Welcome to the AIDS Education Training Center-National Multicultural Center.
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Transcript of Welcome to the AIDS Education Training Center-National Multicultural Center.
Welcome to the AIDS Education Training Center-
National Multicultural Center
To reduce HIV/AIDS disparity by: a) providing quality standardized training in Cultural Competency and HIV/AIDS care; b) to strengthen quality Cultural Competency 1 . (knowledge and practice) capacity of HIV providers and systems nationwide; and 2. to be a resource for the improvement of multicultural health care aimed at building sustainable individual, local, regional and national capacity in HIV care.
WEBINAR PRESENTER:
Rani Srivastava RN, PhDChief of Nursing & Professional Practice (CAMH)Toronto, Ontario
A. Interact with a health care system B. Participate in programs of
prevention and health promotion C. Access financial resources
available to support healthcare (correct response)
D. Implement health seeking behavior and adherence to treatment
E. Access health information and services
A. Expecting and acknowledging differences
B. Reliance on your professional judgment – (correct response)
C. Looking for own biases, assumptions of normalcy and universality
D. Looking for systemic barriers E. Appreciation of the unique
strengths of others
A. InclusivelyB. RespectC. Valuing changeD. Time– (correct response)E. Commitment
A. Effects of migration, racism, and discrimination
B. Concerns relative to disclosure of HIV status
C. Perceptions of the trustworthiness of healthcare providers
D. The incidence/ prevalence of HIV/AIDS in the population
E. All of the above (correct response)
A. Consensus Building, Information Exchange, and Constructive
CritiqueB. Validation, Negotiation and
Reframing (correct response)C. Fact Checking, Open
Communication, and Collaboration
Examine the Culture Care Framework as a guide for practice and service in the delivery of quality HIV care.
Describe the core knowledge and skill necessary to understanding and addressing health disparities in HIV/AIDS care.
Discuss strategies to bridge the gap across cultures in providing quality health care.
Discuss how to apply the strategies of cultural care validation, accommodation and reframing in providing quality clinical care.
• Respond to current and projected demographic changes in the United States.
• Reduce long-standing disparities in the health status of people of diverse racial, ethnic, & cultural backgrounds.
• Improve the quality of services & outcomes.• Meet legislative, regulatory, & accreditation
mandates. National Center for Cultural Competence,
1999
North America1.5 million1.5 million
Caribbean240,000240,000
Latin America1.4 million1.4 million
Sub-Saharan Africa22.5 million22.5 million
North Africa & Middle East460,000460,000
Western &Central Europe820,000820,000
Eastern Europe & Central Asia1.4 million1.4 million
East Asia770,000770,000
South &South-East Asia4.1 million4.1 million
Oceania57,00057,000
Total: 33.3 million
UNAIDS, 2010
• New HIV infection rate steady.• Increased cases in women, esp. in SE.• Heterosexual transmission are increasing.• Minority populations are disproportionately
affected.• Substance use and/or abuse is an
important co-factor.
Culture and ethnicity are products of both personal history and wider situational, social, political, geographic and economic factors.
Factors related to culture and ethnicity shape: the way people interact with a health care system; their participation in programs of prevention and health
promotion; their access to health information and services; their health-related choices and decisions; their understanding of and priorities re: health and
illness; help seeking behavior and adherence to treatment.
44% of new cases of HIV are seen in African-Americans.
Ethnic minorities have a cancer death rate about 33% higher than that of European Americans.
Ethnic minorities are least likely to receive early prenatal care.
African-Americans are 1.7 times more likely to have diabetes than are European Americans.
Coronary heart disease continues to decline at a much slower rate for African-Americans than any other ethnic group.
Health inequity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable – and thus inherently unjust and unfair.
Health equity recognizes differences in health outcomes for members of marginalized communities– poverty, race, age, gender, sexual orientation, immigration or refugee status, etc, and aims to provide service in a manner that mitigates these health impacts.
Access Services in general Specific interventions Appropriate interventions
Engagement & Adherence
But whose culture do we need to understand? Patients? Care providers? Health care systems?
Non
-Min
ori
ty
Min
ori
tyDifference
Clinical Appropriateness and Need
Patient Preferences
The Operation of Healthcare Systems and the Legal and Regulatory Climate
Discrimination: Biases & Prejudice, Stereotyping, &Uncertainty
Disparity
Qual it
y o
f H
eal t
h C
ar e
Figure 1: Differences, Disparities, and Discrimination: Populations with Equal Access to Health Care
Populations with Equal Access to Health Care
From: IOM Report (2002): Unequal Access
A congruent set of workforce behaviors, management practices and institutional policies within a practice setting resulting in an organizational environment that is respectful and inclusive of cultural and other forms of diversity and that leads to reducing inequities in health care
Adapted from Cross et al.
Culturally competent care is about the creation of an environment in which the best medical practices can be safely accessed and implemented affirming all individuals, alienating none due to various differences, assisting clients to be comfortable with the skin they are in.
