CULTURAL HUMILITY IN PRACTICE...2019/04/26 · Define cultural humility and apply its principles to...

CULTURAL HUMILITY IN PRACTICE

A Workshop for HIV Service Providers

Idia B. Thurston, PhDAssistant Professor, University of Memphis

April 26th, 2019

PresenterPresentation NotesHow would you get this car out?

PresenterPresentation NotesHow would you have known it was a toy?

Perception affects what we see and how we think about a situation – thus the angle with which we view things can affect what we see and how we think and what we do.

Can’t look at any one issue in isolation…context matters! Culture is Context!

Objectives

Audience members will be able to: Distinguish between diversity, equity, and inclusion

Explain how discrimination and stigma contribute to poor health outcomes in PLWHA

Define cultural humility and apply its principles to clinical care

Describe systemic solutions to promote cultural humility and reduce disparities

PresenterPresentation NotesExplain the contrast between multicultural competence and multicultural orientation

DialogueDialogue: is a discussion between two or more people or groups, especially one directed toward exploration of a particular subject or resolution of a problem

Dialogue regarding issues of diversity, equity, and inclusion is an important component in fostering an environment of learning, respect, and effective action - an environment where the value of engaging, embracing, and including diversity is put to action

PresenterPresentation NotesBefore I start, I have a little PSAMy goal today is to have a diversity dialogue with each of you; and to encourage each person to have diversity dialogues, rather than debates (which has a winner and a loser) or discussions (which don’t have an inherent shared mission of action)

Talking Points:-Dialogue is a distinct way of communicating, seldom practiced in daily interactions. When people with varied viewpoints converse in order to seek mutual understanding, they are in dialogue.

Roadblocks to Diversity Dialogue

PresenterPresentation NotesEmotions Strong emotions (anger, sadness, defensiveness) might be triggered when discussing experiences of race, culture, gender, religion, sexual orientation, and other demographic variables. These feelings can enhance or negate a deeper understanding of the worldviews of culturally diverse patients and colleagues.

DistractionsTry to be present and respectful. Fully participate. Speak for yourself and from your experience using “I” statements.

Discomfort It is when we are uncomfortable that we have the biggest chance to learn something. Understanding your own emotional reactions is an important part of appreciating diversity. Try to push through your boundaries and see what your discomfort can teach you.

Looking for agreementRemember that we don’t have to agree to appreciate a perspective. When disagreements happen, try to challenge the statement or the behavior instead of the person. Then use it as an opportunity to ask clarifying questions and communicate why the word/action caused the reaction in you in a way that shows respect for yourself and others.

Objectives





◦ On worksheet, jot down these three key words◦ Diversity; Equity; Inclusion

◦ Now define them◦ Write buzzwords, bulleted definitions, anything that comes to mind

◦ What do you notice?◦ Are there clear differences between terms? Any overlap? Could you explain how they are all interrelated?

https://generalassemb.ly/blog/diversity-inclusion-equity-differences-in-meaning/

• The presence of difference within a given setting with respect to age, disability, religion, ethnicity/race, socioeconomic status, sexual orientation, indigenous heritage, national origin, gender (a.k.a. ADDRESSING) Diversity

• Ensuring that individuals with different identities feel and are valued, leveraged, and welcomed within a given setting.Inclusion

• A process that acknowledges an unequal starting place and works to correct and address the imbalance to ensure everyone has access to the same opportunities. Equity

“Diversity is being asked to the party. Inclusion is being asked to dance.”

- Verna Myers

Questions to ask when thinking…

DIVERSITY

How can we get more “diverse” people into our pipeline?

How can we incentivize recruiting “diverse candidates”?

Why aren’t people of differing identities applying for our jobs?

INCLUSION

What is the experience for individuals who are the minority within the organization?

What barriers stand in the way of people with marginalized identities feeling a sense of welcome and belonging?

What don’t we realize we are doing that is negatively impacting our new, more diverse, teams?

Objectives






Conceptual Framework of Health Disparities

Detection Understanding Reduction/elimination of disparities

Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006).

