S03: Health Communication - American Association of Service

8/12/2016
Health Communication:
Bridging the gap through a
shared cultural meaning
Darrin E. Wright, PhD, LMSW, MAC.
Clark Atlanta University
Presented at American Association of Service Coordinators
August 21, 2016
Objectives of Training
1.
2.
3.
Understand the dynamics of normative culture and personal
values influence on the beliefs, ideas and behaviors that a
cultural group values and expect in interpersonal interactions
with their healthcare practitioners.
Become more cognizant of social factors which could influence
health communication, cultural competence and its impact on
how clients’ access services and their overall satisfaction with
services received.
Consider the importance of clients’ help seeking behaviors as it
relates to their various pathways to access, adherence to
treatment and utilization of services.
Key Terms
•
•
•
•
•
•
•
Attitude
Belief
Ideology
Culture
Cultural Awareness
Cultural Sensitivity
Cultural
Competence
• Cultural Relativism
• Cultural
Imperialism
• Cultural Imposition
• Ethnocentrism
• Prejudice
• Discrimination
• Race/Ethnicity
• Racism
• Stereotyping
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Definitions
ATTITUDES:
• A state of mind or feeling
about some matter of a
culture.
BELIEFS:
• Something that is
accepted as true,
especially as a tenet or a
body of tenets accepted
by people in an
ethnocultural group.
Definitions
IDEOLOGY:
• Consists of the thoughts
and beliefs that reflect the
social needs and
aspirations of an
individual or an
ethnocultural group.
CULTURE:
• The totality of socially
transmitted behavioral
patterns, arts, beliefs,
values, customs, lifeways, and all other
products of human work
and thought characteristics of a population of
people that guide their
worldview and decision
making.
Definitions
CULTURAL
AWARENESS:
• An appreciation of the
external signs of
diversity, such as arts,
music, dress, and
physical characteristics.
CULTURAL
SENSITIVITY:
• Personal attitudes and
not saying (or doing)
things that might be
offensive to someone
from a cultural or ethnic
background different
from the health-care
provider’s.
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Definitions
CULTURAL COMPETENCE:
1.
2.
3.
4.
5.
6.
7.
Developing an awareness of one’s own existence, sensations,
thoughts, and environment without letting it have an undue
influence on those from other backgrounds.
Demonstrating knowledge and understanding of the client’s
culture, health-related needs, and meanings of health and
illness.
Accepting and respecting cultural differences.
Not assuming that the health care provider’s beliefs and
values are the same as the client’s.
Resisting judgmental attitudes such as “different is not as
good.”
Being open to cultural encounters.
Adapting care to be congruent with the client’s culture.
Definitions
CULTURAL
RELATIVISM:
• The belief that the
behaviors and practices
of people should be
judged only from the
context of their cultural
system.
CULTURAL
IMPOSITION:
• The intrusive application
of the majority group’s
cultural view upon
individuals and families
(and sometimes other
groups).
Definitions
CULTURAL
IMPERIALISM:
• The practice of extending
the policies and practices
of one group (usually the
dominant one) to
disenfranchised and
minority groups.
ETHNOCENTRISM:
Book> The universal
tendency of human
beings to think that their
ways of thinking, acting,
and believing are the only
right, proper, and natural
ways.
Dr. Trask> Preference for,
and belief in the
centrality of one’s own
ethnic/racial group in
one’s everyday life.
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Definitions
PREJUDICE:
• A psychological
condition in which
individuals/groups are
prejudged on the basis of
certain characteristics
(gender, race, age, etc.)
DISCRIMINATION:
• Actions based on
prejudice thinking.
Definitions
STEREOTYPING:
• An oversimplified
conception, opinion, or
belief about some aspect
of an individual or group
of people.
RACISM:
• A historically-created system
of power in which one
racial/ethnic group dominates
another racial/ethnic group
for the benefit of the
dominating group; economic
and cultural domination as
well as political power are
included in the systemic
dominance of the exploiting
group; a monopoly of the
means of violence is also held
by those in the dominating
group.