1. Inclusivity2. Respect3. Valuing differences4. Equity5. Commitment
RNAO, 2007
To care for someone I must know who I am
To care for someone I must know who the other is
To care for someone I must be able to bridge the gap between myself and the other
Watson cited by Anderson
Culture Sensitivit
y
Culture Resourc
es
Culture Knowled
ge
Health Equity through Culturally
Congruent Care
AFFECTIVE
BEHAVIOURAL COGNITIVE
AFFECTIVE
BEHAVIOURAL COGNITIVE
Dynamics of difference
Environment
Equity
Understanding of issues re:• Power
• Trust
• Equity
•RESPECT
Understanding of OWN
• Biases/Prejudices
• Values / Beliefs
•CULTURE
Understanding of Professional / Organizational CULTURE
Culture Sensitivity
Culture Resources
Culture knowledge
Culture Sensitivity
Culture Resources
Culture knowledge
GENERIC knowledge
CUTLURE SPECIFIC knowledge
Application of Culture Specific Knowledge •Patterns vs. Stereotypes•Holding Knowledge
Basic knowledge about the impact of culture on health that applies across a wide variety of groups
E.g. Cross cultural communication strategies; difference between individualistic cultures and collectivist cultures; Explanatory models of illness
Impact of migration, settlement, racism, and discrimination
Trust re: health system and care providers Selective disclosure
Identify the languages spoken in the community and determine availability of interpreter for non-English speakers and those with disabilities.
Achieve effective encounters with all patients• Send and receive both verbal and nonverbal messages
accurately and appropriately in each culturally different context.
• Communicate respect and inquire about greeting preferences: “How would you like me to refer to you? Mr.? Mrs.? First Name? Nickname? Title?”
• Maintain a non-judgmental attitude.
Elevated Stakes
Power Differences
Time Pressures
CompetitionFeelings and Emotions
Value Differences
Anticipationof Conflict
Differing Needs
Cultural Differences
Ambiguity
Adapted from Mutha, S. (UCSF), 2002
Identify the conflict and define the problem before escalation
Develop a range of acceptable solutions
Analyze the other party’s likely goals and objectives
Analyze the risks inherent in the conflict situation
Review prevalence of HIV in the community/neighborhood served by your practice.
Obtaining knowledge regarding biologic variations based on ethnicity, age, generation, country of origin, language, worldviews, and cultural specific behavioral patterns.
Black gentleman in his mid 30’s from the Carribean
Worked in the community health sector Acute Renal Failure HIV + Requested the advanced practice nurse to
“not have the West Indian nurses caring for me”
What are the key factors to consider behind this request?
Culture ResourcesInternal / External
Client/ Colleagues
Organizational Systems Policies, ToolsPartnershipsCommitmentResourcesInterpreters
/Brokers
Access to information
Culture Sensitivity
Culture Knowledge
Practice Expectations
Maria a 42 year old Latina reported for the results of her HIV test a month after being tested. She is not fluent in English so she brought her two teenage sons, Miguel and Javier to help translate for her. The clinic does not have bilingual staff or hired interpreters. The counselor feels uncomfortable about sharing the results of Maria’s HIV test with her two sons but has no other way to communicate the results to Maria. As the counselor begins to inform the sons that their mother has tested positive for HIV, Miguel begins to cry. Javier, translates the results to his mother and accuses her of sexual promiscuity.
• Provided for persons with challenges in English as a Second Language (ESL)
• Readily available• Culturally appropriate oral and written
language service through such means as bilingual/bicultural staff, trained medical interpreters, and qualified translators
U.S. Department of Health and Human Services, 2000
Culture care preservation / Validation Respect & Honor what we may not know Look for strengths & not just deficits
Culture care Accommodation / Negotiation Does not need to be either / or Ask – what would it take to….
Culture care Re-patterning / Reframing Learn new ways of caring / healing/ meaning of
behaviors Applies to providers & recipients of care
Expect and acknowledge differences Look for systemic barriers Remember Your culture is personal, professional, reflective
of your organization Avoid judgements... Alter your perspective Apply knowledge of cultural factors – barriers & strengths Learn the art of apology and humility Be open to new ideas, new ways of approaching something Use your power and privilege to empower others EARN trust Create SAFE spaces for SENSITIVE conversations
The HIV epidemic will not be over unless and until we develop the capacity, infrastructure and commitment to deliver cultural congruent care. The time to reduce health disparities and inequities is now .
Robert Kerr
A. Interact with a health care system B. Participate in programs of
prevention and health promotion C. Access financial resources
available to support healthcare (correct response)
D. Implement health seeking behavior and adherence to treatment
E. Access health information and services
A. Expecting and acknowledging differences
Reliance on your professional judgment – (correct response)
Looking for own biases, assumptions of normalcy and universality
Looking for systemic barriers Appreciation of the unique strengths
of others
A. InclusivelyB. RespectC. Valuing changeD. Time– (correct response)E. Commitment
Effects of migration, racism, and discrimination
Concerns relative to disclosure of HIV status
Perceptions of the trustworthiness of healthcare providers
The incidence/ prevalence of HIV/AIDS in the population
All of the above (correct response)
Consensus Building, Information Exchange, and Constructive Critique
Validation, Negotiation and Reframing (correct response)
Fact Checking, Open Communication, and Collaboration
1840 7th Street NW, 2nd FloorWashington, DC 20001202-865-8146 (Office)202-667-1382 (Fax)www. AETCNMC.org