Exam 1 Flashcards
1
Q
what is health promotion?
A
HP enables people to increase control over their own health –> address and prevents the causes of illness
2
Q
What does health promotion cover?
A
covers a wide rand of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure
3
Q
What are the 3 key elements of health promotion? Describe
A
- Good governance of health
- Health literacy
- healthy cities
4
Q
3 key elements to health promotion: Good Governance for health
A
requires policy makers to make health central part of government policy (tobacco, alcohol, food, etc)
5
Q
3 key elements to health promotion: health literacy
A
- people need to have skills and knowledge to make health decisions
- people need opportunities to makes those options
- people need to be assured of an environment in which people can demand further policy changes to improve their health
6
Q
3 key elements to health promotion: health cities
A
A. strong leadership/commitment at municipal level is essential to health urban planning and to build up preventive measures in communities and primary health care facilities
B. cities –> countries –> world
7
Q
nowhere are the divisions of race, ethnicity, and cultural more sharply drawn than where?
A
than in the health of the US
8
Q
who faces most deaths due to health disparities here in the US
A
minority groups
9
Q
What needs to be done in order to decrease the disparities of minority groups
A
we need to enhance services for culturally and linguistically diverse populations, and to do this we need an understanding of cultural competence.
10
Q
Cultural competence
A
Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations
11
Q
is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes
A
cultural competence
12
Q
Culture
A
integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious, or social groups
13
Q
Competence
A
implies having the capacity to function effectively as an individual and an organization with the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.
14
Q
cultural competence requires that organizations….
A
A. have set of values and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross culturally.
B. have the capacity (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve.
C. incorporate the above in all aspects of policy making, administration, practice, service delivery, and involve systematically consumers, key stakeholders, and communities
15
Q
Values of cultural competence
A
- Define culture broadly.
- Value clients’ cultural beliefs.
- Recognize complexity in language interpretation.
- Facilitate learning between providers and communities.
- Involve the community in defining and addressing service needs.
- Collaborate with other agencies.
- Professionalize staff hiring and training.
- Institutionalize cultural competence.
16
Q
What is the difference between cultural competence, awareness, and sensitivity
A
Cultural competence emphasizes the idea of effectively operating in different cultural contexts, and altering practices to reach different cultural groups. Cultural knowledge, sensitivity, and awareness do not include this concept. Although they imply understanding of cultural similarities and differences, they do not include action or structural change
17
Q
The Ottawa Charter (1986)
A
When it was signed, it was for UN to make a commitment to population health and improve the health of communities using health promotion intervention
18
Q
Cultural knowledge is needed in doing what?
A
needed in developing health interventions for a targeted population and treating patients based on religious, cultural, and spiritual beliefs and customs
19
Q
Cultural competence in service delivery is increasingly important to….
A
a. respond to demography changes in the US
b. eliminate disparities in the health status of people based on racial, ethnic, and cultural backgrounds
c. improve quality of services and health outcomes
d. meet legislative, regulatory and accreditation mandates
20
Q
How would one develop cultural competence
A
a. self-assessment
b. after self-reflection, determine where you fit along the continuum of cultural competence
Ongoing and complex process – always changing due to demographic changes within the population
21
Q
Demographic shifts
A
Statistical changes in the socioeconomic characteristics of a population or a consumer group
22
Q
Race
A
the categorization of parts of a population based on physical appearance due to a particular historical, social, and political force
- skin color
- structure of face
23
Q
Ethnicity
A
pertaining to a group sharing a common and distinctive culture, religion, language, etc.
24
Q
The US Census Bureau projects that the nation will become _____…
A
more diverse and the majority of people will be concentrated in urban areas
25
Why is is difficult to confirm that diversity will continue based on race/ethnicity
because many people are reporting more than one race
26
Demographic shifts are impacted by what
immigration, emigration, births and deaths
--> Policies such as travel ban, removal of protected status, and the proposed wall between Mexico and the US
27
immigration
people coming in to US
28
Emigration
people leaving the US
29
Describe the US population
increasing and will continue to increase
30
Where does the highest world region of foreign born population come from
Latin America
31
What is the highest % of language spoken in the US
English, the Spanish (Spanish comes from states with higher immigration population)
32
What population in the US has the highest increase in population from 2015
65+ years; as it grows its expected to be more racially and ethnically diverse
33
state with the highest number of Spanish speaking households
Cali
34
second largest racial group in the US
African americans
35
What state has the most AA
NY
36
Where do most AA reside?