Definitions
• RACE:
Book> Having to do with genetic differences such as blood type,
skin color, and other physical characteristics. (there is less
than 1 percent difference)
NB> It is important to note that race is predominantly a social
construct - in other words, scientists have discovered that only
2 percent of our genes are ultimately responsible for the
visible differences such as skin color. Although it is not an
exact science, social groups play a very important role in
defining the rules of race. For example, in some cultures a
light skin person of African and European ancestry who is
also upper class may be considered White, while in others,
this same individual would classify as Black.
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What is Health
Communication?
Purpose of Health Communication
Health Communication
contribute to all aspects of:
Disease/health promotion
Health professional/patient
relationship
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Key components of Health
Communication
Cultural
orientation
Personal
goals
Cultural competence
Culture
Situational
factors
Effective health
communication
Cultural dimensions to the
client/ patient relationship
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• Similarly, Flores, D,(2000) has cited a need for
healthcare practitioners to understand the dynamics
normative culture and values have on the beliefs,
ideas and behaviors that a cultural group values and
expect in interpersonal interactions with their
healthcare practitioners
African American Health
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Historical Perspectives Addressing
African American Health
• Issue of race is persistent theme
throughout history of American society
• Often focused on “Black Experience”
owing to history of slavery
• Prominent African-American
sociologists instrumental in prioritizing
minority health in U.S.
Historical Perspectives Addressing
African American Health
• WEB Du Bois
• Influential African American Intellectual of the 20th
Century
• Used social science methods to describe social and
economic conditions that shaped health status of African
Americans
• In 1906, published The Health and Physique of the Negro
American
• Used epidemiological methods to expose myth that Blacks
suffered higher death rates due to racial inferiority and
vulnerability to northern climates
• Documented how poor health of Blacks was directly
related to conditions of economic poverty, inferior
education, segregation, social and sanitary degradation
Historical Perspectives Addressing
African American Health
• Booker T. Washington
• Founder and president of Tuskegee Institute
• Made direct link between economic progress of Blacks
and the negative impacts of premature death
• Launched Negro Health Improvement Week in 1915 (first
minority health initiative in US)
• Evolved into National Negro Health Movement
• Adopted by the US Public Health Service in 1932 as part
of new federal Office of Negro Health Works
• Laid the foundation for establishment of Office of
Minority Health, 1986
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Social Determinants of
Health
• Income and social status
• Social support networks
• Education
• Employment and working conditions
• Social environments
• Physical environments
Social Determinants of
Health
• Personal health practices and coping
skills
• Healthy child development
• Biology and genetic endowment
• Health services
• Gender
• Culture
PART II
AFRICAN AMERICAN
HEALTH BELIEFS
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Overview, Inhabited Localities,
and Topography
• Have been identified as: “Negro”, “colored”, “black”,
“black American”, and “people of color”.
• Largely descendants of Africans brought to U.S.
between 1619 and 1860.
• See: Ivan van Sertima, Lerome Bennett
• Over 50% of African Americans live in the South.
• “Great Migration” occurred after Civil War, from
southern rural areas to northern urban areas.
• Before 1954 Brown v. Board of Education educational
opportunities were limited.
• In 1961, Pres. Kennedy establishes Committee on
Equal Opportunity.
Communications
• “black English” or “Ebonics”
• Creole, Gullah, and “Pidgin”
• “The dozens”
• “CP Time”
• Mr., Ms., Dr., Aunt, Cousin, etc.
Family Roles and Organization
• Altered by slavery
• Matrifocal/African American women as
“pillar”
• African American grandparents in primary
parental roles
• Value of self-reliance and education
• Teenage pregnancy
• Extended family
• Social status
• Alternative lifestyles
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Workforce Issues
• Ethnic/racial tension
• Four Interacting Styles (Bell and Evans,
1981)
1.
2.
3.
4.
Acculturated Interpersonal
Culturally Immersed
Traditional Interacting
Bicultural Interacting
• Black English in the workplace
Spirituality
• Integral part of community
• Religious involvement associated with
positive mental health
• “Shouting”, laying on of hands, speaking in
tongues.
