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Health Systems – Access to Care and Cultural Competency
Tonetta Y. Scott, DrPH, MPHFlorida Department of HealthOffice of Minority Health
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Objectives
Define culture.Define and discuss culturally and
linguistically appropriate services.Understand how culturally competent
healthcare systems affect access to care.
Understand the principles of culturally competent health systems as it relates to HIV/AIDS services.
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The demographics of Florida are changing…
0.2
3.0
0.6
23.2
15.9
57.1
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Native Hawaiian andOther Pacific Islander
Asian
American Indian andAlaska Native
Hispanic / Latino
Black / AfricanAmerican
White
Percentage (%) of Florida's Total Population
U.S. Census Bureau, 2012
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Access to Care
Health insuranceDelayed or sacrificed careCommunicationPreventive careFamilies’ financial well-beingSocietal effects
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Culture
The integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated, wholly or partially, with racial, ethnic, or linguistic groups, as well as with religious, spiritual, biological, geographical, or sociological characteristics.
Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetime.
Think Cultural Health, 2013
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What do you see?
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What do you see?
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Cultural and Linguistic Competence
A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.
CulturalCompetency
CulturalSensitivity
Cultural Awareness
Cultural Knowledge
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Stages of Cultural Competency
Cultural Knowledge Familiarization with selected cultural characteristics,
history, values, belief systems, and behaviors of the members of another ethnic or cultural group.
Cultural Awareness Developing sensitivity and understanding of another
ethnic or cultural group. Involves internal changes in terms of attitudes and values.
Cultural Sensitivity Knowing that cultural differences as well as
similarities exist, without assigning values to those cultural differences.
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Levels of Cultural Competency
Destructiveness
Incapacity
Blindness
Pre-competence
Competence
Proficiency
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National CLAS Standards
Intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.
Adoption of these Standards will help advance better health and health care.
Think Cultural Health, 2013
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Health Care Systems
A well functioning health system responds in a balanced way to a population’s needs and expectations by: Improving the health status of individuals, families,
and communities. Defending the population against what threatens its
health. Protecting people against the financial consequences
of ill-health. Providing equitable access to people-centered care.
World Health Organization, 2010
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Culturally Competent Healthcare
A culturally diverse staff that reflects the community(ies) served.
Providers or translators who speak the clients’ language(s).
Training for providers about the culture and language of the people they serve.
Signage and instructional literature in the clients’ language(s) and consistent with their cultural norms.
Culturally specific healthcare settings.Anderson et al., 2003
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Cultural Competency and HIV/AIDS
National Minority AIDS Education and Training Center (NMAETC)BE SAFE – A Cultural Competency Model
African AmericansAmerican Indians, Alaska Natives, and Native
HawaiiansAsians and Pacific IslandersLatinos
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BE SAFE
Barriers to CareEthics
Sensitivity of the ProviderAssessmentFactsEncounters
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Becoming Culturally Competent
Addressing overt and covert barriers to care. Assessing their level of awareness and
sensitivity toward culturally diverse patients with HIV/AIDS.
Conducting a cultural assessment. Obtaining knowledge about this cultural
group. Maintaining effective clinical encounters.
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Cultural Competency Strategies
1. Provide interpreter services.
2. Recruit and retain minority staff.
3. Provide training to increase cultural awareness, knowledge, and skills.
4. Coordinate with traditional healers.
5. Use community health workers.
Center on an Aging Society, 2004
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Cultural Competency Strategies
6. Incorporate culture-specific attitudes and values in health promotion tools.
7. Include family and community members in health care decision making.
8. Locate clinics in geographic areas that are easily accessible for certain populations.
9. Expand hours of operation.10. Provide linguistic competency that extends
beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials.
Center on an Aging Society, 2004
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Outcomes of Health Systems Providing CLAS
Decrease in miscommunicationIncreased provider sensitivity to their
own beliefs and behaviorsIncreased ability of providers to
understand and treat a culturally diverse clientele with varied health beliefs and practices
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Outcomes of Health Systems Providing CLAS
Increased trust and confidence of clients in accessing health care.
Increased client satisfaction.Increased access to quality health care
services by diverse populationsIncreased adherence to treatment and
recommendations
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Conclusions
Providing culturally competent services has the potential to: Improve health outcomes. Increase the efficiency of staff.Result in greater client satisfaction with
services.
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Take Home Points
Strengthening of health systems through cultural and linguistic competence is a necessary prerequisite for improving the prevention of HIV infection and the care of HIV-infected persons.
Cultural competence is a journey – not a destination.A process of becoming competent, not
being culturally competent.
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Contact Information
Tonetta Y. Scott, DrPH, MPH
State Partnership Grant Program Manager
www.doh.state.fl.us/minority/SPG
850-245-4941
