One Size Does Not Fit All... Cultural Competence and Community-Engaged Research in Healthcare

Transcription

1 One Size Does Not Fit All... Cultural Competence and Community-Engaged Research in Healthcare Presenter: Elleen M. Yancey, PhD, Associate Clinical Professor, Community Health and Preventive Medicine, Morehouse School of Medicine Prevention Research Center

2 One Size Does Not Fit All...

3 Today s Objectives. To generate exposure to issues of cultural competency, cultural diversity and related areas To present overview of effects of cultural competence on research and healthcare To encourage personal reflection upon feelings that discussion of cultural competence engenders To stimulate thinking, initiate learning process & increase awareness of far-reaching impact of cultural issues (professionally & personally)

4 Why Cultural Competence?

5 Basics of Community- Engaged Research

6 *Traditional Research Approach esearcher defines roblem esearch IN or ON the ommunity Researcher defines problem, community may contribute Research with the community Community-engaged Research Research IN the community, or WITH the community Research WITH community as partner Community-Based Participatory Research Approach Community identifies problem or works with researcher to identify problem Research WITH community as full partner eople as subjects ommunity rganizations may ssist esearchers gain kills & knowledge esearchers control rocess, resources & ata interpretation esearchers own ata, control use & issemination cdonald, MA. (2008). Practicing mmunity-engaged research. ededportal.publication,4:1127 People as participants Community organizations may help recruit participants & serve on Advisory Board Researchers gain skills & knowledge, some awareness of helping community develop skills Researchers control research, community representatives may help make minor decisions Researchers own the data & decide how it will be used & disseminated People as participants & collaborators Community organizations are partners with researchers Researchers & community work together to help build community capacity Researcher & community share control equally Data is shared, researchers and community decide its use and dissemination

7 Principles of Community-Based Participatory Research 1. Recognizes community as a unit of identity. 2. Build strengths and resources within the community. 3. Facilitates collaborative partnerships in all phases of the research. 4. Integrates knowledge and action for mutual benefit of all partners. 5. Promotes a co-learning and empowering process that attends to social inequities. 6. Involves a cyclical and iterative process 7. Addresses health from both positive and ecological perspectives 8. Disseminates findings and knowledge gained to all partners. Israel, B.A., Schulz, A.J., Parker, E.A., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. NNUAL Review of Public Health 19(1),

8 Cultural Competence & Health Care

9 Why Cultural Competence? Health promotion strategies and interventions that infuse elements and techniques of cultural competence can potentially accelerate the reduction of well-known health disparities among racial and ethnic Americans. Boone, L.R., Mayberry, R, Betnacourt, J.R., Coggins, P.C., Yancey, E.M. Cultural Competence in the prevention of sexually transmitted diseases. American Journal of Health Studies. (21) 4, 2006.

10 Where do I stand along the clothesline of our beliefs and values?

11 Why Cultural Competence? We have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams. Jimmy Carter

12 What is Cultural Competence? Implies having the CAPACITY to function effectively among diverse populations.

13 Basics of Cultural Competence Acceptance and respect for difference Continuing self-assessment regarding culture Careful attention to dynamics of difference Continuous expansion of cultural knowledge and resources

14 CRASH-Course Concepts Culture Respect Assess / Affirm Sensitivity / Self-awareness Humility Rust, G., Kondwani, K., Martinez, R., Dansie, R., Wong, W., Fry-Johnson, Y., & Smothers, H. (2005). A crash-course in cultural competence. Ethnicity & Disease, 16(2Suppl 3),S3-29

15 CRASH: Self-Awareness: Becoming aware of our own cultural norms, values, and hot-button issues that lead us to mis-judge or to miss-communicate with others.

16 CRASH Humility: Recognizing that none of us ever fully attains cultural competence Making a commitment to life-long learning Peeling back layers of the onion of our own perceptions and biases Being quick to apologize and accept responsibility for cultural mis-steps Embracing the adventure of learning from others first-hand accounts of their own experience.

