Upload
jnmeeha
View
1.781
Download
4
Tags:
Embed Size (px)
DESCRIPTION
Clemson University
Citation preview
COMMUNICATION WITH LATINO PATIENTS—IMPROVING MEDICAL AND NURSING EDUCATION
Rachel Mayo, Windsor Sherrill, Sarah Griffin, Caroline Swiger, Jessica Meehan, Taylor Hughes,
Janet Evatt, Veronica Parker*Department of Public Health Sciences
*Department of NursingClemson University
Clemson, South Carolina
OUTLINE Current Issue (Introduction/Background)
Communication barriers causing health disparities for Latinos
Study Purpose Develop a tool to measure student provider
readiness to treat Latinos Learn about student provider perceptions and
cultural competence in treating Latino patients Instrument Development (Methods) Focus Groups (Results) Pilot Surveys (Results) Conclusions/Further Research
Final survey currently in progress (n=1500 medical and nursing students)
SIGNIFICANT CHANGE NATIONALLY IN THE SOUTHEAST
NATIONAL GROWTH IN THE LATINO POPULATIONLatino Non-Latino
WhiteTotal Nation
2010 2000 2010 2000 2010 2000Percent of total population (%) 16.3 12.5 63.7 69.1 -- --Percent Growth (%) 43.0 1.2 9.7
State Percent Change (%), 2000-2010
Rank in Nation
South Carolina 148 1Georgia 96 11North Carolina 111 6Tennessee 134 3
LARGEST CHANGE IN LATINO POPULATION, BY STATE
(U.S. Census Bureau, 2010)
RESULTING HEALTHCARE ISSUES AND DISPARITIES FOR LATINOS
More than 1 in 4 Hispanics lack a usual healthcare provider. (Pew Hispanic Center/Robert Wood Johnson Foundation, 2008)
Hispanics are 3 times as likely as non-Hispanic whites to lack a usual healthcare provider. (Centers for Disease Control and Prevention, 2006)
17.8% of Hispanics of all ages report being in fair or poor health. Compared with 11% of non-Hispanic whites. (The Commonwealth Fund, 2008)
RESULTING HEALTHCARE ISSUES AND DISPARITIES FOR LATINOS (CONT.)
23% of Latinos report having received poor quality of medical treatment or care in the last year (Pew Hispanic Center, 2008)
The healthcare provider community does not reflect the ethnic diversity of the patient community in the Southeast. Under-represented as providers
CHALLENGE—COMMUNICATION BETWEEN LATINO PATIENTS AND PROVIDERS “[H]ispanics and Asians report more difficulty
communicating with their doctors than both whites and blacks.” (Mead, et al., 2008)
“[W]hen health care providers fail to understand sociocultural differences between themselves and their patients, the communication and trust between them may suffer.” (Betancourt, et al., 2002)
“[E]fforts to improve the quality of communication with Spanish-speaking Latino patients in outpatient health care settings are needed.” (Morales, et al., 1999)
“[T]he field of ‘cultural competence’ in health care has emerged in part to address the factors that may contribute to racial/ethnic disparities in health care.” (Betancourt, et al., 2002)
DEFINING CULTURAL COMPETENCE “Cultural competence in health care
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.” The Commonwealth Fund (Betancourt, et al., 2002)
Skill sets and cultural knowledge that we can emphasize to prepare our future providers.
HOW TO ADDRESS THE COMMUNICATION CHALLENGE
Improved readiness to treat Latino
patients
THIS STUDY: GOALS AND OBJECTIVES Student Provider Perceptions of Latino Patients in
Cancer Care Settings, NIH/NCI Grant 1R15CA135349-01A2 (PIs: Mayo, RM; Sherrill, WW)
To develop and evaluate an instrument (MaNSRT) to assess medical and nursing students’ readiness to treat Latino patients.
To inform the design of focused, effective interventions in medical and nursing education for the region.
In the process, to learn about medical and nursing student perceptions, existing cultural competence training, and current readiness to treat Latino patients.
