Week 5 Presentation: Culture, Diversity, and Culturally Effective Care

Culture

• A broad term that encompasses many aspects about an individual that has been define in many ways

• A large part of a person’s identity is determined by their culture, OT’s need to learn about their client’s culture in order to fully understand the person

• Race and ethnicity are concepts that are interrelated with the concept of culture

• Things that make people unique

Black and Wells (2007) Define Culture as

• The sum total way of living, including values, beliefs, standards, linguistic expression, patterns of thinking, behavioral norms, and styles of communication that that influence the behavior(s) of people and is transmitted from generation to generation

• It includes demographic variables such as age, gender, and place of residence'; status variables such as social, educational, and economic levels; and affiliation variables

Race

• Biological race

• Identifying a group of people by their skin color (often typifies the concept of race) does not represent a distinct cultural group

• Greater genetic variation exists within the populations typically labeled Back and White than between these populations

• A concept of human minds, not of nature

  • Construct that we have made

• Within each of these social groupings are many different ethnic and cultural groups with different beliefs, values, languages, and behaviors

Racism

• “Most fundamentally the assessment of individual worth on the basis of real or inputed characteristics. Its evil lies in the denial of people’s rights to be judged as individuals, rather than as group members, and in the truncation of opportunities or rights on that basis.”

• A problem in healthcare, where there is still the belief that race is important to consider in clinical care

• Controversy

• Results in health disparities

• A problem in the OT profession- limited multicultural workforce

Ethnicity

• Social grouping of people who share cultural or national similarities

• Common characteristics:

  • Kinship, family rituals, food preferences, special clothing, particular celebrations, people from a particular community or country

• People share a common ethnicity:

  • Share a myth of common descent (they believe themselves to be descended from common ancestors)

• Although ethnicity may reflect a shared culture, the term of ethnicity and culture cannot be used interchangeably

Other Cultural Differences

• Class, socioeconomic status, education, religion, sexual orientation, age, and political views impact occupational choice and behaviors

Prejudice

• Preconceived ideas and attitudes

  • Usually negative about a particular group of people, often without full examination of the facts

• Many OT’s grew up in the US, where many-isms are prevalent, which leads to an (often subconscious) prejudice against certain groups of people

Metaphors for Prejudice

• Difference as a threat

• Difference as aversive

• Difference as competition

• Difference due to hierarchy

Basis for Prejudice: Difference as a Threat

• A fear of difference or the unknown

Basis for Prejudice: Difference as Aversive

• A dislike of difference or the or the unknown

Basis for Prejudice: Difference as Competition

• Competition with difference for scarce resources

Basis for Prejudice: Difference Due to Hierarchy

• Beliefs that are hierarchical and structured

Stereotyping

• When one attributes certain characteristics to an entire group of people

• An exaggerated image of their characteristics, withou regard to individual attributes

Ethnocentrism

• Tendency of people to put their own group at the center

  • To see things through the narrow lens of their own culture and use the standards of that culture to judge others

Discrimination

• Denies equal treatment to people because of their membership in some group

  • Against people or people will be doing it against us

• Systemic discrimination

Systemic Discrimination

• In employment, housing, education, government

• Sustains health disparities and poverty

Development of Discrimination

• Core beliefs develop the stereotypes and ethnocentrism from the subconscious

• Beliefs move on and create our feelings, and those feelings are what move into prejudice

• From the prejudice, you move onto discrimination, which is the action based on those feelings on prejudice based on those beliefs of ethnocentrism

Client-Centered Care

• Based on profession’s belief in the worth and respect of each individual

• Provide clients with unconditional positive regard

• Based on the premise that the client is capable of leading the therapy process and making decisions about their health care and that therapy is a collaborative process between the client and practitioner

  • Requires the OT to understand the client’s condition through the client’s eyes

  • Carefully listen and understand the client’s cultural values and beliefs about health and well-being

  • Let the client lead the way

Culture and Occupation

• Occupational choices

  • What occupations does one choose to spend their time being?

  • What is it that their culture informs what goes on within a day?

• Cultural difference in occupational performance

  • Roles (gender, family structure) play a big part

  • How the occupation is done (eat at table, floor, on the couch, by the fire)

  • Think about all the different cultures in the different areas

• Careful not to make assumptions about clients

Beliefs About Health, Well-Being, and Illness

• Culturally defined

• Biomedical model

• Individualistic society

• Health is the absence of disease

• Folk practices

  • Traditional home remedies which vary in different cultures

Biomedical Model

• Attributes health and illness to physiological, biological, and scientifically explainable changes in one’s body

• Tends to look at things through a certain lens

• Individualistic society

• Health is the absence of disease

Individualistic Society

• Treats the individual’s body and minimizes the links to households, communities, or the supernatural

Health is the Absence of Disease

• Often treated with pharmaceuticals or surgery, often neglecting psychological, behavioral, and social dimensions

Collectivist Culture: Value on the Family; Interdependence

• Priority to the needs of the group

• Motivated by group norms

• Group-imposed duties

• Harmony and cooperation

• Family is the primary unit

• Interdependence

• Family makes decisions for children

• Rarely have advanced directives

• People more important than time constraints

Individualistic Culture: Self-Expression, Personal Choice, Autonomy, Personal Responsibility, and Independence

• Focus on the needs of the individual

• Promotion of self-realization

• Individual goals and desires

• Competition

• Individual is primary

• Independence

• Children given many options and encouraged to make their own decisions

• Advanced directives are valued

• Time constraints are strictly adhered to

AOTA Diversity Statement

• American Occupational Therapy Association’s (AOTA’s) Vision 2025 conveys a strong commitment to diversity, equity, and inclusion

• It affirms the inalienable right of every individual to feel welcomed, valued, a sense of belonging, and respected while accessing and participating in society, regardless of the internal or external factors that make every individual unique

• The statement supports efforts to increase diversity, equity, and inclusion within all aspects of occupational therapy, including practice, education, and research, as well as policy development and advocacy