Florida National University HSA-3412 Cultural Diversity in Health Care: Week 1 Chapters 1 & 2 Objective: To critically replicate your understanding of the readings and your skill to apply them to your Health care Setting. ASSIGNMENT GUIDELINES (10%): Students will judgmentally investigate the readings from Chapter 1 & 2 in your textbook. This assignment is intended to help you appraisal, analysis, and apply the readings to your Health Care setting as well as become the foundation for all of your outstanding assignments. You are requirement to read the PowerPoint Presentation assigned for week 1 and develop a 2-3page paper reproducing your understanding and capacity to apply the readings to your Health Care Setting. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA format when referring to the selected articles and include a reference page. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25%) Arrange for a brief summary of the meaning (not a description) of each Chapter and articles you read, in your own words. 2. Your Critique (50%) a. Answer Review: Questions 1 to 7 in your textbook page 31 b. Answer Review: Questions 1 to 5 in your textbook page 67 Please you must submit your answers in the document. 3. Conclusion (15%) Fleetingly recapitulate your thoughts & deduction to your assessment of the PowerPoint Presentations and Chapter you read. How did these PPP and Chapters influence your thoughts on Diversity within the United States and Cultural Adaptation? Evaluation will be based on how clearly you respond to the above, in particular: a) The clarity with which you critique the articles; b) The depth, scope, and organization of your paper; and, c) Your conclusions, including a description of the impact of these articles and Chapters on any Health Care Setting. ASSIGNMENT DUE DATE: The assignment is to be electronically posted in the Assignments Link on Blackboard no later than noon on Sunday, May 15, 2016. ASSIGNMENT RUBRICS Assignments Guidelines Introduction Your Answers Review Conclusion Total 10 Points 25 Points 50 Points 15 Points 100 points ASSIGNMENT GRADING SYSTEM A B+ B C+ C D F Dr. Gisela LLamas 90% - 100% 85% - 89% 80% - 84% 75% - 79% 70% - 74% 60% - 69% 50% - 59% Or less. 10% 25% 50% 15% 100% Chapter 1 Introduction to Multicultural Health Overview of Chapter Topics Cultural considerations in health care Definitions of race, ethnicity, and culture Ethnocentrism versus cultural relativism Cultural diversity and cultural adaptation in the U.S. Health disparities in the U.S. Causes of health disparities Cultural Considerations in Health care Culture affects: - perceptions of health and illness - beliefs about why/how illness occurs - health behaviors - how symptoms are described and how concerns are expressed - how treatment is pursued and adhered to Cultural Considerations in Health Care Goals/attributes of a multicultural approach to health care - To provide health services in a culturally sensitive, knowledgeable, and nonjudgmental manner - To challenge one's own assumptions and ask the right questions - To integrate different approaches to care - To recognize the culture of the recipient while providing care in accordance with the legal/ethical norms and the medically sound practices of the practitioner's medical system Cultural Considerations in Health Care Stereotypes (the mistaken assumption that everyone in a given culture is alike) vs. generalizations (awareness of cultural norms Generalizations are a starting point, but individual differences need to be taken into consideration Stereotypes and assumptions can lead to errors and ineffective care Cultural Considerations in Health Care Cultural competence: process of knowledge, awareness, and respect for other cultures It occurs on a continuum Definitions of Race, Ethnicity, and Culture Culture - Everything that makes us who we are - E.B. Tylor: \"Culture . . . is that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits . . . .\" - Office of Minority Health (2001): \"The thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.\" Definitions of Race, Ethnicity, and Culture Culture (continued) - Culture is learned, changes over time, and is passed from generation to generation - Culture is complex, and many subcultures exist within a dominant culture - A given person may belong to numerous subcultures Definitions of Race, Ethnicity, and Culture Race - Race as a concept refers to one's physical characteristics and/or genetic or biological makeup - Race is a social, not a scientific, construct - The concept of race was originally developed in conjunction with nonscientific notions of racial superiority and inferiority - Race remains significant because of the discrimination and violence associated historically with this false ideology - The 2000 U.S. Census recognized five \"races\": White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaii or other Pacific Islander Definitions of Race, Ethnicity, and Culture Ethnicity - \"The characteristics of . . . people who share a common and distinctive racial, national, religious, linguistic, or cultural heritage\" (Office of Minority Health, 2001) - Ethnicity pertains to the following characteristics: Geographic origins Family patterns Language Values, symbols, and cultural norms Religion Literature and music Dietary patterns Gender roles Employment patterns Ethnocentricity vs. Cultural Relativism Ethnocentricity - The belief that one's own culture is superior to another one Cultural relativism - Posits that all cultures are of equal value - Attempts to take a neutral, objective view of differing cultures - Incorporates relativism with respect to culture's varying moral codes Cultural Diversity and Cultural Adaptation in the U.S. Cultural diversity in U.S. - Has resulted from the nation having been populated largely by recent immigrants - Has been conditioned by inequality of legal status and of socioeconomic opportunity, leading to racial/cultural strife - Nonwhite population is growing rapidly as a percentage of total population, with a corresponding decrease in the White percentage Cultural Diversity and Cultural Adaptation in the U.S. Cultural adaptation (or acculturation) - Defined as the degree to which a person has adapted to the dominant culture while retaining traditional practices - Can be seen as describing a spectrum between immersion in the dominant culture and immersion in an ethnic culture - High levels of acculturation can have positive health benefits, though some health-positive aspects of traditional culture may also be lost Cultural Diversity and Cultural Adaptation in the U.S. *Assimilated: move away from culture of origin immersing into dominant society *Integrated: immersion in both ethnic and dominant society Marginal: most difficulty, not accepted by culture of origin or dominant society Separated: withdraws from dominant society and is immersed in ethnic society * Considered most healthy adaptation styles Cultural Diversity and Cultural Adaptation in the U.S. Health Disparities in the U.S. Defined as \"Differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions . . . that exist among specific population groups.