Student Provider Knowledge Indicesa.Latino Knowledge Indexb.Latino Cancer Knowledge Index(e.g., knowledge of communities, culture, personal involvement, cancer rates, risk, screening)
Student Provider Psychological Indicesa.Comfort with Latinos Indexb.Cultural Competence with Latinos Indexc.Attitudes Toward/Beliefs About Latinos Index(e.g., provider beliefs about patient compliance and cultural factors impacting care, social and behavioral factors impacting care of Latinos)
Student Provider Language and Experience Indices
a.Spanish Language Proficiencyb.Previous Experience with Latinos
Student Provider Social DemographicsSexRaceAge
Education (nurse/physician)
Medical and Nursing
Students’ Readiness to
Treat Latinos in Cancer Care(MaNSRT)
Theoretical Framework
Model based on Van Ryn (2002)
INSTRUMENT DEVELOPMENT: THE HEALTH PROFESSIONALS SURVEY Systematic literature review (Mayo, Sherrill, et al.,
2007). Preliminary study conducted
Convenience sample of n=65 junior and senior nursing students at Clemson University using draft instrument
Participating students provided feedback (e.g., face validity, question clarity and readability)
Consistent responses across sample; i.e., students did not appear to have a high level of readiness to work with Latino patients
Cronbach’s alphas calculated for subscales to determine reliability
Preliminary correlations among subscales determined Draft survey instrument assessed by expert reviewers Focus groups
6 focus groups n=27 participants
INSTRUMENT DEVELOPMENT (CONT.) Survey Revision First Pilot Test (n=38 nursing students) Second Plot Test (n=99 medical and nursing students Further Survey Revision and Recruitment Final Survey Completed Implementation of Final Survey (n=1500 medical
and nursing students) [[Currently in progress]]
Partnering Institutions:
SURVEY REVISION: PILOT TO FINALLikert scale vs. Item-specific questions
Recent opinion: Uncertainty with Likert ScaleRespondent acquiescenceTendency to agree with attitude statements
Revision with our Survey ExpertQuestions with more discriminatory powerChanged from 1-4 response scale to 1-5 scaleMajority of Final Survey: Item-specific question
SURVEY REVISION: PILOT TO FINALLikert scale vs. Item-specific questions
Importance of Revision Removes potential bias and leading questionsGathers a more direct opinionResponses more representative of participant’s intuitive opinions and knowledge
Other Revisions:Better readability and visual aestheticsFluidity in question order
LIKERT SCALE: PILOT SURVEY
ITEM-SPECIFIC: FINAL SURVEY
ITEM-SPECIFIC: FINAL SURVEY
ITEM-SPECIFIC: FINAL SURVEY
FOCUS GROUPS
FOCUS GROUPS
FOCUS GROUPS: THEMES The medical and nursing students showed some
general cultural knowledge about the Latino population Mostly acquired from media and social influences Also, from basic stereotypical observations made during
everyday encounters with the ethnic group
Clinical and educational settings accounted for a small percentage of the acquired knowledge of Latino cultures, behaviors and practices.
Students express that they are trained more “disease-oriented,” rather than “patient-oriented” Cultural competence training requires assessment and
communication with the patient as a whole, including their family members (especially with Latinos)
FOCUS GROUPS: THEMES (CONT.) Students did not show overt prejudice, but some
admitted some discomfort in treating Latinos. Students revealed issues caused by poorly addressed
communication barriers, especially concerning the use of interpreters.
According to student providers, cultural competency education concerning Latinos is currently very limited. Some institutions recognize the need for personal
non-verbal communication, some language skills and experience with interpreters.
Students perceive that institutions do not always focus on these objectives.
PILOT SURVEY RESULTS:N=99 MEDICAL AND NURSING STUDENTSSurvey Question N Minimum Maximum Mean Standard
DeviationPlease indicate to what extent you agree or disagree: I am able to explain treatment options and clinical trials to H/L patients.
97 1 4 2.67 0.673
As a provider, I feel able to provide satisfactory rapport with H/L patients.
96 1 4 2.84 0.670
In providing clinical care, I will avoid speaking to H/L families because of language barriers.
98 1 4 1.54 0.691
A patient’s cultural background can make it difficult to conduct an adequate clinical assessment.
96 1 4 2.84 0.670
Key: Responses: 1-4 scale
H/L=Hispanic/Latino
PILOT SURVEY RESULTS:N=99 MEDICAL AND NURSING STUDENTS
Survey Question N Minimum Maximum
Mean Standard
Deviation
Based on your training and experience, please rate your skill level in the following aspects of care for H/L patients:Communicating effectively through a healthcare interpreter.
98 1 4 2.93 0.763
Based on your training and experience, please rate your skill level in the following aspects of care for H/L patients:Determining patients’ communication preferences.
99 1 4 2.93 0.659
Key: Responses: 1-5 scale
H/L=Hispanic/Latino
PILOT SURVEY RESULTS: THEMES Student provider skills
Variable ability to explain treatment options and clinical trials
Variable ability to build satisfactory rapport with Latino patients
Variable ability to determine communication preferences
Variable difficulty with clinical assessments due to cultural background of patient
Variable skill level communicating with interpreters Student provider perceptions
Do not avoid speaking to Latino families because of language barriers
CONCLUSIONS In general, medical and nursing students report
insufficient readiness to effectively treat Hispanic/Latino patients Stereotypical attitudes and beliefs Limited cultural competence skills Barriers in the healthcare delivery system Healthcare is still challenged with Latino-
patient-provider communication skills and readiness to treat Latino patients
Presents a challenge for medical and nursing schoolsNot a traditional education model
“Patient-oriented” vs. “Disease-oriented”
CONCLUSIONS The MaNSRT survey may be an effective
instrument to assess nursing and medical student readiness to treat Latino patients. Also indicate the need for improved cultural
competence education, especially in the Southeast Applied to any student provider program or health
profession to employ interventions
The MaNSRT survey is currently being implementing with medical and nursing students of four institutions in the Southeast. Preparation to be used universally Currently recruiting more medical and nursing
programs to participate in the MaNSRT survey
SURVEY PARTICIPATION If your institution or educational program
would be interested in participating in our next survey, please contact our team. Jessica Meehan
[email protected] (856) 305-0110
Dr. Windsor Sherrill [email protected]
Dr. Rachel Mayo [email protected]
QUESTIONS?