final Flashcards
health communication definition
the art and science of using theory based communication strategies and technologies to inform and influence individual and community decisions that advance health
communication model steps
- planning and strategy development
- developing and pretesting
- implementing the program
- evaluation
(goes in circle)
scientific definition of health
health is defined by certain objective parameters (ex: BP is 120/80)
every day reality definition of health
health is defined by subjective physical discomfort
intercultural communication can be viewed from
-individual levels
-interpersonal levels
-intergroup level
-cultural level
individual level of intercultural communication
is patient motivated to make changes?
interpersonal level of intercultural communication
-intimacy of relationships
-social networks
intergroup level of intercultural communication
-social identity
-collective self esteem
cultural level of intercultural communication
-dominant values
-principles
-shared beliefs
non-verbal communication
-paralanguage (language without words)
-proxemics (perception and use of personal and interpersonal spaces)
-non-verbal behavior (body movements, facial expressions)
active voice
wanting individual to participate in some action, pts are more responsive to
passive voice
does not include individual/ “you” statements
anxiety
is particulary present when we relate to people who we consider to be different that us or a stranger
greater anxiety may lead to
avoidance and ineffective non-verbal communications
uncertainty
having some type of certainty leads to more confidence, self efficacy and understanding of expectations
achieving effective communication -cultural competence and communication
-need to consider the characteristics of the speakers or the situation
-incorporate the elements of sensitivity, awareness, and skills
-practice mindfulness
-greater motivation is associated with more positive attitudes towards people of other cultures
facing differences in language
language concordance and the use of interpreters
strategies to achieve effective communication
-health educators need to have a collection of culturally appropriate communication skills such as empathy, care and respect
-need to notice the individuals indications, expectations and nuances of the interaction
-health educators must have sufficient adaptability to adjust to different individuals and individualize their communication according to their characteristics and needs
-use a mix of both verbal and nonverbal communication
evidence has shown that in multicultural encounters relative to health care
there are high levels of anxiety and uncertainty of both individuals and educators which can hinder communication
literacy definition
understanding, evaluating, using and engaging with written text to participate in society, to achieve one’s goals, and to develop one’s knowledge and potential, also included is a person’s ability to comprehend written and oral messages
factors that influence literacy levels
-education
-personal ability
-age/gender
-living conditions
-culture
-language
-education
Healthy People 2030 new definitions for health literacy
-emphasize people’s ability to use health information rather than just understand i t
-focus on the ability to make “well informed” decisions rather than “appropriate” ones
-incorporate a public health perspective
-acknowledge that organizations have a responsibility to address health literacy
three types of health literacy
-functional: acquire and act on information
-interactive: discriminate between health information from different sources
-critical: critically analyze health information from a variety of sources
levels of health literacy
below basic
basic
intermediate
proficient
healthy people 2030 health literacy goals
-increase the proportion of adults whose health care provider checked their understanding
-decrease the proportion of adults who report poor communication with their health care provider
-increase the proportion of adults whose health care providers involved them in decisions as much as they wanted
-increase the proportion of people who say their online medical record is easy to understand
-increase the proportion of adults with limited english proficiency who day their providers explain things clearly
-increase the health literacy of the population
US 5 chronic diseases that cause more than 2/3 of all deaths each year
heart disease
cancer
stroke
COPD
diabetes
national prevention strategy (2011) focuses upon increasing life expectancy and quality of life in the following areas
-building health and safe environments
-expanding quality preventive services
-empowering people to make choices
-eliminating health disparities by utilizing prevention strategies
individuals with low health literacy
-may not be able to engage in self assessment activities
-may not be able to manage their chronic disease
-may not be able to differentiate health care services such as office visit, acute care vs ED
-likely to report poor health status
-healthcare costs (greater use of services designed to treat rather than prevent)
-stigma and shame (may feel a sense of shame so may hide difficulties)
who is most at risk for low health literacy
-older adults
-racial and ethnic minorities
-people with less than a high school degree or GED
-people in low income levels
-non-native speakers of english
-people with compromised health status
health literacy tools to address health literacy among patients
-ABLE (adult basic learning examination)
