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Cultural Considerations in the Delivery of Dental Services to the Hispanic Community. E. Angeles Martínez-Mier, DDS, MSD, PhD Ana G. Gossweiler, DDS, MSD. U.S. Demographics. Rapidly becoming more diverse Minority populations growing at a fast pace

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cultural considerations in the delivery of dental services to the hispanic community

Cultural Considerations in the Delivery of Dental Services to the Hispanic Community

E. Angeles Martínez-Mier, DDS, MSD, PhD

Ana G. Gossweiler, DDS, MSD

u s demographics
U.S. Demographics
  • Rapidly becoming more diverse
  • Minority populations growing at a fast pace
  • Hispanic group becoming the largest minority group in the U.S.
indiana demographics
Indiana Demographics
  • Population has tripled between 1990 and 2002
    • Mexicans 60%
    • Median age 25
  • 13% of the population in Indiana
    • Indianapolis 65 000 to 85 0000 according to local studies
hispanics or latinos in indiana
Hispanics or Latinos in Indiana
  • Hispanics or Latinos of any race 214,536

Mexican 153,042

Puerto Rican 19,678

Cuban 2,754

Others 39,062

U.S. Census Bureau, Census 2000

culture
Culture
  • What is it?
  • Where is it found?
  • Who has it?
  • When is it used?
  • Why is it important?
culture6
Culture
  • The skills, art, etc., of a given people in a given period, civilization

Webster’s New World Dictionary

culture7
Culture
  • Culture is:
    • Guides how people live
    • What they believe and value
    • How they communicate
    • What are their habits, customs and tastes
    • Guides the ways they meet various needs of society
    • How goods and services are produced and distributed

Slide by Valery Yontz, PhD, University of Hawaii

definitions
Definitions
  • Cross-cultural
  • Intercultural
  • Subculture
  • Values
  • Beliefs
  • Stereotyping
  • Ethnocentrism
cross cultural
Cross-cultural
  • Refers to any comparison of cultural differences or the situations in which such differences exist
intercultural
Intercultural
  • Refers to the actual interaction between people of different cultures
subculture
Subculture
  • Formed by a group of persons who have developed interests or goals different from the primary culture, based on such things as occupation, sex, age, social class, or religion.
values
Values
  • Ideas about what is right and wrong, desirable and undesirable, normal and abnormal, proper and improper
  • A set of organized rules for making choices, reducing uncertainty and reducing conflicts within a given society
beliefs
Beliefs
  • Belief is a psychological state in which an individual holds a premise or an argument to be true without necessarily being able to adequately prove their point to other people who may or may not agree.
stereotyping
Stereotyping
  • Refers to the common behavior of assuming that individuals possess certain characteristics or traits because they are members of a particular group.

Fails to recognize the individual

ethnocentrism
Ethnocentrism
  • Natural belief that one’s culture is superior to that of others
  • Care is needed not to demean clients whose oral health practices may be rooted in culture rather than scientific fact
iceberg concept
Iceberg Concept

Is the culture always visible to the observer?

Primarily in Awareness

Primarily out of Awareness

primarily in awareness
Primarily in Awareness
  • Fine arts
  • Literature
  • Drama
  • Music
  • Dancing
  • Games
  • Cooking
  • Dress

May be obvious to the observer

primarily out of awareness
Primarily Out of Awareness

Not necessarily obvious to the observer

  • Notions of modesty
  • Conceptions of beauty
  • Patterns for handling emotions
  • Conception of self
  • Conception of justice
  • Decision making patterns
  • Attitudes toward the dependent
  • Patterns of superior/subordinate relationship
health care issues related to culture
Health Care Issues Related to Culture
  • Culture influences:

- communication (language, tone, nonverbal communication)

- trust

- behavior

- understanding wellness and illness

- seeking health care

- receiving and complying with care

cultural competency s definition
Cultural Competency’s Definition
  • The ongoing process of actively developing and practicing appropriate, relevant, and sensitive strategies and skills in interacting with culturally different people. Includes the capacity to respond appropriately to the needs of populations whose cultures are different from what might be “the dominant or mainstream culture.”

Slide by Valery Yontz, PhD, University of Hawaii

goals of cultural competency
Goals of Cultural Competency
  • Self- exploration
  • Personal development
  • Attitude and values clarification
  • Ethnic and cultural literacy
  • Empowerment—equality and excellence
  • Basic skills proficiency
  • Social competency

Slide by Valery Yontz, PhD, University of Hawaii

skills and characteristics of cultural competency
Skills and Characteristics of Cultural Competency
  • Respectful
  • Willingness to share, risk change,& explore
  • Understand the power of action and words
  • Ability to recognize learning opportunities
  • Possessing knowledge of one’s self
  • Being aware of ignorance
  • Having attitude that “Different is okay: not good or bad

Slide by Valery Yontz, PhD, University of Hawaii

right or wrong
Right or Wrong
  • “We must be able to recognize and deal with beliefs of others if we wish to obtain communication.”