PresenterPresentation NotesKilbourne et al 2006 developed a conceptual framework for understanding health disparities within a health care system

First step is measuring the disparities among vulnerable populationsSecond is identifying determinants of health disparities at multilevels of patient, provider, clinical encounter, and health care system,Third is intervening to reduce disparities and change policyindividual beliefs and preferences, effective patient–provider communication; and the organizational culture of the health care system.





First step is measuring the disparities among vulnerable populations, My colleagues have shown that there is a social divide (i.e., income disparities) and a health divide (i.e., worse health outcomes and lower life expectancy for POC) in the US and one that is even more pronounced in Memphis.

PresenterPresentation NotesStudy, after study, after study has shown significant disparities in disease, health care, and outcomes for minorities so much so that Eliminating disparities in health and health care is defined as a priority in multiple governmental initiatives, such as US DHHS Healthy People 2020; National Institutes of Health; etc

http://www.cnn.com/videos/us/2014/08/27/cnn-tonight-pkg-casarez-white-privilege.cnn

http://www.cnn.com/videos/us/2014/08/27/cnn-tonight-pkg-casarez-white-privilege.cnn





Second is identifying determinants of health disparities at multilevels of patient, provider, clinical encounter, and health care system,

Discrimination

◦ Associated with many negative health outcomes

◦ Discrimination in healthcare settings1

◦ African Americans receive lower quality care and less intensive healthcare than Whites ◦ Disparities persist regardless of insurance or disease severity ◦ Occur due in healthcare contexts due to implicit bias or “unconscious unthinking

discrimination”

◦ PLWHA report being treated as inferior, having healthcare providers avoid them, and being refused service2

1. Williams, D. R., & Mohammed, S. A. (2009); Martin, M. (Host). (2017, October 28). Racism Is Literally Bad for Your Health [Radio Broadcast Episode]; 2. Schuster et al., 2005

PresenterPresentation NotesAs the video described; Day to day discrimination is a stressful experience that contributes to poorer health including coronary heart disease

HIV Stigma in Healthcare◦Qualitative study on what stigma looks like:1

◦ Medical spaces designed for PLWHA are separated from other patients

◦ Labelling patients lab work or records with infection control markings

◦ Health care providers who are nervous or unnecessarily caution for fear of transmission (e.g., wearing protective covering for casual touch)

◦ Systematic review of healthcare providers:2

◦ Stigma shows up through inadvertent behaviors and ideologies

◦ Creates discomfort barriers to HIV prevention, treatment, & care

1. Chambers, Rueda, Baker, Wilson, Deutsch, Raeifar, & Rourke (2015); 2. Geter, Herron, & Sutton (2018)

PresenterPresentation NotesInadvertent ideologies, e.g. homophobia, transphobia, racism, negative views of persons who inject drugs

HIV Stigma Associations◦ Perceived stigma associated with:◦ Poorer adherence to ART1

◦ Lower likelihood of using health and social services2

◦ Having a CD4 count lower than 2003

◦ Poorer access to care4

◦ Anticipated stigma associated with:◦ Greater medical comorbidities3

◦ Avoiding health care settings5

◦ Avoiding HIV/AIDS specific community resources5

1.Sweeney & Vanable (2016); 2. Rueda et al. (2016); 3. Earnshaw, Smith, Chaudoir, Amico, & Copenhaver (2013); 4. Kinsler, Wong, Sayles, Davis, & Cunningham (2007). 5. Chambers, Rueda, Baker, Wilson, Deutsch, Raeifar, & Rourke (2015).

PresenterPresentation NotesFinally, a systematic review in AJPH explored implicit racial/ethnic bias among health care professionals and its influence on health care outcomes and found that perceived stigma resulted in disparities in health outcomes for minorities

Reflections & Group Discussion

What drives barriers to care in your patient population?

• Medical & psychological• Geographical/distance• Personal resources• Community stigma

How could stigma and discrimination be addressed?

• Individual• Interactional (provider-patient)• Systemic level

PresenterPresentation NotesBarriers to care scale – Sample items include the following: ‘‘Long distances to medical facilities and personnel’’ (Geography/distance),‘‘My personal financial resources’’ (Personal resources),‘‘Community residents’ stigma against persons living with HIV/AIDS’’ (Community stigma), ‘‘The shortage of psychologists, social workers, and mental health counselors who can help address mental health issues’’ (Medical and psychological)





Third is intervening to reduce disparities and change policyindividual beliefs and preferences, effective patient–provider communication; and the organizational culture of the health care system.