-LAD (literacy assessment for diabetics)
-NVS (newest vital sign)
-NLS (nutritional literacy scale)
-REALM (rapid assessment of adult literacy in medicine)
-SAHLSA (short assessment of health literacy for spanish speaking adults)
plain writing act of 2010
-requires all levels of the federal government to develop written materials in easy to understand plain language
-engage reader, write clearly, display material correctly and evaluate your document
-written material should be at 4th-5th grade reading levels
tools to improve readability
-large font
-clear headings
-simple words
-white spaces with pictures
-bright contrasting colors
-short sentences
-include “how to” section
ways to improve the impact of culture and language on health literacy levels
-differentiate between culture, race, ethnicity
-avoid stereotypes
-be cognizant of language preference
-translation versus interpretation
-incorporating CLAS standards
-avoid jargon
-ascertain acculturation levels
-diversity in teaching methods
-narrative communication
-never assume that knowledge will lead to action
interprofessional collaboration
-an innovative strategy whereby 2 or more professionals learn about, from and with each other
-enables effective collaboration and improvement of health outcomes
-allows better responses to the health needs of those that serve as practitioners
elder abuse
an intentional or negligent act by any person that causes harm or serious risk of harm to an older adult
ageism
negative stereotypes and discrimination based on age
% of older adults represented racial and ethnic minorities in 2017
23%
by 2034, number of older adults in US will
exceed number of children
51% of older americans live in these 8 states
california
floria
new york
pennsylvania
illinois
ohio
Michigan
north carolina
gender that lives longer
women
fastest growing segment within the US aging population
minority ethnic groups
issues facing older adults
-loss of independence
-loss of economic and social position
-change in marital status including loss of spouse
-loss of family members and friends
-ageism (toward very old or very young)
-elder abuse and neglect (financial, physical, sexual abuse, self neglect, abandonment)
interprofessional collaboration in health education
-patient/client/family community context
-dealing with interprofessional conflicts
-role clarification
-team functioning
-collaborative leadership
-communication
2003 National Assessment of Adult Literacy (NAAL) results for older adults
-71% of adults older than age 60 had difficulty in using print materials
-80% had difficulty using documents such as forms or charts
-68% had difficulty interpreting numbers and doing calculations
when working with the aging population, knowledge of the following is critical
-social needs
-economic
-psychological
Administration on Aging (AoA), a toolkit for serving diverse communities addresses four areas
-assessments
-identifying community resources
-tailoring services
-program evaluation
US census does not collect information on
sexual orientation
part of affordable care act includes a provision to protect
LGBTQ population against discrimination in health care based on sexual orientation, gender identify and sex stereotyping
biological sex
determined by medical factors at birth and is defined as male, female or intersex
gender
sociological construct that has typical characteristics associated with masculinity or femininity
gender identity
a person’s innate sense of self as being male or female and does not always match biological sex
sexual orientation
exists on a spectrum and refers to who an individual is sexually attracted to
health issues of LGBTQ community
-the LGBTQ+ community suffers multiple health disparities as a result of heterosexism and homophobia
-increased risk of chronic diseases (cancer, diabetes, CVD, obesity)
-higher rates of health risk behaviors (smoking, drinking, substance use)
-higher rates of mental illness (depression, anxiety, suicidal)
-higher rates of violence against them
-reduced access to affordable and appropriate health care
health issues in LGBTQ youth
-depression
-family rejection
-suicide
-drugs and alcohol abuse
-running away/homelessness
-prostitution
-school hostile and unsafe environment
-victimization
-violence
-STIs/HIV
-high risk sexual behaviors
-discrimination and harassment
-lack of access to health care
health issues of lesbian/bi women
reproductive cancer:
-less likely to receive gynecological care (pap smears and breast exams)
-higher risk of late diagnosis of cervical, endometrial and ovarian cancer
obesity and heart disease
health issues of gay/bi men
-HIV, AIDS and STIs
-substance use and abuse
-eating disorders and negative body images
health issues in transgender community
-most misunderstood and underrepresented members of LGBTQ
-higher rates of suicide attempts, high poverty levels, housing instability
-postponing healthcare (often due to lack of cultural sensitivity)
-requirements for medical services
-in past there was a need to diagnose gender dysphoria by a psychologist to receive treatment
health educators and professionals can reduce homophobia and heterosexism by
-being aware of personal biases
-contributing to an environment of accountability among colleagues
-migrating bias through training and institutional review
-ensuring systems (eg data collection) use appropriate inclusive language
-avoiding making assumptions about sexual orientation and gender identity
-providing current information and resources regarding health issues specific to LGBTQ people