Samovar & Porter

Intercultural Communication

slide24
Good Bad

http://www.yourpointofview.com/

slide25
Bad Good

http://www.yourpointofview.com/

cultural competency components
Cultural Competency Components
  • Develop an awareness of one’s own existence
  • Demonstrate knowledge and understanding of other cultures
  • Accepting/respecting cultural differences
  • Stop assuming that others’ beliefs and values are the same as yours
  • Stop judging attitudes as good or bad
  • Be open to range of cultural encounters
  • Adapt to be congruent with other cultured persons

Slide by Valery Yontz, PhD, University of Hawaii

cross s cultural competency continuum
Cross’s Cultural Competency Continuum
  • Cultural destructiveness
  • Cultural incapacity
  • Cultural blindness
  • Cultural pre-competence
  • Cultural competence
  • Cultural proficiency
        • Cross, T; 2001

Slide by Valery Yontz, PhD, University of Hawaii

why is cultural competence important to dental professionals
Why is cultural competenceimportant to dental professionals?
  • It assist in recognizing the elements of culture that are relevant during a patient care (communication issues, religion, family networks, gender norms, sense of humor, etc…)
benefits of gaining intercultural competence
Benefits of gaining intercultural competence
  • Provide compatible messages with patient’s cultural values and beliefs
  • Increase the relevancy of health education
  • Increase effectiveness of dental care with a diverse client
  • Increase a practitioner’s multicultural knowledge
cultural assessment domains
Cultural Assessment Domains
  • Ethnic identity/history
  • Communication
  • Activities of daily living
  • Orientation to time
  • Food practices
  • Family relationships
  • Birth and death rituals
  • Spiritual/religious orientation
  • Bio-cultural ecology
  • Illness beliefs
  • High-risk behaviors
  • Health practices and practitioners

Slide by Valery Yontz, PhD, University of Hawaii

hispanics latinos key cultural points
Hispanics/Latinos: Key Cultural Points
  • Ethnic Identity and History
    • Latin America designates all those countries and territories in the Americas where languages derived from Latin are spoken: Spanish, Portuguese, French, and their creoles.
    • The region was home to many indigenous peoples and advanced civilizations (Aztecs, Mayan, and Incas). With the arrival of the Europeans the indigenous peoples lost power to the Europeans. European powers, most notably Spain and Portugal, colonized the region. After independence movements, the countries of the region became independent by the late 19th century.
diversity within the hispanic community
People in Latin America are a mixture of many racial groups.

Their origins include over 22 countries

While Spanish is usually the common language, there is a wide variety of idiomatic speech patterns and dialects

