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Connecting to the Hispanic/Latino Community: Essential Elements for Quality Care. Eduardo R. Ochoa, Jr., M.D. Assistant Professor General Pediatrics, Maternal Child Health UAMS Colleges of Medicine and Public Health. Overview. Introduction Culture and its Role Environmental Landscape

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Connecting to the hispanic latino community essential elements for quality care

Connecting to the Hispanic/Latino Community:Essential Elements for Quality Care

Eduardo R. Ochoa, Jr., M.D.

Assistant Professor

General Pediatrics, Maternal Child Health

UAMS Colleges of Medicine and Public Health


Overview
Overview

  • Introduction

  • Culture and its Role

  • Environmental Landscape

  • Impact on Health and Health Care

  • The Culturally Competent Encounter

  • Connection to Disparities


What is culture
What Is Culture?

  • Material culture

    • Paintings, tools, sculpture, etc.

  • Non-material culture

    • Common behaviors, thoughts, customs, beliefs that bind a group within society

  • Other aspects of culture

    • Food, language, dress, dance, body adornment, dating practices, religion


Culture in the health arena
Culture in the Health Arena

  • Every patient-provider interaction is a cross-cultural experience

    • The provider must have comfort with his or her own cultural background

    • The patient brings a set of cultural values that will uniquely impact his or her health

    • Bridging the cultural divide is the essence of a quality encounter


Cultural competence
Cultural Competence

  • Describes the system meeting the client

  • “The set of behaviors, attitudes and policies that come together in an institution, agency, or among a group of individuals, that allows them to work effectively in cross-cultural situations.”

    • Cross, TL, BJ Bazron, KW Dennis, and MR Isaacs. “The Cultural Competence Continuum”


Cultural competence1
Cultural Competence

  • “…the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.”

    • JR Betancourt, AR Green and JE Carrillo, “Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches”, The Commonwealth Fund, October 2002.


Value of cultural competence
Value of Cultural Competence

  • Vehicle to achieve better access to care

  • Strategy to attract new patients

  • Vehicle to reduce racial and ethnic disparities in outcomes and quality

  • Better understanding of the consumer

  • Part of an organizational strategy to address barriers to quality care



Us demographic projection
US Demographic Projection

  • Children’s Defense Fund 2030 Predictions

    • 5.5 million more Hispanic children

    • 2.6 million more African-American children

    • 1.5 million more children of other races

    • 6.2 million fewer white, non-Hispanic children

      Hanson MJ: “Ethnic, Cultural, and Language Diversity in Intervention Settings,” in Developing Cross-Cultural Competence: A Guide for Working with Young Children and Their Families, eds, EW Lynch, MJ Hanson, Baltimore MD: Paul H. Brookes Publishing Company, 1992, p.7.


Environmental landscape arkansas population
Environmental LandscapeArkansas Population

  • Race/Ethnicity 19902000

    • White 82.7 80

    • African-American 15.9 15.7

    • Hispanic 0.8 3.2

    • Other 1.3 3.1

      • Includes Asian, American Indian, Pacific Islander


Environmental landscape latinos in arkansas
Environmental LandscapeLatinos in Arkansas

  • Top three Latino growth states

    • North Carolina, Arkansas, Georgia

  • 1990 Arkansas Latinos: 20,000

  • 2000 Arkansas Latinos: 87,000+

    • 3.2% total state population, probably 5%+

  • 2004: 121,000+, 4.4%, probably 7%+

  • Hispanics now dominant US minority

    • 5% of all Pulaski County births in 2001



Environmental landscape why latinos come to arkansas
Environmental LandscapeWhy Latinos Come to Arkansas

  • Economic opportunity

    • Relative wage boom, available low-skill jobs

      • Poultry, agriculture, construction, service, factory/manufacturing

  • Social factors

    • Arkansas contacts, perception of safety

  • “American dream” factor

    • Home ownership, family growth, education


  • Environmental landscape public schools
    Environmental LandscapePublic Schools

    • Microcosm of state situation

      • All issues intersect: poverty, health, immigration, hunger, housing

    • Explosion of language minority students

      • ’93-’94: 4,071; ’03-’04: 23,626 480%

        • 5.2% K-12 studs,80% Spanish-speaking

        • 3/4 of Limited English Proficiency


    Impact on health
    Impact on Health

    • Barriers to health and health care access

      • Language, language, language

      • Lack of knowledge about care systems

      • Immigration factors

      • Poverty, educational attainment

      • Provider workforce insufficiency

      • Alternative vs. Traditional US system

      • Lack of health insurance


    Impact on health care public health
    Impact on Health CarePublic Health

    • Of all patients served by ADH, 8.2% Latino in 2001

    • 50% of ADH clientele in Sevier county (DeQueen) and >30% in Benton and Washington counties Latino in 2001