South
37
largest minority group and the fastest-growing population group in the US
hispanics
38
What population has grown more than four times faster than the US population has a while since 2000
asain (Chinese, Asian Indians, Philippine)
39
who are recognized by state and fed
American Indians
40
Cons of stereotypes
Stereotypes create myths which can influence how health educators view and think about certain racial and ethnic groups
--> The person may have some cultural characteristics of a group but not others
41
World population and US popualation
World Population: 7,755,069,375
U.S population: 330,234,700
42
what did the US Census bureau report about minority populations
grew dramatically, from 20% to 58, between 1980 and 2010
43
Understanding the health promotion needs of minority populations is necessary to ...
design appropriate interventions – and will reduce barriers
44
Our future depends
on our ability to embrace and value diversity and remove all forms of ethnic oppression and discrimination
45
A person's cultural background provides what for his or her health beliefs and practices
the foundation
46
A person's cultural background are also influenced by their ___ level
acculturation
47
acculturation
a process of cultural contact and exchange through which a person or group comes to adopt certain values and practices of a culture that is not originally their own, to a greater or lesser extent
Clothing, music, food, language, etc.
48
All cultures classify relations based on
blood relations and marriage
49
dominant culture
often dictates the accepted values when there is a difference in basic values within cultures
50
Dominant cultures use a variety of methods to consolidate their power, such as
including fear, money and force
--> May lead to miscommunication and conflict between culture
EX.
High regard for achievement versus family obligation
Material acquisition versus enjoyment of life
Competition versus tranquility
51
Values Framework
Areas of difference among cultures
52
Values Framework: psycho-behavioral modality
being or becoming
53
Values Framework: Axiology
Interpersonal values
ex. competition or cooperation, direct or indirect communication, emotional constraint or expression, seeking help or saving face
54
Values Framework: Ethos
beliefs in independence or interdependence --> allegiance to self or family, harmony and respect or control and dominance
55
Values Framework: Epistemology
Ways of learning
| --> cognitive processes or affective domain
56
Values Framework: logic or reasoning processes
circular or linear
57
Values Framework: ontology
the nature of reality --> spiritual or objective
58
Values Framework: concept of time
cyclical or event or clock-based
59
Values Framework: concepts of self
individual or collective self
60
health
a groups view of physical, mental, emotional and social components required for a person to be considered healthy
61
What are some ways people think of health
- Traditional western medicine
- Preventive medicine
- Will not disagree with the recommendations of health care providers even though they do
- Illness is God's will
- The older family member makes decision for other family members
- Illness viewed as an imbalance between the ill person and a supernatural force
62
When examining cultural groups, it is important to determine what
whether an individual is a migrant, first-generation immigrant, or refugee
63
Why is it important to determine whether an individual is a migrant, first-generation immigrant, or refugee
- ability to determine the immigrant's emotional state
- resiliency levels
- ability to navigate the stressful changes
- the level of acceptance
- fear of having to leave
64
For migrants, Health problems occur as a result of what
the migratory and adaptation process
65
For migrants, intense stress and little social support can lead to what?
sadness, nervousness, irritability, migraines, insomnia, fatigue, mental health issues
66
Ulysses Syndrome
A series of symptoms that affects migrants confronted with multiple and chronic levels of stress
67
Ulysses Syndrome forms a gateway between what
mental health and mental disorder
68
How can health educators provide culturally competent care when interacting with migrants who experience Ulysses Syndrome
Health educators need to advocate for sociocultural approach using culturally-sensitive health educators to help newly arrive migrants who are experiencing the Ulysses Syndrome
69
Latino Paradox aka "The Hispanic Paradox" or "Health Immigrant Effect"
Refers to the epidemiological finding that Hispanic and Latino Americans tend to have health outcomes that "paradoxically" are comparable to, or in some cases better than, those of their US non-Hispanic White counterparts, even though Hispanics have lower average income and education
--> However, the longer they stay in the US, the worse their health becomes
70
how will Working with community health workers will help to bridge the gap between health educators and members of the community
A community health worker is an individual who lives within a community, so they basically have has no formal education in public health or health promotion, but they are viewed as someone in a position of authority in that community
71
Understanding diversity and developing cultural competence is...