Diversity within the Hispanic Community
hispanics latinos key cultural points34
Hispanics/Latinos: Key Cultural Points
  • Communication
    • Casual conversation prior to “the point”
    • Resistance to lose language
    • Maintain outward expressions of dignity and calm
    • Touching, kissing, hugging between family in public
    • Make eye contact, hold hands, hug
hispanics latinos key cultural points35
Hispanics/Latinos: Key Cultural Points
  • Activities of Daily Living (ADLs)
    • Respect for tradition
    • Hard working
    • Follow cultural/family practices, cleaning, cooking, etc. (practice of traditional things in the U.S.)
collectivism
Collectivism
  • Latinos prefer the company of others versus being alone.
  • Sharing is an activity that is an outgrowth of collectivism.
  • Drinking alcohol and smoking are experiences that are shared with other friends.
    • How long a man drinks with his friends is often determined by when his wife arrives to tell him it is time to come home.
          • Chong, The Latino Patient
hispanics latinos key cultural points37
Hispanics/Latinos: Key Cultural Points
  • Orientation to Time
    • Flexible sense of time
  • Food Practices
    • Very traditional
    • Special events
    • Family traditions
hispanics latinos key cultural points38
Hispanics/Latinos: Key Cultural Points
  • Family Relationships
    • Connectedness to extended family
    • Children taught to repress aggressive and assertive behavior
    • Machismo/Marianismo
cultural values and gender
Cultural values and gender
  • Machismo
    • refers to the man’s masculinity and puts the man at the center of the social life. It is exhibited through courage and authoritarian attitude
  • Marianismo
    • Refers to the woman’s position at home and in the family. A woman earns respect through her dedication to her children and husband
cultural values and gender40
Cultural values and gender
  • As the need for income increases, there is greater financial pressure on the wife to enter the workforce.
  • As she contributes to the family income, she will attain more independence and greater parity in the family decision making process.
  • Her exposure to the workplace and her social contacts outside the home will tend to accelerate the process of acculturation.
hispanics latinos key cultural points41
Hispanics/Latinos: Key Cultural Points
  • Birth and Death Rituals
    • Male/Female roles well defined during funeral and births
    • Women pampered more during pregnancy
    • Cultural traditions practiced at funerals
hispanics latinos key cultural points42
Hispanics/Latinos: Key Cultural Points
  • Spiritual and Religious Orientation
    • Catholics
    • Some develop special relationships with saints
    • Some superstitions
    • Sacrifice in the world is helpful to salvation
hispanics latinos key cultural points43
Hispanics/Latinos: Key Cultural Points
  • Bio-Cultural Ecology
    • Higher caries, periodontal disease prevalence. Lower prevalence of oral pharyngeal cancer
    • Physical appearance: From American Indian to European characteristics
hispanics latinos key cultural points44
Hispanics/Latinos: Key Cultural Points
  • Illness Beliefs
    • Illness result of bad luck or God’s punishment. The causes of some illness are found outside the body. Powers of good and evil.
    • Illness prevented by proper diet, wearing amulets, use of candles, avoiding harmful people
    • May use combination of folk and Western Medicine
folk healers
Folk Healers
  • Use of Natural Healers / Curanderos / SpiritistsHarmful Magic: Evil-eye/Mal de ojo: Excessive admirationFright/Susto: Associated with a traumatic experienceEvil-hex/Mal Puesto: Motivated by jealousy or vengeanceGomez 1977
perception of health and education
Perception of Health and Education
  • Educated Latinos:
    • Healthy refers to “a state of complete physical, mental, and social well-being and not merely the absence of disease.”
          • World Health Organization
  • Less Educated Latinos:
    • Health has a religious perspective. Disease is seeing as a warning or punishment
      • God is the giver of all, including my health
hispanics latinos key cultural points48
Hispanics/Latinos: Key Cultural Points
  • High Risk Behaviors
    • Diet
    • Infants should “eat well”
        • “No come bien”
      • Bottle feeding at night
nutritional habits and acculturation
Nutritional habits and acculturation
  • The Latino/Hispanic diet is very diverse. But, in general the diet is low in vegetable fats and high in fiber content when compared with non-Latino whites diets
  • The less acculturated the Hispanic patient is, the more likely they are to eat fruits, rice, beans, meat, fried food and whole milk
  • More acculturated Latinos have diets that are a risk factor for obesity, diabetes and hypertension
          • Alcalay et al. 1999, Otero-Sabogal et al. 1995, Alcalay et al. 1992
hispanics latinos key cultural points50
Hispanics/Latinos: Key Cultural Points
  • Health Practices and Practitioners
    • Family care for young and old
    • Discuss health of family members
    • Respond well to individualized attention
hispanics latinos key cultural points51
Hispanics/Latinos: Key Cultural Points
  • Health Practices and Practitioners
    • Use of herbs to cure dental diseases
    • Clove – anesthetic properties
    • Honey – healing properties –soft tissue
    • Eruption of primary teeth linked to many diseases
    • Tooth “mouse”, not tooth fairy
what is a culturally competent dental professional
What is a culturally-competent dental professional?
  • A health care provider that understands: The beliefs, values, traditions and practices of a cultural group that influence oral health.
  • Their patients culturally-related needs, illness and health beliefs, health practices and approaches to seeking care.
suggestions for the dental team
Suggestions for the Dental Team
  • Determine your client’s language skills, health beliefs and behaviors, dietary preferences, and cultural remedies for illness
  • Attempt to make connections between cultural remedies and current standards of care
  • Translate context instead of just words
  • Examine current office hours
  • Provide patient material in appropriate language and educational level
  • Work with community health partners to increase the health of the community
  • Create community partnerships
things to avoid
Things to Avoid
  • Judgmental phrases
  • Imposing White Culture
  • Explaining minority issues via “lower on the evolutionary scale”
  • Stereotyping
health disparities
Health Disparities
  • Health disparities refer to gaps in the quality of health and health care across racial and ethnic groups.
  • The Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care."
healthy people 2010
Healthy People 2010
  • “To promote oral health and prevent oral diseases, oral health literacy among all groups is necessary. In addition, oral health services – preventive and restorative – should be available, accessible, and acceptable to all persons in the United States. In areas where different languages, culture, and health care beliefs would otherwise be barriers to care, a cadre of clinically and culturally competent providers must be available to provide care.”
      • CDC
barriers to health care access that are related to health disparities
Barriers to Health Care Access that are Related to Health Disparities
  • Lack of insurance coverage, language barriers, lack of cultural awareness, limited or no bilingual resources or staff, and little or no Spanish language literature
          • Oral Health In America: A report of the Surgeon General
          • THE INDIANA COMMISSION ON HISPANIC/LATINO AFFAIRS
what barriers to health care access can be decreased by culturally competent health professionals
What barriers to health care access can be decreased by culturally competent health professionals?
  • Lack of insurance coverage, language barriers, lack of cultural awareness, limited or no bilingual resources or staff, and little or no Spanish language literature
          • Oral Health In America: A report of the Surgeon General
          • THE INDIANA COMMISSION ON HISPANIC/LATINO AFFAIRS
health disparities59
Health Disparities

Dental Epidemiological Data

Home Page - NIDCR/CDC Dental, Oral and Craniofacial Data Resource Center (DRC)

samuel betances
Samuel Betances
  • “We cannot tell people to forget what they know. We cannot argue that it is better to know less rather than more.”
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