Cultural Competence in Clinical &Translational Research

Transcription

1 Cultural Competence in Clinical &Translational Research Souzan Hawala-Druy, MPH, BSN Howard University- Division of Nursing GHUCCTS - July 25 & 27, 2011

2 Home is where the story Georgetown Howard Universities starts!!! - Saudi-American Hospital nationalities (cultural shock, clashes, pain, assault) - Multicultural Family (Muslim, Jewish, Christian, Atheist, Arabs, American, British, Gay, Lesbian? Straight, one questioning existence of God etc.) - Alien Permanent Resident, Race, Ethnicity, what is the difference???? - Hyphenated American!!! Egyptian-American OR American-Egyptian

3 Pick One: relate it to your own level of culture competency In ancient Greece a certain academy gave a three years course: Students in the first year of the course were called Wise men. In the second year they were called Philosophers meaning persons who wanted to be wise men. In the third year they were called simply Students, meaning that they had been in school long enough to know how much they needed to learn. Wilbur Schram

4 Test your knowledge: Georgetown Howard Universities - What are the four Major areas of disparities in healthcare? - Why do we have to be culturally competent? Legal, moral, ethical, accreditation, etc. - Do you recall some trans-culture theories/models? - What are the cultural-health issues of Hispanic population? - What knowledge do you have about female circumcision /mutilation in specific cultural group? Does it exist? - Can you take care of sex offender, If you are a mother of 12 years old girl? - A pregnant client introduced you to her wife, what is your expected behavior / response?

5 Culture Georgetown Howard Universities Is an integrated pattern of human behavior which includes but not limited to: thoughts, communication, languages, beliefs, values, practices, customs, rituals, manners of interacting, roles, relationships, and expected behaviors of racial, ethnic, religious or social group; the ability to transmit the above to succeeding generations; dynamic in nature National Center for Cultural Competence, 2002

6 Cultural Competence Georgetown Howard Universities Ability to effectively and efficiently work within cultural context of individuals or community from a diverse cultural/ethnic background National Center for Cultural Competence, 2002 Ability of researchers/research staff to provide quality research that takes into account the culture/diversity of a population when developing research ideas, conducting research, and exploring applicability of research findings. Harvard Catalyst, 2009

7 Culturally Congruent Care (Research) Health care that is customized to fit the client s cultural values, beliefs, traditions, practices, and lifestyle. Leininger, 1991

8 Clinical and Translational Research (C&TR) Let us negotiate: Tell me what it means and why it matters, and I will tell what cultural competence means and why it matters WAIT: Let us first discuss contract, rules, regulations, roles, expectations, communication, languages, conduct, point of view, etc.

9 Clinical and Translational Research (C&TR) Let us negotiate: Tell me what it means and why it matters, and I will tell what cultural competence means and why it matters NIH, CTSA program 2006, T1 & T2, Bench-bedside (drug, devices, treatment options), translating research into practice, improve quality by improving access, help clinicians and clients to change behaviors, strengthen patientclinician relationship, reorganizing and coordinating system of care (interdisciplinary), existing treatments or new treatments- stroke-aspirin or more potent anti-platelet agents?? American medical Association, 2008

10 Healthy People 2010 Two major goals require culture -specific care : 1-Increase quality and years of healthy life for all Examining quality of life and meaning of health and well-being within cultural context 2-Eliminate health disparities among different segments of the population Necessitating culture-specific and competent actions designed to eliminate disparities Matches NIH roadmap for medical research

11 Disparities in Health Care Georgetown Howard Universities Four Major areas: Physician s communication Cultural competence in health care services Quality of clinical care delivered care Access to care IOM, Unequal Treatment Report

12 Clinical and Translational Research (C&TR) Core competencies in C&TR: (13) Importance/linkage between culture and research design, analysis &interpretation 3- Study Design: Identify target population, then recruit e.g importance of placenta for specific cultural groups 4- Implementation: Conduct community diagnosis, detect barriers to treatment utilization (access to care, cultural, social & linguistic barriers, acculturation, spirituality, perception of health & illness, etc) 8- Responsible conduct research: protecting participants, vulnerable participants, consent, decision-making capacity of participants, report unprofessional behavior of colleagues Core Competencies in Clinical and Translational Research, 2009