Cultural humility is one such strategy – an approach that addresses change at multiple levels

Objectives






Consider the hardest argument

PresenterPresentation NotesI’m not prejudice or biasedI can only do what I can do within my own circleWe will hit the glass ceiling if we don’t fix the equity issueYet, data shows that these disparities affect us all regardless of whether we are from those marginalized groups or not because health care costs go up for all, when people don’t spend money it affects the economy overall, life expectancy is going down for all of us, etc.

What is Cultural Humility?

◦ “In a multicultural world where power imbalances exist, cultural humility is a process of:◦ openness◦ self-awareness◦ being egoless◦ incorporating self-reflection and critique…after willingly interacting with diverse individuals.”

Foronda, C., Baptiste, D., Reinholdt, M.M., & Ousman, K. (2015)

PresenterPresentation NotesBy show of hands how many have heard of the term cultural humility?

PresenterPresentation Noteshttps://www.youtube.com/watch?v=_Mbu8bvKb_U

1:20-3:05 (definition of cultural humility)

3:30 is the scenario of patient-nurse

Cultural Competence Vs. Cultural Humility

• Cultural competence implies a discrete endpoint

• Cultural humility is a commitment for active engagement in a process of:

Lifelong learning and critical self-reflection Recognizing and challenging power imbalances

Patient-focused interviewing and care strategies Community-based research and advocacy

Pursing institutional accountability

Tervalon & Murray-Garcia (1998)

PresenterPresentation Notes- Awareness of power imbalances in patient-provider communication, and thus using patient-focused interviewing and care strategies- Community-based care and advocacy: developing and maintaining mutually respectful partnerships with communities on behalf of patients

Critical self-reflection: ADDRESSING◦ Age and generational influences◦ Developmental disabilities◦ Disabilities acquired later in life◦ Religion and spiritual orientation◦ Ethnic and racial identity◦ Socioeconomic status◦ Sexual orientation◦ Indigenous heritage◦ National origin◦ Gender◦ *Political affiliation◦ **Size

Hays, P. A. (2009). Integrating evidence-based practice, cognitive–behavior therapy, and multicultural therapy: Ten steps for culturally competent practice. Professional Psychology: Research and Practice, 40(4), 354-360.

PresenterPresentation NotesKeep in mind Intersectionality: Meaningful ways in which various social statuses (e.g., race, gender, sexual orientation, social class) interact and result in differing experiences with oppression and privilege

Power Imbalance: Cultural Humility in Medical Settings

◦ Cultural humility can help healthcare providers constructively address stereotypes, biases, power and community inequalities that would otherwise harm the patient-provider relationship.1

◦ Cultural humility can limit the effects that biases and inequalities have on the healthcare provided.2

1. Stone, J.R. (2017); 2. White, A. A., & Stubblefield-Tave, B. (2017).

Are there opportunities to ask patients about what is truly important to them and how this might influence their care?

How could the imbalance of power and privilege, inherent in patient-provider relationships, be centered more consistently?

How could social identities and its association with stigma, health beliefs, values, health literacy, trust of medical systems, adherence be actively incorporated into care?

PresenterPresentation NotesSplit into groups and take each question – Share out!

As a clinician, please take a moment to reflect…Do patients feel heard? Do patients feel safe? to share aspects of ALL their identities.

Objectives






Cultural Difference Model

What if we saw patient differences as resources…instead of disregarding them or viewing them as deficits to be eliminated

PresenterPresentation NotesSo how might one engage in a practice of applying cultural humility.First is to consider cultural differences in a new light – specifically the cultural difference model states…

Strategies to bring about CHANGE

◦ Dismantle structural oppression and institutional racism

◦ Ensure minorities are empowered to contribute to their care decisions (in non pejorative ways)

◦ Increase the number of minorities in positions of power in health care

◦ Improve training in stigma reduction and cultural humility…


Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006). 2. Geter, Herron, & Sutton (2018)

PresenterPresentation NotesSecond, consider evidence based strategies to bring about CHANGE

