Culturally Competent Diabetes Outreach Strategies for Latino Communities

2. El Poder Sin Ver: Ability Without Sight Initiatives to reach Latino People with low vision

3. Presented By: • Adama Dyoniziak, MPH, CPH Director of Strategic Programs, Braille Institute, Los Angeles • Lynn Dubinsky, MA Adult Programs Manager, Braille Institute, Santa Barbara • Rosie Rascon, BS Independent Living Skills Instructor, Braille Institute, San Diego

4. Learning Objectives • Learn steps to success in working with the visually impaired Latino population in urban, suburban, and rural areas • Gain cultural competencies with regards to working with the Latino population

5. Braille Institute Latino Initiative • Braille Institute is a private, non-profit organization whose mission is to eliminate barriers to a fulfilling life caused by blindness and severe sight loss • Strategic Plan: Focus new services to the underserved segments of the population, particularly the Latino communities using a public health model • Five centers in Southern California – each has its specific population and needs

6. California

7. Statistics: Diabetes • Diabetes 7th leading cause of death in general US population; 5th leading cause of death in Latino population, and leading cause of visionloss • US population 65 years+ expectedtoincrease 93% overthenext 3 decades; US Latino elderlypopulationwillincreaseby 555% (2001, HealthIssues in the Latino Community) • Estimatedprevalence of DiabeticRetinopathyforpeople 65+years in the US is 11% (2004, Archives of Opthalmology, Vol 122) • Total prevalence of diagnosed & undiagnosed diabetes amongMexicanAmericansis 23.9% (vs Whites 12%) • 7.8% of alladults in California have diabetes; 9.2% of Latino adults in California have diabetes (2010, UCLA Center forHealthPolicyResearch)

8. Collaborative Approaches • Partnership development builds infrastructure • Build trust…warm up the crowd…get commitments • One legitimate contact gets your foot in the door • Build momentum through a community outreach process • Consistent follow-up to maintain credibility & program viability

9. Urban Areas: East Los Angeles • Los Angeles’ Latino population increased 11% in the past decade • 48-97% geographically dense Latino enclaves • Los Angeles has the largest number of people with diabetes in California: 642,000 residents

10. Urban Areas: East Los Angeles • Partners: Vision y Compromiso, American Diabetes Association • Contracts: AltaMed Health Care Services, Harder+Co Community Research, RL Public Relations • Clinics, evaluation, public education campaign

11. Instituto Braille website

12. Promotoras, or Health Promoters • Grass roots health educators used in Latino countries for a myriad of health and community interventions • Add a personal and informal style to health care • Bridge the gap between providers and the community

13. Promotoras in Action

14. Promotoras • known grass roots leaders in their communities • majority are members of the target population • culturally competent: language, customs, understand and live the values of the community they serve • trained to facilitate individual, family or small group health education • work in a multidisciplinary approach

15. El Poder Sin Ver In Action

16. Suburban, Urban, & Rural Areas: California South Central Coast

17. Suburban, Urban, & Rural Areas: California South Central Coast • Santa Barbara (43.4%), Ventura (40.9%), & San Luis Obispo (21.3%) Counties (2010 Census) • Sansum Diabetes Research Institute • La Casa de la Raza: Latino Community Center • Neighborhood clinics & farmers’ markets

18. Sansum Diabetes Research Institute

19. La Casa de la Raza

20. Suburban & Urban Areas- San Diego • 113,000+ San Diegans have diabetes; over half are Latino (National Diabetes Stats) • 28.8% (376,000) of San Diegans are Latino (City-data.com)

21. Suburban & Urban Areas: San Diego • Partners: La Maestra Clinic, Family Health Centers • Gap in Diabetic education: eye component • Outcomes: retinal exam grant funding, systems change

22. Culturally Appropriate • Culture  is more than race  and  ethnicity • Socioeconomic status or class • Urban,  suburban,  or  rural  community • Religious traditions and beliefs • Parents’  level  of  education • Length  of  residency  in  the  US assimilation level • Language and traditions of their country of origin • Culturally appropriate means considering how all of these factors will affect participants’ experiences in the program or curriculum.

