CULTURAL COMPETENCE : RACE AND ETHNICITY

NEREIDA CORREA, MD ASSISTANT PROFESSOR

OBS/GYN & FAMILY PRACTICE ALBERT EINSTEIN COLLEGE OF MEDICINE

JANUARY 24, 2001

CULTUREINTEGRATED PATTERN OF HUMAN BEHAVIORINFLUENCES THOUGHT, ACTIONS, CUSTOMS, BELIEFS AND VALUESRELATED TO ETHNIC, RACIAL RELIGIOUS OR SOCIAL GROUP

CULTURES IN THE BRONXWHITE -ALL ETHNIC GROUPSBLACK- ALL ETHNIC GROUPSASIAN - ALL ETHNIC GROUPSINDIAN- EAST AND WESTHISPANIC- MOST GROUPS

COMPETENCEACQUISITION OF KNOWLEDGEDEVELOPMENT OF SKILLSEXPERIENCEAPPLIED TOWARDS INTERVENTIONS ADAPTIVE TO THE DIFFERENT GROUPS SERVED

CULTURAL COMPETENCECONGRUENT BEHAVIORS, ATTITUDES AND POLICIESCOME TOGETHER TO WORK EFFECTIVELY IN CROSS CULTURAL SITUATIONSSERVICES PERCEIVED AS RELEVANT AND HELPFUL

DIVERSITY TRAININGACCEPTANCE AND TOLERANCELOWERS PREJUDICEDEVELOPS CULTURAL AWARENESS AND SENSITIVITYIS A BEGINNING TOWARDS SHOWING THE DIFFERENCES BUT DOES NOT GIVE TOOLS

COMPETENCY TRAININGPROMOTES SKILLS AND KNOWLEDGECONTENT BASEDDIFFICULT TO TEACHINDIVIDUALIZED TRAININGDEVELOPS PRACTICAL SKILLS

CULTURAL AWARENESSGENDERAGEETHNIC IDENTITYRACESOCIAL STATUSROLES

CULTURAL ASSESSMENTBIRTH PLACE AND ETHNICITYSUPPORT FAMILY MEMBERSLANGUAGES AND NONVERBALSRELIGION AND PRACTICESECONOMIC SITUATIONHEALTH/ILLNESS BELIEFSBIRTH/DEATH BELIEFS

COMMUNICATIONINTERPRETORSCONVERSATIONAL STYLEPERSONAL SPACEEYE CONTACTTOUCHTIME ORIENTATION

DIVERSITY ISSUESMIGRATION STATUSETHNICITY/RACIAL GROUPSOCIOECONOMIC STATUSSEXUAL ORIENTATIONDISABILITY

BELIEFSHEALTH AND WELLNESSBIRTHING PRACTICESUSE OF ALTERNATIVE SYSTEMSDEATH AND DYINGBEHAVIOR WITH HEALTH WORKERSRESPONSE TO HISTORY TAKING

NYC POPULATIONSBLACK AMERICAN 2.8 MPUERTO RICAN 1.O MRUSSIAN 455 KWEST INDIAN 452 KCHINESE 285 KEAST INDIAN 133 K

POPULATION UNDERCOUNTING

IMMIGRANT GROUPS GREATLY UNDERCOUNTEDSELF DESCRIPTION VS ASSIGNED GROUPSTATE NET UNDERCOUNTING : 272K ADULTS, 113 K CHILDREN IN ‘90BY GROUP: 1.9K WHITE, 186K BLACK, 136K HISPANIC, 23K ASIAN,

NYS UNDERCOUNTINGNET UNDERCOUNT 272,036NET CHILDREN 113,486WHITE 1,972BLACK 185,873HISPANIC 136,010ASIAN 22,760NATIVE AMERICAN 1,763

LEARNLISTEN WITH EMPATHYEXPLAIN YOUR PERCEPTIONACKNOWLEDGERECOMMEND TREATMENTNEGOTIATE TREATMENT

MODALITIES

DISPARITIESMATERNAL AND INFANT MORTALITYACCESS TO HEALTH CAREEMPLOYMENTEDUCATIONPREVALENCE OF DISEASES RELATED TO DIET AND EXERCISEHOMICIDE AND SUICIDE

HEALTH PROFILE ON MINORITIES

BREAST CANCER INCREASED 3.9% FOR BLACK WOMENTUBERCULOSIS INCREASED BY 51% FOR ASIAN AMERICANS AND 30% FOR HISPANICSAIDS/HIV DISEASE INCREASED FOR BLACKS, HISPANICS, ASIANS AND NATIVE AMERICANS

HEALTH PROFILEINFANT MORTALITY RELATIVE INCREASELIFE EXPECTANCY 6.6 YEARS LESSHEART ATTACK DEATH DECLINED 21% FOR BLACKS VS 29% FOR WHITESDEATH FROM HIV DECLINED 13-22% VS 32% FOR WHITES