17 Kleinman s 9 Questions to Assess Health Beliefs 1. What do you call your problem? (What name does it have?) 2. What do you think caused your problem? 3. Why do you think it started when it did? 4. What does your sickness do to you? (How does it work? How severe is it?) 5. Will it have a short or long course? 6. What do you fear most about your disorder? 7. What problems has your sickness caused for you? 8. What kind of treatment do you think you should receive? 9. What are the most important results you hope to receive from the treatment? Kleinman A. Patients and Healers in the Context of Culture. The Regents of the University of California

18 Self-awareness When people won t make eye contact with me,. When clients show up late for their appointments,. When people touch me a lot or get in my personal space,. When dealing with conflict, people should.

19 Case Study in Diversity for Clinical Practice: A Woman in Labor A woman in active labor received prenatal care from a female OB. Tonight she is in active labor, the female OB is out of town, and the OB s male colleague is on call. The only other OB on staff at your small hospital is male. The woman s husband says that in her religion she would be defiled by a male health care worker seeing her undressed or touching her and he insists that a female doctor deliver the baby. The patient is mostly moaning with labor pains, and her cervix is now 8 cm dilated. What do you do?...

20 Follow-up Questions What could/should have been done differently (hint: much earlier!) to prevent this cross-cultural dilemma from developing? At what point do the values of our own culture require us to resist the cultural preferences of patients or their families (example: Child female circumcision / genital mutilation) What larger ethical principles should be applied in making such decisions?

21 Beyond Cultural Competency Lewis, PH. Beyond Cultural Competency, Race, Ethnicity & Disabilities: State of the Science Conference, Arlington VA. March 2012.

22 Beyond Cultural Competency Critical Consciousness The Development of a critical awareness of how personal dynamics unfold with social & political contexts Ethics Respect for autonomy +Beneficence +Nonmalfeasance +Justice Entreat health care providers to avoid harm Social Justice Fair distribution of society s benefits, responsibilities & their consequences. Focuses on the relative position of one social group in relationship to others in society as well as on root causes of disparities & what can be done to eliminate them. Lewis, PH. Beyond Cultural Competency, Race, Ethnicity & Disabilities: State of the Science Conference, Arlington VA. March 2012.

23 Culturally Competent System of Care Acknowledges Importance of... Culture Assessment of cross-cultural interactions Expansion of cultural knowledge Adaptation to meet culturally unique needs

24 Culturally Competent Healthcare Professional Begins with commitment to provide culturally competent health care and research Must include Awareness/acceptance of cultural differences Awareness of own cultural values Understanding of dynamics of difference Basic knowledge of health consumer s environment(s)

25 Five Elements of Culturally Competent Healthcare Professionals 1. Acknowledge cultural differences and become aware of own effect upon clinical services and research 2. Recognize influence of own culture 3. Understand dynamics of difference. 4. Understand meaning of information provided from both provider AND clients cultural context 5. Know where and how to obtain necessary information regarding culture of populations involved in clinical service

26 Summary Comment There are important considerations that apply uniquely to community-based research. These include the principles that govern relationships between researchers and communities and the principles of cultural competence that prepare researchers to create the community partnerships needed to conduct community-based research. Blumenthal, D.S., Yancey, E.M. Introduction to community-based research. Community-Based Research: Issues and Methods. D.S. Blumenthal & R.J. DiClemente (eds.), New York, NY: Springer Publishing Co., 2004.

27 Movement Toward Cultural Competence Attitudes must change to become less ethnocentric and biased. Policies must change to become more flexible and culturally impartial Practices must become more congruent with cultures

28 Morehouse School of Medicine Prevention Research Center Department of Community Health and Preventive Medicine Elleen M. Yancey, PhD, PRC Website: Westview Drive, SW Atlanta, Georgia (404) (404) Fax