• “Doctor Jesus”
• Sickness viewed as separation between God
and man
• “Root work”, “hex”, “fix”, “conjuring”,
“mojo”, “black magic”, “hoodoo”
Health Care Practices
• Suspicion of healthcare professionals
• Natural and unnatural illness
• Home remedies
• Root doctors
• Pain as sign of illness or disease
• Stigma against mental illness
• Sick role
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Barriers to Health Care
• Lack of Health Insurance
• Access to Care
• Quality of Care
• Racial Concordance
• Provider Bias
High-Risk Behaviors
• Risky sexual behavior
• Violence and unintentional injuries
• Smoking
• Alcoholism
• Drug Abuse
• Sedentary lifestyle
• Delayed seeking of health care
• Lack of Screenings
Nutrition
• Soul food
• Food as symbol of health and wealth
• Rejecting food
• “meat on your bones”
• Infants and solid foods
• Lactose intolerance
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Diseases and Health Conditions
• HIV/AIDS
• Cancer
• Cardiovascular Disease
• High Blood Pressure
• Diabetes
• Infant Mortality
• Mental Health Conditions
Latinos in America
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Percent Hispanic of the Total Population
in the United States: 1970 to 2050
24.4
22.3
20.1
17.8
15.5
12.5
9.0
6.4
4.7
1970
1980
1990
Census
2000
2010*
2020*
2030*
2040*
2050*
Projections
*Projected Population as of July 1
Source: U.S. Census Bureau, 1970, 1980, 1990, and 2000 Decennial Censuses; Population Projections, July 1, 2010 to July 1, 2050
US Census Bureau: FACTS
54.5 million
The estimated Hispanic population of the United States as of July 1,
2015, making people of Hispanic origin the nation’s largest ethnic
minority. Today, Hispanics constitute 15 percent of the nation’s
total population. In addition, there are approximately 3.9 million
residents of Puerto Rico, Hispanic US citizens.
3.3%
Increase in the Hispanic population between July 1, 2006, and July
1, 2007, making Hispanics the fastest-growing minority group.
www.rdtorecovery.com
Hispanic Origin by Type: 2015
Type of origin
Total
Mexican
Number
54,070,096
Percent
100.0
34,053,950
63.0
Puerto Rican
5,032,734
9.0
Cuban
1,969,524
3.6
Dominican
1,500,000
2.8
Central American
3,372,090
6.2
South American
2,421,297
5.0
Other Hispanic
5,720,501
10.5
Source: U.S. Census Bureau, 2014 American Community Survey
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Latinos in America
• North America
Canada > 0.1%
United States (15/64%)
Pochos ½-½ (American/Mexican)
Chicanos 100% (Mexican/Mexican)
Mexico
• Central America
Honduras
Nicaragua
Costa Rica
Guatemala
El Salvador
Panama
* Belize (E)
Latinos in America
• South America
Colombia
Venezuela
Brazil (P)
Ecuador
Peru
Bolivia
Argentina
Chile
Uruguay
Paraguay
• Caribbean
* Puerto Rico
Cuba
Dominican Republic
• Non-Latino SA
Suriname (D)
Guyana (E)
French Guiana (F)
The Islands of America
Anguilla
Antigua and Barbuda
Aruba (D)
Bahamas
Barbados
Bermuda
British Virgin Islands
Cayman Islands
Dominica
Grenada
Guadeloupe (F)
Haiti (F)
Jamaica
Montserrat
Netherlands Antilles (D)
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the
Grenadines
Trinidad and Tobago
Turks and Caicos Islands
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Latino or Hispanic?
• “Hispanic” is not a term used in Latin countries.
• Self-referred not as a group but as nationality or region
• “Hispanic” first used in the US Census in 1980.
Latin America:
Understanding
Language
www.rdtorecovery.com
Understanding Language
Castellano
The number of languages listed for
Spain is 15. Of those, 13 are living
languages and 2 are extinct.
Spanish
(Castilian)
Galician
Catalan &
Basque
Source: Ethnologue.com / languages of Spain
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Understanding Language
Nahuátl
(Aztec)
The number of languages
listed for Mexico is 295.
Of those, 288 are living
languages and
7 are extinct.
