Cultural Competency and Health Education: A Window of Opportunity

Raffy R. Luquis, Ph.D., MCHES

Penn State Harrisburg: rluquis@psu.edu

Miguel A. Pérez, Ph.D. MCHES

Fresno State: mperez@csufresno.edu HP

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Objectives

• An the end of this webinar, you will be able to • Understand and explain the importance of cultural and

linguistic competence in health promotion and health education.

• Discuss ways to integrate cultural and linguistic competence into health promotion and education programs.

• Discuss strategies to promote cultural and linguistic competence in order to work effectively with the individuals or communities served by your organization and address their health needs successfully.

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2 Copyright © 2014. All rights reserved. No reproduction or republication is permitted without permission of Jossey-Bass, an Imprint of John Wiley and Sons, Inc.

Demographic Shift

• The numbers and characteristics of the US population have been changing since the turn of the century.

• Census Bureau projects that in the next four decades the nation:

• Will be more diverse and

• The majority of the population will be concentrated in urban areas

• Immigration will continue to drive demographic shifts

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Demographic Shift

• The number of people 60 and older will continue to increase

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Demographic Shift

• Increasing number of US residents speak a language other than English.

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Demographic Shifts • Non-White population are expected to become the majority

• The Hispanic and Asian populations will continue to grow

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Demographic Shift

• The racial and ethnic diversification of the U.S. population establishes the need for cultural and linguistic competence.

• In order to be effective, health education and prevention strategies must: address each group ’s unique:

• culture,

• experiences,

• language,

• age,

• gender, and

• sexual orientation

In a culturally and linguistically appropriate manner.

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Health People 2020

• In the US, not all men [and women] are created equal which is denoted in their health status.

• Healthy People 2020 goal to achieve health equity, eliminate disparities, and improve the health of all groups”, expands on previous goals for the nation.

• Health disparities are caused by a myriad of factors • lack of health information;

• lack of health insurance;

• individuals’ beliefs and attitudes;

• a shortage of diverse health care providers;

• comorbidity involving other serious health problems; and poverty.

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Definitions

• Diversity is a dynamic philosophy of inclusion based on respect for cultures, beliefs, values, and individual differences of all kinds. It respects and affirms the value in differences in ethnicity and race , gender, age, sexual orientation, socioeconomic status, linguistics, religion, politics, and special needs

• Race refers to the biological variation including phenotypical differences in stature, skin color, hair color, facial shape and other inherited characteristics that may or may not be mutually exclusive in each individual

• Although the concept of race is socially meaningful, it is of limited biological significance.

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Definitions

• Ethnicity refers to a group or individual ’s concept of cultural identity which includes a wide variety of learned behaviors that a human being uses in his or her natural and social environment to survive, which may result in cultural demarcation between and within societies

• An ethnic group consists of people who share a common orientation toward the world, whose members identify with each other on the basis of a real or a presumed common genealogy or ancestry, and who are perceived by others as having a distinctive culture

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Definitions

• Culture comprises values and beliefs

• it is learned, shared, and transmitted from one generation to next

• it helps organize and interpret life

• it includes thoughts, styles of communicating, ways of interacting, views on roles and relationships, values, practices, and customs

• It includes socioeconomic status,

• physical and mental ability,

• sexual orientation, and occupation

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Cultural & Linguistic Competence

• Six reasons why we need cultural and linguistic competence

• To respond to current and projected demographics changes.

• To eliminate long-standing disparities in the health status of people of diverse racial, ethnic, and cultural background.

• To improve the quality of service and health outcomes

• To meet legislatives, regulatory, and accreditation mandates.

• To gain a competitive edge in the marketplace.

• To decrease the likelihood of liability or malpractice claims.

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12 Cohen & Goode, 1999; Goode & Dunne, 2003

Cultural Competence & Confidence

• Cultural Competence

• A developmental process defined as a set of values, principles, behaviors, attitudes, and policies that enable health professionals to work effectively across racial, ethnic, and linguistically diverse groups.

• At the organization level requires a comprehensive and coordinated plan, including for the individual

• Cultural confidence

• A lifelong process based upon individuals' self-reflection on biases and prejudices as well as a motivation to expand their limited understanding of complex issue.

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13 2011 Joint Committee on Health Education and Promotion Terminology

Cultural Competence

• Cultural competence is a journey

• It is characterized by the awareness and acceptance of difference.

• Includes awareness and acceptance of one’s own cultural values.

• Includes the commitment to honor and respect beliefs and values of other cultures.

• Does not mean you agree with everything.

• Includes the ability to develop, adapt, and implement practice skills to fit the cultural context of the person.

• It is a dynamic, ongoing, developmental process that requires a long-term commitment and is achieved over time.

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Cultural Competence Continuum

Negative Positive

Cultural Destructiveness

Cultural Indifference

Cultural Awareness

Cultural Competence

Cultural Proficiency

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The Ongoing Journey of Cultural Competence • Assessing culture by being aware of your own culture

• Value diversity by developing a community of learning with students

• Manage the dynamics of difference by appreciating the power of conflicts

• Resolve the conflicts

• Adapting to diversity by committing to continuous learning

• Institutionalizing cultural knowledge HP

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Linguistic Competence

• The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences.