13 Clinical and Translational Research Georgetown Howard Universities (C&TR) 10- Culture Diversity: Differentiate between cultural competency and cultural sensitivity Researchers own culture, bias & stereotype Recognize the demographic, geographic, and ethnographic features within communities and populations when designing a clinical study Describe the relevance of cultural and population diversity in clinical research design Critique studies for evidence of health disparities, such as disproportional health effects on select population (gender, age, ethnicity, race, ) Core Competencies in Clinical and Translational Research 2009

14 Sharing Life Experiences Trust, comfort, openness, sensitivity - My father is married to 3 wives, cousins, and have 13 kids, we live in harmony, he is financially, emotionally, physically treating all fairly, and equally.. I believe in the future I ll accept being like my mom, you understand what I m trying to say

15 Sharing Life Experiences Trust, comfort, openness, sensitivity -My daughter had been invited last year to a birthday party, she was 5 years old, before I dressed her, she mentioned that the kid has 2 moms, I was shocked. I did not, again I did not take her to the party. This year because of this class, I ll.. Let me see how I ll feel. Why they gave my daughter gifts to take home that are covered with rainbow color, do you think they are trying to convert my daughter.. -My aunt left three daughter to live with another woman, please explain to me why??? She was so close to me, I loved her, I love her, still do, but that is against my religion.

16 Sharing Life Experiences Trust, comfort, openness, sensitivity Please, be sensitive, don t be judgmental do you know any gay or lesbian as friend?? Please be sensitive I don t know why we have to offer interpreters? If they come to live here they should speak the language Abuse is common in our cultural group, that is why I left my family when I was 17, can t stand it I love my mom, but she was so passive I feel sorry for her..

17 Civility & Professionalism Georgetown Howard Universities Mutual Respect Academia, Workplace, & Community Researchers, educators, clinicians, clients, communities Oreos, banana, apple, coconut

18 Civility & Professionalism Georgetown Howard Universities 1- Professional parameters: legal & ethical issues. 2- Professional behaviors: 3- Professional responsibilities: Discipline-related knowledge/skills, Appropriate relationships with clients Acceptable appearances and attitudes. Profession and oneself, clients, colleagues, and community.

19 You read, I watch!!! Georgetown Howard Universities A Chinese-born physician called the night nurse one evening to check on a patient scheduled for surgery in the next day. The nurse noticed that the patient was hesitant to have the surgery. She reported to the physician to tell you the truth, doctor, I think the patient is getting cold feet. The physician was not familiar with this idiom, suspected circulation problems, and ordered vascular tests. Health Communication-2000

20 Clinical and Translational Research (C&TR) 11- Translational teamwork & Leadership: Communication, Communication, Communication, & Communication * Intra/Inter/multidisciplinary team * Multiple point of view * Clarify language differences across disciplines * Manage conflicts & behavioral modifications (behavior/action not values) Challenges associated with merging scholars from diverse backgrounds (researchers cultures, professions culture, disciplines, generations, gender, language, ethnocentrism, communication skills, non-verbal communication, etc.)

21 Gain Trust Georgetown Howard Universities Gain -- s trust to openly discuss real life experiences, biases and stereotypes; negotiate behavior and attitude modification; and then restructure recruiting strategies to match clinical/community dynamics.

22 13- Community engagement: Clinical and Translational Research (C&TR) Examine characteristics that bind people together as community (social, interests, geography, socio-economic, acculturation, environment, etc.), Involve and appraise community engagement (negotiation/ manipulation), Partnership (community/researchers) and locate insider, trust, respect; researcher part of community/community part of research Enhance public trust in C&TR (bias- stereotype, Tuskegee, willingness to participate, etc), Facilitate recruitment from community for research and intervention Core Competencies in Clinical and Translational Research 2009

23 Application of Theory Georgetown Howard Universities Culture Care Diversity & Universality Theory Dr. Leininger s 3 modes of action: * Preservation / maintenance (establish & gained trust) * Accommodation / negotiation (not manipulation) * Re-patterning / restructuring (recruitment of participants & implementation/interventions)

24 Remember: - Health professionals, usually, overestimated their cultural competence level, There is no final end product that labeled cultural competence, culture competence is an ongoing process. Memorizing a multitude of facts about a culture becomes less important than understanding, applying and appreciating the cultural context of facts, and importance of congruent care,and The importance of understanding your own culture including bias & stereotypes.

25 Remember: Across the Fai River the orange becomes the tangerine- things will turn out differently in different locations or surroundings Chinese saying

26 Health Professionals Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habits. Watch your habits; they become character. Watch your character; it becomes your destiny. Frank Outlaw