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Unformatted text preview: Cultural Competency
Lisa Z. Killinger, DC
Diagnosis/Research What is
“cultural What is “cultural competency”?
Set of skills, knowledge & attitudes related to a
clinician’s: understanding and respect for patients’ values,
beliefs, awareness of his/her own assumptions and
value ability to adapt care to be congruent with
patients’ expectations and preferences.
Ethnicity : self-defined group identity in
self-defined religion nationality
Culture: shared beliefs & values affecting social interactions interpretation of experience
Race: A biological concept (Cannot change) Examples of different cultures of
• Sex male/female
• Age children adolescents elderly • Income/education
• Religion WHY should DCs be “culturally
• US population is increasingly culturally
• Different cultures have different health
behavior and health risks
• Doctor-patient communication and rapport
are affected by cultural differences
This affects outcomes! When we improve cultural
• “Reach” patients more effectively
• Enhance the quality of the
• Improve patient compliance
• Achieve better health outcomes!! And…
• We enrich ourselves... Racial Distribution
of US Population
2000 Native Am.
(72%) Oth er Racial Distribution
of US Population
-Am Are we keeping pace with
these Interesting Factoids: The “mixed
ethnicity” category is the fastest
growing sub-population in the US. Hispanics are the fastest growing
specific ethnicity in the US
(aside from mixed ethnicity).
(aside Our society’s growing diversity
is not a problem
(& it’s certainly not going away!)
It’s an opportunity for us all to gain
from each other’s
how does diversity affect us here at
Palmer, (and in practice)
and how do
become more “culturally competent”?
US population vs. chiropractic patients
General population (2000)
DC patients (1974-82)
DC patients (1997-98) 35-45%
5% Ethnic diversity in the US
MD and DC workforce
• % Non-Caucasian
MD students (2000)
DC students (PCC 2002)
9% U.S. Chiropractors
African American 0.5
1 Some keys to cultural competency:
• Fight your fear of
• Learn about
• Don’t let time
pressures rob you
of patience and
tolerance • Ask questions, and
• Recognize that
different does not
• Let your heart
lead; (your head
understand!) Cultural Communication Issues
• Language (spoken and written) Non-English speakers Educational level Acceptable topics
• Voice Loudness/pitch Silence
• Body language personal space touch gestures/facial expressions eye contact Hot Tip:
An African American patient may make great use of
facial expressions to show approval or disapproval,
or to influence the behavior/attitudes of others.
Be aware of your patient’s facial expressions!
in the clinic...
• Body language (examples, anyone?)
Eye contact or no?
Voice tone and vocal-ness
RESPECT Your patient’s culture! Hot Tip:
Arab, Asian, or Indo-Pakistani students
(and others) may show respect for you by
lowering their gaze (not making eye
contact). Such behavior does not reflect a
lack of interest or respect.
in the clinical setting….
• The challenges
The great communication divide
Crossing the divide with grace
The right ‘match’ Hot Tip:
A practicing Muslim or Orthodox Jewish female
patient or student may be unwilling to be partnered
with a male student/doctor, and may not wish to
uncover her hair, arms, legs or torso due to the
value placed in these faiths on modesty.
value Case Study: Hispanic Culture
• Family over
• Respect for
hierarchy • Belief in spirits,
and the evil eye
and • Includes family in
• Patient may expect
Dr. to wear a white
coat, (and to
• Provider, while
may need to stress
the importance of
adhering to care
• Since every patient (of any ethnicity
or faith) is an individual, NEVER
assume anything about their beliefs.
(See next slide)
• Remember all minority persons are
Bi-Cultural (at least!). They meld 2 or
more value systems every day!
• Identify strengths in your
patient/students cultural orientation
and build on them.
build Different cultures and ethnicities
have different health behaviors
and health risks US Health Disparities (Behavior):
Reduced Physical Activity
African-Americans and Hispanics
Older adults by age 75, 33% men, 50% women
have no physical activity at all
S o urc e : He althy Pe o p le 2010 US Health Disparities (Behavior):
• Teens: 39% Caucasian
20% African American • Adults: Highest in Native Amer, blue collar and
military HS dropouts 3x rate of college grads Health Disparities (Behavior):
• >60% of Americans are
• Esp. low income women and teens
• African American/Mexican American
women have highest rates of obesity
*overweight: BMI ≥ 25; obese: BMI ≥ 30 Chronic Low Back Disability
• Activity limitation, rate per 1000 adults: Asian
32 African American
36 Native American
68 Health Disparities:
Chronic Low Back Disability
by income and education 77 54
24 poor mid/high 35
drop grad 28
coll Activity limitation, rate per 1000 adults Health Disparities:
15 14% 16% 8% 10
0 a g e s 50-59
Cauc. Afr-Am Mex-Am Native
Am. Disparities in Health Risk:
• Homicide 3rd COD ages 5-14
Homicide 2nd COD ages 15-24
Homicide rate for Afr. Am. aged 15-24
2x rate for Hispanics and 14x rate for
• Suicide 3rd COD ages 15-24;
Caucasians OK, OK, I GET IT.
There are differences
So, what should I do? Developing Cultural Competency
• Turn pre-conceived notions into questions
Use or develop empathy
Tread lightly, and if you don’t know, ask
Express respect for the patient’s
• Become familiar with your own attitudes about
cultures/faiths. Do you stress assimilation or
value maintenance of patient’s/students
cultural To gain information about a
patient’s health beliefs, ASK!
• What do you think caused your problem?
Why do you think it started when it did?
How severe do you think it is?
What are the main problems this has
caused for you?
• What kind of care do YOU think you
• What results do you hope to receive? Read all about it….
• Kiss, bow , or shake hands? (Morrison)
• Cultural Health Assessment-Mosby’s
Pocket Guide (D’Avanzo and Geissler)
(D’Avanzo Try not to be
a cultural klutz.
will thank you!
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- Summer '09