Diversity and cultural competency(1 hr)

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Diversity & Cultural Competency

1 CE Hour

Course # 20-451497

Class Objectives

Understand why cultural competency is important

Understand guidelines for achieving cultural competency

Understand techniques for communication with clients from diverse backgrounds

Instructor

Michael Ames, LMT

www.AdvFundamentals.com

407-913-9755


Advanced Fundamentals Education, LLC

Advanced Fundamentals Education, LLC is an approved continuing education provider for

massage therapists. We are approved through the National Certification Board for Therapeutic

Massage & Bodywork (NCBTMB) and the State of Florida to offer continuing education credits

to massage therapists.

NCBTMB Provider #: 451911-12

State of Florida Provider #: 50-13930

Advanced Fundamentals Education, LLC

Phone: 407-913-9755

Email: [email protected]

Website: www.AdvFundamentals.com

Disclaimers:

The information in this course is generally accepted as factual at the time of publication. The

information has been gathered through research or practical experience. Advanced

Fundamentals Education, LLC holds no responsibility for any information later found or claimed

to be inaccurate. It is the responsibility of individual practitioners to determine what is right for

themselves and their clients. It is also the responsibility of individual practitioners to work

within their scope of practice, laws and limitations.

This course is for informational and CEU credit purposes only. There is no certification of any

kind involved. Advanced Fundamentals Education, LLC does not advocate or condone any

illegal, unethical or immoral activity, and no such advocacy or condonation should be implied

from anything herein. Any discussion points throughout this course are merely used as a tool

to facilitate thought and encourage creativity, while still abiding by the laws and ethics of your

location and organization.

The information contained in this course does not necessarily reflect the views of Advanced

Fundamentals Education, LLC. Any similarity to any people or organizations is coincidental. The

original content of this course is copyright protected. You may use the information provided

for your personal use only as it is related to your continuing education or informational needs

as a massage therapist. You may not reproduce this material in any way without written notice

from Advanced Fundamentals Education, LLC.


Directions:

You can download this PDF file to your computer or review the material online while you take

the exam.

The reading material and exam are NOT timed. Read through the material presented

thoroughly.

Once you are ready to take the exam:

1) If you are not on the password protected page, go to it. This is the same page where you downloaded your course material. A password was emailed to you when you purchased your online CEU course(s). The link to the Course Material and quiz can also be found on the “Access Courses” Page.

2) Complete the quiz. A passing grade is 70% or higher. You have unlimited attempts to pass your exam.

3) The quiz is graded automatically and you are shown whether you pass or fail the quiz along with your percentage score. You are not shown what questions you answered incorrectly. However, upon passing, you are shown all the correct answers so you can compare them to your answers (if you have them written down.)

4) Make sure you have saved our email to your contacts to ensure proper delivery of your certificate of completion. [email protected]

5) For Florida Massage Therapists, Course Completions are reported daily to Cebroker.com.

6) If you have any questions not answered here or in the FAQ section of the website, please contact us. We’re here to help any way we can.

* Note: It is highly recommended that you print out any course material you wish to keep, as

well as your certificate of completion. Your certificate of completion is your proof you

completed this course.

* Note: If you are submitting credit for your NCBTMB re-certification, you are responsible for

submission of all your hours along with course information and any certificates needed as proof

of completion.

http://www.advfundamentals.com/massage/access-online-courses/

mailto:[email protected]


Diversity and cultural competency for massage therapists

Introduction

Diversity means the condition of having differing elements and qualities. It is the inclusion of

different types of people (as in race, gender, sexual orientation, or culture) in a group or

organization. Lots of things make up a person's culture and world view. Ethnicity, family

heritage, spiritual tradition, beliefs about illness and wellbeing, views about life and death, food

beliefs, family structure, language and non-verbal communication, and attitudes about touch are

a few such examples. In the context of healthcare, cultural competence is simply the ability to relate to and provide

services for people from cultures and traditions other than one's own. What follows are tactics to

become a more culturally competent and sensitive healthcare practitioner in our diverse society.

