Word Association

Word AssociationWord Association

What Do All Of The What Do All Of The Following Words Have In Following Words Have In

Common?Common?

Word Association Word Association ContinuedContinued

Commission Corp OfficersCommission Corp OfficersFederal StaffFederal StaffCivilian PersonnelCivilian PersonnelTribal StaffTribal Staff

The Common Association The Common Association Between All Of The Personal Between All Of The Personal

IsIs Healthier Nation Healthier Nation

In the United States, In the United States, Immigrant Health Is A Immigrant Health Is A

Challenge That all health care Challenge That all health care providers Face.providers Face.

As Medical Doctors, Nurse As Medical Doctors, Nurse Practitioners, Physician Practitioners, Physician

Assistants, Nurses… We All Assistants, Nurses… We All Must Work TowardsMust Work Towards

Reaching Immigrant Reaching Immigrant Populations Populations

on Health Promotion and on Health Promotion and Disease PreventionDisease Prevention

LCDR Linda Egwim, DNP, ANP-LCDR Linda Egwim, DNP, ANP-BC, GNP-BCBC, GNP-BC

USPHS COF 2011USPHS COF 2011

Learning ObjectivesLearning Objectives

At the end of the presentation, At the end of the presentation, participants will be able to:participants will be able to:

1.1. Identify 2 modifiable immigrants’ barriers to Identify 2 modifiable immigrants’ barriers to HPDPHPDP

2.2. Describe cultural myths & beliefs that hinder Describe cultural myths & beliefs that hinder immigrants’ participation in HPDPimmigrants’ participation in HPDP

3.3. Utilize knowledge gained to individualize patient Utilize knowledge gained to individualize patient care planscare plans

4.4. Increase cultural sensitivity as it relates to Increase cultural sensitivity as it relates to immigrant patient populationimmigrant patient population

Introduction/Case presentationIntroduction/Case presentation An elderly Nigerian female presented to the clinic for a follow-up An elderly Nigerian female presented to the clinic for a follow-up

with her primary care provider for hypertension management. The with her primary care provider for hypertension management. The patient was in the company of her daughter who acted as the patient was in the company of her daughter who acted as the interpreter. During the clinic encounter, the physician asked the interpreter. During the clinic encounter, the physician asked the patient, as part of routine health maintenance, when she had her patient, as part of routine health maintenance, when she had her last well-woman exam. The patient looked at the physician last well-woman exam. The patient looked at the physician bewildered, and to the daughter for interpretation. The physician bewildered, and to the daughter for interpretation. The physician further attempted to clarify by asking specifically, when the further attempted to clarify by asking specifically, when the patient’s last mammogram was completed. Again, the patient patient’s last mammogram was completed. Again, the patient could not understand the term mammogram, due to lack of could not understand the term mammogram, due to lack of familiarity with the terminology. The physician explained that it familiarity with the terminology. The physician explained that it was a breast-screening exam used for early detection of breast was a breast-screening exam used for early detection of breast cancer. The daughter, who understood the cultural conflict with cancer. The daughter, who understood the cultural conflict with mammograms, was at a loss for words to explain to the patient. mammograms, was at a loss for words to explain to the patient. Surprisingly, the patient heard and understood breast cancer. She Surprisingly, the patient heard and understood breast cancer. She jumped down from the exam table in a hospital robe and forbade jumped down from the exam table in a hospital robe and forbade the physician from making such a statement. She walked out of the physician from making such a statement. She walked out of the clinic and swore never to return to that physician. the clinic and swore never to return to that physician.

EvidenceEvidence

Studies identified the growing increase in the Studies identified the growing increase in the immigrant population in the US, and Minnesota is immigrant population in the US, and Minnesota is home to the largest immigrant refugee population home to the largest immigrant refugee population from African countries (U.S. Census Bureau, from African countries (U.S. Census Bureau, 2007). 2007).

Studies have identified evidence of the disparities Studies have identified evidence of the disparities in health and access to health services among in health and access to health services among ethnocultural minorities in the United States and ethnocultural minorities in the United States and Canada (Dunlop, Coyte, & Melsaac, 2002; Canada (Dunlop, Coyte, & Melsaac, 2002; Groeneveld, Laufer, & Garber, 2005; Moy, Dayton, Groeneveld, Laufer, & Garber, 2005; Moy, Dayton, & Clancy, 2005; Williams, 2005). & Clancy, 2005; Williams, 2005).

EvidenceEvidence

Minority elders in the United States tend to face Minority elders in the United States tend to face more barriers than the general older adult more barriers than the general older adult population and report a lower level of use of population and report a lower level of use of services designed for aging adults than the services designed for aging adults than the general population (Woodruff, 1995).general population (Woodruff, 1995).

Needs AssessmentNeeds Assessment Healthy people 2020, nation’s goals and objectives for Healthy people 2020, nation’s goals and objectives for

health promotion and disease preventionhealth promotion and disease prevention

USPHS Mission to protect, promote, and advance the USPHS Mission to protect, promote, and advance the health and safety of our nation.health and safety of our nation.

