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cultural competency > Exam 1 > Flashcards

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

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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

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3
Q

What are the 3 key elements of health promotion? Describe

A
  1. Good governance of health
  2. Health literacy
  3. healthy cities
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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)

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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
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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

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7
Q

nowhere are the divisions of race, ethnicity, and cultural more sharply drawn than where?

A

than in the health of the US

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8
Q

who faces most deaths due to health disparities here in the US

A

minority groups

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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.

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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

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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

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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

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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.

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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

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15
Q

Values of cultural competence

A
  1. Define culture broadly.
  2. Value clients’ cultural beliefs.
  3. Recognize complexity in language interpretation.
  4. Facilitate learning between providers and communities.
  5. Involve the community in defining and addressing service needs.
  6. Collaborate with other agencies.
  7. Professionalize staff hiring and training.
  8. Institutionalize cultural competence.
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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

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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

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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

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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

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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

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21
Q

Demographic shifts

A

Statistical changes in the socioeconomic characteristics of a population or a consumer group

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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
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23
Q

Ethnicity

A

pertaining to a group sharing a common and distinctive culture, religion, language, etc.

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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

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25
Q

Why is is difficult to confirm that diversity will continue based on race/ethnicity

A

because many people are reporting more than one race

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26
Q

Demographic shifts are impacted by what

A

immigration, emigration, births and deaths

–> Policies such as travel ban, removal of protected status, and the proposed wall between Mexico and the US

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27
Q

immigration

A

people coming in to US

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28
Q

Emigration

A

people leaving the US

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29
Q

Describe the US population

A

increasing and will continue to increase

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30
Q

Where does the highest world region of foreign born population come from

A

Latin America

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31
Q

What is the highest % of language spoken in the US

A

English, the Spanish (Spanish comes from states with higher immigration population)

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32
Q

What population in the US has the highest increase in population from 2015

A

65+ years; as it grows its expected to be more racially and ethnically diverse

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33
Q

state with the highest number of Spanish speaking households

A

Cali

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34
Q

second largest racial group in the US

A

African americans

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35
Q

What state has the most AA

A

NY

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36
Q

Where do most AA reside?

A

South

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37
Q

largest minority group and the fastest-growing population group in the US

A

hispanics

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38
Q

What population has grown more than four times faster than the US population has a while since 2000

A

asain (Chinese, Asian Indians, Philippine)

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39
Q

who are recognized by state and fed

A

American Indians

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40
Q

Cons of stereotypes

A

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

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41
Q

World population and US popualation

A

World Population: 7,755,069,375

U.S population: 330,234,700

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42
Q

what did the US Census bureau report about minority populations

A

grew dramatically, from 20% to 58, between 1980 and 2010

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43
Q

Understanding the health promotion needs of minority populations is necessary to …

A

design appropriate interventions – and will reduce barriers

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44
Q

Our future depends

A

on our ability to embrace and value diversity and remove all forms of ethnic oppression and discrimination

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45
Q

A person’s cultural background provides what for his or her health beliefs and practices

A

the foundation

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46
Q

A person’s cultural background are also influenced by their ___ level

A

acculturation

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47
Q

acculturation

A

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.

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48
Q

All cultures classify relations based on

A

blood relations and marriage

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49
Q

dominant culture

A

often dictates the accepted values when there is a difference in basic values within cultures

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50
Q

Dominant cultures use a variety of methods to consolidate their power, such as

A

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

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51
Q

Values Framework

A

Areas of difference among cultures

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52
Q

Values Framework: psycho-behavioral modality

A

being or becoming

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53
Q

Values Framework: Axiology

A

Interpersonal values
ex. competition or cooperation, direct or indirect communication, emotional constraint or expression, seeking help or saving face

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54
Q

Values Framework: Ethos

A

beliefs in independence or interdependence –> allegiance to self or family, harmony and respect or control and dominance

