Cultural Competence in Healthcare

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Cultural Competence in Healthcare

• Fern R. Hauck, MD, MS
• Department of Family Medicine
• University of Virginia Health System

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• I dont think one can ever really know any but
  ones own countrymen. For men and women are not
  only themselves they are also the region in
  which they were born, the city apartment or farm
  in which they learned to walk, the games they
  played as children, the old wives tales they
  overheard, the food they ate, the schools they
  attended, the sports they followed, the poets
  they read, the god they believed in. It is all of
  these things that have made them what they are
  and these are the things that you cannot come to
  know by hearsay you can only know them if you
  have lived them.

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• It is all of these things that have made them
  what they are and these are the things that you
  cannot come to know by hearsay you can only know
  them if you have lived them.
• Somerset Maughan, The Razors Edge
  (Introduction), 1944.

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Definition of Cultural Competence

• The knowledge and interpersonal skills that
  allow providers to understand, appreciate, and
  work with individuals from cultures other than
  their own. It involves an awareness and
  acceptance of cultural differences
  self-awareness knowledge of the patients
  culture and adaptation of skills.
• AMA, Culturally Competent Health Care for
  Adolescents, 1994.

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Culturally Competent Healthcare Systems

• Interpreters or bilingual providers
• Cultural diversity training for staff
• Linguistically and culturally appropriate health
  education and information materials
• Tailored healthcare settings
• Task Force on Community Preventive Services, 2002.

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Comparisons of Cultural Norms and Values
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Comparisons of Cultural Norms and Values (
continued)
Gardenswartz L, Rowe A. Managing Diversity A
Complete Desk Reference and Planning Guide, 1993.
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Commonwealth Fund 2001 Healthcare Quality Survey

• 6,772 adults surveyed
• Communication problems reported more commonly for
  African Americans (Af A), Hispanics (H) and Asian
  Americans (As A)
• H and Af A adults highest uninsured rates
• H and As A patients had greatest difficulty
  understanding information from doctor
• Less than one half of limited English proficient
  patients always or usually had interpreters
• Af A, H, and As A more often felt that they had
  been treated disrespectfully or with little
  understanding of their culture

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Commonwealth Fund 2001 Healthcare Quality Survey
(www.cmwf.org)

• Three main factors in ensuring that minority
  populations receive optimal medical care
• Effective patient-physician communication
• Overcoming linguistic and cultural barriers
• Access to affordable health insurance
• Policy implications
• Financing interpreters (few states only)
• Training of clinicians and medical students in
  communicating and interacting effectively with
  patients from different cultures
• Expanding health coverage and access to all

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Promoting Cultural Diversity and Cultural
CompetencySelf-Assessment Checklist
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Ethnic Mnemonic

• E Explanation
• T Treatment
• H Healers
• N Negotiation
• I Intervention
• C Collaboration and Communication
• Developed by Steven J. Levin, MD Robert C.
  Like, MD Jan E. Gottlieb, MD. Department of
  Family Medicine, UMDNJ-Robert Wood Johnson
  Medical School.

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Ethnic Mnemonic E

• E Explanation
• What do you think may be the reason you have
  these symptoms?
• What do friends, family, others say about these
  symptoms?
• Do you know anyone else who has had or who has
  this kind of problem?
• Have you heard about/read/seen it on
  TV/radio/newspaper? (If patient cannot offer
  explanation, ask what most concerns them about
  their problem).

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Ethnic Mnemonic T

• T Treatment
• What kinds of medicines, home remedies or other
  treatments have you tried for this illness?
• Is there anything you eat, drink, or do (or
  avoid) on a regular basis to stay healthy? Tell
  me about it.
• What kind of treatment are you seeking from me?

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Ethnic Mnemonic H

• H Healers
• Have you sought any advice from alternative/folk
  healers, friends or other people (non-doctors)
  for help with your problems? Tell me about it.

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Ethnic Mnemonic N

• N Negotiation
• Negotiate options that will be mutually
  acceptable to you and your patient and that do
  not contradict, but rather incorporate your
  patients beliefs.
• Ask what are the most important results your
  patient hopes to achieve from this intervention.

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Ethnic Mnemonic I

• I Intervention
• Determine an intervention with your patient. May
  include incorporation of alternative treatments,
  spirituality, and healers as well as other
  cultural practices (e.g. foods eaten or avoided
  in general, and when sick).

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Ethnic Mnemonic C

• C Collaboration and Communication
• Collaborate with the patient, family members,
  other health care team members, healers and
  community resources.
• Effectively use interpreters in encounters with
  patients with limited English proficiency.

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International Family Medicine Clinic
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International Family Medicine ClinicGoals

• Provide comprehensive, high quality, culturally
  competent care to the growing population of
  limited English proficiency (LEP) patients
• Develop systems to more efficiently care for
  patients, including better communication with
  community partners and standardized screening and
  evaluation
• Become a resource for the medical center and
  others who serve LEP patients
• Document, evaluate and advocate

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Current Clinic Structure

• 5 half-day sessions
• 3 clinicians
• Interpreters
• New refugee patients
• scheduled after Health
• Department Screening
• Special forms, cultural profiles, and database
• Mental health referral to Family Stress Clinic
  (bilingual, volunteer counselors)
• International Health Intern

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Common Health Issues

• Full range of acute and chronic illnesses
• Infectious diseases
• Skin rashes
• Dental disease
• Need for eye exams and glasses
• Children developmental issues
• Anemia/nutritional deficiencies
• Preventive care, e.g., Pap smears, mammograms for
  women

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Common Health Issues (2)

• Depression, anxiety, PTSD
• Medically unexplained symptoms (e.g., backaches,
  headaches, abdominal pain)
• Culturally-based syndromes

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Community Partners Patients Served
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Community Outreach Collaboration

• ESL program/health literacy presentations and
  role plays
• Health fairs

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UVa Refugee and Immigrant Health Advisory Board
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Patient Demonstration Part 2

• All art courtesy of www.art.com