Lecture 10 - Cultural Competancy

What is the core concept of culturally competent eye and vision care?

Culturally responsive care links clinical quality with equity, patient trust, access, and meaningful participation in treatment.

Why does cultural competence matter in eye care?

Culture and language can shape symptom recognition, willingness to seek care, treatment preferences, and follow-through.

Who shares responsibility for culturally competent care?

Individual clinicians need communication skills, and practices need policies and systems that make equitable care possible.

What is culture?

All the ways of life, including arts, beliefs, institutions, manners, dress, language, religion, rituals, cuisine, laws, morality, and systems of belief that are passed from generation to generation.

How has culture been described sociologically?

As the way of life for an entire society.

What does culture generally refer to?

Patterns of human activity and the symbolic structures that give those activities significance and importance.

How can cultures be understood?

As systems of symbols and meanings that lack fixed boundaries, constantly change, and interact with one another.

What dimensions besides race and ethnicity are included in culture?

Language, age, religion, education, disability, occupation, and socioeconomic status.

What is meant by multiple cultural identities?

Individuals belong to several cultural groups simultaneously, and these identities influence beliefs, behaviors, and healthcare experiences.

How should clinicians assess patients culturally?

Ask how patients understand illness and treatment rather than inferring preferences from identity.

What is clinical culture?

The culture healthcare professionals develop through education, training, professional values, and assumptions about health, illness, and treatment.

What is self-identity?

The collection of individual cultural characteristics that define a person.

What aspects of self-identity were highlighted in the lecture?

Ethnicity, religion, sex, occupation, and relationship or parental status.

What is race?

A grouping of humans based on shared physical or social qualities into categories generally viewed as distinct by society.

What is ethnicity?

Shared cultural characteristics such as language, ancestry, practices, and beliefs.

What is group organization?

The practice of acting toward a person based in part on that person's social group.

What is a stereotype?

A cognitive structure containing knowledge, beliefs, and expectations about a human group that may be positive or negative.

What is bias?

A cognitive tendency to make systematic decisions based on cognitive factors rather than evidence; it may be positive or negative.

What is discrimination?

Differential behavior toward a person or group based on prejudice or institutionalized prejudicial attitudes; it is always negative.

What is prejudice?

An explicit, known, conscious, and usually negative judgment or attitude toward a group.

What is explicit bias?

Attitudes, stereotypes, and beliefs that consciously affect understanding, actions, and decisions about a person or group.

What is unconscious or implicit bias?

The unintentional activation of prejudicial attitudes toward a group based on stereotypes that have become invisible to the holder over time.

Why is self-awareness important in cultural competence?

Personal beliefs, stereotypes, and assumptions can influence patient interactions and clinical judgments.

Why should clinicians examine professional norms?

Education, training, and practice environments shape expectations of patient behavior and healthcare decisions.

Why should clinicians avoid assumptions about patients?

Individuals may not share beliefs, behaviors, or preferences commonly associated with a cultural or social group.

How should clinicians learn about patients' beliefs and preferences?

By asking open-ended questions about health beliefs, treatment concerns, communication preferences, and barriers to care.

Why should clinicians practice self-reflection?

To reassess initial impressions and recognize when bias may influence patient care.

What is cultural competency?

A set of behaviors, attitudes, and policies that enable individuals and organizations to work effectively in cross-cultural situations.

Is cultural competence a one-time achievement?

No, it is an ongoing developmental process requiring long-term commitment.

What role does respect play in cultural competence?

Recognizing and valuing patients' beliefs, cultural practices, expectations, and preferences without judging them against personal values.

What role does adaptation play in cultural competence?

Modifying communication, patient education, and treatment plans to meet individual needs while maintaining standards of care.

Is cultural competence simply knowledge about different cultures?

No, it involves recognizing differences, adapting approaches, and providing individualized respectful care without compromising clinical standards.

How can culture affect timely access to care?

Patients may interpret symptoms differently, influencing when they seek examinations or urgent evaluation.

How can culture affect communication in healthcare?

Misunderstood diagnoses, medication instructions, or follow-up plans can reduce treatment effectiveness and safety.

How can cultural beliefs affect patient expectations?

Beliefs about clinicians, family involvement, and decision-making influence consent and acceptance of care.

How can culturally responsive care improve outcomes?

Individualized explanations and negotiated plans may improve trust, satisfaction, and adherence.

How does the ASCO guideline relate to cultural competence?

It links cultural competence to equity, informed consent, risk management, and quality of care.

