInitiatives to reach

Latino People with low vision

Presented By:

• Adama Dyoniziak, MPH, CPHDirector of Strategic Programs, Braille Institute, Los Angeles

• Lynn Dubinsky, MAAdult Programs Manager, Braille Institute, Santa Barbara

• Rosie Rascon, BSIndependent Living Skills Instructor, Braille Institute, San Diego

Learning Objectives

Learn steps to success in working with the visually impaired Latino population in urban, suburban, and rural areas

Gain cultural competencies with regards to working with the Latino population

Braille Institute Latino Initiative

Braille Institute is a private, non-profit organization whose mission is to eliminate barriers to a fulfilling life caused by blindness and severe sight loss

Strategic Plan: Focus new services to the underserved segments of the population, particularly the Latino communities using a public health model

Five centers in Southern California – each has its specific population and needs

California

Statistics: Diabetes

Diabetes 7th leading cause of death in general US population; 5th leading cause of death in Latino population, and leading cause of vision loss

US population 65 years+ expected to increase 93% over the next 3 decades; US Latino elderly population will increase by 555% (2001, Health Issues in the Latino Community)

Estimated prevalence of Diabetic Retinopathy for people 65+years in the US is 11% (2004, Archives of Opthalmology, Vol 122)

Total prevalence of diagnosed & undiagnosed diabetes among Mexican Americans is 23.9% (vs Whites 12%)

7.8% of all adults in California have diabetes; 9.2% of Latino adults in California have diabetes (2010, UCLA Center for Health Policy Research)

Collaborative Approaches

Partnership development builds infrastructure Build trust…warm up the crowd…get

commitments One legitimate contact gets your foot in the

door Build momentum through a community

outreach process Consistent follow-up to maintain credibility &

program viability

Urban Areas: East Los Angeles

• Los Angeles’ Latino population increased 11% in the past decade

• 48-97% geographically dense Latino enclaves

• Los Angeles has the largest number of people with diabetes in California: 642,000 residents

Urban Areas: East Los Angeles

Partners: Vision y Compromiso, American Diabetes Association

Contracts: AltaMed Health Care Services, Harder+Co Community Research, RL Public Relations

Clinics, evaluation, public education campaign

Instituto Braille website

Promotoras, or Health Promoters

Grass roots health educators used in Latino countries for a myriad of health and community interventions

Add a personal and informal style to health care

Bridge the gap between providers and the community

Promotoras in Action

Promotoras

known grass roots leaders in their communities

majority are members of the target population

culturally competent: language, customs, understand and live the values of the community they serve

trained to facilitate individual, family or small group health education

work in a multidisciplinary approach

El Poder Sin Ver In Action

Suburban, Urban, & Rural Areas: California South Central Coast

Suburban, Urban, & Rural Areas: California South Central Coast

Santa Barbara (43.4%), Ventura (40.9%), & San Luis Obispo (21.3%) Counties (2010 Census)

Sansum Diabetes Research Institute

La Casa de la Raza: Latino Community Center

Neighborhood clinics & farmers’ markets

Sansum Diabetes Research Institute

La Casa de la Raza

Suburban & Urban Areas- San Diego

113,000+ San Diegans have diabetes; over half are Latino (National Diabetes Stats)

28.8% (376,000) of San Diegans are Latino (City-data.com)

Suburban & Urban Areas: San Diego

Partners: La Maestra Clinic, Family Health Centers

Gap in Diabetic education: eye component

Outcomes: retinal exam grant funding, systems change

Culturally Appropriate

Culture  is more than race  and  ethnicity Socioeconomic status or class Urban,  suburban,  or  rural  community Religious traditions and beliefs Parents’  level  of  education Length  of  residency  in  the  US assimilation level Language and traditions of their country of origin

Culturally appropriate means considering how all of these factors will affect participants’ experiences in the program or curriculum.