    • WIC, prenatal, immunization services highly utilized

    • Partnerships formed to deliver services


    Impact on healthcare
    Impact on Healthcare

    • US public and private health workforce

      • US 15% Latino, 3.5% US MDs Latino

      • CA 31% Latino, 4% CA MDs Latino

      • 6.1% 2001 Med School Graduates Latino

        • 7% African American (13% US population)

      • 3.2% 2000 medical school faculty Latino

      • 1.9% UAMS COM Latino faculty

      • Largely without culture or language training


    Impact on healthcare1
    Impact on Healthcare

    • Language

      • 39% of Spanish-speaking adults speak English “not well” or “not at all”

      • Inability to cross language barrier affects all health and social service delivery

      • Agencies have few, if any, bilingual staff

      • Federal mandate to improve service to LEP persons-Executive Order 13166



    Impact on health new immigrants
    Impact on HealthNew Immigrants

    • Unfamiliar US care systems

      • Not accustomed to making appointments

      • Difficult to navigate large medical centers

      • Little help available in Spanish

      • Unsure how to apply for, use and renew health insurance

      • Not accustomed to preventive care, screenings, disease surveillance


    Impact on health and healthcare
    Impact on Health and Healthcare

    • Immigration Issues

      • Many mixed status and separated families

      • 1996 welfare reform laws bar even documented from benefits for 5 years

      • No documents=Invisible=Vulnerable

      • Fear of being asked for documents

      • Mobility across border

      • Possible comprehensive reform



    Impact on health2
    Impact on Health

    • Traditional methods of care

      • Herbal remedies

      • Alternative caregivers

        • curanderas, parteras, sobadoras, hierbistas

      • Availability of prescription drugs

      • Family-centered decisions about health

      • Cultural beliefs about health and disease

        • “sugar” vs. diabetes, etc.


    Culturally competent encounter
    Culturally Competent Encounter

    • Country of origin-not all from Mexico

      • Reasons for leaving native country

    • First or native language

    • Education attained, literacy issues

      • Informed consent issues

    • Religion-not all Catholic

      • End of life considerations


    Latino cultural concepts
    Latino Cultural Concepts

    • La Familia-The Family, Gender roles

    • Respeto-Respect

      • Social modesty; sensitivity in HC encounter

    • Confianza-Confidence

    • Personalismo-Personal Familiarity

    • Spiritual Impact-role of faith and religion

      • Fatalismo, espiritismo


    Latino cultural concepts1
    Latino Cultural Concepts

    • Other beliefs about disease

      • Empacho, Bilis

      • Mal Ojo

      • Envidia

      • Mal Aire

    • Traditional Healers

    • Non-licensed providers


    The culturally competent encounter
    The Culturally Competent Encounter

    • National Standards for Culturally and Linguistically Appropriate Services in Health Care

      • HHS Office of Minority Health, March 2001

      • 14 standards organized by themes

        • Culturally Competent Care, Language Access Services, Organizational Supports for Cultural Competence


    The culturally competent encounter1
    The Culturally Competent Encounter

    • Realms for cultural competence

      • Organizational

        • Minority leadership recruitment, development, promotion; community involvement

      • Systemic

        • Community assessment, data collection, quality

      • Clinical

        • Awareness of sociocultural influences, training of staff, patient empowerment


    The culturally competent encounter2
    The Culturally Competent Encounter

    • Understand community or client being served and what social and cultural influences impact health and behavior

    • Understand how these factors interact with the system in ways that prevent quality care access

    • Identify barriers and intervene

    • Monitor outcomes


    The culturally competent encounter3
    The Culturally Competent Encounter

    • Avoid stereotyping

      • Vast heterogeneity among racial and ethnic subgroups

        • Differences by national origin, educational attainment, socioeconomics, religion

    • Engage in dialogue

      • Linguistically appropriate communication and negotiation is the key


    Connection to disparities
    Connection to Disparities

    • Access to health information, services

    • Language access

    • Quality measurements, data collection

    • Workforce education

    • Community education

    • Systems change


    Connection to disparities current efforts
    Connection to DisparitiesCurrent Efforts

    • Community

      • La Casa Health Network

      • Community Health Center expansion

        • Multi-partner effort: ADHHS, JCCSI, ACH, Baptist Health, La Casa, LULAC, Pulaski County, City of LR

    • UAMS

      • Chancellor’s Racial and Ethnic Health Disparities Taskforce


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