The population of the United States continues to become more ethnically diverse. As a result, it

is important that you become more familiar with the cultural differences of your clients to

become more sensitive to their perspectives so that you may provide the best care. Additionally,

it is important that you impart sensitivity to other cultures to your support staff, so that each

person you, and any of your support staff are in contact with, is treated with consideration.

This is the essence of the ability to successfully relate with clients or students who come from

cultures other than your own. Because we live in a world rich in texture, sound, color, and

meanings, the study of cultures and the influences of each on the society in which we live and

work can be intriguing, exciting, and an awesome responsibility. In fact, massage therapists and

bodyworkers need personal and interpersonal awareness and sensitivity to develop cultural

knowledge and a set of skills that underlie effective cross-cultural thinking.

With the evolving globalization of society, massage and bodywork professionals require an

understanding of the ethnic and cultural differences and similarities of the varied populations

they serve. Understanding the diversity of your clients' cultures – their beliefs, customs, values

and traditions – is integral to eliminating common cultural biases and providing high-quality,

culturally competent client care. From a social perspective, increased cultural competence is

required for reducing disparities in the health of people of diverse racial, ethnic and cultural

backgrounds.

The Scope of this Course:

This course on diversity and cultural competency for massage therapists defines important

concepts including race, ethnicity, culture, health literacy and health disparities. The course

determines what cultural competence means, how one becomes culturally competent, and

distinguishes between cultural sensitivity and cultural competence.


This massage therapy CEU course looks at diversity and cultural awareness in an employment

and massage therapist setting. The course covers statistics regarding diversity within the massage

industry, definitions of numerous relevant terms, and areas of focus for diversity training within

an organization. It examines ways to avoid pitfalls when working with various clients from

diverse cultures.


Section (1)

What is Cultural Competency?

Cultural competency can be defined as “a set of integrated attitudes, knowledge and skills that

enable a healthcare professional or organization to care effectively for patients from diverse

cultures, groups and communities”. It is a set of congruent behaviors, attitudes and policies that

come together in a system, agency or among professionals that enable working effectively in

cross-cultural situations. Cultural competency for one population may not necessarily translate to

another; it needs to be regarded as an ongoing process developed in a particular intercultural

context.

Cultural competence, a term particularly used in the health field, is the skill to respect and

interact effectively with other cultures. Cultural competence works both ways – some therapists

may be the strangers in a foreign culture. If the culture is very different from their own, they will

inevitably experience “culture shock.” The degree of shock depends upon how willing they are

to accept the new culture. Some of the symptoms of culture shock are confusion, disorientation

and depression. But these pass as one learns to adapt to the new culture.

What is Diversity?

When we talk about diversity, are we simply talking about

tolerance of others, even though they may be different?

Tolerance of other lifestyles is a totally different ball game than

being able to successfully integrate other cultures and their

idiosyncrasies into your working environment.

On the surface, people are very accommodating; they maneuver

easily among people of different cultures and colors. But

underneath that accepting exterior, there may be decades of

prejudice that has either been taught or studied. This is when it is

very important to accurately define the concept of diversity, how

it works, and how beneficial it can be to your business as a

massage therapist.

Discussions about diversity can make many folks feel a bit squeamish and downright

uncomfortable. So, let’s dive in and see what we can do to make things a bit more comfortable

for everyone who comes in contact with you and your business.

Case Study

Her English is slightly broken, but you understand every word she says. She is a native of

Bulgaria. When asked if she would like to take a steam before her treatment, she thinks about it a

second and nods her head “Yes.” You show her to the steam room. She seems surprised. She

turns to give you a confused look. You wonder where the communication broke down.


You’ve just encountered a cultural difference. In Bulgaria, nodding the head up and down means

“No.”

Before starting the treatment you say to the client “If you feel too cool or need me to adjust the

pressure, just let me know, okay?” The client gently agrees. But 15 minutes into the massage, he

hasn’t relaxed. What’s up?

You’ve just encountered another cultural difference. The tense client is cold. He is from one of

the many cultures where they communicate a problem with more delicacy or subtlety, and you

missed it.

