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2. 2HEALTHWELLNESSLITERACYExplanatoryModel 3. 3HEALTH BELIEFSWELLNESS BELIEFSLITERACY 4. 4 5. The Regulatory BasisAccreditation organizations, such as the Joint Commissionon Accreditation of Healthcare Organizations (JCAHO),following up on standards of the National Standards forCulturally and Linguistically Appropriate Services in HealthCare, commonly called the CLAS, require that health careprofessionals receive training in delivery of services todiverse populations, so do some state contracts forMedicaid and Medicare.The Centers for Medicare and Medicaid Services (CMS) arerecommending that health care organizations with whom they contractfor these services provide culturally and linguistically appropriate care.5 6. Service Delivery MechanismsDemographicsThe Clinical Community InitiativesCompetitionQuality ExpectationsCommunity PartnershipsConsumerism6 7. The Institute of Medicine (IOM):Healthcare should be safe,effective, patient-centered,timely, efficient and equitable7 8. Seven Domains ofHealthcare Quality8SEVEN 9. GROUP CULTUREAccepted ways of behaving within theorganization or the group. This typicallyincludes attitudes, communications,conduct, beliefs, values and actions.9 10. Demographics & Its Influence onHealthcarePopulationDemographicsPractitionerDemographicsPatientDemographics10 11. 11 12. PowerShared DecisionsHealth LiteracyCollaboration12 13. What is Competency?Why is itrelevant toculturalhealthcare?13 14. 14Your Explanatory Model**Dr. Arthur Kleinman 15. Four Centers Where the ExplanatoryModel Intrudes1. Pediatric Care2. Primary Care3. Palliative Care4. Hospice/End of Life Care15 16. Eliciting the patients explanatorymodel (PEM)Predisposing vs Enabling Factorsand the Fundamental Question16 17. 17 18. The Etiology of DiseaseComparing thepatients explanatorymodel with theclinicians explanatorymodel18 19. The inherently unequal nature of power in allclinical-patient relationships and whyBut where does powerultimately rest and how isit exercised?19 20. Shared Decisions MakingThe False-Consensus Effect:Across a wide range of beliefs and behaviors,people assume that we are more like them thanwe really are.**Scientist and physician Dr. Peter UbelHow to move from patient empowerment toclinician-patient partnership20 21. Whats the the difference between patient trustand patient satisfaction?Two recent studiesshow that when patientstrust a doctor stronglythis will influencemedication adherence.21 22. Health Literacy What Is It & What Does It Mean?Health literacy depends on cultural and linguistic factors, and patientassessment tools that can efficiently collect information on patienthealth literacy, linguistic ability, and cultural beliefs.(Andrulis & Brach, 2007)Key terms that explain via casestudies how culture and languageneed to be considered in anyinteraction designed to addresshealth literacy of culturally diversepatients22 23. A Cultural EncounterA cultural encounter is the direct engagement incross-cultural interactions. It allows for validation,negation, or modification of existing culturalknowledge, and provides allparties with a culturally specificframe-work from whichculturally competentinterventions can be designed.Clinician: Different people have very different ways ofunderstanding health and illness. Please help me understand what youbelieve.23 24. Cultural SafetyConnecting patient safety,self-determination and trust*What do we learn from thesterilization of US citizensand the inoculation of syphilis?*Madeleine Leininger and Irihapeti Ramsden24 25. The Pachter Inquiry*LP: Ive been told that there are ways of treating(specific illness) that doctors dont know about,but people such as your grandparents and olderpeople know about.*Lee Pachter, OD, Chairman, Department of Pediatrics, Childrens Hospital, Drexel University Medical School25 26. HospiceHospice care provides humaneand compassionate care forpeople in the last phases ofincurable disease so that theymay live as fully and comfortablyas possible.It is loaded with beliefs, ritualand actions that impact howcare at this stage is delivered.26 27. Leadership OpportunitiesBecome familiar with the issues affecting and influencinghealthcare disparity and its connection to cultureAdvocate for those who are receiving less than satisfactorycare because of cultural factorsAssist in educating, equipping and advocating for those whohave a sense of powerlessness during healthcare encounterswhere culture may be an influencerInsist on respectful, safe, and culturally competent care duringevery healthcare intervention for you and your loved ones27 28. 28Kudos to you!