Cultural AwarenessCultural AwarenessIssues in ChiropracticIssues in Chiropractic

Faculty Faculty Development Day Development Day

July 15, 2002July 15, 2002Cheryl Hawk, DC, PhD Cheryl Hawk, DC, PhD

Director of Chiropractic SciencesDirector of Chiropractic SciencesDept. of Graduate StudiesDept. of Graduate Studies

DefinitionsDefinitions

• Culture:Culture: shared beliefs & values shared beliefs & values affecting affecting social interactionssocial interactions interpretation of experienceinterpretation of experience

• Race: Race: biological concept biological concept• EthnicityEthnicity : : self definedself defined group identity in group identity in

religionreligion nationality nationality cultureculture

Examples of different Examples of different cultures of chiropractic cultures of chiropractic

patientspatients• SexSex

male/female male/female sexual sexual

orientationorientation• AgeAge

childrenchildren adolescentsadolescents elderlyelderly

• Income/educationIncome/education• Race/ethnicityRace/ethnicity• ReligionReligion

What is “cultural competency”?What is “cultural competency”?

Set of skills, knowledge & attitudes Set of skills, knowledge & attitudes related to a clinician’srelated to a clinician’s understanding and respect for patients’ understanding and respect for patients’

values, beliefs, expectationsvalues, beliefs, expectations awareness of his/her own assumptions and awareness of his/her own assumptions and

value systemvalue system ability to adapt care to be congruent with ability to adapt care to be congruent with

patients’ expectations and preferences.patients’ expectations and preferences.

WHY should DCs be WHY should DCs be “culturally competent”?“culturally competent”?

• US population is increasingly US population is increasingly culturally diverseculturally diverse

• Different cultures have different Different cultures have different health behavior and health riskshealth behavior and health risks

• Doctor-patient communication and Doctor-patient communication and rapport are affected by cultural rapport are affected by cultural differencesdifferencesThis affects outcomes!This affects outcomes!

US population is US population is increasingly culturally increasingly culturally

diversediverse

Racial Racial Distribution of Distribution of US Population US Population

20002000

White White (72%)(72%)

HispaniHispanicc

Afr-AmAfr-Am

AsianAsian

Am. Am. IndianIndian

Are we keeping pace with Are we keeping pace with these changes?these changes?

US population vs chiropractic US population vs chiropractic patientspatients

% non-white/Hispanic% non-white/Hispanic

General population (1998)General population (1998) 28%28%

DC patients (1974-82)DC patients (1974-82) 4% 4%

DC patients (1997-98)DC patients (1997-98) 5%5%

Ethnic diversity in the US Ethnic diversity in the US MD and DC workforceMD and DC workforce

% Non-white/Hispanic% Non-white/Hispanic• General populationGeneral population 28% 28%• MDsMDs 7% 7%• MD students (2000)MD students (2000) 34% 34%• DCsDCs 7% 7%• DC students (PCC 2002)DC students (PCC 2002) 9% 9%

US DCsUS DCs

19911991 1998 1998

FemaleFemale 13.3% 19.2% 13.3% 19.2% 51%51%

AsiaAsia nn 0.8 0.8 1.81.8 4 4

HispanicHispanic 1.6 1.6 1.71.7 1313

African AmericanAfrican American 0.5 0.5 0.60.6 1212

American IndianAmerican Indian 0.2 0.2 0.80.8 1 1

GenGen. . poppop..

and… and… why should we care?why should we care?

• Only Only 11%11% of all Americans see a of all Americans see a chiropractor annuallychiropractor annually

• Minority populations are not Minority populations are not benefiting from chiropractic carebenefiting from chiropractic care

• Chiropractic is not helping eliminate Chiropractic is not helping eliminate health disparitieshealth disparities

• Bottom line: Bottom line: it’s the right thing to it’s the right thing to do!do!

