Cultural Sensitivity

Question 1

Lecture objectives

Answer 1

1) define cultural sensitivity in health care 2) identify impact of culturally insensitive care and provider barriers to cultural sensitivity 3) application of cultural sensitivity to optometric care
4) recognize high risk groups for and impact of low health literacy 5) identify ways to address patients with low health literacy

Question 2

What is culture?

Answer 2

the accepted behaviors, beliefs, values, and symbols that are passed along by communication and imitation from one generation to the next

Question 3

Major culture groups

Answer 3

race/ethnicity, religion, country of origin, and primary language

Question 4

Subcultures

Answer 4

age, gender, political party, sexual orientation, disability, education level, socioeconomic status, occupation

Question 5

T/F culture is only passed on explicitly

Answer 5

false, implicitly or explicitly

Question 6

What is counterculture?

Answer 6

somewhat deviant against society; this type of subculture defies at least one aspect of the dominant culture

Question 7

What is cultural sensitivity in healthcare?

Answer 7

the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patient’s social, cultural, and linguistic needs

Question 8

T/F cultural sensitivity = cultural relativism

Answer 8

false, they are not equal

Question 9

What does culturally insensitive care contribute to?

Answer 9

poor treatment adherence, inadequate diagnostic testing, racially inconsistent application of procedures, radically disparate mortality from treatable disease, incomplete screening of newly arrived immigrants

Question 10

Systemic barriers to culturally sensitive care

Answer 10

language, time, lack of diversity in health care (~80% white), practitioner prejudices

Question 11

Common practitioner prejudices

Answer 11

patients who do not practice healthy behaviors “don’t care about their health”, personal health is the most important priority for each family member, biomedicine is right, science is the only appropriate basis for practice, traditional beliefs should be changed rather than built upon

Question 12

Common practitioner prejudices cont

Answer 12

everyone understands the concept of chronic illness, people should and will follow directions given by health practitioners, adherence failure is the patient’s problem, patients have autonomy– except with regard to adherence, health care is available and accessible to all

Question 13

How to provide culturally sensitive care

Answer 13

be patient, watch body language, be careful of assumptions, focus on the message, provide materials in patient’s primary language, use medical interpreters when appropriate

Question 14

T/F we are contractually obligated to provide free interpreter services for some patients enrolled in federal programs

Answer 14

true, medicare/medicaid/some vision plans

Question 15

What are TEC interpretation options

Answer 15

bilingual SCO staff/students, telephone interpretation, lay interpreters, iPad translation

Question 16

T/F ASL interpreters are federally mandated for all licensed professionals

Answer 16

true

Question 17

How can you manage your prejudices?

Answer 17

identify personal biases (explicit and implicit) ex: educate yourself via Project Implicit and develop compensatory behaviors (practice patience, seek ongoing education about cultural sensitivity and your community, train your staff)

Question 18

What does project implicit do?

Answer 18

assess conscious and unconscious preferences for over 90 topics; ex: political issues, ethnic groups, sports teams, pets

Question 19

What is health literacy?

Answer 19

the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness

Question 20

How many people does low health literacy affect?

Answer 20

80 million Americans (~36% of adults)

Question 21

What are activities affected by limited health literacy?

Answer 21

locating providers and services, filling out complex health forms, sharing medical history with providers, seeking preventative health care, knowing the connection between risky behaviors and health, managing chronic health conditions, understanding directions on medicine

Question 22

Health outcomes of low health literacy

Answer 22

more hospitalizations, greater use of emergency care, lower receipt of mammographies and flu vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, among elderly persons, poorer overall health status and higher mortality rates

Question 23

What are health literacy risk groups?

Answer 23

older adults, minority populations, low SES, medically underserved people (geographic areas and populations with a lack of access to primary care services)

Question 24

What are health literacy risk factors?

Answer 24

hearing impairment, visual impairment, medication, stress, fatigue, inadequate sleep, lack of nutrition

Question 25

How can you identify patients with limited health literacy?

Answer 25

avoid reading in office, complete forms inappropriately, unable to name medications, non-compliance with medications, ask fewer questions, unable to give coherent/sequential history, frequently missed appointments

Question 26

What is the vital sign test?

Answer 26

3 minute test with 6 questions pertaining to a nutrition label; 1 point for each correct answer, score of 4-6 is adequate health literacy

Question 27

How to address low health literacy with verbal communication

Answer 27

talk slower, use lay language, limit the information provided to 2-3 key points and repeat key points more than once, ask patients to repeat instructions back to you (teach-back), encourage questions, supplement instructions with video/model/pictures

Question 28

How to address low health literacy with written materials

Answer 28

explain the purpose and limit the content, involve the reader, make it easy to read, make it look easy to read, select visuals that clarify and motivate, offer assistance in completing forms, provide materials in patients’ primary language