Immigrant community and familiesImmigrant community and families

Healthcare providers that serve the immigrantsHealthcare providers that serve the immigrants

Literature reviewLiterature review

scopescope

This presentation is about increasing This presentation is about increasing participation of immigrants on HPDP participation of immigrants on HPDP measures, which include basic physical measures, which include basic physical activity, healthy food choices, age activity, healthy food choices, age appropriate screening, and appropriate screening, and immunization, through health education immunization, through health education on the benefits of HPDP. Also, on the benefits of HPDP. Also, collaborate with healthcare providers collaborate with healthcare providers and PHS Officers who serve immigrants and PHS Officers who serve immigrants to promote participation in HPDP to promote participation in HPDP measures. measures.

Goal Goal

To increase Immigrants’ participation To increase Immigrants’ participation in the recommended age appropriate in the recommended age appropriate HPDP through health education on HPDP through health education on the benefits of HPDP while remaining the benefits of HPDP while remaining culturally sensitive to their beliefs, culturally sensitive to their beliefs, values and norms.values and norms.

MethodologyMethodology

Develop a trusting working relationship Develop a trusting working relationship

Establish contact with interpreters familiar with Establish contact with interpreters familiar with the healthcare system and terminologythe healthcare system and terminology

Assess baseline level of understanding Assess baseline level of understanding

Cultural myths and beliefsCultural myths and beliefs

The belief that mentioning a terminal or deadly The belief that mentioning a terminal or deadly disease is forbidden. disease is forbidden.

The mere mention of a disease such as cancer or The mere mention of a disease such as cancer or AIDS is perceived as inviting the spirit of the AIDS is perceived as inviting the spirit of the disease from an evil spirit and witchcraft. disease from an evil spirit and witchcraft.

The spirit of the disease must be warded off The spirit of the disease must be warded off through spiritual healing and traditional medicine. through spiritual healing and traditional medicine.

Cultural myths and beliefs, cont.Cultural myths and beliefs, cont.

It is believed that seeing a physician or It is believed that seeing a physician or healthcare provider confirms the presence of a healthcare provider confirms the presence of a terminal illness or disease. terminal illness or disease.

This population does not routinely screen for This population does not routinely screen for diseases that are initially asymptomatic like diseases that are initially asymptomatic like cancer, AIDS, hypertension, and diabetes. cancer, AIDS, hypertension, and diabetes.

It is believed that what an individual does not It is believed that what an individual does not know will not kill the individual.know will not kill the individual.


The belief is that ignorance of a disease by The belief is that ignorance of a disease by avoiding early detection through screening grants avoiding early detection through screening grants an individual the ability to live and enjoy life an individual the ability to live and enjoy life without fear. without fear.

Breast cancer, as an example, is perceived to be Breast cancer, as an example, is perceived to be as a result of an injury to the breast.as a result of an injury to the breast.

Cervical cancer is erroneously believed to be a Cervical cancer is erroneously believed to be a disease of sexual promiscuity. disease of sexual promiscuity.


Treatment is believed to be rendered in the form Treatment is believed to be rendered in the form of medication that will help them live healthy of medication that will help them live healthy and longer.and longer.

They have a myth that oral medication is not as They have a myth that oral medication is not as potent and effective as an intramuscular (IM) or potent and effective as an intramuscular (IM) or intravenous (IV) medication. However, in the intravenous (IV) medication. However, in the event they cannot get an IV or IM medication, event they cannot get an IV or IM medication, they will settle for an oral medication. they will settle for an oral medication.

They do not believe that health education without They do not believe that health education without medication is worth their time.medication is worth their time.

Ethical Threats/Barriers & Ethical Threats/Barriers & SolutionsSolutions

BarriersBarriers

Administrative problems in Administrative problems in service delivery:service delivery:

(a) long physician (a) long physician appointment appointment

waiting listwaiting list

(b) inconvenient office hours(b) inconvenient office hours

(c) complicated procedures.(c) complicated procedures.

Immigrants perceive the American Immigrants perceive the American healthcare system of making a clinic healthcare system of making a clinic appointment as complex, and they appointment as complex, and they would rather show up at the clinic would rather show up at the clinic when they are sick than make a when they are sick than make a clinic appointment. clinic appointment.

SolutionsSolutions

Establish a trusting Establish a trusting relationship, flexible clinic relationship, flexible clinic schedule, assure them of the schedule, assure them of the importance of their culture, importance of their culture, valves and normsvalves and norms

Ethical Threats/Barriers & Ethical Threats/Barriers & Solutions, Cont.Solutions, Cont.

BarriersBarriers

Cultural incompatibility:Cultural incompatibility:(a) language barriers (a) language barriers

between professionals between professionals and patients. and patients.

(b) healthcare providers (b) healthcare providers are not able to speak are not able to speak the same language as the same language as the patients.the patients.

(c) the healthcare (c) the healthcare providers do not providers do not understand the understand the patients’ culture, and patients’ culture, and programs are not specific or programs are not specific or specialized for the specialized for the immigrant elderly Africans immigrant elderly Africans (Lai & Chau, 2007).(Lai & Chau, 2007).

