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Cultural Competency > Term 1 > Flashcards

Term 1 Flashcards

0
Q

White hemography

A

est. privilege, power and land ownership

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1
Q

Early social definition of Race Classification

A

Membership of N. Am, Europeans, and Blacks all based on social circle, appearance and non-white ancestry

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2
Q

blood quantum theory

A

one drop of blood- you=african decent

preserved labor force and black oppression

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3
Q

early views on race

A

marginalized N. Americans, helped lead to the power difference and removal of certain populations (Jewish, mentally disabled)

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4
Q

rule of hypodecent (english common law)

A

race of father determined the race of child.
black mother + white father=white child
Created a dynamic power- marginalization can occur VERY quickly (jr. high kids ex)

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5
Q

Hypodescent order

A 
est mixed-race children as lower class, ignored kinship
created a CAST SYSTEM- children of slaves born into low class roll (ignored common law)
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6
Q

Definition of White

A

less than 1/8 Black (before Civil War)

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7
Q

early expansion in US

A

led to further marginalization of N. Am

were given smallpox-infected blankets

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8
Q

forced migration

A

forced N. Am out of their homeland

Blacks forced into slavery, brought over during slave trade

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9
Q

Internal Migration

A

1 Underground Railroad-AA moved north for freedom
2 Post WWI- more AA moved north
3 Urbanization- brought people north for jobs
4 dust bowl- forced people to leave affected states
5 AC- brought people south

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10
Q

Jim crow laws

A

colored phone booths-Oklahoma
separate lines for license plates-Mississippi
separate tellers at 1st Nat’l bank-Atlanta
couldn’t play checkers together-Birmingham
different Bibles for races-throughout the south

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11
Q

2012 US census

A

Form from US Census-classification according to socio/political backgrounds. Attempt to classify a wider range of races. White pop in Tx will be minority by 2050

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12
Q

geography and race

A

whites-majority race in every region
Midwest-whites 85%
South-AA 55%

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13
Q

Melting Pot vs Multi-Cultural

A

where you embrace your new culture and your own culture is just cherished. Society has become MULTICULTURAL. Primary cultures/beliefs embraced BEFORE American concepts.. Cultural beliefs/ practices affect communication-must be able abide by other persons beliefs

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14
Q

Care Provider Challenges

A

need to be aware of different beliefs, diets, death expectations (west-maintain life funct. others-death is natural)
WE need to provide culturally competent health care- based on the rate of satisfaction of patient care**

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15
Q

Cultural Competancy satisfaction

A

WE must understand what factors contribute to satisfaction (religion,language, traditions, expectations and Belief practices)

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16
Q

factors of trust

A

societal racism
Experiences with discrimination
Prior experiences with system of others with providers, hospitals and insurance carriers
distrust of hospitals/insurance plans

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17
Q

attitudes in healthcare

A

Non-white providers are of lower quality
Minority providers allowed to practice only on minorities
Common belief- takes longer for minorities to get accredited

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18
Q

Patient Selection practices

A

Patient selection preferences- (concordance or match)- race concordance= person is more knowledgable, better interpersonal communication/understanding is perceived.

typically patient more likely to interact with physician

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19
Q

Concordance

A

Lang & Race( highest concordance achieved when races match)

Concordance= better patient satisfaction (concordance with lang, race ethnicity etc). You are more likely to follow instructions and come back to the same place where you found concordance

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20
Q

diversifying the health workforce

A

Institute of Medicine-
URM under rep. minority- placed in settings of lower minorities for longer before they could receive their credits and pract elsewhere

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21
Q

minorities in the workforce

A

Minority persons tend to receive better interpersonal care from providers of their own race and ethnicity

ESL persons experience increased understanding and greater likelihood of follow-up care with language concordant provider

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22
Q

service patterns hypothesis

A

Health professionals from minority/disadvantaged backgrounds- more likely than others to serve minority disadvantaged pop, improving access to care

Hypothesis is supported-more diverse medical community will help service those that are minority

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23
Q

Concordance hypothesis

A

AA children in US- looked at opinions of their parents- wanted access to quality care for child, concordance didnt matter as much. Concordance mattered for them as adults though

Increasing # of minority health professionals will increase opportunity for minority patients to see practitioner of own race or who speaks their primary language & understands their cultural practices

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24
Q

Trust in Healthcare

A

Greater diversity in health care workforce will increase trust in the healthcare delivery system among minority populations, and increase propensity to use health care services, improving healthcare outcomes.
Hypothesis holds to be TRUE

