One Size Does Not Fit All.... Cultural

Competence and Community-Engaged

Research in Healthcare

Presenter: Elleen M. Yancey, PhD,

Associate Clinical Professor,

Community Health and Preventive Medicine,

Morehouse School of Medicine Prevention Research Center

One Size Does Not Fit All....

Today’s Objectives….

▪ To generate exposure to issues of cultural competency, cultural diversity and related areas

▪ To present overview of effects of cultural competence on research and healthcare

▪ To encourage personal reflection upon feelings that discussion of cultural competence engenders

▪ To stimulate thinking, initiate learning process & increase awareness of far-reaching impact of cultural issues (professionally & personally)

Why Cultural Competence?

Basics of Community-

Engaged Research

Data is shared, researchers and community decide its use and dissemination

Researchers own the data & decide how it will be used & disseminated

Researchers own data, control use & dissemination*McDonald, MA. (2008). Practicing community-engaged research. MedEdPORTAL.Publication,4:1127

Researcher & community share control equally

Researchers control research, community representatives may help make minor decisions

Researchers control process, resources & data interpretation

Researchers & community work together to help build community capacity

Researchers gain skills & knowledge, some awareness of helping community develop skills

Researchers gain skills & knowledge

Community organizations are partners with researchers

Community organizations may help recruit participants & serve on Advisory Board

Community organizations may assist

People as participants & collaborators

People as participants People as subjects

Research WITH community as full partner

Research IN the community, or WITH the community

Research IN or ON the community

Community identifies problem or works with researcher to identify problem

Researcher defines problem, community may contribute

Researcher defines problem

Community-Based

Participatory Research

Approach

Research with the

community

Community-engaged Research*Traditional Research Approach

Research WITH community as partner

Principles of Community-Based

Participatory Research

1. Recognizes community as a unit of identity.

2. Build strengths and resources within the community.

3. Facilitates collaborative partnerships in all phases of the research.

4. Integrates knowledge and action for mutual benefit of all partners.

5. Promotes a co-learning and empowering process that attends to social inequities.

6. Involves a cyclical and iterative process

7. Addresses health from both positive and ecological perspectives

8. Disseminates findings and knowledge gained to all partners.

Israel, B.A., Schulz, A.J., Parker, E.A., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. NNUAL Review of Public Health 19(1), 173-202.

Cultural Competence &

Health Care

Why Cultural Competence?

▪ “Health promotion strategies and interventions that infuse elements and techniques of cultural competence can potentially accelerate the reduction of well-known health disparities among racial and ethnic Americans.”

Boone, L.R., Mayberry, R, Betnacourt, J.R., Coggins, P.C., Yancey, E.M. Cultural Competence in the prevention of sexually transmitted diseases.American Journal of Health Studies. (21) 4, 2006.

Where do I stand…

…along the clothesline of our beliefs and values?

Why Cultural Competence?

We have become not a melting pot but a

beautiful mosaic. Different people,

different beliefs, different yearnings,

different hopes, different dreams.

Jimmy Carter

What is Cultural Competence?

▪ Implies having the

CAPACITY to function

effectively among diverse

populations.

Basics of Cultural Competence

▪ Acceptance and respect for difference

▪ Continuing self-assessment regarding

culture

▪ Careful attention to dynamics of

difference

▪ Continuous expansion of cultural

knowledge and resources

CRASH-Course Concepts

▪ Culture

▪ Respect

▪ Assess / Affirm

▪ Sensitivity / Self-awareness

▪ Humility

Rust, G., Kondwani, K., Martinez, R., Dansie, R., Wong, W., Fry-Johnson, Y., & Smothers, H. (2005). A crash-course in cultural

competence. Ethnicity & Disease, 16(2Suppl 3),S3-29

CRASH: Self-Awareness:

▪ Becoming aware of our own

cultural norms, values, and

“hot-button” issues that lead

us to mis-judge or to

“miss-communicate” with

others.

CRASH Humility:

▪ Recognizing that none of us ever fully

attains “cultural competence”

▪ Making a commitment to life-long learning

▪ Peeling back “layers of the onion” of

our own perceptions and biases

▪ Being quick to apologize and accept

responsibility for cultural mis-steps

▪ Embracing the adventure of learning from

others’ first-hand accounts of their own

experience.