HEALTH PROFILEHOMICIDE AND SPINAL CORD INJURY DOMESTIC VIOLENCEEXPOSURE OF CHILDREN TO DRUGSCIGARETTES AND ALCOHOLTEEN PREGNANCYSCHOOL FAILURE AND DROP-OUT

INTERVENTION STRATEGIES

INVOLVEMENT IN COMMUNITY GROUPSINVOLVEMENT IN LEADERSHIP OF PROFESSIONAL GROUPSMENTORING OF YOUTHPOLITICAL ACTIVISMRESEARCH

VIGNETTES

RACE AND ETHNICITY

PRACTICE VIGNETTES

PRACTICUM: RISKSStereotyping can occurOversimplification of true valuesMay be misinterpretedMay offend members of the group

PRACTICUM: BENEFITSIncreases awareness of behaviorInculcates sensitivityPromotes understanding between groupsDevelops strategies in practitioners that will help them to give care to diverse populations

OBJECTIVESDemonstrate by illustration how culture impacts on the physician-patient interactionProvide examples of various ethnic groups in the Bronx and some common beliefs with in the cultureExplore the impact of a lack of understanding on the therapeutic relationship

ETHNIC GROUPSAfrican-AmericanArab HaitianMexicanPuerto RicanVietnameseWest Indian

AFRICAN-AMERICANA 14 year old teenage boy is brought in for a routine physical exam His mother wants routine exams done and is concerned about school performance

Beliefs: Strong family links; demanding of respectIssues around gender identity, expected roles and independence

AFRICAN-AMERICANAssess developmental level and institute age appropriate counseling regarding safety issues, sex and pregnancy prevention, career issuesProvide flexible access for questionsAppreciate gestures such as lack of eye contact and looking down related to respect

ARABA 24 year old woman pregnant for the first timeVisit with her husbandEstablishing plans for her care

BeliefsConcernsOutcomes

ARABBeliefs: Birth is a natural process

Modesty to be conserved-privacy, veilsHusband, father, brother make decisionsChildren are sacred

ARABSConcerns:

Usually requesting female providerMale family member to be involved in decision makingPrefer natural delivery, will accept pain medicationPrayer time essential for strict MoslemsAmulets: blue stone to ward off evil eye

ARABPrenatal care with female providersDelivery plan made with negotiations regarding the need for some male practitionersActual delivery with husband present-involved in decisionsPatient wore veils and robes when in halls

PUERTO RICANCouple seen for evaluation of infertilityPartner has one child from previous marriageSuspicion is male factor infertility

Beliefs: Male sexual productivity is indication of masculinityConcerns: Inability to impregnate partner can be interpreted as lossOutcomes

PUERTO RICANAssurance of language competence and use of translator if needed, not family memberPresentation of data on infertility and the facts related to male factorReassurance that there is no correlation with sexual performancePrivacy

VIETNAMESEA 5 year old girl brought in for fever and a coldBruising noted on chest wall in reddish streaksSeveral cup marks seen on her back

Beliefs: Hot and cold theory of medicine and use of alternative medicines; illness related to sins of past lifeConcerns: Distinguish injury to child

VIETNAMESEAssurance of language competency; use of translator unless fluent in EnglishHistory taking to include beliefs and practices in an open-ended wayNegotiate plan to include parental belief to improve complianceHelp family to deal with guilt at illness

HAITIANA 50 Year old man diagnosed with cancer of the stomachHas experience gradual illness and now is dying

Beliefs:Illness a continuum

Kompa bonMoin maladmoin malad anpilmoin pap refebon die vs loa

HAITIANAssurance of language competencyDiscuss beliefs about illness and death; believer in spiritualism, or catholic or bothAllow space for as much family as possibleFinal bath given by family memberPrefer to die at home

WEST INDIAN35 Year old woman with new diagnosis of hypertensionSees herself as healthy, has no painTold to avoid salt and fatty foods in diet

Beliefs: Diet with strong broths and organ meats will build up the bodyFatigue and pain are symptoms of diseaseHot and cold foods

WEST INDIANNutritional interventions with cultural beliefs in mind; hot and cold combinations and restrictionsDiscussions regarding asymptomatic nature of her diagnosis and the need for preventive interventionsRegard for issues of respect, eye contact and touching

MEXICANA 15 year old girl brought in by her mother for amenorrheaHistory of recent arrival to cityConcerns regarding pregnancy

Beliefs: Family loyalty, concerns regarding respect, family reputationCuranderos:Maladies such as mal de ojo, susto. Empacho, caida de mollera, antojos

MEXICANAssurance of language competencyIncluding mother in the interviewSpeaking to the teenager aloneExploring cultural beliefs and issuesProviding interventions and bridging cultural gap

UNIFYING PRINCIPLESDiversity vs. SimilarityLanguage competency essentialRespectful InquisitivenessNegotiation to improve complianceNon-verbal communication is universal