23. Culturally Sensitive • Culturally sensitive care targets the entire person not just his or her physical ailment • Recognize, understand, respect, and respond to the client’s cultural convictions. • Success requires patience, a willingness to listen carefully, and a respect for cultural diversity

24. Culturally Competent • Awareness of one's own cultural worldview • Personal Attitude towards cultural differences • Knowledge of different cultural practices and worldviews • Cross-cultural Skills • The culturally competent organization fosters a culture of openness and respect, and is committed to: • serving diverse clients, • hiring diverse staff, and • establishing programs that address the needs of different client populations.

25. Cultural Values • The Latino family is an interdependent and interactive kin network that allows for mutual and reciprocal help among its members • Some relevant values include: colectivismo, familismo, simpatía, respeto y confianza, machismo, presentismo, amistad

26. Colectivismo, or Collectivism • The emphasis is on the needs, objectives, and points of view of the group vs the individual • Interdependence within a group has higher priority than independence of the individual

27. Colectivismo, or Collectivism

28. Familismo, or Familialism • This value fosters strong identification with and attachment to the nuclear and extended families and feelings of loyalty, reciprocity, and solidarity among family members • Value facilitates a natural network of support and a structure for sharing successes and failures

29. Familialism

30. Simpatía, or Avoiding Conflict • This value stresses the importance of avoiding conflicts and promoting behaviors that foster pleasant social interactions • People may agree to participate in workshops and never attend because initially saying no would create a conflict • Participants want to comply with provider suggestions so they will agree with a provider - but the suggestions may not be compatible with what the participant believes or what they are able to do • Providers who form relationships with participants need to converse about topics important to participants, although this may be unrelated to the services

31. Simpatía • Participating in non-traditional activities ie., Zumba, eating Three Kings Bread • No shows for workshops or events

32. Respeto (Respect) y Confianza (Trust) • Latinos are high power-distance individuals in that they value conformity and obedience and support authoritarian attitudes • These individuals include those with more education and greater wealth, or greater experience • The cultural tendency to encourage respect for authority and to discourage disagreement is even more pronounced if a provider is perceived as more powerful

33. Respect and Trust • Instructors or other professionals are referred to as Doctora or Maestra • Can lead to fear of authority, especially institutes or governmental-like organizations

34. Machismo, or Gender Roles • Traditionally, Latino men are more dominant and are more likely to assume financial responsibility for elderly parents, and other family members • Latino women are expected to be submissive, passive, selfless and home centered and are more likely to assume caretaking roles for the extended family

35. Machismo • Males are less likely to ask for help • Latino men may avoid “learning” activities if they perceive it as threatening their control or dignity, or indicates that they have flaws or weaknesses.

36. Presentismo, or Time Orientation • Future oriented: planning, delayed gratification, punctuality, efficiency • Present oriented: less able to delay gratification, less able to plan for the future, place less emphasis on punctuality and efficiency • Latinos are more likely to be present oriented, valuing the quality of their interpersonal relationships rather than the length of time of an interaction • Latinos may be dissatisfied with the inflexibility and rigidity of time devoted to issues based on efficiency; providers may be frustrated with the inability to provide a complete service because of less planning by the participant

37. Time Orientation • Being late as rude vs handling practical matters • Have a time cushion • Take time to warm up the group

38. Amistad or Social Warmth • Latinos need less physical space when interacting socially, and is a sign of being demonstrative and responsive with the person you are interacting • Latinos may view providers of other ethnic groups as impersonal or distant when they need more space; while non-Latinos may view Latinos as emotional or too personal in a professional setting

39. Social Warmth • When teaching a class, students often socially embrace the instructor or offer food

40. In Conclusion • Your agency cannot be “outside” the community trying to get “in” and provide services. • Be a legitimate part of the community with people and organizations being aware, taking part in, and referring to your services. • Be integral to the community’s success because they are integral to your success.

41. For More Information • 1-800-BRAILLE (1-800-272-4553) Monday - Friday, 8:30am - 5 pm • access our website http://www.brailleinstitute.org • Se hablaespañol