L5 - Applications of Cultural Competence

What does it mean to be acculturated?

The individual has a high orientation towards the host culture and a low orientation towards the culture of origin

What does it mean to be bicultural?

The individual has a high orientation towards the host culture and a high orientation towards the culture of origin

What does it mean to be marginal?

The individual has a low orientation towards the host culture and a low orientation towards the culture of origin

What does it mean to be traditional?

The individual has a low orientation towards the host culture and a high orientation towards the culture of origin

What groups of people (acculturated, bicultural, marginal, traditional) would have the highest risk for poor health outcomes?

Marginal and Traditional

Define acculturation

The process by which individuals or groups from one culture adapt to and adopt aspects of another culture, usually the dominant one

Define assimilation

The process by which individuals or groups from a minority culture gradually adopt the norms, values, and behaviors of the dominant culture to the point that their original cultural identity is largely replaced or lost.

Define cultural competence

Ability of individuals and systems to respond respectfully and effectively to people of all cultures, classes, races, ethnic backgrounds, and religions in a manner that recognizes, affirms, and values the cultural differences and similarities and the worth of individuals, families, and communities, protects and preserves the dignity of each

Define enculturation

The process by which developing individuals acquire the cultural and psychological qualities needed to function as members of their own group. Can occur either by generalized learning or as a result of specific instruction and training

Define ethnocentrism

View that one's own cultural orientation is the 'correct' view of reality.

Viewing other groups and cultures from the perspective of your own culture

Define generalization

Draws on experiences and commonalities of groups or cultures while allowing room for the individual experience

Define stereotypes

Imposing preconceived assumptions or observations about behaviors, beliefs, and actions on individuals without evaluating their unique values and experiences.

What is the cultural development model?

A model used to suggest six stages on the path toward cultural proficiency

What is step one of the cultural development model?

Cultural incompetence: the individual does nothing to increase knowledge of different cultures

What is step two of the cultural development model?

Cultural knowledge: learn facts about cultures, especially related to health and health behaviors

What is step three of the cultural development model?

Cultural awareness: understand implications of culture on health behaviors

What is step four of the cultural development model?

Cultural sensitivity: combine knowledge and awareness into individual and institutional behaviors.

Actively tries to respect and understand differences.

What is step five of the cultural development model?

Cultural competence: routinely employ culturally appropriate health care interventions and practices.

Has developed skills to effectively interact across cultures. Can adapt communication and care plans to the patient's cultural context.

What is step six of the cultural development model?

Cultural proficiency: practice with cultural competence and integrate it into one's research and scholarship activities

Cultural competence is integrated into practice and policy. Promotes cultural competence in the workplace and mentors others.

What can result when there are incongruent beliefs and expectations between a patient and pharmacist?

Hostility, misunderstandings, confusion, drug misadventures (e.g., medication errors, inappropriate medication use), and poor clinical outcomes.

How can a pharmacist's inadequate awareness of the effects of ethnicity affect patient care?

It can lead to inappropriate drug therapy and poor clinical outcomes due to differences in drug metabolism, response, and sensitivity.

Why might pharmacy services be compromised due to cultural incompetence?

Pharmacists may lack understanding of patient perceptions of illness and treatment, which affects the patient's response to therapy.

What is the primary goal of multicultural patient care?

To promote full and active communication among patients and providers.

Why must the communication process be altered in multicultural patient care?

To account for cultural issues that may impede the patient's learning process

What is step one towards achieving cultural proficiency in pharmacy practice?

Understand one's own ethnocentric view of the world, and how it has shaped one's view of self and others

What is step two towards achieving cultural proficiency in pharmacy practice?

Acquire background knowledge about different groups of people the pharmacist serves with the goal of understanding them and resisting stereotypes.

What methods can pharmacists use to acquire background knowledge about different cultural groups?

Focus groups, interviews, surveys, libraries, internet research, and culture-specific organizations.

What is the purpose of a cultural assessment of a patient's health beliefs (step 2)?

To actively probe and elicit feedback about the patient's beliefs regarding their illness, treatments, and fears.

Name some key areas to explore when assessing a patient's health beliefs

How the illness is labeled

Cause and duration of the illness

Severity of the illness

Views toward treatments

Any fears associated with the illness and treatment

What is step three towards achieving cultural proficiency in pharmacy practice?

Develop effective communication skills to minimize misunderstandings.

How can a pharmacist develop effective communication skills with patients of a different culture?

Learn key words in another language and nonverbal cues, work with interpreters, and avoid violating cultural norms

What is step four towards achieving cultural proficiency in pharmacy practice?

Tailoring treatment recommendations based on what you know about the patient's culture, treatment concerns, and how they feel about the treatment

What technique is used to tailor treatment effectively for patients of different cultures?

LEARN

Describe the aspects of the LEARN technique used to tailor treatment effectively

L = listen with empathy

E = explain differences in view between pharmacist and patient

A = acknowledge and discuss the difference in view

R = recommend treatment options

N = negotiate an agreement regarding the treatment plan

What is step five towards achieving cultural proficiency in pharmacy practice?

Develop strong ties in the community. This can be done through volunteer work and informing health assets in the community about pharmacy resources

What traditional healing system is common among Hispanic/Latino Americans?

Curanderismo - a mix of spiritual, homeopathic, Spanish, and Western foundations.

What is the "hot-cold" concept in Hispanic/Latino health beliefs?

Illness and remedies are classified as "hot" or "cold," and treatment involves restoring balance.

What factors influence healthcare use among Hispanic/Latino populations?

Hispanic Paradox - good health despite lower SES

Salmon effect - self-treat or return home for serious illnesses

Acculturation - does not always improve health outcomes

What traditional beliefs influence African American health practices?

Spirituality, folk healing, natural vs. unnatural causes of illness.

What are key factors in healthcare use among African Americans?

Healthy mistrust of the healthcare system

Belief in harmony with nature for good health

Spiritual/religious influence (e.g., Black church)

Access issues, low literacy, lifestyle factors (e.g., diet)

What traditional concepts influence Asian American health beliefs?

Balance of yin and yang; hot-cold illness and remedies.

How does culture affect healthcare use in Asian American communities?

Kinship solidarity; decisions may involve family, not just patient

Health seen as state of harmony/balance

Trust and disclosure issues with providers

Lack of culturally competent providers

What are key health beliefs among American Indian/Alaska Native populations?

Balance of mind-body-spirit, spiritual and holistic approach, respect, self-sufficiency, and patience as commitment.

What factors impact healthcare use in AI/AN populations?

Distrust of outsiders

Behavioral impacts (e.g., ceremonial tobacco use)

Environmental and access issues, especially in rural areas

Diversity in health beliefs across tribes

What traditional health beliefs are common in Pacific Islander Americans?

Holistic approach - balance of spiritual, psychological, physical, and family; interconnectedness of health; sickness as a community concern.

How do the beliefs of Pacific Islander Americans influence healthcare use?

Treatment often guided by traditional healers; indigenous vs. foreign illnesses dictate the type of care sought.

What traditional health beliefs are seen in Arab Americans?

Natural, social, hereditary, and supernatural causes; hot-cold illness; spirits and evil eye.

What factors influence healthcare use among Arab Americans?

Acculturation (varies by immigration wave)

Family-centered decision-making

Religious identity and cultural values

Language, socialization, and gender roles