11/04/2018. Background. Background

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1 RESEARCH INSTITUTE Practitioner perspectives on barriers and facilitators to culturally competent services Viviane Grandpierre RESEARCH INSTITUTE Background Increasing diversity in North America can create challenges for practitioners providing pediatric hearing loss services to minority culture families. Pediatric hearing loss services are informed by the needs of majority populations, which may hinder the provision of culturally competent care. Background What is cultural competence in healthcare? understanding the importance of social and cultural influences on patients health beliefs and behaviors; considering how these factors interact at multiple levels of the health care delivery system; and, finally, devising interventions that take these issues into account to assure quality health care delivery to diverse patient populations (Betancourt et al., 2003, p. 293). 1

2 Background Efforts to improve cultural competence should be informed by evidence. Yet, there is minimal research barriers and facilitators to cultural competence in hearing loss services (Grandpierre et al., 2018). RESEARCH INSTITUTE Objective To examine possible barriers and facilitators to improving cultural competence in early hearing loss services by exploring the perspectives of the providers of care from across the country. Methods Based on our previous findings studies (Grandpierre et al., 2018a, 2018b; Grandpierre et al., under review), a survey was developed and distributed across Canada to practitioners in the field of pediatric hearing loss The survey included questions on: demographics (e.g., education, profession, cultural background), experiences in delivering services to cultural minority families, as well as perceived barriers and facilitators to delivering culturally competent care. 2

3 Methods Eligibility criteria: have provided early hearing loss services (e.g., diagnostic and therapy-related services) to children with permanent hearing loss, and have provided services to minority culture children (e.g., not the majority culture in Canada: English and/or French Canadian). Analysis Data were entered in the Statistical Package for the Social Sciences (SPSS) Open-ended questions were analyzed by simple content analysis with the use of open coding. Results 130 surveys were received. 111 were eligible according to the inclusion criteria. 75.2% were audiologists. The remaining were auditory-verbal and speech language. 3

4 Barriers to the provision of culturally competent hearing loss services Cultural barriers reportedly occurred at each level of service delivery: during diagnoses, amplification discussions, language assessments, and interventions. Table 1 Cultural challenges experienced by practitioners Cultural challenge Audiologists Auditoryverbal Speechlanguage Association with professional group X 2 (p value)* Cultural challenges when conducting 57/81 (71.3) audiologic testing Reasons for testing challenges: Instructions not understood 43/81 (53.1) Religious attire 9/81 (11.1) Different practitioner gender preferred 8/81 (9.9) Other 22/81 (27.2) Unexpected reactions related to culture 52/73 (71.2) (88.9) (90.0) (0.341) 8/9 9/ when communicating the diagnosis Reactions due to cultural stigma 49/73 (67.1) 7/9 (77.7) 7/10 (70.0) -- Hearing loss seen as divine gift 10/73 (13.7) 3/9 (33.3) 0 -- Hearing loss seen as a consequence 17/73 (23.3) 4/9 (44.4) 5/10 (50.0) -- Other 16/73 (21.9) 1/9 (11.1) 1/10 (10.0) -- Cultural challenges when discussing 63/75 (84.0) 8/9 (88.9) 8/9 (88.9) (~1.0) amplification Dismissive or denial of hearing loss 50/75 (66.7) 7/9 (77.8) 7/9 (77.8) -- Caregivers keep hearing loss hidden 46/75 (61.3) 7/9 (77.8) 6/9 (66.7) -- Concerns for marriageability 17/75 (22.7) 1/9 (11.1) 2/9 (22.2) -- Belief hearing loss can be cured 31/75 (41.3) 5/9 (55.6) 6/9 (66.7) -- Other 11/75 (14.7) 1/9 (11.1) 0 -- * Based on Fisher s Exact test. Table 1b Cultural challenges experienced by practitioners Cultural challenge Audiologists Auditoryverbal Speechlanguage Association with professional group X 2 (p value)* Cultural challenges when conducting 46/67 (68.7) 9/11 (81.8) 13/14 (92.9) (0.154) language assessments Lack of culturally appropriate 15/67 (22.4) 8/11 (73.0) 13/14 (92.9) -- assessments Lack of assessments available in the 38/67 (56.7) 8/11 (73.0) 13/14 (92.9) -- caregivers language(s) Other 9/67 (13.4) 1/11 (9.1) 2/14 (14.3) -- Cultural challenges when providing 26/42 (61.9) 10/12 (83.3) 13/14 (92.9) 5.65 (0.058) interventions Level on family verbal interaction 16/42 (38.1) 9/12 (75) 11/14 (78.6) -- varies according to culture Lack of culturally appropriate 12/42 (28.6) 7/12 (58.3) 7/14 (50.0) -- assessments Different expectations regarding who 13/42 (31.0) 7/12 (58.3) 9/14 (64.3) -- conducts therapy Different listening and language 12/42 (28.6) 8/12 (66.7) 7/14 (50.0) -- expectations Primary caregiver(s) do not attend 9/42 (21.4) 5/12 (41.7) 5/14 (35.7) -- appointments Other 5/42 (12.0) 1/12 (8.3) 1/14 (5.9) -- * Based on Fisher s Exact test. 4

