Understanding health - helping others

Adrianna Gutierrez

Sally James

April 2013

What is Cultural Competency?

Knowing how to speak to people across cultures.

Developing cultural competency helps you understand and

communicate with people across

cultures.

Cultural Competency has 4 Components

• Awareness of one’s own cultural worldview

• Attitude towards cultural differences

• Knowledge of different cultural practices and worldviews

• Cross-cultural Skills

Who do we serve?

People from many countries, ages, incomes and cultures.

African Americans

• 13% of the US population is AA• 3.8% of WA, 6.5% King County• AA are more likely to develop and die from

cancer than any other racial or ethnic group• These higher rates could be attributed

inequalities in work, wealth, income, education, housing and overall standard of living, barriers to high quality health care, and racial discrimination.

Native Hawaiian and Other Pacific Islanders

• 874,000 Pacific Islanders currently live in the United States.

• 0.8% of King County population• They are a relatively young population, with a medium

age of 25 years.• Many Pacific Islanders, including Native Hawaiians, are

socioeconomically disadvantaged and underserved in terms of access to health and social services.

• Cancer is among the top 3 causes of death of Pacific Islanders.

American Indian/Alaska Natives

• There are more than 500 federally recognized tribes, each with unique cultural, genetic, and socio-demographic characteristics.

• 1.1% of King County population• The poor survival rate of American Indians

suggests that AI cancer patients experience the disease differently.

• Access to healthcare is a problem for AI’s, who are second only to Latinos in lacking health insurance.

Hispanics/Latinos

• The Census Bureau announced that Hispanics/Latinos have become the largest, fastest-growing, and youngest ethnic minority population in the United States, comprising 16% of the total population. 9.2% KC

• Despite having lower cancer rates for the most common cancers, they are more likely to be diagnosed with a more advanced stage of disease.

• 33% of Hispanics/Latinos are uninsured• Major issues to be addressed are the concept of

prevention, the under-utilization of screening programs, and the lack of bilingual staff and education materials.

Asian Americans

• According to the Census Bureau, 10.8 million Asian Americans currently live in the US

• 15.0% of KC population• The Asian American community is comprised of

those who are recent immigrants and those born in the US.

• Cancer has been the leading cause of death for Asian American women since 1980

• Significant disparities exist among sub-populations

LGBTQ Americans

• LGBTQ community is diverse in terms of cultural background, ethnic or racial identity, age, education, income, rejection or acceptance of societal stereotypes, and prejudice.

• Discrimination and bias can play a role in inadequate medical assessment, treatment, and prevention of LGBTQ health-care access.

• Significant barriers include: previous negative health experiences, fear of sexual orientation disclosure, perceived or actual exclusion from health promotion campaigns, misinformation about risks and screening, exclusion of significant others.

Health Disparities

Health disparities refer to gaps in the quality of health and health care across racial, ethnic,

and socioeconomic groups

http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf

Barriers

• The language barrier

• The culture barrier

• Literacy

• Racial and ethnic discrimination

• Economic barriers

• Education

• Inadequate health insurance

Recognize your own attitude

• Check your own feelings when you are interacting with someone.

• How are these feelings influencing your opinion/idea of this person?

Assessing Health Literacy

Opening the conversation

What is Health Literacy?

The ability to read, understand, and act on health care information

You can’t “tell by looking, or hearing”

• In one study, 23 of 58 patients who admitted having reading difficulties had never told their spouse. Nine had told no one.

• Physicians at a women’s health clinic could identify only 20% of their patients who were at the lowest health literacy level (<third grade)

How do you know if a person has low health literacy?

• Listen: does the person explain what s/he needs or do they need help in stating their problem?

• Listen: does the person know a diagnosis?

• Listen: can the person describe the basics of the treatment prescribed?

• Listen: does the person seem to know medical terms?

How to interact with callers who have low health literacy

Using plain talk

Listen

• Listen to the words the person uses, try to use those same words.

• Do not correct them by telling them the “correct” scientific word, unless it is important to the conversation.

Plain talk is…

• Clear straightforward expression

• Only necessary words

Plain talk is not…

• Obscure words

• Inflated vocabulary

• Convoluted sentence construction

• Baby talk

• A simplified version of the English language

What makes up plain talk?

• “you”, “we” and other pronouns

• Active voice

• Common, everyday words

• Short sentences

• Jargon-free zone

Active versus Passive Voice

Passive Voice• Chemotherapy is

offered when there is a threat of metastasis

• Consultations are performed to confirm the diagnosis

• Increases number of words

Active Voice• Chemotherapy can

prevent cancer from spreading.

• Doctors consult to confirm the diagnosis

• Decreases number of words

Common, everyday words

• Abdomen Belly

• Benign Not Cancer

• Tumor Growth

Checking Comprehension

• Simply asking callers if they understand is not enough

• Use open-ended questions

“What can I help explain more?”

“I’ve given you a lot of information, what can I clarify for you?”

Things to Remember

• Think about your culture, what has influenced the way you think and feel.

• Recognize your own biases and attitudes toward other cultures.

• Make this an open, caring and understanding service for everyone.

Resources

Websites for finding health information in various languages:

• RadiologyInfo™ Web sitehttp://www.radiologyinfo.org/sp/info.cfm?pg=pros_cancer

• Lab Tests Online

http://labtestsonline.org/

• US National Library of Medicine

http://www.nlm.nih.gov/medlineplus/spanish/medlineplus.html

• Ethnomed

http://ethnomed.org/patient-education

Articles and Videos on health lliteracy:

• Article on health disparity in our area

http://seattletimes.com/html/localnews/2020655212_duwamishpollutionxml.html

• Video explaining interpreter services https://www.youtube.com/watch?v=jfiYYyt_MLk