Kilbourne et al 2006 developed a conceptual framework for understanding health disparities within a health care system

Suggest cultural humility is a way to address disparities

Stigma reduction for healthcare

◦ Online assessments◦ Teach Tolerance survey – https://www.tolerance.org/professional-development/test-yourself-for-hidden-

bias◦ Implicit association test - https://implicit.harvard.edu/implicit/

◦ Use opt-out testing ◦ Reduces stigma by normalizing HIV testing and removing risk-based screening practices

◦ Offer patients opportunities to provide feedback ◦ Helps them feel heard & supported; provides feedback to admin for changes needed


Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006). 2. Geter, Herron, & Sutton (2018)

PresenterPresentation NotesSecond, consider evidence based strategies to bring about CHANGE

Kilbourne et al 2006 developed a conceptual framework for understanding health disparities within a health care system

Suggest cultural humility is a way to address disparities

https://www.tolerance.org/professional-development/test-yourself-for-hidden-biashttps://implicit.harvard.edu/implicit/

PresenterPresentation NotesThird is to think larger – consider the environment more.This is AlexFish in a bowl – teach fish not to smoke, use drugs, or drink alcohol in excess, not to have unprotected sex, to have strong social relationships, to eat healthy and exercise daily, when the fish is sick we get the best unbiased doctor around to provide the best care. However, if we do ALL that and don’t change the water – none of the healthy behaviors matter – the fish still dies.

So when we get frustrated that patients aren’t adhering to our interventions; think about the water they are swimming and why they might not be able to prioritize that

Also think about how we can start to address the water problem so that our all healthy solutions can actually be meaningful

PresenterPresentation NotesHow do we consider the environment- The first step is to target who needs their water changed.

PresenterPresentation NotesWithout considering equity we may inadvertently INCREASE disparities (because people who can uptake our solutions do so and do even better than they were before while those who don’t or can’t uptake our solutions appear even worse than they were relative to the others – who did better)

PresenterPresentation NotesCould we take away the barrier completely…

https://www.storybasedstrategy.org/the4thbox

https://www.storybasedstrategy.org/the4thbox

Partnering to create solutions

In a city of a million residents, 40%

expansion of transit developments has

annual health benefit of $216 million

Financial support for habitable homes: After rehabilitating housing,

62% of adults have excellent health vs 33%

before

Early childhood education associated

with benefit:cost ratioof $5:$1 with reduction

in crime rate, childmaltreatment, teen

pregnancy, and better academic achievement

PresenterPresentation Noteshttps://www.cdc.gov/policy/hst/hi5/publictransportation/index.html; Litman, T., Evaluating Public Transportation Health Benefits. 2010, Victoria Transport Policy Institute

https://www.cdc.gov/policy/hst/hi5/homeimprovement/index.html ; Breysse J et al. Health Outcomes and Green Renovation of Affordable Housing. Public HealthRep. 2011; 126(Suppl 1): 64–75. doi: 10.1177/00333549111260S110

https://www.cdc.gov/policy/hst/hi5/earlychildhoodeducation/index.htmlThe Guide to Community Preventive Services, Promoting Health Equity Through Education Programs and Policies: Center-Based Early Childhood Education. TheCommunity Guide: What Works to Promote Health 2015 October 27, 2015 [cited 2015 November 30]; Available from: Promoting Health Equity Through EducationPrograms and Policies: Center-Based Early Childhood Education.Halfon, N. and M. Hochstein, Life course health development: an integrated framework for developing health, policy, and research. Milbank Quarterly, 2002. 80(3): p.433-479.Isaacs, J.B., Cost-Effective Investments in Children Isaacs. 2007, The Brookings Institute: Washington D.C.

◦ What is one step you can take this week to put one aspect of today’s talk into action?

◦ What skills do I need to ensure my patients (& co-workers) are heard and feel safe?

◦ What are my roadblocks to practicing cultural humility?

◦ Who can I partner with to begin to create systemic solutions within my community?

• Perception and context matter!

• Think cultural humility & work toward being culture brave to ensure all people are heard and feel safe

• If the water is dirty, interventions won’t have the effects we are looking for

Presentation Summary

PresenterPresentation NotesMy hope is that my talk today has illustrated how Perception and Context matter!