Kleinman’s 9 Questions to Assess Health Beliefs1. What do you call your problem? (What name does it

have?) 2. What do you think caused your problem? 3. Why do you think it started when it did?4. What does your sickness do to you? (How does it

work? How severe is it?)5. Will it have a short or long course? 6. What do you fear most about your disorder?

7. What problems has your sickness caused for you? 8. What kind of treatment do you think you should

receive? 9. What are the most important results you hope to

receive from the treatment?

Kleinman A. Patients and Healers in the Context of Culture. The Regents of the University of California. 1981.

Self-awareness

▪ When people won’t make eye contact

with me, ______________________.

▪ When clients show up late for their

appointments, ___________________.

▪ When people touch me a lot or get in my

personal space, ___________________.

▪ When dealing with conflict, people should

____________________________.

Case Study in Diversity for Clinical Practice:

A Woman in Labor

▪ A woman in active labor received prenatal care from a female OB. Tonight she is in active labor, the female OB is out of town, and the OB’s male colleague is on call.

▪ The only other OB on staff at your small hospital is male. The woman’s husband says that in her religion she would be defiled by a male health care worker seeing her undressed or touching her and he insists that a female doctor deliver the baby.

▪ The patient is mostly moaning with labor pains, and her cervix is now 8 cm dilated.

What do you do?...

Follow-up Questions

▪ What could/should have been done differently (hint: much earlier!) to prevent this cross-cultural dilemma from developing?

▪ At what point do the values of our own culture require us to resist the cultural preferences of patients or their families (example: Child female circumcision / genital mutilation)

▪ What larger ethical principles should be applied in making such decisions?

Beyond Cultural Competency

Lewis, PH. Beyond Cultural Competency, Race, Ethnicity & Disabilities: State of the Science Conference, Arlington VA. March 2012.

Beyond Cultural Competency

Lewis, PH. Beyond Cultural Competency, Race, Ethnicity & Disabilities: State of the Science Conference, Arlington VA. March 2012.

Critical

Consciousness

The

Development of

a critical

awareness of

how personal

dynamics unfold

with social &

political contexts

Ethics

Respect for

autonomy

+Beneficence

+Non-

malfeasance

+Justice

Entreat health

care providers to

avoid harm

Social Justice

Fair distribution of

society’s benefits,

responsibilities &

their consequences.

Focuses on the

relative position of

one social group in

relationship to others

in society as well as

on root causes of

disparities & what

can be done to

eliminate them.

Culturally Competent System of Care

Acknowledges Importance of...

▪ Culture

▪ Assessment of cross-cultural

interactions

▪ Expansion of cultural knowledge

▪ Adaptation to meet culturally unique

needs

Culturally Competent

Healthcare Professional

▪ Begins with commitment to provide culturally

competent health care and research

▪ Must include

– Awareness/acceptance of cultural

differences

– Awareness of own cultural values

– Understanding of dynamics of difference

– Basic knowledge of health consumer’s

environment(s)

Five Elements of Culturally Competent

Healthcare Professionals

1. Acknowledge cultural differences and become aware of own effect upon clinical services and research

2. Recognize influence of own culture

3. Understand dynamics of difference.

4. Understand meaning of information provided from both provider AND clients’

cultural context

5. Know where and how to obtain necessary information regarding culture of populations involved in clinical service

Summary Comment

▪ “There are… important … considerations that apply uniquely to community-based research. These include the principles that govern relationships between researchers and communities and the principles of cultural competence that prepare researchers to create the community partnerships needed to conduct community-based research.”

Blumenthal, D.S., Yancey, E.M. “Introduction to community-based research”. Community-Based Research: Issues and Methods. D.S. Blumenthal & R.J. DiClemente (eds.), New York, NY: Springer Publishing Co., 2004.

Movement Toward Cultural

Competence

▪ Attitudes must change to become less

ethnocentric and biased.

▪ Policies must change to become more

flexible and culturally impartial

▪ Practices must become more

congruent with cultures

Morehouse School of Medicine

Prevention Research CenterDepartment of Community Health and Preventive Medicine

Elleen M. Yancey, PhD,

Email: eyancey@msm.edu

PRC Website: www.msm.edu/prc

720 Westview Drive, SW

Atlanta, Georgia 30310

(404)752-1022

(404) 765-9771 Fax

www.msm.edu/prc