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55
Q

Values Framework: Epistemology

A

Ways of learning

–> cognitive processes or affective domain

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56
Q

Values Framework: logic or reasoning processes

A

circular or linear

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57
Q

Values Framework: ontology

A

the nature of reality –> spiritual or objective

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58
Q

Values Framework: concept of time

A

cyclical or event or clock-based

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59
Q

Values Framework: concepts of self

A

individual or collective self

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60
Q

health

A

a groups view of physical, mental, emotional and social components required for a person to be considered healthy

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61
Q

What are some ways people think of health

A
  • 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
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62
Q

When examining cultural groups, it is important to determine what

A

whether an individual is a migrant, first-generation immigrant, or refugee

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63
Q

Why is it important to determine whether an individual is a migrant, first-generation immigrant, or refugee

A
  • 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
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64
Q

For migrants, Health problems occur as a result of what

A

the migratory and adaptation process

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65
Q

For migrants, intense stress and little social support can lead to what?

A

sadness, nervousness, irritability, migraines, insomnia, fatigue, mental health issues

66
Q

Ulysses Syndrome

A

A series of symptoms that affects migrants confronted with multiple and chronic levels of stress

67
Q

Ulysses Syndrome forms a gateway between what

A

mental health and mental disorder

68
Q

How can health educators provide culturally competent care when interacting with migrants who experience Ulysses Syndrome

A

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
Q

Latino Paradox aka “The Hispanic Paradox” or “Health Immigrant Effect”

A

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
Q

how will Working with community health workers will help to bridge the gap between health educators and members of the community

A

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
Q

Understanding diversity and developing cultural competence is…

A

an ongoing process

72
Q

What is the first step in reaching cultural competency

A

learn more about oneself (self-reflection)

73
Q

Consider cultural competency as ____

A

A “call to action”

74
Q

What is something to avoid when treating ANYONE

A

Avoid stereotyping and treat each person as a unique individual since cultural practices may be different

75
Q

Health disparities

A

when there is a disproportionate prevalence or incidence of a disease between populations

Ex. Higher prevalence of diabetes in Hispanics compared to whites

76
Q

social determinants of health

A

any type of factors or influences related to socioeconomic status outside of medical care that impact health

77
Q

Why will the nations health status not reach optimal level

A

health disparities continue to exist

78
Q

Whose priority is the elimination of health disparities?

A

a national priority established by the Health People initiatives

79
Q

Why was The office of the National Center on Minority Health and Health Disparities established

A

to create a strategic plan to address the poor health status of minorities, low-income individuals, and those living in rural areas

80
Q

health equality

A

refers to a person’s ability to attain their full health potential without interference from their social position or ethnic/racial background

81
Q

health inequality is synonymous to what

A

health disparity

82
Q

According to Healthy People 2020, What are the morbidity indicators

A 
Environmental quality
Mental health
Nutrition, PA, and obesity
Oral health
Tobacco use
83
Q

Healthy People 2020 –> Morbidity Indicators: Environmental quality

A

WHO has confirmed that 1/4 of global disease burden comes from this —> many of the environmental factors are modifiable

84
Q

Healthy People 2020 –> Morbidity Indicators: Mental health

A

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
Q

Healthy People 2020 –> Morbidity Indicators: Nutrition, PA, and obesity

A

Still a very high % of obesity in the US and globally

86
Q

Healthy People 2020 –> Morbidity Indicators: Oral health

A

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
Q

Healthy People 2020 –> Morbidity Indicators: Tobacco use

A

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
Q

The differences in the incidence and prevalence of health conditions and health status between groups is based on what

A

race/ethnicity, socioeconomic status, gender, disability status or a combination of these factors
–> health disparities

89
Q

Disparities: Infant mortality

A

US has high rates of this compared to a lot of other high income countries
–> based on race of mother; no infant

90
Q

Infant mortality def

A

number of infant deaths per 1000 child births within the first year of life

91
Q

who are infant mortality rates prevalent in?