As providers it is important to keep these tenets in mind because how we (i.e., the things we do, say) are perceived affects whether patients listen to us, do what we ask, and change their behaviors. We also MUST consider the context of our patients lives otherwise we may be providing recommendations that are irrelevant to them or that don’t hold meaning for them.

Remember that discrimination, racial empathy gap, and stigma abound and continue to drive health disparities in this country

Emphasize strengths, especially among individual’s experiencing stress and adversity. When behavior change is associated with values change is most likely and stereotype threat is less likely to be triggered. Consider values affirming interventions are race-specific interventions that identify aspects of racial disadvantage that might be missed by interventions that target overall populations.

Aim to be color brave instead of color blind: Ted talk by Mellody Hobson https://www.ted.com/talks/mellody_hobson_color_blind_or_color_brave/discussion

Williams DR, Purdie-Vaughns V. Social and Behavioral Interventions to Improve Health and Reduce Disparities in Health. In: Kaplan RM, Spittel ML, David DH, eds. Population Health: Behavioral and Social Science Insights: NIH Office of Behavioral and Social Science Research; 2015:51-68.

Questions & Comments

Idia B. Thurston, PhD

Assistant Professor

Department of Psychology

[email protected]

References◦ Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal Of Behavioral Medicine, 32(1), 20-47.

◦ Schuster, M. A., Collins, R., Cunningham, W. E., Morton, S. C., Zierler, S., Wong, M., ... & Kanouse, D. E. (2005). Perceived discrimination in clinical care in a nationally representative sample of HIV‐infected adults receiving health care. Journal of general internal medicine, 20(9), 807-813.

◦ Martin, M. (Host). (2017, October 28). Racism Is Literally Bad for Your Health [Radio Broadcast Episode]. https://www.npr.org/2017/10/28/560444290/racism-is-literally-bad-for-your-health?utm_source=twitter.com&utm_campaign=health&utm_medium=social&utm_term=nprnews

◦ Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301.

◦ Trawalter S, Hoffman KM, Waytz A (2012) Racial Bias in Perceptions of Others’ Pain. PLOS ONE 11(3): e0152334.

◦ Anderson, K.O., Green, C.R., & Payne, R. (2009). Racial and Ethnic Disparities in Pain: Causes and Consequences of Unequal Care. The Journal of Pain 10(12), pp 1187-1204.

◦ Staton, L. J., Panda, M., Chen, I., Genao, I., Kurz, J., Pasanen, M., . . .Cykert, S. (2007). When race matters: Disagreement in pain perception between patients and their physicians in primary care. Journal of the National Medical Association, 99, 532–538.

◦ Tait, R. C., & Chibnall, J. T. (2014). Racial/ethnic disparities in the assessment and treatment of pain: Psychosocial perspectives. American Psychologist, 69(2), 131-141.

◦ LaVeist, T. A., Nickerson, K. J., & Bowie, J. V. (2000). Attitudes about racism, medical mistrust, and satisfaction with care among African American and White cardiac patients. Medical Care Research and Review, 57(4, Suppl. 1), 146–161.

◦ Lillie-Blanton, M., Brodie, M., Rowland, D., Altman, D., & McIntosh, M. (2000). Race, ethnicity, and the health care system: Public perceptions and experiences. Medical Care Research and Review, 57(Suppl. 1), 218–235.

◦ Burgess, D. J., Ding, Y., Hargreaves, M., van Ryn, M., & Phelan, S. (2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal Of Health Care For The Poor And Underserved, 19(3), 894-911.

◦ Owen, J., Imel, Z., Adelson, J., & Rodolfa, E. (2012). 'No-show': Therapist racial/ethnic disparities in client unilateral termination. Journal Of Counseling Psychology, 59(2), 314-320.

