Integrating Cultural Competence and Health Literacy into HIVMental Health Care

1
Integrating Cultural Competenceand Health
Literacy intoHIV/Mental Health Care

• Stephanie Le Melle, MD
• New York/New Jersey AETC
• New York State Psychiatric Institute
• Columbia University

2
Cultural Competence and Health Literacy in
HIV/Mental Health Care

• Assessment
• Treatment
• Adherence
• Dynamic Understanding
• Communication

3
Assessment

• Symptom vs Cultural Custom
• Intensity of affect
• Frequency of behavior
• Acceptance by others
• Diagnosis in Minority Groups
• Over diagnosis of schizophrenia / psychosis
• Over diagnosis of attention deficit
• hyperactivity disorder (ADHD)

4
Treatment

• Aggressiveness of treatment
• Males vs Females
• Minorities vs Non-Minorities
• Types of treatment
• Pills vs Liquid vs Patches vs Intra-muscular
• Metabolic response to treatment

5
Adherence

• How people feel about mental illness
• How people feel about HIV
• How people feel about substance abuse

6
Mental Illness

• Seen as a weakness or volitional
• Seen as a consequence of religious beliefs
• Seen as a consequence of witchcraft / spirits
• Seen as a family induced disorder
• Seen as a consequence of the environment
• Seen as a biological disorder

7
HIV

• Seen as a punishment for sexual activity
• Seen as a consequence of religion
• Seen as a consequence of witchcraft / spirits
• Seen as an infectious disease

8
Substance Abuse

• Similar issues
• Volitional
• Weakness
• Self induced

9
Dynamic Understanding

• Culture is layered
• How a patient identifies themselves
• How a patient is identified by their family
• How a patient is identified by their community
• How the patient is identified by society

10
How to be Culturally Competent

• Dont make assumptions
• Ask questions
• Get collateral information
• Assess all of the layers of culture

11
How to be Culturally Competent

• Questions
• When do you bring up cultural issues?
• Is it better for the clinician to share a common
  culture with the patient?
• Should clinicians disclose information about
  themselves?

12
How to Teach Health Literacyto Clients

• Use language the client understands (i.e., not
  technical)
• Assess clients understanding in every
  interaction
• Use a variety of approaches to assess and enhance
  clients health literacy
• Talk-back
• Rehearsal of scenarios
• Role-play and anticipate challenging
• situations

13
Cultural Competence and Health Literacy in
HIV/Mental Health Care

• Conclusion
• Health Care Workers must understand their own
  views about culture before they can help others
• Education about Cultural Competence should be
  available for staff and clients
• Health literacy of clients should be assessed and
  enhanced in every interaction