D1.A

Cultural Competency

Acknowledging differences helps us to understand how both culture and diversity have a significant impact on how people perceive and react to healthcare providers’ attitudes, diagnosis, and treatment and ultimately reflect on their experience overall. The more we are aware of cultural differences  = better patient experience!According to US Department of Health and Human Services:A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs,values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers andtheir communities.

Areas of Cultural Sensitivity (13 Areas)

Communication.  Varies among culture-specific groups in terms of language or dialect spoken, pitch, volume, pronunciation, use ofsilence, and use of body/nonverbal communication. Language/Reading Proficiency. When English is the patient’s second language the probabilities of misunderstanding andmiscommunication become higher. Personal Space. In cultures like the United States, personal space is respected and if encroached can be considered threatening. Touching. The meaning of a simple touch differs between individuals, genders, and cultures. Social Orientation. Components of social organization vary by culture with differences observed in what constitutes one’s understanding of culture, race, ethnicity, family role and function, work, leisure, church, and friends in day-to-day life. Time. The United States culture is mono-chronic where time is money and focused primarily on one task at a time versus Hispanic, Asian, and Middle Eastern cultures, which are polychromic cultures where time is flexible, relationships come first then business, where many tasks are done at the same time. Family organization. Egalitarian/Hierarchical: they also vary in social structure. In US culture follows to anegalitarian model, where everyone is supposed to be equal. Other cultures, for example the Asian cultures, tend to follow a hierarchical model where status and power are based on gender, age, and occupation.

Relationship to nature. People view nature as either being able to control it, being part of it, or having no control whatsoever on it (i.e. Preventive health care measures are likely to be ignored; they would do no good anyway). Eye contact/Gestures. Some cultures, such as the Hispanic & Asian cultures are humble, so they avoid direct eye contact as a sign of respect. Ethnicity/Country of Origin. Considering and portraying women is different in various cultures, for example, Hispanic Women, are often portrayed in movies, and “novellas” as being caregivers who tend to put the well-being of their families before their own. This attitude can contribute to a tendency not to take care of their health conditions in early stages. Values, Beliefs & Customs. Understanding people’s values is a key to understanding their behavior, for our behavior generally reflects our values. Spirituality. Each culture has its own degree of spirituality (i.e. male Sikhs are not to shave their beards or any hair on their body even if needed for surgery). Religion. Many behaviors and customs are regulated by religion (i.e.  conservative Jewish and Muslim patients will not accept the replacement of their mitral valve if acquired from pig tissue as both religions do not consume pork).

Areas of Cultural Sensitivity (continued)

Diversity = Unique Individual Characteristics

While diversity includes some protected classes by law, such as minorities, women, sexual orientation, disabilities, etc., the concept ofdiversity reaches well beyond protected categories to encompass all characteristics that make an individual unique. It includes education, socio-economic factors, titles, jobs, abilities and disabilities, marital and parental status, geographical location, and more.Factors that can impact the relationship between patients and health providers: Communication and interpersonal relationship styles: word choice, voice tone and volume, eye contact, and proper titles. Gender issues and consideration of appropriate male/female interaction Age, respect, and seniority Individualism and equality Clothing, hair styles, and body adornment Informal and social interactions Language spoken/use of interpreters or family The more we are aware of diversity  = better patient experience!