◦ Chambers, L. A., Rueda, S., Baker, D. N., Wilson, M. G., Deutsch, R., Raeifar, E., & Rourke, S. B. (2015). Stigma, HIV and health: a qualitative synthesis. BMC Public Health, 15(1), 1–17. https://doi-org.ezproxy.memphis.edu/10.1186/s12889-015-2197-0

◦ Earnshaw, V. A., Smith, L. R., Chaudoir, S. R., Amico, K. R., & Copenhaver, M. M. (2013). HIV stigma mechanisms and well-being among PLWH: A test of the HIV stigma framework. AIDS and Behavior, 17(5), 1785–1795. https://doi-org.ezproxy.memphis.edu/10.1007/s10461-013-0437-9

◦ Geter, A., Herron, A. R., & Sutton, M. Y. (2018). HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review. AIDS patient care and STDs, 32(10), 418-424

https://www.npr.org/2017/10/28/560444290/racism-is-literally-bad-for-your-health?utm_source=twitter.com&utm_campaign=health&utm_medium=social&utm_term=nprnewshttps://doi-org.ezproxy.memphis.edu/10.1186/s12889-015-2197-0

References◦ Kang, S., Tucker, C. M., Wippold, G. M., Marsiske, M., & Wegener, P. H. (2016). Associations among perceived provider cultural sensitivity, trust in provider, and treatment adherence

among predominantly low-income Asian American patients. Asian American Journal Of Psychology, 7(4), 295-304. doi:10.1037/aap0000058

◦ Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., & ... Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal Of Public Health, 105(12), e60-e76.

◦ Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006). Advancing health disparities research within the health care system: a conceptual framework. American journal of public health, 96(12), 2113-2121.

◦ Foronda, C., Baptiste, D., Reinholdt, M.M., & Ousman, K. (2015). Cultural Humility: A Concept Analysis. Journal of Transcultural Nursing 27(3), 210–217.

◦ White, A. A., & Stubblefield-Tave, B. (2017). Some Advice for Physicians and Other Clinicians Treating Minorities, Women, and Other Patients at Risk of Receiving Health Care Disparities. Journal of Racial and Ethnic Health Disparities, 4(3), 472–479.

◦ Stone, J.R. (2017). Cultivating humility and diagnostic openness in clinical judgment. AMA Journal of Ethics 19(10), 970-977.

◦ Sue & Sue (2013). Counseling the culturally diverse: Theory & Practice

◦ Tervalon & Murray-Garcia (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved, 9(2), 117-125.

◦ Phinney, J.S. & Ong, A.D. (2007). Conceptualization and measurement of ethnic identity: Current status and future directions. Journal of Counseling Psychology, 54, 271-281.

◦ Rueda, S., Mitra, S., Chen, S., Gogolishvili, D., Globerman, J., Chambers, L., ... & Rourke, S. B. (2016). Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ open, 6(7), e011453.

◦ Sweeney, S., & Vanable, P. (2016). The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature. AIDS & Behavior, 20(1), 29–50. https://doi-org.ezproxy.memphis.edu/10.1007/s10461-015-1164-1

◦ Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The Effect of Perceived Stigma from a Health Care Provider on Access to Care Among a Low-Income HIV-Positive Population. AIDS Patient Care & STDs, 21(8), 584–592. https://doi-org.ezproxy.memphis.edu/10.1089/apc.2006.0202

https://doi-org.ezproxy.memphis.edu/10.1007/s10461-015-1164-1https://doi-org.ezproxy.memphis.edu/10.1089/apc.2006.0202

cultural humility In PracticeSlide Number 2Slide Number 3Objectives Slide Number 5Roadblocks to Diversity DialogueObjectives Slide Number 8Slide Number 9Questions to ask when thinking…Objectives Conceptual Framework of Health DisparitiesConceptual Framework of Health DisparitiesSlide Number 14Conceptual Framework of Health DisparitiesDiscriminationHIV Stigma in HealthcareHIV Stigma AssociationsReflections & Group DiscussionConceptual Framework of Health DisparitiesObjectives Consider the hardest argumentWhat is Cultural Humility?Slide Number 24Cultural Competence Vs. Cultural HumilityCritical self-reflection: ADDRESSINGPower Imbalance: �Cultural Humility in Medical Settings Slide Number 28Objectives Cultural Difference ModelStrategies to bring about CHANGEStigma reduction for healthcareSlide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Partnering to create solutionsSlide Number 39Slide Number 40Slide Number 41Slide Number 42ReferencesReferences

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