Culturally Sensitive

Culturally sensitive care targets the entire person not just his or her physical ailment

Recognize, understand, respect, and respond to the client’s cultural convictions.

Success requires patience, a willingness to listen carefully, and a respect for cultural diversity

Culturally Competent

Awareness of one's own cultural worldview

Personal Attitude towards cultural differences

Knowledge of different cultural practices and worldviews

Cross-cultural Skills

The culturally competent organization fosters a culture of openness and respect, and is committed to: serving diverse clients, hiring diverse staff, and establishing programs that address the needs of different

client populations.

Cultural Values

The Latino family is an interdependent and interactive kin network that allows for mutual and reciprocal help among its members

Some relevant values include: colectivismo, familismo, simpatía, respeto y confianza, machismo, presentismo, amistad

Colectivismo, or Collectivism

The emphasis is on the needs, objectives, and points of view of the group vs the individual

Interdependence within a group has higher priority than independence of the individual

Colectivismo, or Collectivism

Familismo, or Familialism

This value fosters strong identification with and attachment to the nuclear and extended families and feelings of loyalty, reciprocity, and solidarity among family members

Value facilitates a natural network of support and a structure for sharing successes and failures

Familialism

Simpatía, or Avoiding Conflict

This value stresses the importance of avoiding conflicts and promoting behaviors that foster pleasant social interactions

People may agree to participate in workshops and never attend because initially saying no would create a conflict

Participants want to comply with provider suggestions so they will agree with a provider - but the suggestions may not be compatible with what the participant believes or what they are able to do

Providers who form relationships with participants need to converse about topics important to participants, although this may be unrelated to the services

Simpatía

Participating in non-traditional activities ie., Zumba, eating Three Kings Bread

No shows for workshops or events

Respeto (Respect) y Confianza (Trust)

Latinos are high power-distance individuals in that they value conformity and obedience and support authoritarian attitudes

These individuals include those with more education and greater wealth, or greater experience

The cultural tendency to encourage respect for authority and to discourage disagreement is even more pronounced if a provider is perceived as more powerful

Respect and Trust

Instructors or other professionals are referred to as Doctora or Maestra

Can lead to fear of authority, especially institutes or governmental-like organizations

Machismo, or Gender Roles

Traditionally, Latino men are more dominant and are more likely to assume financial responsibility for elderly parents, and other family members

Latino women are expected to be submissive, passive, selfless and home centered and are more likely to assume caretaking roles for the extended family

Machismo

Males are less likely to ask for help

Latino men may avoid “learning” activities if they perceive it as threatening their control or dignity, or indicates that they have flaws or weaknesses.

Presentismo, or Time Orientation

Future oriented: planning, delayed gratification, punctuality, efficiency

Present oriented: less able to delay gratification, less able to plan for the future, place less emphasis on punctuality and efficiency

Latinos are more likely to be present oriented, valuing the quality of their interpersonal relationships rather than the length of time of an interaction

Latinos may be dissatisfied with the inflexibility and rigidity of time devoted to issues based on efficiency; providers may be frustrated with the inability to provide a complete service because of less planning by the participant

Time Orientation

Being late as rude vs handling practical matters

Have a time cushion

Take time to warm up the group

Amistad or Social Warmth

Latinos need less physical space when interacting socially, and is a sign of being demonstrative and responsive with the person you are interacting

Latinos may view providers of other ethnic groups as impersonal or distant when they need more space; while non-Latinos may view Latinos as emotional or too personal in a professional setting

Social Warmth

When teaching a class, students often socially embrace the instructor or offer food

In Conclusion

Your agency cannot be “outside” the community trying to get “in” and provide services.

Be a legitimate part of the community with people and organizations being aware, taking part in, and referring to your services.

Be integral to the community’s success because they are integral to your success.

For More Information

1-800-BRAILLE (1-800-272-4553) Monday - Friday, 8:30am - 5 pm

access our website http://www.brailleinstitute.org

Se habla español