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Cultural Competency

Lisa Z. Killinger, DC Palmer College Diagnosis/Research

What is “cultural competency”?

What is “cultural competency”?
Set of skills, knowledge & attitudes related to a clinician’s:
 understanding and respect for patients‟ values, beliefs, expectations  awareness of his/her own assumptions and value system  ability to adapt care to be congruent with patients‟ expectations and preferences.

Definitions Ethnicity : self-defined group identity in  religion  nationality  culture Culture: shared beliefs & values affecting  social interactions  interpretation of experience Race: A biological concept (Cannot change) .

Examples of different cultures of chiropractic patients • Sex  male/female  sexual orientation • Age  children  adolescents  elderly • Income/education • Race/ethnicity • Religion .

WHY should DCs be “culturally competent”? • US population is increasingly culturally diverse • Different cultures have different health behavior and health risks • Doctor-patient communication and rapport are affected by cultural differences This affects outcomes! .

. .When we improve cultural competency. we... • “Reach” patients more effectively • Enhance the quality of the doctor/patient interaction • Improve patient compliance • Achieve better health outcomes!!  And… • We enrich ourselves..

Hispanic Caucasian (72%) .Racial Distribution of US Population 2000 Asian Afr-Am Native Am.

Racial Distribution of US Population 2020 Caucasian .

Are we keeping pace with these changes? .

Hispanics are the fastest growing specific ethnicity in the US (aside from mixed ethnicity). .Interesting Factoids: The “mixed ethnicity” category is the fastest growing sub-population in the US.

.Our society’s growing diversity is not a problem (& it’s certainly not going away!) It’s an opportunity for us all to gain from each other’s cultural wealth.

(and in practice) and how do WE become more “culturally competent”? . how does diversity affect us here at Palmer.So….

chiropractic patients (% Non-Caucasian) General population (2000) DC patients (1974-82) DC patients (1997-98) 35-45% 4% 5% .Diversity: US population vs.

Ethnic diversity in the US MD and DC workforce • • • • • % Non-Caucasian General population ~40% MDs 7% MD students (2000) 34% DCs 7% DC students (PCC 2002) 9% .

8 1.2% 1.U.6 African American 0. Chiropractors 1991 Female 13. 0.8 Hispanic 1.2 1998 19.7 0. 51% 4 13 12 1 .5 Native Amer.S.6 0. pop.8 Gen.3% Asia n 0.

(your head just wouldn‟t understand!) . • Let your heart lead. and LISTEN! • Recognize that different does not = inferior.Some keys to cultural competency: • Fight your fear of the unknown • Learn about someone different • Don‟t let time pressures rob you of patience and tolerance • Ask questions.

Cultural Communication Issues • Language (spoken and written)  Non-English speakers  Educational level  Acceptable topics • Voice  Loudness/pitch  Silence • Body language  personal space  touch  gestures/facial expressions  eye contact .

Hot Tip: An African American patient may make great use of facial expressions to show approval or disapproval. Be aware of your patient’s facial expressions! . or to influence the behavior/attitudes of others.

• • • • • • Body language (examples.. anyone?) Eye contact or no? Voice tone and vocal-ness Facial expressions Modesty RESPECT Your patient‟s culture! ..Cultures. in the clinic.

Asian. .Hot Tip: Arab. Such behavior does not reflect a lack of interest or respect. or Indo-Pakistani students (and others) may show respect for you by lowering their gaze (not making eye contact).

• • • • The challenges The great communication divide Crossing the divide with grace The right „match‟ .Cultures in the clinical setting….

arms.Hot Tip: A practicing Muslim or Orthodox Jewish female patient or student may be unwilling to be partnered with a male student/doctor. legs or torso due to the value placed in these faiths on modesty. . and may not wish to uncover her hair.

may need to stress the importance of adhering to care plan • Belief in spirits. to wear a white coat. and the evil eye . while respecting beliefs.Case Study: Hispanic Culture • Family over individual • Respect for hierarchy • Includes family in health decisions • Patient may expect Dr. (and to perform miracles!) • Provider.

.WARNING!!! • Since every patient (of any ethnicity or faith) is an individual. (See next slide) • Remember all minority persons are Bi-Cultural (at least!). They meld 2 or more value systems every day! • Identify strengths in your patient/students cultural orientation and build on them. NEVER assume anything about their beliefs.

Different cultures and ethnicities have different health behaviors and health risks .

33% men.US Health Disparities (Behavior): Reduced Physical Activity • • • • Women Lower income/education African-Americans and Hispanics Older adults  by age 75. 50% women have no physical activity at all Source: Healthy People 2010 .

blue collar and military  HS dropouts 3x rate of college grads .US Health Disparities (Behavior): Smoking • Teens:  39% Caucasian  33% Hispanic  20% African American • Adults:  Highest in Native Amer.

obese: BMI  30 .Health Disparities (Behavior): Overweight/obesity* • >60% of Americans are overweight/obese!! • Esp. low income women and teens • African American/Mexican American women have highest rates of obesity *overweight: BMI  25.

Chronic Low Back Disability (by race) • Activity limitation. rate per 1000 adults:  Asian 15  Hispanic 28  Caucasian 32  African American 36  Native American 68 .

rate per 1000 adults .Health Disparities: Chronic Low Back Disability by income and education 77 54 24 poor mid/high 35 hs hs drop grad 28 some coll Activity limitation.

Health Disparities: Diabetes 25 18% 16% 14% 8% 20 15 10 5 a g e s 50-59 0 Cauc. . Afr-Am Mex-Am Native Am.

aged 15-24 2x rate for Hispanics and 14x rate for Caucasians • Suicide 3rd COD ages 15-24. Caucasians highest .Disparities in Health Risk: Intentional Injury • Homicide 3rd COD ages 5-14 • Homicide 2nd COD ages 15-24 • Homicide rate for Afr. Am.

OK. what should I do? . I GET IT.OK. There are differences between cultures! So.

Do you stress assimilation or value maintenance of patient‟s/students cultural traditions? . ask Express respect for the patient‟s values/culture/faith • Become familiar with your own attitudes about cultures/faiths.Developing Cultural Competency in Yourself: • • • • Turn pre-conceived notions into questions Use or develop empathy Tread lightly. and if you don‟t know.

To gain information about a patient‟s health beliefs. ASK! • • • • What do you think caused your problem? Why do you think it started when it did? How severe do you think it is? What are the main problems this has caused for you? • What kind of care do YOU think you should receive? • What results do you hope to receive? .

bow . • Kiss. or shake hands? (Morrison) • Cultural Health Assessment-Mosby’s Pocket Guide (D’Avanzo and Geissler) .Read all about it….

Your patients will thank you! .Try not to be a cultural klutz.

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