Cultural Competency - PBworksnewenglandtb.pbworks.com/f/Cultural+Competency... · cultural...

March 24, 2010 World TB Day Conference -

Providence, RI

Cultural

CompetencyPresented by:

Chioma Nnaji, MPH, MEd Program Director

Multicultural AIDS Coalition

Community Health NEXUS

Africans For Improved Access (AFIA) Program


Providence, RI

Why?

have healthier, more satisfied clients;

increase staff competency and satisfaction;

improve business;

become more marketable when responding

to RFRs;

comply with anti-discrimination laws;

protect your federal funding; and

improve your ability to secure funding.


Providence, RI

Objectives

At the end of the presentation, participants

should be able to:

1. Define Cultural Competency

2. Explain the phases of cultural competency

development

3. Identify ways to implement each phase of

cultural competency development


Providence, RI

What is Cultural

Competency?

The ability to interact effectively with

people of different cultures.

Cultural Sensitivity

Cultural Responsiveness

Cultural Awareness

Cultural Effectiveness

Cultural Humility

Cultural Literacy


Providence, RI

Culture

… integrated patterns of human

behavior that include the language,

thoughts, communications, actions,

customs, beliefs, values, andinstitutions of racial, ethnic,

religious, or social groups


Providence, RI

Culture cont’d

Everyone has a

culture

Culture is

complicated

by multiple

layers of

identity

There is

diversity

within

cultures

Cultures

evolve


Providence, RI

Phases of Cultural

CompetencyCognitive Phase

Awareness of one’s

own cultural views

Awareness of one’s

attitude towards

different cultures

Affective Phase

Knowledge of

different cultural

values, beliefs,

and practices

Respecting

cultural

differences

Active Phase

Cross-cultural skills

Cross-cultural tools

Cross-cultural

strategies


Providence, RI

Cognitive Phase

Attitudes, Beliefs, Bias,

Prejudices, Unconscious Bias,

Isms …


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We must learn to

become comfortable

with the uncomfortable

and uncomfortable with

the too comfortable.

-- David Tulin


Providence, RI

Forms of Oppression

BELIEFs

• Stereotype

• Prejudice

• Bias

• Ethnocentrism

FEARs

• Homophobia

• Addictophobi

a

• Xenophobia

ACTIONs

• Sexism

• Racism

• Transgender

Oppression

• Heterosexism

• Classism

• Ableism

• Religious

Oppression

• Ageism/Adultis

m


Providence, RI

Definitions of Racism

system of advantage based on race

prejudice plus power

culturally sanctioned beliefs, which, regardless of

intentions involved, defend the advantages whites have

because of the subordinated position of racial minorities

a highly organized system of 'race'-based group privilege that

operates at every level of society and is held together by a

sophisticated ideology of color/'race' supremacy

… not just the sum total of all the individual acts that discriminate,

harass, stereotype, or otherwise mistreat people of color. The

accumulated effects of centuries of racism have given it an

institutional nature that is more entrenched than racial prejudice.

hatred of one person by another


Providence, RI

Racism is …

1. A legacy

2. Privilege and Power

3. Superior and Inferior

Operates on different levels:

1. Individual

2. Institutional/Societal

3. Internalized


Providence, RI

Education

Job

Opportunity

Socioeconomic

Status

Environmental

Exposure

Health Behaviors

Access to

Health Services

Safe and Affordable

Housing

Reducing Violence

Health

Racism Outcomes

Boston Public Health Commission

http://www.bphc.org/programs/healthequitysocialjustice/Pages/Home.aspx

Social Determinants of Health

Disparities


Providence, RI

Ways to Implement

Cognitive PhaseSelf Reflection

• What was I told about certain social or cultural

groups?

• What was my first interaction with/introduction

to a certain social or cultural group?

• How do I perceive my race/ethnicity?

• Who are a part of my personal, social and

professional interactions?

• How have I experienced oppression (the

oppressed or oppressor)?


