CULTURALLY COMPETENT HEALTH CARE: WHAT DOES IT REALLY MEAN?

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1 CULTURALLY COMPETENT HEALTH CARE: WHAT DOES IT REALLY MEAN? KATHERINE LIESENER, PHD, LAT, ATC CONCORDIA UNIVERSITY WISCONSIN 2018 WISCONSIN ATHLETIC TRAINERS ASSOCIATION ANNUAL MEETING AND SYMPOSIUM

2 DISCLOSURES The speaker has no conflict of interest The content of this presentation and views expressed are my own, except where cited The content of this presentation and views expressed are not the views of the Wisconsin Athletic Trainers Association or Concordia University Wisconsin The participants should use this information at their own discretion

3 CURRENT NATA COMPETENCIES Foundational Behaviors of Professional Practice: Cultural Competence Demonstrate awareness of the impact that clients /patients cultural differences have on their attitudes and behaviors toward healthcare Demonstrate knowledge, attitudes, behaviors, and skills necessary to achieve optimal health outcomes for diverse patient populations Work respectfully and effectively with diverse populations and in a diverse work environment PS-4: Summarize and demonstrate the basic processes of effective interpersonal and cross-cultural communication as it relates to interactions with patients and others involved in the healthcare of the patient PS-5: Summarize contemporary theory regarding educating patients of all ages and cultural backgrounds to effect behavioral change PS-10: Explain the impact of sociocultural issues that influence the nature and quality of healthcare received (eg, cultural competence, access to appropriate healthcare providers, uninsured/underinsured patients, insurance) and formulate and implement strategies to maximize client/patient outcomes (NATIONAL ATHLETIC TRAINERS ASSOCIATION, 2011)

4 2020 CAATE STANDARDS Standard 56: Advocate for the health needs of clients, patients, communities, and populations Standard 57: Identify health care delivery strategies that account for health literacy and a variety of social determinants of health Social determinants of health defined: The conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. (COMMISSION ON ACCREDITATION OF ATHLETIC TRAINING EDUCATION, 2018)

5 WHAT IS CULTURALLY COMPETENT HEALTH CARE? Involves being responsive and sensitive to all cultural and sociocultural differences present in the population, when providing medical care In a manner that respects the worth of the individual and preserves their dignity (CHIN, 2000; HOBGOOD ET AL., 2006; ROSE, 2013)

illness assessment The management process Providing culturally competent health care will likely: Account for various influences on healthcare

6 WHY IS PROVIDING CULTURALLY COMPETENT HEALTH CARE IMPORTANT? 3 cultures present A patient s culture or cultural identity will influence: Their perception of care Compliance Communication The injury or illness assessment The management process Providing culturally competent health care will likely: Account for various influences on healthcare Provide holistic care Decrease health disparities Provide better patient outcomes (BJARNASON ET AL., 2009; BLACK & PURNELL, 2002; CAMPINHA-BACOTE, 1999; FORD, 2003; HOBGOOD ET AL., 2006; MARRA ET AL., 2010; ROBINS ET AL., 1998; ROSE, 2013)

7 DISCLAIMER! There s not a single method Every patient encounter is different It s not just about race & ethnicity This session will not provide a blueprint

8 DEVELOPMENTAL PROCESS Understand this approach Self-reflection Patient exploration Clinical application

APPROACH There is a tendency to discount the importance of cultural differences with statements such as: "We are all just human beings" "Color/culture doesn't matter "I am color-blind" Color/culture

9 APPROACH There is a tendency to discount the importance of cultural differences with statements such as: "We are all just human beings" "Color/culture doesn't matter "I am color-blind" Color/culture blindness, cultural insensitivity, & cultural incompetence Do not permit clinicians to see the facets that make up an individual Contribute to the injury manifestations or illness Affect the management of the condition Athletic trainers have to be willing to confront personal biases & stereotypes (FORD, 2003)

10 SELF-REFLECTION: WHAT IS YOUR CULTURAL IDENTITY? It is not a static entity Often created from experiences and/or attitudes about: Race & ethnicity Education, language, & literacy National origin & citizenship status Religion Age, gender, & sexual orientation Employment & socioeconomic status Disability / ability Diet & nutrition Beliefs, thoughts, customs, & rituals Styles of communication & manners Expected behaviors, courtesies, & actions Views on roles & relationships Values & attitudes Attitudes about illness & death Family traditions (BLACK & PURNELL, 2002; DUPRE & GOODGOLD, 2007; FORD, 2003; MAURER-STARKS ET AL., 2007; ROBINS ET AL., 1998)

11 SELF-REFLECTION: WHAT IS YOUR HEALTH CARE CULTURE? My general health is When I have the flu, I When I have a sore throat, I When I have a sore muscle, I When I have a headache, I When my back hurts, I When my tooth aches, I When I am sick, these are the medicines, foods, and treatments I normally seek: When I need to go to the doctor, I get there via: (car, bus, etc) (JENKS, 2011)

12 SELF-REFLECTION: ASSUMPTIONS & STEREOTYPING Culturally competent health-care practitioners understand that: Age, education, or individual personality can determine how culture is expressed An individual might identify with multiple cultures There is diversity within racial & cultural groups (BLACK & PURNELL, 2002; DUPRE & GOODGOLD, 2007; FORD, 2003; ROBINS ET AL., 1998)

13 ASSUMPTIONS & STEREOTYPING ACTIVITY QUICK FIRE AD LIB Men are Women are Wealthy people are Poor people are Catholics are Atheists are Single moms are Single dads are Dual parent homes are Homosexuals are Heterosexuals are (RODRIGUEZ & ROMANELLO, 2008)