• Includes a myriad of strategies to accomplish proper communication with diverse audiences.

• It requires that individuals and organizations have the capacity to respond effectively to the health literacy needs of the populations served.

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Linguistic Competence

• Includes, but is not limited to, the use of: • bilingual/bicultural or multilingual/multicultural staff; • cross-cultural communication approaches; • foreign language interpretation services including distance

technologies; • sign language interpretation services; • multilingual telecommunication systems; • print materials in easy to read, low literacy, picture and symbol

formats; • materials in alternative formats (e.g., audiotape, Braille, enlarged

print ); • materials developed and tested for specific cultural, ethnic and

linguistic groups; • translation services; • ethnic media in languages other than English (e.g., television, radio,

newspapers). 19

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Standards for Cultural and Linguistic Appropriate Services • CLAS serves as a blueprint for individuals, health and health

care organizations to implement culturally and linguistically appropriate services

• CLAS are structured:

• Principal Standard (standard 1),

• Governance, Leadership, and Workforce (standards 2–4),

• Communication and Language Assistance (standards 5–8), and

• Engagement, Continuous Improvement, and Accountability (standards 9–15)

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https://www.thinkculturalhealth.hhs.gov/Content/clas.asp

Program Planning Models and Cultural Diversity • Planning models provide structure, direction, and sequence to

the planning process.

• The concepts of cultural competence help to direct the focus of the planning model toward programs appropriate for the diverse population.

• Community-based participatory research models are useful in development of culturally and linguistically appropriate programs to address health disparities.

• As part of CBPR, it is important to recognize the collaboration of community-based leaders and academic communities in this process.

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Planning, Implementation, & Evaluation of Culturally Appropriate Programs

• When working with diverse groups, health educators must get a clear picture of how cultural issues influence a health problem and related risk behaviors.

• Needs Assessment

• Tool to help get the bid picture of the health problem.

• Allow for the identification of community capacities and needs

• Qualitative methods and secondary data gathering are useful in needs assessment with diverse groups.

• Careful attention should be given when using population based surveys.

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Planning, Implementation, & Evaluation of Culturally Appropriate Programs

• Culturally appropriate evaluation

• Requires a balance of the program goals and objectives, the target population, and the resources available.

• Collaboration of all program staff and representatives of the target population is key.

• Several factors must be consider when determining how to design, adapt, or collect data with diverse groups.

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Planning, Implementation, & Evaluation of Culturally Appropriate Programs

• Education

• formalized education is a mechanism by which individuals are taught how to function within the organization of society.

• education provides opportunities to learn and practice assessment constructs that are commonly used in planning and measuring program outcomes.

• lack of formal Western education can compromise the use of standard assessment constructs when working with diverse groups. H

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Planning, Implementation, & Evaluation of Culturally Appropriate Programs

• Language

• When translating evaluation assessments, the translation must accurately reflect a specific target population’s language, standards, traditions, and culture.

• Lack of written language or the inability to read is also a significant challenge in evaluation design.

• Cultural protocol

• These are culturally sanctioned behaviors acceptable to a specific population.

• These patterns of behaviors pose considerable challenges in the planning, implementation, evaluation of community-based programs.

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Cultural Appropriateness and Diverse Individuals and Groups • Trust and sensitivity are pillars in building positive working

relationships and interactions between the health professional and cultural groups.

• Cultural desire and cultural awareness are exemplified in the selection and design of health education program approaches and materials.

• Health professionals can develop the personal sensitivity, trust, and credibility that are pivotal for integrating cultural competence into health education programs.

• Cultural appropriateness in working with diverse individuals and groups requires a collaborative partnership that recognizes and respects the skills of all parties.

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Strategies to Incorporate CLC into Health Education • Health educators must

learn to recognize the importance of culture and respect diversity.

• Maintain a Current Profile of the Cultural Composition of the Community

• Consider the language of both younger and older generations.

• Provide Ongoing Cultural and Linguistic Competence Training to Health Educators and other Staff.

• Involve cultural brokers from the targeted racial and ethnic groups during the development of health education programs.

• Ensure that health education programs and services are culturally and linguistically appropriate.

• Assess and evaluate the program’s level of cultural and linguistic competence.

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Standards for C&LC in Health Education and Health Promotion • Health Education and

Promotion Programs • Needs assessment &

appropriate assessment tools

• Work with and include members of the target group

• Use target group preferred language

• Empower racial/ethnic and cultural communities

• Ensure that programs are accessible, appropriate and equitable

• A Trained Workforce • Professional preparation

programs • Continue education for

practitioners

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Points to Remember • Health educators need to understand that cultural and

linguistic competence are an integral part of the development, implementation, and evaluation of health education and promotion programs.

• Health educators need to promote cultural and linguistic competence in order to work effectively with the individuals or communities served by their organizations and to address these individuals’ or communities’ health needs.

• We already know a number of good strategies for incorporating cultural and linguistic competence into health education.

• It is time for our profession to develop standards that address cultural and linguistic competence in health education programs and in the preparation of health education professionals.

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Q&A!

Thank You

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