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WELCOMENew York State New York State
Department of Department of HealthHealth
HIV Oral Health HIV Oral Health Regional Resource Regional Resource
CenterCenter
Cheryl Stolarski, DMDCheryl Stolarski, DMDDental Co-DirectorDental [email protected]@health.state.ny.us
Howard LavigneHoward LavigneProgram DirectorProgram [email protected]@health.state.ny.us
Oral Health Cultural Oral Health Cultural Competency for Competency for HIV/AIDS 2010HIV/AIDS 2010
Cheryl R. Stolarski,DMDCheryl R. Stolarski,DMDCo-Dental Director Co-Dental Director
NY/NJ AIDS Education & Training CentersNY/NJ AIDS Education & Training Centers
Elias J. Llerandi, DMDElias J. Llerandi, DMDStaff Dentist, U.S. Dept. of Veterans Affairs Staff Dentist, U.S. Dept. of Veterans Affairs
Consultant, NYS Dept. of HealthConsultant, NYS Dept. of HealthAttending Dentist, The Brooklyn Hospital CenterAttending Dentist, The Brooklyn Hospital Center
OBJECTIVESOBJECTIVES
Define and Recognize Fundamental Define and Recognize Fundamental Characteristics of CultureCharacteristics of Culture
Identify Standards and Steps Identify Standards and Steps
Towards Cultural Competence Towards Cultural Competence
Discuss the Importance of Discuss the Importance of Understanding Cultural Variation in Understanding Cultural Variation in the Dental Settingthe Dental Setting
Definition of CultureDefinition of Culture
““Integrated patterns of human Integrated patterns of human behavior that include language, behavior that include language, thoughts, communications, actions, thoughts, communications, actions, customs, beliefs, values and customs, beliefs, values and institutions of racial, ethnic religious institutions of racial, ethnic religious or social groups”or social groups”
Cross et al (1989)Cross et al (1989)
Why is it Important that Oral Why is it Important that Oral Health Care Providers be Health Care Providers be
Culturally Competent?Culturally Competent? Closes disparities between patient and Closes disparities between patient and
providerprovider
Respect of culture and language can bring Respect of culture and language can bring about positive treatment outcomesabout positive treatment outcomes
Patient behaviors/attitudesPatient behaviors/attitudes
Lack of minority providers Lack of minority providers
Oral Health Care for HIV/AIDS Oral Health Care for HIV/AIDS Patients can include these Patients can include these
PopulationsPopulations Racial & Ethnic MinoritiesRacial & Ethnic Minorities WomenWomen Substance UsersSubstance Users Gay/Lesbian/Bisexual/TransgenderGay/Lesbian/Bisexual/Transgender AdolescentsAdolescents
• FemaleFemale• MSMMSM
Cultural Competence Standards Cultural Competence Standards and Stepsand Steps
National Standards on Culturally and National Standards on Culturally and Linguistically Appropriate Services Linguistically Appropriate Services (CLAS)(CLAS)
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15
Cultural Competence ContinuumCultural Competence Continuumhttp://nccc.georgetown.edu/projects/sids/dvd/continuum.pdfhttp://nccc.georgetown.edu/projects/sids/dvd/continuum.pdf
LEARN ModelLEARN Modelhttp://www.diversityrx.org/html/MOCPT2.htmhttp://www.diversityrx.org/html/MOCPT2.htm
Cultural Competence ContinuumCultural Competence Continuum
Cultural Destruction
CulturalIncapacity
Cultural Blindness
Cultural Pre-Competence
Cultural Competence
Cultural Proficiency
““LEARN” MODELLEARN” MODEL
LISTEN – Identify YourselfLISTEN – Identify Yourself Is Interpreter neededIs Interpreter needed Ask Open ended questionsAsk Open ended questions
EXPLAIN- Clear and easy languageEXPLAIN- Clear and easy language PicturesPictures
ACKNOWLEDGE- Find Common GroundACKNOWLEDGE- Find Common GroundRECOMMEND- Tx that involves both RECOMMEND- Tx that involves both
Doctor and Patient Doctor and PatientNEGOTIATE- Decide on a Plan that is NEGOTIATE- Decide on a Plan that is
Agreeable to both Doctor and Agreeable to both Doctor and Patient Patient
Berlin&Fowkes1989Berlin&Fowkes1989
Dental Providers should rememberDental Providers should remember
Cultural factors may influence a patients Cultural factors may influence a patients and/or providers viewsand/or providers views
Communication must be on the patients Communication must be on the patients levellevel
-Language barriers-Language barriers
-Examples and illustrations might-Examples and illustrations might
be needed be needed
Examples of Cultural Views at the Provider Level
HCP are reluctant to offer Tx plan option HCP are reluctant to offer Tx plan option to pts they believe will be non-compliantto pts they believe will be non-compliant
MDs are more likely to Rx HAART to MDs are more likely to Rx HAART to those perceived to be likely to be those perceived to be likely to be adherentadherent
MDs were more likely to tx African MDs were more likely to tx African Americans as non-adherentAmericans as non-adherent
(Bogart et al 2001)(Bogart et al 2001)
DO NOT LIMIT TREATMENT DO NOT LIMIT TREATMENT PLAN CHOICES BASED ON PLAN CHOICES BASED ON ASSUMPTIONS ABOUT A ASSUMPTIONS ABOUT A
CULTURAL GROUP…CULTURAL GROUP…
Body Language Speaks VolumesBody Language Speaks Volumes
Verbal vs. Non-VerbalVerbal vs. Non-Verbal Touch (What is Appropriate?)Touch (What is Appropriate?) Personal SpacePersonal Space Eye Contact Eye Contact Be DirectBe Direct Sit at the Patient’s height or belowSit at the Patient’s height or below Shaking HandsShaking Hands Avoid crossing your arms and legsAvoid crossing your arms and legs
Cultural Factors Limiting Cultural Factors Limiting ComplianceCompliance
LanguageLanguage
Limited Health LiteracyLimited Health Literacy
Indigenous BeliefsIndigenous Beliefs
Trust in the Medical/Dental ProfessionTrust in the Medical/Dental Profession
Burroughs,et al National Pharm Council & National Medical Assoc. 2002. Burroughs,et al National Pharm Council & National Medical Assoc. 2002.
Health LiteracyHealth Literacy
Dental Providers shouldDental Providers should
Respect differencesRespect differences Expand Cultural KnowledgeExpand Cultural Knowledge Adapt service modifications:Adapt service modifications:
-language barriers-language barriers-use appropriate terminology-use appropriate terminology-use illustrations when necessary-use illustrations when necessary-seek staff who represent the -seek staff who represent the community community-develop good patient rapport-develop good patient rapport
Linking Communication to Linking Communication to OutcomesOutcomes
Communication leads to:Communication leads to:
Patient SatisfactionPatient Satisfaction
AdherenceAdherence
Better Health OutcomesBetter Health Outcomes
Joseph Betancourt MD. Harvard UniversityJoseph Betancourt MD. Harvard University
Final ThoughtsFinal Thoughts
If you miss being understood by If you miss being understood by laymen and fail to put your hearers laymen and fail to put your hearers in this condition, you will miss reality.in this condition, you will miss reality.
HippocratesHippocrates
Ancient MedicineAncient Medicine
Adapted from Rose Jones PhD, Medical AnthropologistAdapted from Rose Jones PhD, Medical Anthropologist
TX/OK AETCTX/OK AETC
Additional ReferencesAdditional 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