an ongoing process
72
What is the first step in reaching cultural competency
learn more about oneself (self-reflection)
73
Consider cultural competency as ____
A "call to action"
74
What is something to avoid when treating ANYONE
Avoid stereotyping and treat each person as a unique individual since cultural practices may be different
75
Health disparities
when there is a disproportionate prevalence or incidence of a disease between populations
Ex. Higher prevalence of diabetes in Hispanics compared to whites
76
social determinants of health
any type of factors or influences related to socioeconomic status outside of medical care that impact health
77
Why will the nations health status not reach optimal level
health disparities continue to exist
78
Whose priority is the elimination of health disparities?
a national priority established by the Health People initiatives
79
Why was The office of the National Center on Minority Health and Health Disparities established
to create a strategic plan to address the poor health status of minorities, low-income individuals, and those living in rural areas
80
health equality
refers to a person's ability to attain their full health potential without interference from their social position or ethnic/racial background
81
health inequality is synonymous to what
health disparity
82
According to Healthy People 2020, What are the morbidity indicators
```
Environmental quality
Mental health
Nutrition, PA, and obesity
Oral health
Tobacco use
```
83
Healthy People 2020 --> Morbidity Indicators: Environmental quality
WHO has confirmed that 1/4 of global disease burden comes from this ---> many of the environmental factors are modifiable
84
Healthy People 2020 --> Morbidity Indicators: Mental health
There is a mental health crisis in the US
- 1 in 4 adults have mental disorder
- 1 in 5 youth have mental disorder
- most common is ADHD
85
Healthy People 2020 --> Morbidity Indicators: Nutrition, PA, and obesity
Still a very high % of obesity in the US and globally
86
Healthy People 2020 --> Morbidity Indicators: Oral health
Pain, gum disease, tooth disease, etc. inflict numerous adults and children in the US; this could be from not having dental insurance or not having access to dental care
87
Healthy People 2020 --> Morbidity Indicators: Tobacco use
Single more preventable thing someone can stop doing to reduce their change of getting diseases such as lung cancer
--> the most costly issue inflicted by the US today
88
The differences in the incidence and prevalence of health conditions and health status between groups is based on what
race/ethnicity, socioeconomic status, gender, disability status or a combination of these factors
--> health disparities
89
Disparities: Infant mortality
US has high rates of this compared to a lot of other high income countries
--> based on race of mother; no infant
90
Infant mortality def
number of infant deaths per 1000 child births within the first year of life
91
who are infant mortality rates prevalent in?
High infant mortality rates of AA mothers compared to white mothers as well as Asian and pacific islanders
92
Disparities: cancer screenings and management
Could include prostate check, mammogram, papsmear, colonoscopy
93
Who are cancer rates prevalent in? What cancer is prevalent for that group? Give reasons why cancer is more prevalent in that group
AA women have higher mortality from breast and cervical cancer compared to white this is primarily die to limited access, language barriers, cultural barriers
94
Disparities: Diabetes
A lot of disparities of this in AA and Hispanics; more than 2x as likely as whites to have type 1 diabetes
American Indians under 20 have higher prevalence of type 2
95
Disparities: immunizations
Non-Hispanic whites are more likely to get immunizations than AA and Hispanics
Children from low income households are less likely to get their immunizations
96
What are the focus areas of disparities in the United States
1. infant mortality
2. cancer screenings and management
3. diabetes
4. HIV infection and AIDs
5. immunizations
97
Suggestions for working with diverse groups: differentiate among culture
do not want to assume that people in the same race have the same culture
98
Suggestions for working with diverse groups: be cognizant of language preference
offer written language, spoken, use TRAINED interpreter (someone who knows the medical terms)
99
Suggestions for working with diverse groups: remember family dynamics
maybe the older or the male of the household make decisions
100
Suggestions for working with diverse groups: create strong coalitions
goes back to when we talked about community health workers
101
Suggestions for working with diverse groups: develop trust
if your patients do not trust you, they are less likely to follow treatment, share with you and come back
102
Suggestions for working with diverse groups: select communication methods carefully
nonverbal communication can be misread
103
HHS Disparities Action Plan
The HHS Action Plan to Reduce Racial and Ethnic Disparities was launched to stress the importance of workforce diversity and the reduction of racial and ethnic disparities
104
The HHS Action Plan to Reduce Racial and Ethnic Disparities: 5 major goals
1. transforming healthcare
2. strengthening infrastructure and workforce
3. advancing the health, safety and well-being of Americans
4. advancing scientific knowledge and innovation
5. increasing efficiency, transparency, and accountability
105
What are the 6 priority areas identified by the CDC that need immediate attention?
module 4
106
How should health education and prevention programs be designed?
to reach diverse groups
107
What are the CLAS Standards?