How does cultural awareness benefit patient encounters?

It facilitates culturally sensitive interactions.

How does cultural competence influence health disparities?

It helps reduce disparities and improve outcomes for vulnerable populations.

How does cultural competence affect patient communication?

Patients are more likely to share concerns, ask questions, and participate in treatment decisions when they feel respected and understood.

How does understanding cultural and socioeconomic barriers improve eye care?

It helps identify obstacles preventing timely and appropriate care.

How does individualized communication improve care?

It enhances patient understanding, treatment adherence, and overall quality of care.

How can provider implicit bias affect healthcare?

It may contribute to racial and ethnic health disparities.

What did the systematic review by Hall et al. find regarding provider implicit bias?

Providers demonstrated mild to moderate implicit bias associated with patient-provider interactions, treatment decisions, adherence, and health outcomes.

What aspect of care was most consistently related to implicit bias in providers?

Patient-provider interactions and health outcomes.

Why are interventions targeting implicit bias important?

Implicit bias may contribute to health disparities among people of color.

How can historical distrust of healthcare providers affect care?

It can create barriers to seeking healthcare.

How can culture affect perceptions of illness and disease?

Different cultures may interpret causes, severity, and meaning of disease differently.

What types of health belief systems may influence healthcare decisions?

Western, Eastern, homeopathic, and other belief systems.

How can cultural beliefs influence health-seeking behavior?

Beliefs about disease, illness, and religion can affect when and how patients seek care.

What communication barriers may occur in culturally diverse healthcare settings?

Misunderstandings involving terminology, language, or body language.

What is meant by incompatibility of explanations in healthcare?

Health concepts may be lost in translation between patient and provider perspectives.

How can family structure influence healthcare decisions?

Decision-making may be matriarchal, patriarchal, communal, or follow other family structures.

Which populations may be vulnerable to cultural misunderstandings in healthcare?

Non-English speakers, ESL patients, non-U.S.-born individuals, immigrants, refugees, racial and ethnic minorities, elderly patients, gender non-conforming populations, and religious groups.

What does the L in the LEARN communication model stand for?

Listen to the patient's perception of the problem with empathy and without interruption.

What does the E in the LEARN communication model stand for?

Explain your clinical interpretation and the reasons behind recommended treatment.

What does the A in the LEARN communication model stand for?

Acknowledge similarities and differences between the patient's and clinician's viewpoints.

What does the R in the LEARN communication model stand for?

Recommend an evidence-informed treatment plan that addresses patient concerns.

What does the N in the LEARN communication model stand for?

Negotiate a mutually acceptable and safe treatment plan.

How can language barriers create clinical risk?

Incomplete histories and misunderstood instructions can affect diagnosis, consent, and medication use.

Why should clinicians ask about language preference?

To determine which spoken and written language patients prefer for clinical information.

How should educational materials be provided to patients with language differences?

Using clear explanations and understandable written information appropriate to the patient.

How should clinicians verify patient understanding?

Ask patients to explain the treatment plan in their own words rather than relying on yes/no responses.

What glaucoma example was used to illustrate cultural competency?

A patient discontinued pressure-lowering eye drops because vision seemed unchanged.

How should clinicians respond when a glaucoma patient stops using drops?

Avoid assuming the patient is unmotivated or noncompliant.

What should be explored with a glaucoma patient who stops using medication?

Their understanding of glaucoma, eye pressure, and vision loss.

How should clinicians explain glaucoma risk to patients?

Glaucoma can progress without symptoms, and treatment aims to prevent future damage.

What barriers should be assessed when a glaucoma patient stops medication?

Cost, dosing routine, side effects, and competing treatments.

What are best practices for cultural competency in healthcare?

Build rapport and trust with patients.

What are best practices for cultural competency in healthcare?

Learn about the people living in the community you serve.

What are best practices for cultural competency in healthcare?

Use gender-, culture-, and home situation-inclusive paperwork.

What are best practices for cultural competency in healthcare?

Be aware of your communication style and cultural mismatches.

What examples of communication style differences were discussed?

Shaking hands and direct eye contact.

What are best practices for cultural competency in healthcare?

Do not assume a traditional family or home structure.

What are best practices for cultural competency in healthcare?

Practice personal cultural humility.

What are best practices for cultural competency in healthcare?

Consider barriers to care, access to care, and cultural beliefs and differences.

What are best practices for cultural competency in healthcare?

Ensure staff are appropriately trained in cultural competency.