Providence, RI

Ways to Implement

Cognitive Phase cont’d

Resources

What Is Race?

http://www.pbs.org/race/001_WhatIsRace/001

_00-home.htm

White Privilege: Unpacking the Invisible

Knapsack

Peggy McIntosh

http://www.slcan.org/whiteness_handouts.pdf


Providence, RI

Affective Phase

Building Knowledge


Providence, RI

Cultural KnowledgeCommon Attitudes, Beliefs and Practices Related to TB

Disease Experience

• Knowledge about TB

• Perception of

Causes

• Common names for

TB

• Stigma/Taboos

• Cures/Treatments

Social and Cultural

Context

• History of country

• Health care system

• Politics of country

• Communication

• Religion

• Immigration

• Language

• More …


Providence, RI

Disease Experience

Example …

African & Haitian Immigrants

• Incidence of TB in Africa and Haiti is high

• Mortality rates of TB in Africa and Haiti is high

• TB is associate with HIV/AIDS

• TB has a physical causation, natural

(biomedicine) causation, supernatural causation

• Cures and treatments for TB vary:– Possession– Fasting– Praying– Talismans– Home remedies

– Spiritual cleansing


Providence, RI

Health Care System

Example …


• Limited free/subsidized health insurance

• Lack of confidentiality laws governing health

information

• Walk-in

• Limited choices

• Curative care

• Time


Providence, RI

Social

ContextLite racyLite racy

Lan gu ageLan gu age

Im m igration

Statu sIm m igration

Statu s

Eth n ic

Grou pEth n ic

Grou p

Cou n try of

OriginCou n try of

Origin

Cu ltu ral

P ractice sCu ltu ral

P ractice sRe lig ionRe lig ion

Socia l

Stru ctu reSocia l

Stru ctu re

Re sou rce sRe sou rce s

He alth

Be lie fsHe alth

Be lie fs

Trau m aTrau m a

Lite racyLite racy

Lan gu ageLan gu age

Im m igration

Statu sIm m igration

Statu s

Eth n ic

Grou pEth n ic

Grou p

Cou n try of

OriginCou n try of

Origin

Cu ltu ral

P ractice sCu ltu ral

P ractice sRe lig ionRe lig ion

Socia l

Stru ctu reSocia l

Stru ctu re

Re sou rce sRe sou rce s

He alth

Be lie fsHe alth

Be lie fs

Trau m aTrau m a

Example …



Providence, RI

Communication

Example …


• Language

• Speak in idioms/proverbs/folk tales

• Interaction with authority

• Trust and confidentiality

• Community/family values

• Decision Making


Providence, RI

Ask

questions!

Ways to Implement

Affective Phase• Staff gatherings

• Community gatherings

• Media & literature

(ethnic)

• Community leaders

• More …

elicit the specifics of the client

Client-Centered Approach


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Active Phase

Effective Cross-Cultural

Interactions


Providence, RI

Cross-Cultural Skills

• Communication

• Outreach


Providence, RI

Cross-Cultural Skills:

CommunicationInappropriate• Affectionate words,

such as “honey” and “sweetheart”

• Loud voice• Eye contact• Interrupting• Dressing

Appropriate• Speak in low tones• Addressing clients by

appropriate name (considering age, gender and relationship)

• Speak at a slow pace• Maintain positive

reputation and be sincere

• Be aware of meeting surroundings

Example …



Providence, RI

Cross-Cultural Skills:

OutreachAdditional Skills

• Community (defined by community)

• Culture

• Gatekeepers –vs-Movers/Shakers

• Group Dynamics (ethnic, social, and gender)

• Social competence

Basic Skills

• Patience

• Interaction

• Tactfulness

• Cultural sensitivity

• Listening

• Effective communication

• Motivational

• Positive interpersonal relationships

• Inter-group relationships

Example …



Providence, RI

Cross-Cultural Tools

• Collecting racial/ethnic data

• Client Assessments

• Staff/Organizational Assessments– Cultural and Linguistic Competence Policy Assessment

(CLCPA)

– Cultural Competence Health Practitioner Assessment

(CCHPA)


Providence, RI

Cross-Cultural

Strategies• Incorporate social and cultural

principles

• Language access

• Link to other diseases and

services

• Building and maintaining

community relationships


Providence, RI

Resources (limited list)

National Center for Cultural Competence

EthnoMed

National Standards for Culturally and Linguistically

Appropriate Services in Health Care

(Office of Minority Health)

Southeastern National Tuberculosis Center

National Prevention Information Network


Providence, RI

Resources cont’dMaking CLAS Happen: Six Areas for Action (June 2009)

MDPH – Office of Health Equity

A guide to implementing the CLAS Standards in a variety of

public health settings.

To view and

download the guide,

go to

www.mass.gov/dph/

healthequity

http://www.mass.gov/dph/healthequity

http://www.mass.gov/dph/healthequity


Providence, RI

Questions?


Providence, RI

Chioma NnajiProgram Director

Multicultural AIDS Coalition

Tel: 617.238.2421

Email: [email protected]

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