14 PATIENT EXPLORATION: INDIVIDUAL PATIENT What is my patient s cultural identity and health care culture? Talk to the patient Include cultural questions during the evaluation Include purposeful questions & conversations during the treatment & rehabilitation sessions Add in health care related features like perception of health & access to appropriate care

15 PATIENT EXPLORATION: GROUP OF PATIENTS What if a large percentage of my patients are from a certain cultural group? Be careful with knowledge acquisition & application Research the culture Become familiar with common healing systems and beliefs Community involvement Speak to community leaders or representatives Consult with other clinicians

16 PATIENT EXPLORATION: MAJOR AREAS TO CONSIDER Age (influences) Gender & sexual orientation (issues) Employment (flexible, consistent, multiple, restrictive, none) Education (health / health care implications) Literacy (literate, moderately literate, illiterate) Language (barriers, interpreters) Socioeconomic Status (health / health care implications) Citizenship Status (full, new, restrictive/visa, none) Culture (barriers, clashes) Religion (health / health care implications) Insurance ( good, restrictive, expensive, none) Access to Appropriate Care (full, limited, none) Social Stressors & Support (health / health care implications)

17 CLINICAL APPLICATION OVERVIEW Create a safe, comfortable environment Approach each patient as a unique individual Seek the patient s point of view through cultural discussions Respect & embrace differences Respond with sensitivity & reassure the patient Ask about and try to understand barriers to care and compliance Healthcare providers cannot SOLVE all factors, but can assist in improving negative ones Advocate for the patient Adjust treatments accordingly Integrate cultural systems & beliefs into the management plan EXPERIENCE

CLINICAL APPLICATION: CREATE A SAFE, COMFORTABLE ENVIRONMENT Starts with the Intake / History Phrase questions in a manner that is not leading and/or Western orientated How would you like me to

18 CLINICAL APPLICATION: CREATE A SAFE, COMFORTABLE ENVIRONMENT Starts with the Intake / History Phrase questions in a manner that is not leading and/or Western orientated How would you like me to address you? What brings you in today? Can you describe your { }? What do you believe is the cause of this { }? What do you most fear about this { }? What kind of treatment makes this { } feel better? What kind of treatment do you think you should receive? What expectations do you have of me? Is there anything else you would like me to know about you or your { }? What times of the day work the best for you?

CLINICAL APPLICATION: STRATEGIES TO ADDRESS LITERACY & LANGUAGE BARRIERS Literacy barriers Easily understood written materials Oral translation of written materials Language barriers Have strategies

19 CLINICAL APPLICATION: STRATEGIES TO ADDRESS LITERACY & LANGUAGE BARRIERS Literacy barriers Easily understood written materials Oral translation of written materials Language barriers Have strategies in place to address language barriers Have a network of interpreters Must demonstrate bilingual medical proficiency Parental written communication & injury-education materials (U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES, 2017).

20 REFERENCES Bjarnason, D., Mick, J., Thompson, J. A., & Cloyd, E. (2009). Perspectives on transcultural care. The Nursing Clinics of North America, 44(4), Black, J. D., & Purnell, L. D. (2002). Cultural competence for the physical therapy professional. Journal of Physical Therapy Education, 16(1), Campinha-Bacote, J. (1999). A model and instrument for addressing cultural competence in health care. Journal of Nursing Education, 38(5), Chin, J. L. (2000). Culturally competent health care. Public Health Reports, 115(1), Commission on Accreditation of Athletic Training Education. (2018). Standards for the Accreditation of Professional Athletic Training Programs, Master s Degree Programs. Retrieved from Dupre, A., & Goodgold, S. (2007). Development of physical therapy student cultural competency through international community service. Journal of Cultural Diversity, 14(3), Ford, M. G. (2003). Working toward cultural competence in athletic training. Athletic Therapy Today, 8(3), 60. Hobgood, C., Sawning, S., Bowen, J., & Savage, K. (2006). Teaching culturally appropriate care: A review of educational models and methods. Academic Emergency Medicine, 13(12), Jenks, A. (2011). From 'lists of traits' to 'open-mindedness': Emerging issues in cultural competence education. Culture, Medicine & Psychiatry, 35(2), Marra, J., Covassin, T., Shingles, R. R., Canady, R. B., & Mackowiak, T. (2010). Assessment of certified athletic trainers' levels of cultural competence in the delivery of health care. Journal of Athletic Training, 45(4), Maurer-Starks, S., Whalen, S., & Halls, C. (2007). America's melting pot-- the need for cultural competence. Athletic Therapy Today, 12(4), 8-9. National Athletic Trainers Association. (2011). Athletic training education competencies (5th ed.). Dallas, TX. Robins, L. S., Fantone, J. C., Hermann, J., Alexander, G. L., & Zweifler, A. J. (1998). Improving cultural awareness and sensitivity training in medical school. Academic Medicine, 73, S31-S34. Rodriguez, M., & Romanello, M. L. (2008). Promoting multiculturalism in athletic training education. Athletic Therapy Today, 13(3), Rose, P. R. (2013). Cultural Competency for the Health Professional. Burlington, MA: Jones & Bartlett Learning U.S. Department of Health & Human Services. (2017). National standards on culturally and linguistically appropriate services (CLAS). Retrieved from

PROVIDER & PATIENT. Communication Guide CULTURAL COMPETENCY COALITION. QB C3 Provider and Patient Communication Guide Document Date: 05/27/2016

PROVIDER & PATIENT. Communication Guide CULTURAL COMPETENCY COALITION. QB C3 Provider and Patient Communication Guide Document Date: 05/27/2016 QB 2021 - C3 Provider and Patient Communication Guide Document Date: 05/27/2016 PROVIDER & PATIENT Communication Guide CULTURAL COMPETENCY COALITION All health care organizations that receive federal funds