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25
Q

Professional Advocate Hypothesis

A

more diverse pop of care providers=more advocation for needs of those they serve

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26
Q

cultural competency training

A

Now must be accredited in CC for medical programs

will take time to diversify work force- edu, college, decision to stay in the field- as society becomes more diverse we need to be able to communicate b/c we cant diversify as fast as the society is

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27
Q

Patient Centeredness

A

Provider’s patient centeredness influences patient trust

how we interact with people we care for influences the trust process/ engagement of the patient. must keep cultural concordance in mind- more important w/ taking care of adults. Patient-centeredness=key for trust

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28
Q

Determinants of personal health

A

Biological-Genetics, Immunity, Nutritional status

Socioeconomic-Occupation, income, Family, social networks, Self-esteem

Behavioral-Risk-taking behaviors,Religious beliefs, Perceived susceptibility

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29
Q

Health disparity

A

health disparity- has different meaning for different people

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30
Q

Health field framework

A

endowed genetically w/ certain defects-determine whether low/high risk
social, physical environment play a role in already predetermined health
wellbeing becomes apparent-becomes feedback loop
exposed to vrus/disease-become well again and cycle reinstates BUT doesnt always happen that way
acute injury (MVC fire etc) and chronic disease affect us much more sig from a cost standpoint

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31
Q

Health field framework II

A

environments we are born into can determine our health cost standpoint
costs are also associated with our behaviors

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32
Q

Disparity as a definition -looking at person and enviroment

A

“Racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention. Institute of Medicine, 2002.
A particular type of difference in health closely linked with social, economic, or environmental disadvantage.” Healthy People 2020, DHHS, 2010.

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33
Q

Difference in outcomes

A

ANY DIFFERENCE FOUND- if also disadvantages person it is also considered a disparity. Cost 229 BILLION in 2006

Race, ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geography all contribute to an individual’s ability to achieve good health.

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34
Q

Social determinants I

A

Employment - Unemployment much higher among Blacks, Hispanics, and American Indian/Alaska Natives in 2010 with unemployed adults much less likely to report their health as very good or excellent

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35
Q

Social determinant II

A

Education - Highest percentage of adults not completing high school were Hispanic, persons below the poverty level, those with disabilities, and foreign born

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36
Q

Social determinant III

A

Nutrition - Persons living in rural census tracts were more often lacking a nearby food retailer (grocery store) within ½ mile

location is important but if below the poverty level, does not matter how close or far-do not have funds to buy what they need

37
Q

Enviro hazard I

A

Air quality - Minorities, foreign-born persons and persons speaking a non-English language at home more likely to live near a major highway resulting in increased traffic-related pollution and elevated risks for adverse outcomes
exposure to poor air quality/ pollution, work related risk- higher among those who are less edu/ in lower skilled jobs

38
Q

Enviro hazard II

A

Work-related risks - Hispanic persons, low wage earners, and foreign born are more likely to work in high risk occupation and an elevated I

less opportunity for advance/ lower wages= higher work related stress

39
Q

Enviro hazard III

A

Mortality- Work-related death and homicide rates are highest for Hispanics, non-Hispanic Blacks and males.

high work stress linked to coronary heart disease, higher suicide/ traumatic injury rates

40
Q

Behavioral risk I

A

Substance abuse - Binge drinking more common among persons 18-34 years of age, men, Whites and persons with higher household incomes

need resources to alcohol and drugs-typically misused among higher income

41
Q

Behavioral risk II

A

Teen pregnancy - Birth rates among Black and Hispanic teenagers double that of other groups

42
Q

Behavioral risk III

A

Smoking - Cigarette smoking rates remain high in persons of low socioeconomic status

less money people make- the Higher the chance that they smoke

43
Q

Genetic link I

A

Infants born to black women are 1.5 to 3 times more likely to die than those born to women of other races/ethnicities.

44
Q

Genetics II

A

American Indian and Alaska Native infants die from SIDS at nearly 2.5 times the rate of white infants.

45
Q

Genetics III

A

African American men are more than twice as likely to die from prostate cancer.

46
Q

Genetics IV

A

Hispanic women are more than 1.5 times as likely to be diagnosed with cervical cancer.

47
Q

Genetics V

A

Hispanics, African Americans, American Indians and Alaska Natives are twice as likely to have diabetes.

minorities tend to be at higher risk for genetic issues
huge increases in obesity in youth, esp in minorities

48
Q

Mortality

A

Rates of premature death from stroke & CAD higher in Blacks

Drug-induced deaths highest among Native Americans and Whites

Homicide rates highest in Black males

Motor vehicle-related deaths highest among Native Americans- alcohol link??

