Migrant Health Facts Alberto Moreno, MSW Migrant Health Coordinator Department of Human Services.
Dealing with Cultural Differences Dr. Jill Benson Director, Health in Human Diversity Unit,...
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![Page 1: Dealing with Cultural Differences Dr. Jill Benson Director, Health in Human Diversity Unit, University of Adelaide Senior Medical Officer, Migrant Health.](https://reader036.fdocuments.us/reader036/viewer/2022062314/56649f345503460f94c5114b/html5/thumbnails/1.jpg)
Dealing with Cultural Differences
Dr. Jill BensonDirector, Health in Human Diversity Unit,
University of AdelaideSenior Medical Officer, Migrant Health Service, Adelaide and Tullawon Health Service, Yalata Aboriginal community
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Dominant vs Minority cultures
> 25% of the current Australian population was born in a foreign nation where English is not the dominant language
> Culture is about more than just the country of birth - it is also about age, gender, education, socio-economic status, religion, language, occupation, sexuality, politics and life experiences
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What is culture?
> What is your culture?
> Are there any other ‘cultures’ in your life?
> Does living in Adelaide give you a different culture?
> Do doctors have a culture of our own?
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Culture> The total way of life – the underlying
pattern of thinking, feeling and acting – of particular groups of people
> How people make sense of their surroundings including attitudes and behaviour, assumptions and values
> What people ‘take for granted’, what they notice about others but is largely invisible to themselves
> The interaction between language, social structure, religion, world view, environment, economy, technology, belief and values
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Other cultural concepts
> Multiculturalism: An ideology advocating that society should consist of, or at least allow and include, distinct cultural groups, with equal status
> Cultural awareness: Knowing and understanding that there is a difference between people or cultural diversity; having insight into the physical, psychological, social, spiritual, economic and political context in which people live or have lived
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Ethnocentricism
> The unconscious tendency to assume that how we behave, think and feel is the absolute (behaviour, thoughts, feelings) way of being for everyone• Normal • Good• Right• Appropriate• Expected
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Where does this come from?
> Genetic predisposition> Childhood history> Culture> Spirituality> Personality> Finances> Education> Health> Sense of Humour> Personal Insight
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Differences in other cultures> Communication styles
> Attitudes towards conflict• Always agreeing
> Approaches to completing tasks• Tomorrow will be fine
> Decision-making styles• Procrastinators
> Attitudes towards disclosure• Only if I know you and trust you
> Approaches to knowing• “You’re the doctor”
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Will this impact on patient care?
> Eye contact
> Medication – cure vs treatment
> Appointments
> Relationship with people in authority
> Are they telling the ‘truth’ anyway?
> Is health a priority in their life?
> Consulting with other people – family, other healers
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World-view> ‘Western’ individualistic world-view
• Individualism and consumerism
• Body and mind are separate
• Usually assumes people are responsible for their own misfortune
> Collectivist world-view(Indigenous cultures and the developing world)
• Spiritual and ecological
• Consensual and communal
• Spirituality pervades every aspect of the lives of people from most indigenous cultures and cannot be differentiated from either their physical or mental well-being
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Health literacy> Understanding of anatomy and how the body
works
> Must be taken into account when talking to patients from different cultures
> Causes of illness might be seen as spiritual or environmental rather than as bacteria or lifestyle
> What causes disease, pregnancy etc?
> What does this illness mean to the patient?
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Concordance and communication
> About 50% of our patients do not take the medication, have the investigations or follow the advice we give
> If we listen to our patients for just 2 minutes they are more likely to comply with our advice
> During this time we need to practice active listening techniques
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‘The answers to health problems must include giving people a sense of personal self-worth, a sense of being needed or loved, an ability to influence and control their own environment, and an ability to manage their own problems.’ (Trudgen)
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Cultural Awareness Tool> What do you think caused your problem?> Why do you think it started when it did?> What do you think the illness does to you?> What are the chief problems it has caused for
you?> How severe is your illness?> What do you most fear about it?> What kind of treatment/help do you think you
should receive?> Within your own culture how would your illness
be treated?> How is your community helping you?> What have you been doing so far?> What are the most important results you hope to
get from treatment?
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Working with different views of illness
> The doctor works exclusively within the biomedical model
> The patient and doctor function exclusively within each of their own cultures
> The doctor works within the patient’s cultural framework
> The patient and doctor negotiate between their concepts of the cause of the problem/illness/disease and the most appropriate management to reach mutually desirable goals
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Styles of communicating
> Authoritarian > Instructional > Empathic > Collaborative with the family, community and
management team
> Which are you most of the time?
> Are any of these inappropriate?
> Are there times when each might be appropriate?
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Are any of these styles more helpful if there are different health beliefs?
> Authoritarian• if their life is in danger
> Instructional• if it is important to understand what is going on so that
will feel safe, have the investigations, have the treatment, return for follow-up
> Empathic• if what is happening is overwhelming or frightening
> Collaborative• if there is a strong collectivist world-view or there is a
need for support
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Language Competency Tips
> Asking people their name, address, date of birth and other predictable information is not an adequate test of English skills
> Having social conversation skills does not always mean that the person understands complex information in spoken or written English
> Verbal skills do not always equate with reading and writing skills
> People often lose their second language skills in stressful situations
> Always use a properly qualified interpreter
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Family members
> If you use family members• They might filter the information to "protect" their
parent, relative or friend
• They might not be able to handle, or cope with things they will hear
• They might use information for private advantage or gain
• They cannot be expected to know the specialised terminology, and might make a serious or even fatal mistake
• They will not be impartial
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Jargon> ‘I think your ticker’s on the blink’
> ‘I guess you’re keen to hit the road’
> ‘That probably drives you up the wall’
> ‘Hey dude, how’s it hanging?’
> It is important that health professionals do not use jargon or local dialect when speaking to patients from a different culture, even if that culture has English as a first language
> Always ask the patient if you don’t know what something means
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Conclusion> Culture is an important aspect of any interaction with
patients
> Reflect on your own ethnocentricism
> Ask the patient about the impact of their culture on their health
> Remember to take health literacy into account
> Be aware of what style is appropriate
> Use the right interpreter if necessary
> Don’t be afraid, be compassionate – courage and a good heart go a long way
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Thank you