5 Facilitators to the provision of culturally competent hearing loss services Facilitators reported included: Strategies for facilitating communication, Strategies for ensuring culturally competent care, Strategies for learning about cultures Table 2 Proportion of practitioners who used strategies Facilitators: proportion of practitioners who reported that they used strategies all or most of the time Audiologists Auditory-verbal Speech-language Strategies for facilitating communication Use simple language 71/78 (91.0) 10/12 (83.3) 13/15 (86.7) Use interpreters 53/78 (68.0) 4/12 (33.3) 8/15 (53.3) Write key words 12/77 (15.6) 3/12 (25) 2/15 (13.3) Use visual aids 34/77 (44.2) 2/12 (16.7) 6/15 (40.0) Learn key phrases in patient s language 6/79 (7.6) 4/12 (33.3) 6/15 (40.0) Strategies for ensuring culturally competent care Select culturally relevant materials 44/72 (61.1) 8/11 (72.7) 12/15 (80.0) Encourage all family members to 45/69 (65.2) 9/12 (75.0) 11/15 (73.3) attend Use some of family s home language 17/70 (24.3) 8/12 (66.7) 8/15 (53.3) Use interpreters 68/75 (90.7) 6/12 (50.0) 11/15 (73.3) Modify assessments 44/65 (67.7) 8/12 (66.7) 11/14 (78.6) Modify interventions 14/68 (20.6) 1/12 (8.3) 9/15 (60.0) Table 3 Proportion of practitioners who viewed strategies as important Facilitators: proportion of practitioners who viewed strategies as essential or very important Audiologists Auditory-verbal Speech-language Strategies for learning about cultures Attend workshops, lectures, training on 53/80 (66.2) 8/12 (66.6) 14/15 (93.3) cultural sensitivity Ask caregivers questions about home life 65/80 (81.2) 12/12 (100) 14/15 (93.3) Ask caregivers about cultural 62/79 (78.4) 12/12 (100) 14/15 (93.3) perceptions of hearing loss Schedule home visits 11/66 (16.6) 7/12 (58.3) 11/15 (73.3) 5

6 Conclusion Findings stemming from this study can be used to inform practitioners seeking to provide culturally competent care. More insight is needed from patient families. More research is also needed from practitioners who provide long-term services (e.g., language therapy or home/school support). Questions? References Grandpierre, V., Milloy, V., Sikora, L., Fitzpatrick, E., Thomas, R., Potter, B. (2018a). Barriers and facilitators to cultural competence in rehabilitation services: A scoping review. BMC Health Services Research, 18(1), 23. Grandpierre, V., Fitzpatrick, E., Thomas, R., Mendonca, O., Sikora, L., Potter, B. (Under review). Barriers and facilitators to cultural competence in rehabilitation services: A qualitative inquiry. Submitted to Canadian Journal Of Speech-Language Pathologists and Audiologists. Grandpierre, V., Fitzpatrick, E., Thomas, R., Thomas, O., Sikora, L., Potter, B. Barriers and facilitators to cultural competence in rehabilitation services: A qualitative inquiry of caregivers perspectives. (2008b: Unpublished research). 6