\" Population groups in which such disparities occur can be based on gender, age, ethnicity, socioeconomic status, geography, sexual orientation, disability, or special health care needs. Health Disparities in the U.S. In the U.S., many minority groups have higher incidences of chronic diseases, high mortality, and poorer health outcomes in comparison with Whites Approaches to reducing health disparities include making policy changes, increasing access to care, and creating culturally competent health care systems Contributions to Health Problems Environment: physical and social Human biology: all aspects of physical and mental health developed within the body Lifestyle: the sum of behavioral decisions over which the individual has control Health care organization: quantity and quality Socioeconomic circumstances: poverty, education, etc. Causes of Health Disparities in the U.S. Causes of Health Disparities in the U.S. Environmental exposures (exposure to pollution, toxins) Minority neighborhoods (higher exposure to toxins, more cigarette and fast food ads, less access to healthy food choices) Genetics (little affect, combination of factors) Lifestyle (i.e., eating behavior, level of physical activity, smoking) Social circumstances (i.e., poverty, stress, racism, education, crowding, fear) Medical care (i.e., quality, access, limited providers with same ethnic background) Summary Diversity is great strength of U.S. Healthcare providers need to be understanding and respectful of cultural differences. Chapter 2 Cross-Cultural Concepts of Health and Illness Overview of Chapter Topics Personalistic versus naturalistic explanations of health/illness Principal healthcare approaches in U.S. - Biomedical and holistic Major dimensions of a personal or a cultural worldview Modes of effective intercultural communication Overview of Chapter Topics Importance of cultural competence in healthcare delivery Promoting cultural competence within an organization - Assessment of individual cultural competence - Assessment of organizational cultural competence Theories of Health and Illness Are beliefs people hold about how to maintain health and the causes of illness Two major theories: Personalistic and naturalistic Personalistic versus Naturalistic Explanations of Health and Illness Personalistic explanations - Health/illness seen as resulting from a person's behavior - Often invokes normative ideas of spirituality and/or morality Shamanistic/animistic Susto \"Evil eye,\" witchcraft/sorcery, voodoo Personalistic versus Naturalistic Explanations of Health and Illness Naturalistic explanations - See health as reflecting a state of harmony between a person and his/her environment - Examples: Ayurvedic medicine (links energy centers associated with organs to primal force such as the breath of life) Chinese medicine (balance of polar energies i.e. ying-yang) Humoral pathology (Hippocrates, four fluids or humours cause illness when out of balance) Germ theory (microrganisms cause disease) Naturalistic Explanations of Health and Illness Pathways to Care Two general systems: biomedical and holistic Select system based on culture, access to care, health beliefs, affordability Pathways to Care Biomedical (or allopathic) approach - Often viewed as scientific - Focuses on physical components of illness - Care provided by licensed professionals such as doctors, nurses, physical therapists Holistic approach (alternative or complementary) - Viewed by some as unscientific - Based on a psychosocial model of health care - Providers have vast levels of trainingfew training and licensing standards Worldview Overall perspective from which one sees and interprets the world Closely linked to cultural and religious beliefs Major Facets of Worldview Time orientation (i.e., past, present, or future)is prevention important? Personal spaceviolating boundaries can be offensive Social organization--dominant patterns of social interaction Belief in fate versus free willbeliefs people have over ability to change their lives and have control (life is outside of their own control vs. masters of their own fate) Individualism versus collectivismaffects how decision are made i.e., advanced directives, autonomy vs. family made Worldview Effective Interpersonal Communication Potential barriers in verbal communication - Varying connotative meanings of words - Specialized biomedical jargon and vocabulary - Culture-specific taboos against patients questioning healers - Culture-specific taboos against discussing specific topics Effective Interpersonal Communication Modes of nonverbal communication - Gestures - Posture - Silence - Spacial relationships - Facial expressions - Amount and location of touch - Pace of speech - Eye contact Importance of Cultural Competence in Health Care Delivery The essentials of cultural competence - Understanding one's own worldview - Understanding the worldview of another person or community - Avoiding stereotyping, judging, and misapplication of scientific knowledge Cultural competence models - Campinha-Bacote's Process of Cultural Competence in the Delivery of Healthcare Services - Purnell's Model for Cultural Competence Importance of Cultural Competence in Health Care Delivery Campinha-Bacote model, based on 5 constructs - - - - - Cultural awareness Cultural knowledge Cultural skill Cultural encounter Cultural desire Purnell model, based on concentric social rings - - - - The individual person That person's family That person's community Global society Importance of Cultural Competence in Health Care Delivery Source: Reprinted with permission from Dr. Larry Purnell, University of Delaware. Summary Different belief systems about health and illness Affected by worldview Influences how, where, when, and why we seek care