Introduction to Cultural Competency in TB Prevention and Control

1. Introduction to Cultural Competency in TB Prevention and Control Lauren Moschetta, MA Training and Consultation Specialist New Jersey Medical School National Tuberculosis Center Audio conference April 25, 2005

2. “To learn every aspect of each culture that could influence the patient encounter is impractical, if not impossible”

3. Background “…we are a more diverse country now than ever before….” (Institute of Medicine, 2002) • Growing minority populations • (Significant) immigrant influx

4. Why is Cultural Competency Important for TB Control?-1

5. Why is Cultural Competency Important for TB Control?-2

6. Why is Cultural Competency Important for TB Control?-3 • Patient diversity • Concepts of illness and healthcare • Health disparities • Changing expectations in the medical and nursing fields

7. What is a “Health Disparity?” A health disparity is a difference in health status that is persistent across subgroups of a population. Source: Minnesota Department of Health Website http://www.health.state.mn.us/

8. Health Status

9. Unequal Treatment: Confronting Racial and Ethnic Barriers in Health Care, March, 2002

10. Culturally and Linguistically Appropriate Standards (CLAS) of Care • 14 standards developed by the Office of Minority Health • Culturally competent care, organizational supports for cultural competence and organizational structure and policies

11. Standards (by topic) -2 1. Understandable and Respectful Care 2. Diverse Staff and Leadership 3. Ongoing Education and Training 4. Language Assistance Services 5. Right to Receive Language Assistance Services • Competence of language Assistance • Patient- Related materials • Written Strategic Plan • Organizational Self-assessments • Patient/Consumer Data • Community Profile • Community Partnerships • Conflict /Grievance Processes • Implementation

12. What is “Culture”? “Culture refers to integrated patterns of human behavior that include the language, thoughts, communication, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.” Source: The National Standards for Culturally and Linguistically Appropriate Services in Health Care, adapted from Cross, Basron, Dennis & Issacs, 1989

13. What is “Competence”? “…having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices and needs presented by patients and their communities.” Source: The National Standards for Culturally and Linguistically Appropriate Services in Health Care, adapted from Cross, Basron, Dennis & Issacs, 1989

14. What is “Cultural and Linguistic Competence”? “Cultural and linguistic competence is a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.” Source: The National Standards for Culturally and Linguistically Appropriate Services in Health Care, adapted from Cross, Basron, Dennis & Issacs, 1989

15. In health care, cultural competency means treating patients from different racial and ethnic backgrounds, as well as the elderly and indigent, in accordance with their unique cultural needs, beliefs and risk factors. Linguistic competency means being able to converse in a limited-English-speaking patient’s native tongue or having access to a qualified interpreter. Adapted from: Learning about Difference www.minoritynurse.com

16. Other Terms: • Cultural sensitivity • Cultural responsiveness • Cultural awareness • Cultural effectiveness • Cultural humility • Cultural literacy

17. [Concept of] Culture: Developed & Produced By the National Center for Primary Care at Morehouse School of Medicine, with Support From the Pfizer Foundation • Race • Ethnicity • National origin • Geographic region • Spirituality/Religion • History

18. Culture Expressed Through Individuals: Developed & Produced By the National Center for Primary Care at Morehouse School of Medicine, with Support From the Pfizer Foundation Gender Age • Race • Ethnicity • National origin • Geographic region • Spirituality/Religion • History Personal Psychology Family Dynamics

19. Culture Expressed Through Individuals Over Time Developed & Produced By the National Center for Primary Care at Morehouse School of Medicine, with Support From the Pfizer Foundation Social Status & Power Gender Age • Race • Ethnicity • National origin • Geographic region • Spirituality/Religion • History Marriage & Family Education & Vocation Acculturation Family Dynamics Personal Psychology

20. Domains of Cultural Competency • Knowledge • Attitude • Skill

21. Knowledge (examples) -1 • Self awareness • Concept of culture • Local and national demographics • Disparities in health status • Appropriate use of an interpreter (resources for information are included in handouts)

22. Ethnocentrism: The assumption that the beliefs, values, norms and behaviors of one’s own culture are the correct ones, and that those of other cultures are inferior or misguided Source: The California Endowments Principles and Recommended Standards for Culturally Competence Education of Health Care Professionals Knowledge -2

23. Knowledge -3Cultural Competency Continuum • Cultural Destructiveness • Cultural Incapacity • Cultural Blindness • Cultural Pre-competence • Basic Cultural Competence • Advanced Cultural Competence Cross Model of Cultural Competency by Terry Cross, 1988

24. Attitudes (examples) • Lifelong commitment to continuous learning • Open-mindedness and respect for all • Humility • Curiosity • Empathy • Awareness of all outside influences on the patient

25. Skills (examples)-1 • Communication tools • To assess patient expectations about interactions • To demonstrate respect • To structure interaction

26. Skills (examples) -2 • Assessment skills • Patient language and literacy level • Health knowledge • Health beliefs • Health seeking behaviors • Relevant relationships • Decision making preferences • Perception of biomedicine and complementary medicine • Incentives

27. What is the difference? A stereotype is an ending point A generalization serves as a starting point A Word About Stereotypes:Stereotyping vs. Generalizations

28. Some Things to Consider: • Folk illnesses • Folk medicines • Common health beliefs • Disease incidence, prevalence, and outcomes • History of oppression • Effects of war and torture on refugee populations

29. Community Vital Signs • Prevailing cultural beliefs • Pressing issues for the community • Unemployment rate • Level of poverty • Access to healthcare • Community leaders • Level of trust among healthcare providers and people in community Source: Urban Update Newsletter, Johns Hopkins University Urban health Institute, September, 2001

30. Final Thoughts • A “one size fits all” health care system cannot meet the needs of an increasingly diverse American population • No “one” way to treat a racial or ethnic group given the great “socio-cultural” diversity • Clinicians working in TB control must “check their own pulse” and become aware of personal attitudes, beliefs, biases and behaviors that may influence (consciously or unconsciously) the care of TB patients • Rather than making assumptions, adopt a line of questioning that will help uncover the information you need while fostering a working rapport with the patient • We are the most culturally diverse nation in the world, and through our work in TB we gain exposure and involvement with people from all over the world.  Thus we are presented with a unique opportunity for learning just by being mindful of this fact and open to the experience