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and healthcare organizations
108
What are the steps to building a culturally competent practice (3)
1. Create a shared vision by defining the concept of cultural and linguistic competence and it's achieved goals
2. conduct an initial assessment
3. evaluate capacity: define goals
4. Implement changes
109
When building a culturally competent practice, how would you achieve step 1. of creating a shared vision by defining the concept of cultural and linguistic competence and it's achieve goals
Can be achieved by inviting local families, advocacy groups, or other vested parties to participate in the discussions
110
What are some suggestions when you are looking at building a shared vision in building a culturally competent practice? (4)
a. Be informed
- -> know the groups you are looking to serve
b. Beware of stereotyping
c. Respect patients
d. Enlist community support
111
Explain step 2 of building a culturally competent practice (conduct an initial assessment)
Clinical practices need to conduct an assessment
112
What are some things a practice may assess when trying to build a culturally competent practice (4)
- assess different groups the practice may encounter
- collect patient info to determine communication needs
- involved patients in the process of developing communication strategies
- be aware that patients will have different levels of health literacy
- assess patient satisfaction
- evaluate communication performance over time
113
Explain step 3 of building a culturally competent practice (evaluate capacity: define goals)
Evaluate the financial and human resources available to improve cultural competency practices
--> resources should be identified each fiscal year and analyzed over time
114
How should priorities be clearly defined when evaluating capacity (3)
- raise awareness for cultural and linguistic competence
- increase understanding related to the delivery of healthcare services
- Developing skill sets that apply knowledge of cultural and linguistic competence to health disparities, health care access and utilization, patient and provider satisfaction, and participatory research
115
Explain step 4 of building a culturally competent practice (implement changes) (6)
- some changes in service delivery may be needed to accommodate different racial/ethnic minorities
- offer services at flexible time and accessable locations
- be mindful of religious holidays
- gender-neutral language on forms
- know how to decide is certain staff need more training in cultural competence
- include policies, procedures, and fiscal planning to ensure the provision of translation and interpretation services
116
Research has shown that healthcare organizations continue to face challenges related to what?
the translation of standards, policies, and evidence-based practices of CLAS into everyday practices
117
what does CLAS stand for
culturally and linguistically appropriate services
118
The use of CLAS in health care organizations may assist in what
reducing patient risk of medication errors because of language barriers, misdiagnosis, readmissions, excessive emergency department use, and health disparities
119
Research studies have shown that adoption and dissemination of the CLAS standards into clinical practices have been what
absent, slow, or partially adopted
120
The importance of cultural competency is recognized, but many barriers exist such as...(4)
1. Quality measures were more stratified by race/ethnicity, primary language, education or insurance status
2. Human resource policies did not address the cultural competency of staff
3. Ongoing training to physicians not provided
4. Did not recognize patient safety related to patient's culture
121
Diffusion of innovation therapy
? module 5
122
Why is dissemination and implementation science? (4)
1. Translational research closes the gap and improves quality
2. Research also helps to help clinicians, nurses, and patients change behaviors and make more informed decisions
3. Help to coordinate care among patient's health care team
4. Strengthens the patient-provider relationships
123
What does CAM stand for
Complimentary and Alternative Medicine
124
According to the National Health Interview Survey (NHIS), 2007, ___ percent of the adult population and about ___ of children use CAM therapies
38.3; 12
125
the use of CAM by adults increased how much from 2000
2.3%
126
Commonly used CAM therapies are...?
Natural products, deep breathing exercises, meditation, chiropractic care, yoga, massage, and diet-based therapies
127
When looking at the adult use of CAM, what is the first thing to know?
the use of CAM in relationship to musculoskeletal diseases.
Much higher percentage of adults were using CAM in response to treatment and management of back pain.
128
Describe the CAM remedy use trend from 2002 to 2007
The use increased slightly in the use of CAM therapies for back pain
A much higher percentage than of all other musculoskeletal diseases that are listed.