49
Q

Morbidity

A

Periodontal disease -present in half of Black and Hispanic adults over 30
Tb rate remain high among racial/ethnic minority groups

Obesity increased significantly in minority boys and men

Non-Asian racial/ethnic minorities experienced higher HIV rates

50
Q

Morbidity/ mortality contin

A

N. Americans-higher alcohol consumption + higher MVC death %
periodontal disease-lack of access/money?

why more obesity in boys/men- we are more sedentary, no more PE in schools, increased consumption (sodas, food

51
Q

CDH Example

A

Occurrence has much to do with social features of society

low income=higher stress=more likely to smoke=poorer heath. cant afford= even worse health

52
Q

CDH example

A

Migrants trend toward the rates of country of adoption:

Age, gender, family history,
Smoking, obesity, High blood pressure,
High blood cholesterol, Diabetes,
Physical inactivity, High stress

53
Q

Disparities facts

A

Blacks had worse access to care than Whites for one-third of measures, and AI/ANs had worse access to care than Whites for about 40% of access measures .

Poor people had worse access to care than high-income people for all measures; and low-income people had worse access to care for more than 80% of measures

54
Q

Disparities facts

A

Asians had worse access to care than Whites for about 20% of access measures.
Hispanics had worse access to care than non-Hispanic Whites for about 70% of measures.

55
Q

Quality of care disparity

A

Blacks received worse care than Whites, and Hispanics received worse care than non-Hispanic Whites for about 40% of quality measures.

American Indians and Alaska Natives (AI/ANs) received worse care than Whites for one-third of quality measures.

56
Q

Quality of care disparity

A

Asians received worse care than Whites for about one-quarter of quality measures but better care than Whites for a similar proportion of quality measures.

Poor and low-income people received worse care than high-income people for about 60% of quality measures

57
Q

Treatment measures

A

About half of all process and outcome measures showed improvement.

Of the quality measures related to treatment of acute illness or injury, more than 80% showed improvement.

58
Q

Acute treatment measures

A

In contrast, only about 40% of quality measures related to preventive care and chronic disease management showed improvement.

Acute treatment includes a high proportion of hospital measures, settings which often have more infrastructure to improve quality.

59
Q

Areas needed attention

A

Health care quality and access are suboptimal, especially for minority and low-income groups.

Overall quality is improving, access is getting worse, and disparities are not changing.

60
Q

Areas in need of attention

A

Urgent attention warranted to ensure improvements in:

Diabetes care, maternal and child health care, and adverse events.
Disparities in cancer care.
Quality of care among states in the South.

61
Q

Affordable care act

A

Est. Federal infrastructures to reduce health disparities

Transferred Office of Minority Health within DHHS to the Office of the Secretary

Established six individual Offices of Minority Health within the DHHS.

62
Q

Affordable care act

A

Designated National Institute on Minority Health and Health Disparities.

Created an Office of Minority Health within CDCP to monitor trends and evaluate programs and initiatives.

first step- collect people and system to collect data to track disparities
may give better markers to how quality of health is improving/ decreasing

63
Q

Expansion of Medicaid

A

Medicaid covers nearly 40 percent of African American and Latino children.
.
Expansion will costs at 100 percent in 2014 then lowering to 90 percent by 2020.

64
Q

Expansion of Medicaid

A

All individuals eligible for Medicaid up to 133 percent of federal poverty level ($14,404 for an individual in 2009).

Of the 46 million people currently uninsured, 47 are living in household with incomes at or below 133 percent federal poverty guidelines

65
Q

Insurance regulation

A

ACA prevents companies from denying insurance coverage to people who have pre-existing conditions or charging higher premiums.

survey showed that a good portion of people have been denied due to pre-exist condition
found that people would like to leave job but wont because afraid of losing insurance

66
Q

Insurance regulation

A

Prohibits higher premiums based on gender and determining insurance rates and coverage according to race and ethnicity.

Since minorities disproportionately affected by chronic conditions including, diabetes, heart disease, and cancer, this will be a significant factor in obtaining health insurance coverage

67
Q

Health benefit exchanges

A

Create a marketplace for health insurance to provide choices to consumers in picking their health coverage

Fill the gaps for people who do not qualify for Medicaid or have employer sponsored insurance.