Experts agree that the single most important tactic for working with people of different cultures

is understanding their values. For example:

Americans often feel uncomfortable when someone stands less than three feet

away from them, while most people from the Middle East need to stand almost

nose-to-nose with the person to whom they are speaking.

Although not regularly practiced, some traditional Koreans believe that the soul

rests in the head and may become uncomfortable, even fearful if a provider or

staff member pats their child on the head or ruffles his or her hair.

In Chinese or other Asian cultures, use of the first name could be considered

disrespectful. People from these cultures may not complain about pain, so be

aware of non-verbal clues.

Address Hispanic individuals formally, especially elders. Handshaking is

considered a polite greeting. Hispanics have a holistic understanding of

emotional, spiritual, social and physical factors that affect an illness. Illness is

seen as a crisis for the entire family because Hispanic culture is very family

oriented.

When you encounter cultural differences, you’ll find people saying or doing things which are

different from the way to which you’ve grown accustomed. Knowing those cultural differences

is part of “cultural competence”.

The assessment and management of any patient in pain should always be done in the context of

their cultural, religious and ethnic status. Whilst an understanding of these factors is essential in

all medical care in general, these factors are particularly pertinent to understanding the

following:

pain assessment

incidence of specific pain conditions, and

incidence of co-morbidities and burden of diseases relevant to pain treatment in that

population

possible treatment options and approaches

expected responses and difficulties with implementing treatments

follow-up and attendance


What does Cultural Competency Teach?

Cultural competency is about the acquisition

of skills to achieve a better understanding of

members of other cultures. It is a commitment

to engage respectfully with people from other

cultures. The focus on cultural competency is

a response to ongoing health inequalities and

related disparities in access to health services

and healthcare experiences for different

communities.

A commitment to cultural competence is the

beginning of an ongoing process that requires

motivation and a willingness to improve cross-cultural communication and practice both in

individuals and organizations. It emphasizes the idea of effectively operating in different cultural

contexts, and fostering constructive interactions between people of different cultures. By doing

so, it encompasses and extends elements of cultural respect, cultural awareness, cultural security

and cultural safety.

Massage therapists’ own biases, stereotypes, values and assumptions about human behavior may

differ from those held by other cultural groups. Cultural competency teaches a set of behaviors

and attitudes that respects and takes into account the person’s cultural background, cultural

beliefs, and values. It incorporates this into the way healthcare is delivered to that individual.

This is important as minorities are usually under-represented in the healthcare workforce.


Section (2)

The Cultural Competency Process

Cultural competency is a dynamic process that is constructed in the context of human relations,

including the process of crossing cultural boundaries. It needs to be considered within a broader,

system-wide social, historical, political and economic context, as well as at the level of

individual professional practice. It should be understood within the context of an individual,

their family and peers, their school and social or sporting clubs, ethnicity, class, race, and gender.

Cultural competency in healthcare describes the ability of systems to provide care to patients

with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social,

cultural, and linguistic needs. It increases access to quality care for all patient populations.

Cultural competency focuses on the capacity of the health worker to improve health status by

integrating culture into the clinical context. Importantly, for individuals, cultural competence

requires more than becoming culturally aware or practicing tolerance. It can be defined as the

ability to identify and challenge one’s own cultural assumptions, one’s values and beliefs that

can impact on people from diverse cultures.

It should create the willingness to move away from using one’s own cultural values as a

benchmark for measuring and judging the behavior of people from other cultural backgrounds. It

is about developing empathy and connected knowledge, the ability to see the world through

another’s eyes, or at the very least to recognize that others may view the world through a

different cultural lens.

Results of Cultural Competency

Socio-cultural differences among patients, healthcare providers, and the healthcare system are

potential causes of disparities in health and healthcare among racial and ethnic groups.

Inadequate cross-cultural communication between providers and patients may lead to patient

dissatisfaction, poor adherence to medications and health promotion strategies, and poorer health

outcomes.