systems change process is recommended for practice change
-community health
-community psychologists
-health care providers
-community support
steps in the change process
- formation of team of champions
- assess levels of readiness at multiple levels
- initiate training in cultural competency/cultural humility
- measure pre and post training efforts
impairment
condition of the body or mind, such as lacking a limb, being partially sighted or experiencing depression… an attribute of an individual
disability
loss or limitation of opportunities to take part in the life of the community on an equal level with others. it arises from the social, economic, and physical environment in which people with impairments find themselves
prevalence of disability
-over a billion people in the world have a disability
-15% of the world’s population
-1 in 4 US adults reported disability
-6% reported hearing disability
most prevalent disability
mobility
3 critical issues regarding disability and health
-to better inform both policy and program development
-to implement evidence-based wellness programs
-improve environmental design and infrastructure
developmental disability definition
a set of heterogenous disorders characterized by difficulties in one or more domains, including but not limited to learning, behavior and self care (fetal alc. syndrome, genetic/chromosomal disorders, down syndrome, autism)
children with developmental disabilities is
increasing
prevalence of gender for developmental disabilities
-higher in boys than girls
-autism 3x higher in boys than girls
developmental disabilities are lowest among what racial and ethnic groups
lowest in hispanic children
developmental disabilities are highest among what racial and ethnic groups
highest in non-hispanic white children
barriers to disabilities
-attitudinal (stereotyping, stigma, discrimination)
-communication (print too small, no braille)
-physical (no mobility access, curb stops wheelchairs)
-policy (deny access to federal funded services, deny benefits)
-programmatic (schedule time inconvenient, no adaptive equipment, not enough time at apt)
-social (less likely to be employed or finish school)
health concerns for those with disabilities
-3x more likely to have diabetes, stroke, heart disease, cancer
-more likely to be current smokers
-women less likely to have a mammogram during past 2 years
-greater risk of arthritis
-less likely to receive preventive health care
-more likely to have multiple risk factors
emerging issues in disability and health
-the need for better disability health data
-the need to increase the implementation of evidence-based programs
-the need to improve environmental designs and public infrastructure
strategies of disability and health inclusion
-national policies
-enhanced protection and health care choices
-new health care options
-improved access to affordable and high quality health care
-a mandate that preventive screening equipment is accessible
-a mandate that data is collected on the assessment of health disparities and designates disability status as a demographic category
universal design (or universal access)
ensures facilities, products, services, and overall environments are useable by all people
use of social model of disability for universal design
people with disabilities not necessarily disabled by impairment but more so by their environment and attitudes of others
7 principles of universal design
- equitable use
- flexibility in use
- simple and intuitive use
- perceptible information
- tolerance for error
- low physical effort
- size and space for approach and use
universal design for learning
engagement
representation
action and expression
universal design: accessible physical environments
providing ramps, railings, and ample space for all people to navigate the environment
universal design: accessible web design
-create text alternatives in order for non-text content to be utilized by an individual’s read-aloud technology
-provide captions for multimedia
-allow for multiple means for content to be accessed
-consider the ease of use (east to navigate, easy to understand)
universal design: accessibility in health care and health promotion
-encourage the use of tools that works for a diverse group of people (ex: large display digital thermometer makes temp easy to read for all)
accessibility in health education
-close captioning in a video
-limiting the number of questions per page of a test/quiz (online and on paper allows)
–students with attention disorders to focus on one question at a time
–students with test anxiety to process in a calmer, slower fashion
-allowing quizzes/exams to be taken online, providing students the opportunity to utilize screen readers
intellectual disability
a disability characterized by significant limitations in both intellectual functioning and adaptive behavior, which covers many everyday social and practical skills
primary health conditions of those with ID
epilepsy
mobility and sensory difficulties
secondary health conditions of those with ID
-obesity
-bone fractures
-poor oral health
-constipation and grastroesophageal reflux
-poorer health outcomes related to health disparities
attributes characterizing health promotion for people with ID
-supporting health lifestyle (PA, diet, weight management)
-providing health education (multiple strategies/methods)
-involving supporters (family, non-family, community members, etc)
-being person centered (look hollistically)
antecedents
what happened before health promotion for ID was practiced?