SolutionSolution

Reassurance regarding Reassurance regarding confidentiality of patient confidentiality of patient information. Culturally information. Culturally sensitive training of sensitive training of healthcare healthcare providers/personnelproviders/personnel


BarriersBarriers

Personality attitudePersonality attitude(a) individual’s (a) individual’s

nonadherence nonadherence to free preventive to free preventive medicine. medicine.

(b) refused to be (b) refused to be vaccinated vaccinated

because of cultural beliefs because of cultural beliefs for fear of harm.for fear of harm.

(c) identified autonomy (c) identified autonomy issuesissues

(d) ashamed of their lack (d) ashamed of their lack of of

knowledgeknowledge

SolutionSolution

An understanding of their An understanding of their unique characteristics. unique characteristics.


BarriersBarriers

Circumstantial Circumstantial challengeschallenges

SolutionSolution

Provide them with Provide them with information on information on the services and the services and resources resources available to them available to them at no cost, at no cost, connect them to connect them to caseworkercaseworker

Theoretical Framework: Pender's HPM

DiscussionDiscussion There is no doubt that the benefits of There is no doubt that the benefits of

immigrants’ participation in HPDP grossly immigrants’ participation in HPDP grossly outweighs non participation. The benefits outweighs non participation. The benefits are not limited to the patients, families on are not limited to the patients, families on land, on sea and overseas. There are land, on sea and overseas. There are extensive cost savings on healthcare for extensive cost savings on healthcare for the third party payers, and tax payers. the third party payers, and tax payers. More so, to improve the quality of life within More so, to improve the quality of life within the community, through increased public the community, through increased public awareness and understanding of HPDP and awareness and understanding of HPDP and the opportunities for progress; while the opportunities for progress; while supporting the PHS Mission and Healthy supporting the PHS Mission and Healthy People 2020 vision, mission and goals. People 2020 vision, mission and goals.

ReferencesReferences

Dunlop, S., Coyte, P. C., & Melsaac, W. (2002). Socio-economic Dunlop, S., Coyte, P. C., & Melsaac, W. (2002). Socio-economic status and the utilization of physicians’ services: Results from the status and the utilization of physicians’ services: Results from the Canadian National Population Health Survey. Canadian National Population Health Survey. Social Science & Social Science & Medicine, 51,Medicine, 51, 123-133. 123-133.

Groeneveld, P. W., Laufer, S. B., & Garber, A. M. (2005). Groeneveld, P. W., Laufer, S. B., & Garber, A. M. (2005). Technology diffusion, hospital variation, and racial disparities Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000. among elderly Medicare beneficiaries: 1989-2000. Medical Care, Medical Care, 43,43, 320-329. 320-329.

Lai, D. W., & Chau, S. B. (2007). Effects of service barriers on Lai, D. W., & Chau, S. B. (2007). Effects of service barriers on health status of older Chinese immigrants in Canada. health status of older Chinese immigrants in Canada. National National Association of Social Workers, 52Association of Social Workers, 52(3), 261-269.(3), 261-269.

Moy, E., Dayton, E., & Clancy, C. M. (2005). Compiling the Moy, E., Dayton, E., & Clancy, C. M. (2005). Compiling the evidence: The National Healthcare Disparities reports. evidence: The National Healthcare Disparities reports. Health Health Affairs, 24,Affairs, 24, 376-387. 376-387.

U. S. Census Bureau. (2007). U. S. Census Bureau. (2007). 2006 American community 2006 American community surveysurvey. Available from . Available from http://factfinder.census.gov/servlet/DatasetMainPageServlethttp://factfinder.census.gov/servlet/DatasetMainPageServlet?_program=ACS&submenuId=&_lang=en&_ys=?_program=ACS&submenuId=&_lang=en&_ys=

ReferencesReferences

Willems, S., De Maesschalek, S., Deveugele, M., Derese, A., & De Willems, S., De Maesschalek, S., Deveugele, M., Derese, A., & De Maeseneer, J. (2005). Socio-economic status of the patient and doctor-Maeseneer, J. (2005). Socio-economic status of the patient and doctor-patient communication: Does it make a difference? patient communication: Does it make a difference? Patient Education and Patient Education and Counseling, 56,Counseling, 56, 139-146. 139-146.

Williams, D. R. (2005). The health of U.S. racial and ethnic population. Williams, D. R. (2005). The health of U.S. racial and ethnic population. Journals of Gerontology Series B: Psychological Sciences and Social Journals of Gerontology Series B: Psychological Sciences and Social Services, 60b,Services, 60b, S53-S62. S53-S62.

Yee, D. L. (1992). Health care access and advocacy for immigrant and Yee, D. L. (1992). Health care access and advocacy for immigrant and underserved elders. underserved elders. Journal of Health Care for the Poor and Underserved, Journal of Health Care for the Poor and Underserved, 22(4), 148-464.(4), 148-464.

THE ENDTHE END

THANKS FOR YOUR TIME THANKS FOR YOUR TIME AND ATTENTIONAND ATTENTION

QUESTIONS????QUESTIONS????

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Word Association