The ultimate goal is a healthcare system and workforce that can deliver the highest quality of

care to every patient, regardless of race, ethnicity, or cultural background. There are links

between cultural competence, quality improvement, and the elimination of racial and ethnic

disparities in care. Cultural competence improves relationships and thereby may improve clinical

results. There remains, however, a need to translate cultural competence into quality indicators or

outcomes that can be measured.


How to implement cultural competence in your practice?

In communicating with clients of diverse backgrounds, it is helpful if you:

Speak a little more slowly (but not more loudly).

Avoid jargon — words you and your co-workers use but which outsiders may not know.

Avoid slang — it might be taken literally or simply confuse the listener.

Avoid giving more information than they need.

Ask them to tell you how they understand what you said — “teach back” or “show me”

techniques.

Create an accepting and respectful environment.

It may be useful to learn a few key phrases in different languages. It will save you time and

clients will interpret your extra effort as professional, respectful and friendly.

Some phrases that would be handy to know in another language are:

“Do you feel comfortable?”

“Are you warm enough?”

“Would you like a drink of water?”

How will being culturally competent help your business?

Improves Service. Being culturally competent helps ensure that you understand what the client

says — and more importantly doesn’t say — and what the client meant to convey.

Builds Trust. The Washington State Department of Health says patients with higher levels of

trust are more satisfied. This is probably true of massage clients as well. Therapists who are

culturally competent build trust in their clients because they appear more professional, more

interested and more experienced.

Competitive Edge. Being culturally competent gives you a business advantage by increasing

your client base.

Cultural competency benefits for clients

Too often, cultural competence is thought of as something that's “nice to achieve.” But it’s more

than that; it’s essential to optimal care. Your ability to deliver culturally competent care can

affect everything from your client’s access to healthcare to whether he or she shows up for

appointments.

“You need to have a broad understanding of how to interact with many different cultures,” says

Erin Shilling, a physical therapist at UCLA Medical Center in Los Angeles. She notes that

connecting with patients promotes a working relationship and makes them more likely to return

for follow-up visits.


The diversity of the U.S. population continues to grow. Unfortunately, disparity in healthcare

among ethnic groups is growing too. According to the most recent census data, people of color

are less likely to be insured than whites, which can be partly explained by differences in income

and types of employment. Latinos, African-Americans, Asians, and American Indian/Alaska

Natives are less likely to have a regular source of medical care and less likely to have visited a

healthcare provider in the past year than whites.

Shilling’s parents are from different cultures, and she cares for patients with a wide range of

cultures at UCLA. She finds comfort in knowing that “it’s possible for people of many cultures

to interact positively.”

So, how can you deliver culturally competent care that benefits you, your clients, and your

clients’ families? Let’s find out what steps you can take.

1. Experts in the field of trans-cultural nursing, as well as professional chaplains, suggest

exploring your personal cultural identity. The idea here is that your own cultural

influences determine how you think and behave towards others socially and in the

workplace. Identifying your social roles, spiritual self-knowledge, cultural heritage,

personal habits and attitudes, and how you relate to various groups of people in society

expands perspective and self-awareness.

2. Identify the cultural mix in your own community. The cultural tapestry of Miami is

different from that of San Francisco or Des Moines or the Appalachian mountains. What

shapes the tapestry where you live?

3. Generalize, rather than stereotype. Stereotyping is applying a belief or attitude to

everyone in a cultural group. For example, saying that, “all Hispanics do this” or “all

Chinese think that.” We are all individuals. To generalize is to have a basic understanding

about a culture and use that knowledge as a starting point to learn more about a person,


family or group. You don’t have to be an expert about cultures to become more culturally

sensitive and competent, but gathering accurate basic information is a good start.

4. Be curious and ask questions. Suppose you have a client in a hospital or eldercare facility

and you don’t know if there are cultural considerations that would impact your plan of

care or relationship with this client. First ask the client’s social worker to share any

information they may have. The client’s chaplain may be a good resource as well. In

hospice settings, the interdisciplinary team is your best resource. You can also

respectfully ask your client or their family to share relevant information with you. If there

is something you don’t understand, ask!

5. Practice authentic listening. Listen to your client with your ears, eyes, heart and mind.

Authentic listening is paying attention in the moment while gathering information that

can guide right action.