Source: Ethnologue.com / languages of México
www.rdtorecovery.com
Understanding Language
Quiché
(Mayan)
The number of languages listed
For Guatemala is 56. Of those,
54 are living languages and
2 are extinct.
Source: Ethnologue.com / languages of Guatemala
www.rdtorecovery.com
Understanding Language
Quechua
(Inca)
The number of languages
listed for Peru is 106. Of
those, 92 are living languages
and 14 are extinct.
Source: Ethnologue.com / languages of Perú
www.rdtorecovery.com
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Understanding Language
A “cultural” hangover
Peru
“Resaca”
Mexico
“Cruda”
Venezuela
“Enratonado”
Colombia
“Guayabo”
El Salvador
“Goma”
Ecuador
“Chucaque”
Puerto Rico
“Hanguiao”
www.rdtorecovery.com
DHS and US Immigration
• March 1, 2003 - service and benefit functions of the U.S.
Immigration and Naturalization Service (INS) transitioned into
the Department of Homeland Security (DHS) as United States
Citizenship and Immigration Services (USCIS).
• The U.S. Immigration and Customs Enforcement (ICE),
became the investigative arm of the DHS, responsible for
eliminating vulnerabilities in the nation's border and enforcing
immigration laws within our borders.
Immigration Status
Undocumented (Illegal)
(Estimate: 12 million as of March 2006)
Temporary & Permanent
US Residents (US Aliens)
(27% of Latinos, Non-US Citizens, have a
temporary or permanent resident status)
US Citizens (Naturalized)
(the population of Naturalized US Citizens
reached 12.8 million in 2005)
*Source Pew Hispanic Center
www.rdtorecovery.com
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Immigration Status
Work Permit
(H2A, Seasonal Farm Workers;
H1B Professional, J1 Trainees,
O Artist, Others)
Students (I-20 Visa)
Tourists (I-94 Visa)
Political Asylum
(No quotas are set for asylum
admissions)
Refugees
(Since 2004, the limit has been
70,000 per year worldwide)
*Source Pew Hispanic Center
www.rdtorecovery.com
Latinos Religion & Faith
Aztec, Maya and Inca
cults and rituals
Shamans used powers for
the purpose of curing the
sick and “controlling
events,” (rain, sun).
Animism, existence of
protecting spirits,
“Animas,” separable from
bodies (usually ancestry)
All beings having a soul
Shamans, Andes & Amazonia
Latinos Religion & Faith
The early 16th century
brought Roman
Catholicism, imposed by
the Christian Spanish and
Portuguese
Cristo Blanco
Cusco, Peru
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Europeans Conquistadors also brought
Enslaved African’s with their spiritual
and religious traditions.
http://family.webshots.com/photo/2310153
580025635374Xltztb
Santera, Cuba
Afro-Latin American traditions such as
Santeria, Candomble, Umbanda, Macumba
and Voodun religions are also practiced,
mainly in Cuba, Brazil, Trinidad and Haiti.
Latinos Religion & Faith
Nineteenth century brought Protestantism and
the increase in immigration brought …
Muslims
Hindus
Buddhists
Judaism
… greater religious
tolerance!
www.rdtorecovery.com
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Latinos & Education
Nearly one-third of children in primary school
in rural areas of Latin America repeat a grade.
Source: UNESCO
Latinos & Education
In Mexico, only 13% of adults receive a high school diploma
versus 87% of American adults.
Latin Americans in
rural areas receive an
average of six years of
schooling.
About one in 20 adults
in the U.S. is not
literate in English
Source: UNESCO
Latinos & Education
Latin America has
relatively standard
inequality levels in
education among all
countries, along with
high income
inequality
Although the countries in the region have expanded educational
coverage and provide equitable access to learning opportunities for
most children, income inequalities, underdevelopment, and poverty are
persistent and impact education primarily in rural areas.
