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 clinicians:
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...

Racial Distribution of US Population 2000

Asian
Afr-Am

Native Am.

Hispanic

Caucasian (72%)

Racial Distribution of US Population 2020

Caucasian

Are we keeping pace with these changes?

Interesting Factoids: The mixed ethnicity category is the fastest growing sub-population in the US.

Hispanics are the fastest growing specific ethnicity in the US (aside from mixed ethnicity).

Our societys growing diversity is not a problem (& its certainly not going away!) Its an opportunity for us all to gain from each others cultural wealth.

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

Diversity: US population vs. chiropractic patients (% Non-Caucasian)

General population (2000) DC patients (1974-82) DC patients (1997-98) 35-45% 4% 5%

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%

U.S. Chiropractors
1991 Female 13.3% Asia n 0.8 Hispanic 1.6 African American 0.5 Native Amer. 0.2 1998 19.2% 1.8 1.7 0.6 0.8
Gen. pop.

51% 4 13 12 1

Some keys to cultural competency:

Fight your fear of the unknown Learn about someone different Dont let time pressures rob you of patience and tolerance Ask questions, and LISTEN! Recognize that different does not = inferior. Let your heart lead; (your head just wouldnt understand!)

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, or to influence the behavior/attitudes of others. Be aware of your patients facial expressions!

Cultures, in the clinic...

Body language (examples, anyone?) Eye contact or no? Voice tone and vocal-ness Facial expressions Modesty RESPECT Your patients culture!

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

Cultures in the clinical setting.

The challenges The great communication divide Crossing the divide with grace The right match

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

Case Study: Hispanic Culture

Family over individual Respect for hierarchy Includes family in health decisions Patient may expect Dr. to wear a white coat, (and to perform miracles!) Provider, while respecting beliefs, may need to stress the importance of adhering to care plan

Belief in spirits, and the evil eye

WARNING!!!
Since every patient (of any ethnicity or faith) is an individual, NEVER assume anything about their beliefs. (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.

Different cultures and ethnicities have different health behaviors and health risks

US Health Disparities (Behavior): Reduced Physical Activity

Women Lower income/education African-Americans and Hispanics Older adults by age 75, 33% men, 50% women have no physical activity at all
Source: Healthy People 2010

US Health Disparities (Behavior): Smoking

Teens:
39% Caucasian 33% Hispanic 20% African American

Adults:
Highest in Native Amer, blue collar and military HS dropouts 3x rate of college grads

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; obese: BMI 30

Chronic Low Back Disability

(by race) Activity limitation, rate per 1000 adults: Asian 15 Hispanic 28 Caucasian 32 African American 36 Native American 68

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, rate per 1000 adults

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.

Disparities in Health Risk: Intentional Injury

Homicide 3rd COD ages 5-14 Homicide 2nd COD ages 15-24 Homicide rate for Afr. Am. aged 15-24 2x rate for Hispanics and 14x rate for Caucasians Suicide 3rd COD ages 15-24; Caucasians highest

OK, OK, I GET IT. There are differences between cultures!

So, what should I do?

Developing Cultural Competency in Yourself:

Turn pre-conceived notions into questions Use or develop empathy Tread lightly, and if you dont know, ask Express respect for the patients values/culture/faith Become familiar with your own attitudes about cultures/faiths. Do you stress assimilation or value maintenance of patients/students cultural traditions?

To gain information about a patients 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?

Read all about it.

Kiss, bow , or shake hands? (Morrison)
Cultural Health Assessment-Mosbys Pocket Guide (DAvanzo and Geissler)

Try not to be a cultural klutz.

Your patients will thank you!