68
Q

Health benefit exchanges

A

Provide premium assistance to individuals up to 400 percent of poverty level to ensure affordable options.

Hispanics and African Americans tend to have lower rates of employer sponsored coverage, making those groups more likely to take advantage of the new market created by health exchange

69
Q

Summary thoughts

A

personal genetic makeup, environment, social environment and personal lifestyle- can all influence chance of disease

as a society we can moderate that but at current point, not making enough change

we will make change at a individual level- to maintain/minimize side effects of their current conditions

70
Q

Communication facts

A

Less information given by providers to lower SES group patients

71
Q

communication facts

A

Persons trained to ask questions and show assertive behavior received better care

72
Q

communication facts

A

Provider IP skills more important than receiving health-related information

Perceptions of competence associated with interpersonal skills

73
Q

Communication

A

you can train people to ask more effective questions

patient centeredness makes the info we convey more effective

74
Q

communication

A

our competence judged by how well we can communicate-that we present ourselves well (correct pronunciation ect)

perceptions of our competance our based off our interpersonal disclosers

75
Q

rationale of improvement

A

Despite improvement in the overall health of the majority of Americans, the burden of health disparities continues to disproportionately affect minority populations.

76
Q

defining culturally sensitive

A

culturally sensitive- is different from competent (i.e. ability); sensitivity-refining a skill to identify a problem
assesment-make others aware of different practices spread knowledge about patient centeredness
we must have skills to care for people but its HOW we deliver those skills that makes us effective

77
Q

Key strategies for enhancing competence

A

solutions -recruit and train more diverse workforce but what about those already present?
need to enhance CC/ sensitivity of those already in the field to improve care

78
Q

key concepts for increasing competency

A

Enhancing cultural competence
& Expanding diversity within the health professions
Most cited strategies for decreasing health disparities for persons of color and ethnic/cultural minorities

79
Q

professional competence

A

“The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice to benefit the individual and community being served”

Epstein & Hundret, JAMA, 287(2): 2002, p226
80
Q

professional competence

A

Cultural competence should be part of our core professional competencies, rather than an isolated aspect of medical care

communication is key word added to JAMA statement

81
Q

performance competence

A

C4.8: Physician assistants must demonstrate a … sensitivity to diverse patient populations…defined as…sensitivity and responsiveness to patients’ culture, age, gender, and disabilities (NCCPA)

A.2.3 Demonstrate an awareness of the humanity and dignity of all patients and related individuals within a diverse and multicultural society (NCOPE).

82
Q

educational expectations

A

The curriculum must include instruction on multicultural issues and their impact on patient care. (ARC-PA Standard B6.01, 2010)

The curriculum must provide instruction that emphasizes respect for self and others, adherence to concepts of privilege and confidentiality, and a commitment to the patient’s welfare? (ARC-PA Standard B6.02, 2010)

83
Q

educational expectations

A

competency statement not that prescriptive- expectation but doesnt tell you how to do it

84
Q

legal

A

“No person in the United States shall, on the grounds of race, color, or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination” under any federally supported program (Civil Rights Act of 1964)

85
Q

legal

A

US Office of Civil Rights extends this protection to language, viewing inadequate interpretation as a form of discrimination

CA of 1964 drives the legislation of language and communication skills
we may not deny someone b/c of lang barrier- obligation to provide interpreter if you use government dollars-w/o providing they can deny you

86
Q

ethnocentrisim

A

Syndrome of attitudes and behaviors

See own in-group as virtuous and superior and out-group as contemptible and inferior

Cooperative relations with in-group, absence of cooperative relations with the out-group

87
Q

ethnocentrism

A

Underpinning for ethnic conflict, war, consumer choice and voting
In-group favoritism or out-group hostility

privilege- impact on being in ‘in’ vs ‘out’ group. In group has control of the resources, if out group doesnt like it- not too much is done (tribes in Africa and Iraq ex-creates prob in society)
Favoritism does occur

88
Q

muslim patient 1

A

language, traditions, practices differences
always ask for preferences and accommodate if possible (TCH patient, child, with mother) wanted the physician to knock and announce gender before entering- they did not- distrust was established-patient centeredness was forgotten at that moment

89
Q

culture and encounters

A

initial visual impressions-form a lot of attitudes

90
Q

patient #2 South-east asian

A

in a nursing home and wheelchair:

South-east Asian, although it doesn’t match current last name.. is she immobile or just weak?
if she entered US as older adult (70-80) don’t usually learn the lang

Cultural Competency (1 decks)

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