6. Be sensitive to cultural rules regarding touch.

Remember, everyone is unique!

Since massage therapy fosters a holistic approach, factoring in the needs of people from a range

of cultures seems logical. With greater opportunities to serve clients in medical settings, you can

be an example of cultural competence to other healthcare practitioners while at the same time

providing excellent service for your client. Culture can even affect preferences for

complementary therapy. For example, some experts have noticed that Americans use yoga and

massage, while Hispanics may prefer herbal remedies.

It is critical that healthcare providers recognize individual differences and do not participate in

“cultural stereotyping”. Because persons of the same ethnicity can have very different beliefs and

practices, it is important to understand the particular circumstances of the patient or family by

obtaining information on: place of origin; social and economic background; degree of

acculturation; and personal expectations concerning health and medical care.


Section (3)

Cultural Trends and Shifts within the US

Culture includes language, religion, customs, food, codes of manners, behavioral standards,

patterns, and beliefs. Culture may also be defined as values and behaviors shared by a group of

people such as an ethnic, racial, geographic, religious, gender, class, or age group. Everyone

belongs to multiple cultural groups, so that each individual is a blend of many influences.

Cultural values and beliefs are the foundations of behavior, including that related to health. This

integrated pattern of human behavior includes thoughts, communication, beliefs, and customs,

and is learned through exposure to the speech, judgments, and actions of others.

Ethnicity refers to a shared culture and way of life and is socially distinguished by national origin

characteristics. Like ethnicity, race has been described as a socio-cultural concept used to

distinguish groups of people who share history, geography, and physical characteristics.


The U.S. population has been changing significantly and rapidly, as shown in the Table below.

With this increasing diversity, massage therapists must be aware of the influence of culture on

the manner in which people seek support and help. Census data helps us understand some of

these trends and shifts; however, this data can be skewed by a group’s perception of identity and

often overlook the diversity that exists within groups.

The term Asian American includes people from a variety of nations, such as Afghanistan, China,

India, Pakistan, Syria, and Japan, among others. This group includes families who have

immigrated to and lived in the U.S. for generations. African Americans come from 54 countries,

speak up to 2,000 different languages, and are composed of 33.9 million people who are related

to and share characteristics with the 797 million people living in Africa. Native Americans are

people with unmixed ancestry or who have native lineage as a fraction of their backgrounds —

who may trace roots to any of more than 500 tribes. Native Americans may or may not identify

with their tribal ancestry and culture.

People identified as Hispanic can have Mexican, Puerto Rican, Cuban, Salvadoran, or

Dominican backgrounds. Others within the Hispanic group have Central American, South

American, or other Latino origins.

General Health Behavior and Beliefs

Here are some suggested generalizations about health behavior and beliefs of just a few of the

more common cultures in the U.S.

Hispanic and Latino Patients: Men tend to seek care only when they are unable to perform

their necessary work. If they can continue to work with discomfort, they will often do so for the


sake of their family. Women tend to be the ones who seek care for the family, and often sacrifice

their own health to accomplish this goal. Family is often engaged in decision making for

significant healthcare matters. For Hispanics who seek complementary and alternative medicine

(CAM), providers should consider that holistic healers may be included in self-care and not

disclosed for fear of negative responses by traditional Western physicians.

African American Patients: Patients within this group are reported not to seek preventive

services due to the belief that life is of the present rather than the future. Obesity is common and

accepted as a cultural norm for many. Individuals may also exhibit a great degree of mistrust for

the health system for a variety of reasons, including centuries of mistreatment and abuse. Folk

medicine alternatives may be used to treat certain illnesses, so practitioners should be aware of

this possibility.

American Indian and Alaska Native Patients: Patients within these groups have a common

belief that harmony with nature and traditional healing ceremonies are designed to reestablish

balance. It is common for American Indians to use traditional therapies with the Western

medications they receive. Some American Indians believe that illness is a punishment and is

associated with evil spirits. If the tribal medicine healer cannot heal the disease, he or she will

refer the patient for Western medicinal interventions. It is recommended that Western medical

healthcare practitioners blend traditional cultural health and values with Western medical

strategies.