A

High infant mortality rates of AA mothers compared to white mothers as well as Asian and pacific islanders

92
Q

Disparities: cancer screenings and management

A

Could include prostate check, mammogram, papsmear, colonoscopy

93
Q

Who are cancer rates prevalent in? What cancer is prevalent for that group? Give reasons why cancer is more prevalent in that group

A

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
Q

Disparities: Diabetes

A

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
Q

Disparities: immunizations

A

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
Q

What are the focus areas of disparities in the United States

A
  1. infant mortality
  2. cancer screenings and management
  3. diabetes
  4. HIV infection and AIDs
  5. immunizations
97
Q

Suggestions for working with diverse groups: differentiate among culture

A

do not want to assume that people in the same race have the same culture

98
Q

Suggestions for working with diverse groups: be cognizant of language preference

A

offer written language, spoken, use TRAINED interpreter (someone who knows the medical terms)

99
Q

Suggestions for working with diverse groups: remember family dynamics

A

maybe the older or the male of the household make decisions

100
Q

Suggestions for working with diverse groups: create strong coalitions

A

goes back to when we talked about community health workers

101
Q

Suggestions for working with diverse groups: develop trust

A

if your patients do not trust you, they are less likely to follow treatment, share with you and come back

102
Q

Suggestions for working with diverse groups: select communication methods carefully

A

nonverbal communication can be misread

103
Q

HHS Disparities Action Plan

A

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
Q

The HHS Action Plan to Reduce Racial and Ethnic Disparities: 5 major goals

A
  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
Q

What are the 6 priority areas identified by the CDC that need immediate attention?

A

module 4

106
Q

How should health education and prevention programs be designed?

A

to reach diverse groups

107
Q

What are the CLAS Standards?

A

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
Q

What are the steps to building a culturally competent practice (3)

A
  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
Q

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

A

Can be achieved by inviting local families, advocacy groups, or other vested parties to participate in the discussions

110
Q

What are some suggestions when you are looking at building a shared vision in building a culturally competent practice? (4)

A

a. Be informed
- -> know the groups you are looking to serve

b. Beware of stereotyping
c. Respect patients
d. Enlist community support

111
Q

Explain step 2 of building a culturally competent practice (conduct an initial assessment)

A

Clinical practices need to conduct an assessment

112
Q

What are some things a practice may assess when trying to build a culturally competent practice (4)

A
  • 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
Q

Explain step 3 of building a culturally competent practice (evaluate capacity: define goals)

A

Evaluate the financial and human resources available to improve cultural competency practices
–> resources should be identified each fiscal year and analyzed over time

114
Q

How should priorities be clearly defined when evaluating capacity (3)

A
  • 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
Q

Explain step 4 of building a culturally competent practice (implement changes) (6)

A
  • 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
Q

Research has shown that healthcare organizations continue to face challenges related to what?

A

the translation of standards, policies, and evidence-based practices of CLAS into everyday practices

117
Q

what does CLAS stand for

A

culturally and linguistically appropriate services

118
Q

The use of CLAS in health care organizations may assist in what

A

reducing patient risk of medication errors because of language barriers, misdiagnosis, readmissions, excessive emergency department use, and health disparities

119
Q

Research studies have shown that adoption and dissemination of the CLAS standards into clinical practices have been what

A

absent, slow, or partially adopted

120
Q

The importance of cultural competency is recognized, but many barriers exist such as…(4)

A
  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
Q

Diffusion of innovation therapy

A

? module 5

122
Q

Why is dissemination and implementation science? (4)

A
  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
Q

What does CAM stand for

A

Complimentary and Alternative Medicine

124
Q

According to the National Health Interview Survey (NHIS), 2007, ___ percent of the adult population and about ___ of children use CAM therapies

A

38.3; 12

125
Q

the use of CAM by adults increased how much from 2000

A

2.3%

126
Q

Commonly used CAM therapies are…?

A

Natural products, deep breathing exercises, meditation, chiropractic care, yoga, massage, and diet-based therapies

127
Q

When looking at the adult use of CAM, what is the first thing to know?

