Culturally and Linguistically Diverse Communities: Risks and Opportunities

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Culturally and LinguisticallyDiverse
Communities Risks and Opportunities

• NIFL/LINCS Regional Health Literacy Summit,
• Center for Literacy Studies
• Atlanta, GA
• March 5, 2008

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Faculty Presenter Disclosure

• No discussion of any drugs or medical devices
• No financial arrangement or other relationship
  with manufacturers of any commercial products

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Hablamos Juntos

• Practical, affordable solutions that eliminate
  language barriers and increase quality of care
  for Latino patients
• Increase availability of language
  services/interpreters
• Useful health-related materials
• Easy to use signage

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Presentation Objectives

• Explore risk associated with culture and language
  differences in patient-provider communication
• Describe promising practices for overcoming
  language barriers to provide patient-centered
  care
• Offer thoughts on health system level
  opportunities

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Why culture and language matter

• National Demographic Trends
• 91 ratio person (1950)
• 1.51 ratio under age 40 (2000)
• Today, nearly 50 of children under age 5 are
  children of color
• The portion of the U.S. population that speaks a
  language other than English increased more than 7
  million, in 5 years bringing the total to 52
  million, while the limited English speaking
  population increased by almost 4 million, to a
  total of 23 million (2005)

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California the bellwether state

• 1 of 4 Majority-minority states
• Nearly 1 in 3 (27.2) are foreign born
• 1 in 5 (20.2) report speaking English less than
  "very well" considered limited English proficient
  (LEP) (2006 American Community Survey)

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Yes Doctor lo que diga
Henry Ford Hospital 1932 Frida Kahlo
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Implications for clinical care

• Comprehension and behavior is influenced by
  cultural values and beliefs
• Language differences go beyond vocabulary and
  require more than interpreters
• Health literacy barriers include limited health
  knowledge and lack of familiarity with human
  anatomy

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Institute of Medicine Report

• Health Literacy A Prescription to End Confusion
  (2006)
• Ability to obtain, process, and understand
  basic health information and services needed to
  make appropriate decisions
• Confusion more likely in unfamiliar contexts
• A reflection of both the patient and the health
  care system (professional skills and processes)

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Communication a cornerstone of patient safety

• Communication problems are the leading root cause
  of accidental patient deaths and serious injuries
  among all patients reported by hospitals over the
  last decade (JCAHO 2005)
• Ineffective communications place patients at
  greater risk of preventable adverse events

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Communication Challenges

• Beyond language differences, the language we
  speak in health care is often not plain English
• Studies show the skills required to understand
  and use health care-related communications exceed
  the abilities of the average person Health
  Literacy A Prescription to End Confusion (2006)
• Disparities in health status/heath outcomes more
  frequent in populations with language barriers

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Opportunities for patient-centered care with
diverse patient populations
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Multilevel strategies are needed

• Building skills among patients, providers and
  health workforce in general
• Adapting health care systems and practices to
  enable personalize health care delivery
• Using incentives and rewards (e.g. pay for
  performance)
• Increasing public awareness and common vision
  about our multilingual, multicultural world

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Process of inquiry

• Culture is a product of lived experiences, it is
  important to understand the individual in context
  
• Health care is personal one reason why every
  health care encounter is a cross cultural
  experience
• Seek to discover - Communication approaches and
  strategies that emphasize the interaction
  process. Goal is Cross cultural efficacy with
  less emphasis on cultures per se (Ana Nunez 2000)

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Communication-based Approaches

• BATHE Model (psychological social context)
• CRASH Model (foundational values)
• ESFT Model (patients explanatory model)
• ETHNIC Model (patients explanatory model)
• Kleinmans Nine Questions
• LEARN Model (communication model)

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Communication Techniques

• Use plain language
• Use teach back and show back techniques to
  assess and ensure patient understanding
• Limit information provided to two or three
  important points at a time
• Use drawings, models or devices to demonstrate
  points
• Encourage patients to ask questions
• Employ a universal precautions approach to all
  patient encounters by using clear communications
  and plain language, and probing for understanding

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The significant problems we have cannot be solved
at the same level of thinking with which we
created them. Albert Enstein
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Mission, vision and values

• The politics and policies of the U.S. health
  industry and workplaces with systems, policies
  and practices great influenced by
  licensing/accreditation and revenue seeking
  strategies
• Change requires missions that embrace diverse
  populations, visions of accommodation and
  flexibility and values that place the patient
  first

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Growing multilingual capacity its about time

• US is the only developed country that is not
  growing multilingual capacity 3/4th of the
  world population is multilingual
• English as a Second language is an important
  investment
• Early language learning and basic health content
  can be twin goals

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Thank youFor more information...Yolanda
Partida, MSW, DPA, DirectorHablamos Juntos,
National Program OfficeUCSF Fresno Center for
Medical Education Research  yolanda_at_hablamosjun
tos.org
www.hablamosjuntos.org or www.wespeaktogether.org