Every client has a belief about illness, treatment, and expected recovery. This belief regarding

the underlying cause and resolution may have a spiritual basis. Therefore, massage therapists

need to have the skills that allow them to develop a treatment plan that respects the client’s

spiritual health beliefs. Religion also impacts many areas related to medication management.


As massage therapists become more culturally competent and learn about the cultures of their

clients, they must use care not to stereotype them. Stereotyping involves defining all the

members of a group with the same terms, and is often viewed as an endpoint without variance.

Instead, it is more appropriate to gather information from your interactions and research and use

this to generalize in order to create a starting point from which you can begin to interact with

clients of a particular culture. Generalizations help understand and anticipate client behavior.

The following questions may be useful in assessing culturally diverse clients and families:

So that I might be aware of and respect your cultural beliefs…

1. Can you tell me what languages are spoken in your home and what languages you

understand and speak?

2. Please describe your usual diet. Also, are there times during the year when you change

your diet in celebration of religious or other ethnic holidays?

3. Can you tell me about your beliefs and practices for special events such as birth, marriage

and death that you feel I should know?

4. Can you tell me about your experiences with healthcare providers in your native country?

How often each year did you see a healthcare provider before you arrived in the U.S.?

5. Have you noticed any differences between the type of care you received in your native

country and the type you receive here? If yes, could you tell me about those differences?

6. Do you use any traditional health remedies to improve your health?

7. Is there someone, in addition to yourself, with whom you want us to discuss your medical

condition?

8. Are there certain healthcare procedures and tests which your culture prohibits?

9. Are there any other cultural considerations I should know about to serve your health

needs?

10. Is there anything else you would like to know? Do you have any questions for me?

(Encourage two-way communication.)

Conclusion

Culture is learned; it changes gradually and has different layers. It is immeasurably persuasive

and complex. Some aspects of culture (language, art, clothing and food) are readily apparent

compared with attitudes, values and beliefs. Culture and language are closely linked. Culture is

not static. It is constantly changing as a result of events and contacts with other cultures. The

development of cultural competence is a continuous process, slowly progressing from cultural

incompetence to gaining knowledge, awareness and sensitivity, before becoming competent.

Every person who requires medical or behavioral healthcare is unique both in the way clinical

symptoms are exhibited and in how that individual’s culture impacts his or her health behavior.

As clients journey along the continuum of care, it is critical that the health system prepare to

identify and address both the clinical aspects of care and the patient’s cultural and demographic

differences.


Cultural issues are now recognized to be important elements in the provision of effective

healthcare. Massage therapists must learn and understand the cultural factors that affect clients’

healthcare decisions. Experts agree that all patients, regardless of race, ethnicity, sex, age,

religion, or physical or mental disability, have the right to high-quality healthcare that reflects

knowledge of and sensitivity to the factors of difference. With the majority of the population

growth within the U.S. expected to be within racial and ethnic minorities and immigrant groups,

our healthcare system must learn how to address the disparities in healthcare that arise from

factors such as race, ethnicity, and cultural and language barriers.

Members of racial minority groups, including Latinos and African Americans, are more likely to

under-utilize mental health services and to delay seeking treatment. Rates of mental illness

among people in most ethnic minorities are similar to those of Caucasians; however, members of

these minorities are more likely to experience confounding factors such as violence, poverty, and

discrimination that may exacerbate the disorder.

We must remember that the delivery of safe and effective care is the priority for all of our

clients. Ethnic and cultural differences must be acknowledged in order for us to apply unbiased

communication skills and the necessary empathy to improve healthcare for clients who have

different physical, spiritual, and language needs.

……………………………………………………………………………………………………………………………………………………….