A

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
Q

Describe the CAM remedy use trend from 2002 to 2007

A

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
Q

The use of CAM by adults when looking at other types of diseases was extremely high use of CAM when trying to treat what

A

head or chest cold

130
Q

In 2002, the treatment of CAM for treating a head or chest cold was extremely high at about ____%.

A
  1. 5%

- -> in 2007, this significantly decreased

131
Q

The only increase in the use of CAM from 2002-2007 was to treat what?

A

high cholesterol

132
Q

The second most common use of CAM when looking at other than musculoskeletal diseases was for what

A

anxiety and depression, followed by stomach/intestinal illness, and then cholesterol

133
Q

The use of CAM therapies is greater for what children

A

great for children whose parents use CAM

134
Q

In regards to non-adults, the use of CAM therapies is higher for who

A

adolescents (12-17) compared to younger children

135
Q

What is the most common CAM therapy use by children?

A

natural products

136
Q

Describe the prevalence of the use of CAM for children by race

A

CAM use is higher in white children compared to Hispanic and Black children

137
Q

CAM

A

the medical and healthcare practices, systems, and products that are not included yet in the conventional medicine delivery system

138
Q

Conventional medicine

A

(allopathic care or biomedicine) - the body of scientific knowledge practiced by doctors of medicine, doctors of osteopathic medicine, and allied health professionals

139
Q

Folk medicine

A

treatment of illnesses through remedies and therapies that are based on experience and knowledge transmitted throughout generations

140
Q

integrative medicine

A

combination of conventional practices and CAM therapies

141
Q

the practice of health education is based on what

A

a holistic understanding of human life and the multidimensional nature of health

142
Q

why would it be beneficial for healthcare professionals to educated the public about the use of CAM and how to choose a CAM practitioner

A

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
Q

refer to box 4.6 NCCAM Guidelines for Selecting a CAM Practitioner

A

i think in book –> module 6

144
Q

Religion and spiritual beliefs can contribute to what

A

improved health, life expectancy, mental health, social support, and quality of life

145
Q

religion

A

The practice of participation in culturally based activities, including prayer and meditation, attendance at services, reading religious texts, and performance or rituals

146
Q

Spirituality

A

the emotional or experiential expression of “feelings or experiences of awe, wonder, harmony, peace, or connectedness with the universe or a higher power

147
Q

Approximately ___ percent of Americans reported some form of religious identity (2012)

A

82.5

148
Q

There has been a ____ in mainline church attendance among Americans, with an _____ to a non-denominational identity

A

Steady decline; upward shift

149
Q

_____ has had a small – but significant – impact on religious groups in the U.S

A

Immigration

150
Q

_____ have increased to over 173 million members due to immigration, primarily from Latin American countries

A

Catholics

151
Q

The percentage of Americans who self-
identified as Christian declined from _____
in 1990 to an estimated _____ in 2008

A

86.2%; 76%

152
Q

Who are the less frequent church attendences

A

Males (39%)
Not married (36%)
18-29 years old (35%)
Asian (31%)

153
Q

Worldview

A

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
Q

Even though self-identification for religious identification remains subjective, can be viewed on what

A

continuum of idealogies

155
Q

What are the ideologies of religious identification

A

monotheism, polytheism, pantheism, deism, agonistic, atheism

156
Q

Very religious and moderately religious Americans were more likely to practice what

A

healthy behaviors compared to non-religious Americans

157
Q

Very religious and moderately religious Americans did not do what compared to non-religious Americans

A

smoke

158
Q

What was the diet of Very religious and moderately religious Americans compared to non-religious Americans

A

reported having 5 or more servings of fruits and vegetables

159
Q

Although formalized religious affiliation has declined among Americans, faith-based organizations have remained a what

A

central focus

160
Q

Spiritual competence is a dynamic process characterized by three interrelated dimensions

A
  • 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
Q

Why is spiritual competence necessary?

A

Increases religious diversity
Negotiates potential value conflicts
Enhances insight into clients’ challenges
Accesses spiritual strengths

162
Q

Strategies for Developing Spiritual Competence

A

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)

cultural competency (2 decks)

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