-having limited health care access
-lack of sensitized health care providers
consequences (following the occurrence of the concept of health promotion for ID)
-improved health
-being empowered (control)
-enhanced quality of life
-reduced health disparities
finding about disability from concept analysis
-health promotion activities, both in research and practice, have to be better adapted to the target individual
-research focus needs to be expanded to other health aspects such as avoiding stress of learning about stress relief techniques
-include the perspectives of people with ID in health promotion research
steps to becoming a culturally competent practitioner
-INCORPORATE the 7 principles of Universal Design into your practice
-ALLOW for multiple means of engagement, representation and action/expression
-BE an advocate (disability rights are human rights)
-FACILITATE inclusion and foster inclusive practices
-EMPOWER the individual by respecting the choice of person- first or identity first language
2 specific questions addressed by review for cultural competency
-how effective is cultural competence training versus no training on increasing cultural competence levels of health care providers?
-does cultural competence training of health care providers increase patient satisfaction of clients from minority groups?
variation in training characteristics for cultural competency review
-settings and participants: majority of the trained providers were Caucasian, majority of the patients interviewed were a racial minority
-assessment tools: all were different and included using patient scenarios, non-verbal communication, questionnaires and surveys
-content and contract time: contact hours ranged from 4.5 to 36 hours in duration
results of cultural competence review for healthcare providers
-6/7 studies concluded that cultural competence had a positive impact on the healthcare providers
-physician scores in coding accuracy test on nonverbal cross cultural expressions were correlated with patient satisfaction scores
-physicians who completed medical spanish course were more likely to collect patient data without use of interpreter
number results of nurse practitioners for cultural competency
out of 15 nurse practitioners:
-2 culturally proficient
-7 culturally competent
-6 culturally aware
-0 culturally incompetent
cultural competence review results for patient satisfaction
-cultural competence training was significantly associated with increased patient satisfaction in 5 of 7 studies
-patient satisfaction increased with trained vocational dental practitioners compared to untrained
-latina patient’s satisfaction as greater with NPs who had received training compare to those who didn’t
-patients felt like they are receiving individualized care
-training increased patient family satisfaction
implications for cultural competence research
- there is a need to develop and evaluate the effectiveness of specialty specific cultural competency training programs
- there is a need to develop reliable and valid cultural competence assessment tools for specific health care providers
- there is a need for the investigation of the degree of relationship between cultural competence and patient satisfaction levels
- there is a need for additional research using a higher sample size- and consistency of intervention
skills to provide between patient care using the categorical approach
- methods to determine the patient’s understanding of their illness
- strategies for identifying different styles of communication
- skills for assessing decision making preferences
- techniques for ascertaining the patient’s perception of biomedicine
- tools for recognizing sexuality and gender issues
- negotiating
- awareness of issues of mistrust and prejudice
lessons learned from field of cultural competence
-the “buy in” is critical
-focus on cases and clinical applications
-address the demand for categorical approach
-think longitudinally
-integrate when possible
linking cultural competence to health care outcomes by creating a framework with following characteristics:
-focus on particular condition (ex: diabetes, cancer)
-target a specific population (type of intervention)
-teach a specific skill
-develop practice enabling strategies
-create a patient component (pt is active member of care team)
-choosing measures (to evaluate goals of training have been met)
-measurement of patient and physician satisfaction
-process of care measures and health care outcomes (chart audit, do providers actually use what they learned)
-test ordering or utilization
-control for confounders (look at other determinants influencing health)
7 areas of responsibility for cultural and linguistic competence
- assess needs, resources, and capacity for health education/promotion
- plan health education/promotion
- implement health education/promotion
- conduct evaluation and research related to health education/promotion
- administer and manage health education/promotion
- serve as a health education/promotion resource person
- communicate, promote, and advocate for health, health education/promotion and the profession
CLAS standards
intended to advance health equity, improve quality, and help eliminate health care disparities
the principle standard for CLAS
calls for organizations to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs
5 salient reasons for cultural and linguistic competence
-to respond to current and projected demographic changed in the US
-to eliminate long standing disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds
-to improve the quality of services and health outcomes
-to meet legislative, regulatory and accreditation mandates
-to decrease the likelihood of liability/malpractice claims