Bibliography

Leininger, M. (2005) Culture Care Diversity and Universality, Jones and Bartlett Publishers, Sudbury, MA

Galanti, G., An introduction to cultural differences. Western Journal of Medicine, 2000 May; 172(5).

http://www.nursingcenter.com/lnc/journalarticle?Article_ID=733509

http://www.med.umich.edu/pteducation/cultcomp.htm

http://www.massagetoday.com/mpacms/mt/article.php?id=14603

http://www.uspharmacist.com/continuing_education/ceviewtest/lessonid/108684/

http://www.apollo123.com/downloads/cultural_diversity_in_massage_practice_text.pdf

http://www.nursingcenter.com/lnc/journalarticle?Article_ID=733509

http://www.med.umich.edu/pteducation/cultcomp.htm

http://www.massagetoday.com/mpacms/mt/article.php?id=14603

http://www.uspharmacist.com/continuing_education/ceviewtest/lessonid/108684/

http://www.apollo123.com/downloads/cultural_diversity_in_massage_practice_text.pdf


Directions:

You can download this PDF file to your computer or review the material online while you take

the exam.

The reading material and exam are NOT timed. Read through the material presented

thoroughly.

Once you are ready to take the exam:

7) If you are not on the password protected page, go to it. This is the same page where you downloaded your course material. A password was emailed to you when you purchased your online CEU course(s). The link to the Course Material and quiz can also be found on the “Access Courses” Page.

8) Complete the quiz. A passing grade is 70% or higher. You have unlimited attempts to pass your exam.

9) The quiz is graded automatically and you are shown whether you pass or fail the quiz along with your percentage score. You are not shown what questions you answered incorrectly. However, upon passing, you are shown all the correct answers so you can compare them to your answers (if you have them written down.)

10) Make sure you have saved our email to your contacts to ensure proper delivery of your certificate of completion. [email protected]

11) For Florida Massage Therapists, Course Completions are reported daily to Cebroker.com.

12) If you have any questions not answered here or in the FAQ section of the website, please contact us. We’re here to help any way we can.

* Note: It is highly recommended that you print out any course material you wish to keep, as

well as your certificate of completion. Your certificate of completion is your proof you

completed this course.

* Note: If you are submitting credit for your NCBTMB re-certification, you are responsible for

submission of all your hours along with course information and any certificates needed as proof

of completion.

http://www.advfundamentals.com/massage/access-online-courses/

mailto:[email protected]


Take your exam online at the password protected page where you

downloaded the material

The 10 questions below are the exact questions in the exact order as the

online quiz.

It is recommended that you prepare your answers here before taking the

online quiz.

1) TRUE or FALSE: Diversity means the condition of having differing elements and qualities.

2) Some of the things that make up a person’s culture and world view are:

a. Ethnicity

b. Family

c. Heritage

d. Spiritual tradition

e. All of the above

3) TRUE or FALSE: Cultural competency can be defined as “a set of integrated attitudes,

knowledge and skills that enable a healthcare professional or organization to care

effectively for patients from diverse cultures, groups and communities.”

4) TRUE or FALSE: The assessment and management of any client in pain should always be

done in the context of their cultural, religious and ethnic status.

5) TRUE or FALSE: Cultural competency, at the very least, is to recognize that others may

view the world through a different cultural lens.

6) Inadequate cross-cultural communication between providers and patients may lead to:

a. Patient dissatisfaction

b. Poor adherence to medications

c. Poor adherence to health promotion strategies

d. Poorer health outcomes

e. All of the above


7) In communicating with clients of diverse backgrounds, it is helpful if you:

a. Speak a little more slowly (but not more loudly)

b. Avoid jargon

c. Avoid slang

d. Have them use the “teach back” or “show me” techniques

e. All of the above

8) TRUE or FALSE: Learning a few key phrases in different languages will save you time,

and clients will interpret your extra effort as professional, respectful and friendly.

9) TRUE or FALSE: According to the most recent census, Latinos, African-Americans, Asians,

and American Indian/Alaska Natives are less likely to have a regular source of medical

care and less likely to have visited a healthcare provider in the past year than whites.

10) How can you deliver culturally competent care that benefits you, your clients, and your

clients' families?

a. Explore your personal cultural identity

b. Generalize, rather than stereotype

c. Be curious and ask questions

d. Practice authentic listening

e. All of the above

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