Different cultures have Different cultures have different health behavior and different health behavior and

health riskshealth risks

Examples of US Health Behavior Examples of US Health Behavior Differences: Differences: Reduced Physical Reduced Physical

ActivityActivity

• WomenWomen• Lower income/educationLower income/education• African-Americans and HispanicsAfrican-Americans and Hispanics• Older adultsOlder adults

by age 75, 33% men, 50% women by age 75, 33% men, 50% women have no physical activity at allhave no physical activity at all

Source: Healthy People 2010

Examples of US Health Examples of US Health Behavior Differences: Behavior Differences: overweight/obesity*overweight/obesity*

• ALL: 50%!!ALL: 50%!!• Lower income women and Lower income women and

adolescentsadolescents• African American/Mexican African American/Mexican

American womenAmerican women

*overweight: BMI 25; 25; obese: BMI obese: BMI 3030

Examples of US Health Examples of US Health Behavior Differences: Behavior Differences:

smokingsmoking• Among adolescents:Among adolescents:

39% white39% white 33% Hispanic33% Hispanic 20% African American20% African American

• Among adults:Among adults: Highest in Am. Ind., blue collar and Highest in Am. Ind., blue collar and

militarymilitary HS dropouts 3x rate of college gradsHS dropouts 3x rate of college grads

Examples of US Health Risk Examples of US Health Risk Differences: Differences: Chronic LB Chronic LB

DisabilityDisability

• Activity limitation, rate per 1000 Activity limitation, rate per 1000 adults:adults: AsianAsian 1515 HispanicHispanic 2828 WhiteWhite 3232 African AmericanAfrican American 3636 American IndianAmerican Indian 6868

by raceby race

Examples of US Health Risk Examples of US Health Risk Differences: Differences: Chronic LB Chronic LB

DisabilityDisabilityby income and by income and

educationeducation

poorpoor mid/mid/highhigh

2828

hs hs dropdrop

hs hs gradgrad

somsome e

collcollActivity limitation, rate per 1000 adultsActivity limitation, rate per 1000 adults

7777

2424

54543535

Examples of US Health Risk Examples of US Health Risk Differences: Differences: DiabetesDiabetes

0

5

10

15

20

25

WhiteWhite

8%8%

1414%%

1616%%

1818%%

Afr-AmAfr-Am Mex-Mex-AmAm

Am. Am. Ind.Ind.

a g e s 5 0 - a g e s 5 0 - 5 95 9

Examples of US Health Risk Examples of US Health Risk Differences: Differences: Unintentional Unintentional

InjuryInjury

• leading COD ages 1-44leading COD ages 1-44• ages 65+ higher rate for fireages 65+ higher rate for fire• all non-whites higher rate for fireall non-whites higher rate for fire• Males 2x-4x rate for drowning Males 2x-4x rate for drowning • American Indians 3x higher rate overallAmerican Indians 3x higher rate overall

Examples of US Health Risk Examples of US Health Risk Differences: Differences: Intentional Intentional

InjuryInjury

• Homicide 3rd COD ages 5-14Homicide 3rd COD ages 5-14• Homicide 2nd COD ages 15-24Homicide 2nd COD ages 15-24• Homicide rate for Afr. Am. aged 15-Homicide rate for Afr. Am. aged 15-

24 2x rate for Hispanics and 14x 24 2x rate for Hispanics and 14x rate for whitesrate for whites

• Suicide 3rd COD ages 15-24; whites Suicide 3rd COD ages 15-24; whites higher although Af. Am. rate risinghigher although Af. Am. rate rising

Doctor-patient communication Doctor-patient communication and rapport are affected by and rapport are affected by

cultural differencescultural differences

Cross-Cultural Communication BarriersCross-Cultural Communication Barrierson BOTH sides: doctor and patienton BOTH sides: doctor and patient

• Stereotypes affecting perceptionsStereotypes affecting perceptions• RolesRoles

authority figuresauthority figures gendergender familyfamily

• Personal vs. impersonal stylePersonal vs. impersonal style• Non-verbal cuesNon-verbal cues• LanguageLanguage• Respect (it’s a two-way street!)Respect (it’s a two-way street!)

Communication issuesCommunication issues

• Language (spoken and written)Language (spoken and written) Non-English speakersNon-English speakers Educational levelEducational level Acceptable topicsAcceptable topics

• VoiceVoice Loudness/pitchLoudness/pitch SilenceSilence

• Body languageBody language personal spacepersonal space touchtouch gestures/facial expressionsgestures/facial expressions eye contacteye contact