The one that is second most common is for the treatment of neck pain, join pain, than arthritis, gout, lupus, then fibromyalgia
129
The use of CAM by adults when looking at other types of diseases was extremely high use of CAM when trying to treat what
head or chest cold
130
In 2002, the treatment of CAM for treating a head or chest cold was extremely high at about ____%.
9. 5%
| - -> in 2007, this significantly decreased
131
The only increase in the use of CAM from 2002-2007 was to treat what?
high cholesterol
132
The second most common use of CAM when looking at other than musculoskeletal diseases was for what
anxiety and depression, followed by stomach/intestinal illness, and then cholesterol
133
The use of CAM therapies is greater for what children
great for children whose parents use CAM
134
In regards to non-adults, the use of CAM therapies is higher for who
adolescents (12-17) compared to younger children
135
What is the most common CAM therapy use by children?
natural products
136
Describe the prevalence of the use of CAM for children by race
CAM use is higher in white children compared to Hispanic and Black children
137
CAM
the medical and healthcare practices, systems, and products that are not included yet in the conventional medicine delivery system
138
Conventional medicine
(allopathic care or biomedicine) - the body of scientific knowledge practiced by doctors of medicine, doctors of osteopathic medicine, and allied health professionals
139
Folk medicine
treatment of illnesses through remedies and therapies that are based on experience and knowledge transmitted throughout generations
140
integrative medicine
combination of conventional practices and CAM therapies
141
the practice of health education is based on what
a holistic understanding of human life and the multidimensional nature of health
142
why would it be beneficial for healthcare professionals to educated the public about the use of CAM and how to choose a CAM practitioner
Because you want to make sure you are choosing a CAM practitioner who got a good practitioner education and who can prescribe CAM therapies
143
refer to box 4.6 NCCAM Guidelines for Selecting a CAM Practitioner
i think in book --> module 6
144
Religion and spiritual beliefs can contribute to what
improved health, life expectancy, mental health, social support, and quality of life
145
religion
The practice of participation in culturally based activities, including prayer and meditation, attendance at services, reading religious texts, and performance or rituals
146
Spirituality
the emotional or experiential expression of “feelings or experiences of awe, wonder, harmony, peace, or connectedness with the universe or a higher power
147
Approximately ___ percent of Americans reported some form of religious identity (2012)
82.5
148
There has been a ____ in mainline church attendance among Americans, with an _____ to a non-denominational identity
Steady decline; upward shift
149
_____ has had a small – but significant – impact on religious groups in the U.S
Immigration
150
_____ have increased to over 173 million members due to immigration, primarily from Latin American countries
Catholics
151
The percentage of Americans who self-
identified as Christian declined from _____
in 1990 to an estimated _____ in 2008
86.2%; 76%
152
Who are the less frequent church attendences
Males (39%)
Not married (36%)
18-29 years old (35%)
Asian (31%)
153
Worldview
focused on individual inner subjectivity in relation to an external world. It strives to identify the meaning and value of the universe and human life.
154
Even though self-identification for religious identification remains subjective, can be viewed on what
continuum of idealogies
155
What are the ideologies of religious identification
monotheism, polytheism, pantheism, deism, agonistic, atheism
156
Very religious and moderately religious Americans were more likely to practice what
healthy behaviors compared to non-religious Americans
157
Very religious and moderately religious Americans did not do what compared to non-religious Americans
smoke
158
What was the diet of Very religious and moderately religious Americans compared to non-religious Americans
reported having 5 or more servings of fruits and vegetables
159
Although formalized religious affiliation has declined among Americans, faith-based organizations have remained a what
central focus
160
Spiritual competence is a dynamic process characterized by three interrelated dimensions
- An awareness of one’s personal worldview
- An understanding of the client’s spiritual worldview
- The ability to design and implement intervention strategies that are appropriate, relevant, and sensitive to the client’s spiritual worldview
161
Why is spiritual competence necessary?
Increases religious diversity
Negotiates potential value conflicts
Enhances insight into clients’ challenges
Accesses spiritual strengths
162
Strategies for Developing Spiritual Competence
Self-assessment
- Identifying one’s values and biases
Consultation
- Consult with informed experts (colleagues, members of the clergy)
Religious norms
- Expand knowledge (resources, clients, patients)
Epistemological humility
- Many ways of knowing exists (cultural humility)
