Emerging Populations and Culturally Competent Care
- 1. Emerging Populations and Culturally Competent Care Fall 2018 Jacey Mitchell, RDH, MS
- 2. Objectives MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 2 1. Define cultural competence and analyze its importance in dental hygiene. 2. Identify health issues relevant to cultural/ethnic groups and identify barriers to dental hygiene care with different minority groups. 3. Relate the dimensions of ADPIE to culturally competent care.
- 3. Cultural Competence MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 3 • What is cultural competence? A set of congruent behaviors, attitudes, and policies that…enables that system, agency, or those professionals to work effectively in cross cultural situations” • By 2035, 40% of the U.S. population will be composed of minorities
- 4. Goals of Culturally Competent Care MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 4 Cultural knowledge Cultural Awareness Cultural Sensitivity
- 5. Cultural Knowledge 5 • Emerging Populations • Ethnic Minorities • Asian Americans/Pacific Islanders • Blacks/African Americans • Latinos/Hispanic Americans • Native Americans • Arab Americans • Persons with HIV/AIDS • Homeless Persons
- 6. Cultural Awareness: Race vs. Ethnicity MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 6 Race • Categorization of people based on physical properties and biological heredity • Social construct—not useful to identify populations for health/research purposes Ethnicity • Sense of collective identity; distinctiveness • Sharing of customs, food, dress, language
- 7. Your Experience MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 7 • Write down one experience you had with a patient who was of a minority race or culture. Was treating that patient different than treating a patient of the same race as your own? Was it the same? What assumptions might you have made based on their race or culture?
- 8. Cultural Knowledge MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 8 • Voluntary migration • Immigrants- come for positive experience • Permanent vs. sojourner • Involuntary migration • Refugees- Fleeing or being forced out of homeland
- 9. Ethnic Diversity MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 9 • Ethnic group • Group set apart on basis of cultural/national origin characteristics • Values/perceptions about health/illness • Socialization process within ethnic group • Minority group • People who receive disproportionately less wealth, power, social status
- 10. Culture, Values, and Value Orientation MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 10 • Culture • Shared patterns of values/behaviors—shaped by cultural group • Cultural values • Unique cultural beliefs of what is valued that guide decisions and behavior (such as health values) • Value orientation • Values learned by socialization by group and that reflect overall beliefs of that group
- 11. MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 11
- 12. Folk Healing vs. Professional Care MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 12 • Self-care: 70% to 90% population; mild illnesses • Professional health care system • Specialized training; remuneration for services • Folk healing practices • Reflect beliefs, values, treatment of cultural group • Ethnocentrism • Practice of viewing other ways as inferior or unnatural • Obstacle in therapeutic provider-patient relationships • Holism • Incorporates family and support system in care • Considers patient viewpoint
- 14. Arab Americans
- 15. Background • Three major waves of immigration from late 1800s to 1960s • Three largest groups: Lebanese, Syrians, Egyptians • Religions: Christianity, Judaism, Islam Barriers to care • Religious belief and practices • Cultural norms/modesty • Gender issues regarding providers • Communication difficulty • Folk remedies • Lack of culturally competent providers Selected health-related cultural aspects • Importance of family; male-dominated family structure • Present-oriented Health concerns and care issues • Adult-Onset Diabetes Mellitus • Coronary artery disease • Role of acculturation • Mental health • Teenage smoking
- 17. Background • Two waves of migration • Largest groups: Chinese, Koreans, Filipinos • Diverse origins, cultures, lifestyles • Value education Health concerns and care issues • Hesitancy to seek early diagnosis/screening • Higher rate of tuberculosis • Mental health problems due to adjustment issues • Lower rate of obesity, hypertension • Poverty • Cultural norms that prevent health • Loss of social networks • Poor access to services Selected health-related cultural aspects • Value of collectivism vs. individualism • Family most important social institution; respect for elders • Cultural value of passivity to avoid conflict • Taoism: Foundation of Chinese medicine “achieving harmony” • Use of folk medicine/alternative treatment modalities common
- 19. Background • Largest ethnic group; relatively young population • Mexican, Puerto Ricans, Cubans most common • Large diversity within Latino population Health concerns and care issues Higher incidence of • Stomach cancer • Diabetes mellitus • Cardiovascular disease • HIV Barriers to care • Highest uninsured rate of any U.S. racial/ethnic group • Lack of interpreter services in health care • Lack culturally appropriate health care services • Reliance on folk systems of healing Selected health-related cultural aspects • Family supersedes individual needs • Spiritual strength important • Hot and cold concept of disease • Disease attributed to supernatural or psychological causes • Folk remedies used in combination with Western medicine
- 21. Background • Involuntary migration history • American slave system facilitated racism/alienation • Recent substantial progress; inequities remain Health concerns and care issues • Higher cancer deaths • HIV • Hypertension • Obesity • Mental health concerns Barriers to care • Poverty • Lack of health insurance • Inadequate or unsafe environments • Centered on family and religion • Family needs to be involved in care • Churches important in promoting health • Use traditional healing approaches
- 23. Background • Native to North/South America for thousands of years • Experience minority group status; lower education and income levels compared to other groups Health concerns and care issues • Linked to social and economic conditions • Smoking, substance abuse • Deaths: unintentional injuries, cirrhosis, homicide, suicide, pneumonia, diabetes Barriers to care • Difficult access to care • Underserved population Selected health-related cultural aspects • Present-oriented; take one day at a time • Value cooperation over competition • Share resources • Value families—form kinship systems • Believe health exists when person is in harmony with nature • Traditional health practices important (shaman)
- 24. Persons With HIV/AIDS MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 24 • Overview • Over 1 million persons in United States affected • Affects all ethnic groups, sexual orientations • Adults over 50 years old fastest growing cohort • HIV strategies • Prevention—Most Important! • Rapid diagnosis • Symptom management
- 25. Persons With HIV/AIDS MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 25 • African Americans most severely affected population • Barriers to treatment • Communication gap between health care professionals and at-risk populations • Socioeconomic factors such as poverty • Cultural values, stigma • Personal values and attitudes, behaviors • Political influences
- 26. Responses to Health Challenges of Emerging Populations 26 • The nation’s response • NIH is devoting significant resources to reducing health disparities • Congress created National Center on Minority Health and Health Disparities in 2010 • Healthy People 2020 lists as one of primary goals to reduce/eliminate health disparities • Dental profession’s response • Professional organizations: Commitment to development of culturally competent care • Professional journals with transcultural and cultural diversity focus • Educational materials for dental professionals • Continuing education/staff development
- 27. References MOSBY ITEMS AND DERIVED ITEMS © 2010, 2006, 2002 BY MOSBY, INC., AN AFFILIATE OF ELSEVIER INC. 27 • Edelman, C., Mandle, C. “Health Promotion throughout the Life Span” Seventh Edition. St. Louis, MO: Mosby, Elsevier, 2010 • Darby, M., & Walsh, M. (2015). Dental hygiene theory and practice. (4th ed.). St. Louis: Elsevier.