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Latinos & Education
Universidad Nacional Mayor de San
Marcos
“Dean University of the Americas”
Established: May 12, 1551
Type: Public, general
Faculty:2559 (full time)
674 (part time)
Undergraduates:29,710
Postgraduates:3,549
Location: Lima City, Peru
Website:www.unmsm.edu.pe
United Nations Human
Development Programme Report
2014
Latin American Country Literacy rate
Argentina
Bolivia
Brazil
Chile
Colombia
Costa Rica
Cuba
Dominican Republic
Ecuador
El Salvador
Guatemala
Honduras
Mexico
Nicaragua,
Panama
Paraguay
Peru
Uruguay
Venezuela
96.8
85.4
86.9
95.8
91.6
95.6
96.7
83.7
91.6
78.7
68.5
75.0
91.2
66.5
91.9
93.3
89.9
97.6
92.5
Caribbean Country Literacy rate
Bahamas
95.4
Barbados
99.7
Belize
93.2
Grenada
98.5
Guyana
49.8
Haiti
54.8
Jamaica
86.9
Netherlands Antilles
96.5
Trinidad and Tobago
98.3
United Nations Human
Development Report - 2014
Common Misconceptions about
Latinos
Speak Spanish
Come from Mexico
Undocumented
Catholic
Uneducated
www.rdtorecovery.com
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Latin America

Latin American culture is the
formal or informal
expression of the peoples of
Latin America

Latin American culture
includes both high culture
(literature, high art) and
popular culture (music, folk
art and dance) as well as
religion and other customary
practices.
Latin America
Definitions of Latin
America vary. From a
cultural perspective,
Latin America generally
includes those parts of
America (as continent)
where Spanish, French,
or Portuguese prevail:
Mexico, most of Central America, South America, and
part of the Caribbean are generally included.
Latin America

There is an important Latin American cultural presence in
the USA (e.g. California and the Southwest, and cities
such as New York and Miami).
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Latin America
• The rich of Latin
American culture is the
product of many
influences including its
millenarian cultures
Pre-Columbian cultures are
particularly important today
and most notable in countries
such as Mexico
(Aztec/Mayan), Guatemala
(Mayan) and Peru (Pre-Inca
& Inca)
Latin America
• Nineteenth- and
twentieth-century
immigration to Latin
America (from Italy,
Germany, and Eastern
Europe) also influenced
Latin American culture
specially in countries
such as Argentina,
Uruguay, Chile and
Paraguay.
Latin America
• Chinese and Japanese
immigration influenced the
culture in Cuba, Panamá and
Peru.
• The introduction of
Enslaved Africans from
Africa strongly influenced
ethnicity, music, dance and
religion, especially in
countries such as Brazil,
Venezuela, Colombia,
Dominican Republic and
Cuba.
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Latin America
• Boys from Bluefield
Nicaragua.
• Mexican of African descent
• Children from Dominican
Republic
Latin America
• East Indian descent family.
In
this sense, it might be more accurate to
speak of a …
"Indo-Euro-Afro-Latin American culture."
• Messi and Maradona
Latin America
• The population of Latin
America is a true mosaic of
ethnic groups. The
composition varies from
country to country.
• Some have a high percentage
of people of Amerindian
origin; some are dominated
by inhabitants of European
origin; some have strong
influence from Asia and
some have a high proportion
who are of African origin.
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Latin America
Purnell Model for Cultural Competence
Key points of Purnell Model
• To understand any culture thoroughly, examining it
with the use of a conceptual framework is helpful.
• The Purnell and Paulanka model is an example of a
conceptual framework that is geared specifically to
health care providers.
• This model identifies 12 domains of every culture
that care providers should consider.
• Communication is an important factor of culture that
must be considered and assessed.
Adopted from: wolters/Lippincott williams & Wilkins.
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CRASH-Course in Cultural Competence
• The goal of the CRASH-Course in
Cultural Competency is to build
confidence and competence in the
clinician’s ability to communicate
effectively with diverse patient
populations
What is CRASH?
C
• Consider culture
R
• Respect cultures different from yours.
A
• Assess and affirm differences.
S
• Show Sensitivity and Self-awareness
H
• And always do it with Humility
Role of Service Coordinator
Professionals
• Seek to understand
• Do not stereotype
• Recognize heterogeneity
• Build trust
• Know the risk-factors
• Use respected position to emphasize
prevention
• Seek to increase awareness
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Contact Information
Darrin E. Wright, PhD, LMSW,MAC.
dwright@cau.edu
404-880-8553
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