1 dept of health education and promotion diane levin-zamir, mph, ches director, department of health...
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1Dept of Health Education
and Promotion
Diane Levin-Zamir, MPH, CHES
Director, Department of Health Education and Promotion
Clalit Health Services
"Refuah Shlema" – Cultural Liasons in Primary Care
Lessons Learned from 10 Years of Implementation
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and Promotion
Since 1984, nearly 80,000 Ethiopians have
immigrated to Israel – new immigrants arrive each
week
A Cross-Cultural Program for Promoting Health Among Ethiopian Immigrants in the Primary Care Setting
Significant adjustment problems due to
cultural disparities exist particularly regarding
health and health care; navigation of the
primary health care system.
“Refuah Shlemah”
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and Promotion
Population in Israel by Culture
Other2.34%
Jews living in
Israel more than 10 years
63.43%
Jews New
Immigrants 16. 01%
Moslem Arabs 14.80%
Druze1.64%
Christian Arabs1.77%
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and Promotion
Clalit Health Services
3.6 million members, 30,000 workers1,350 primary and specialized care clinics14 hospitals416 pharmacies40 diagnostic imaging centers67 laboratory centers83 physiotherapy units30 occupational therapy units87 diet & nutrition consultation units22 mental health clinics20 alternative medicine clinics70 dental clinics
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HospitalHospitalPrimaryPrimary
Care ServicesCare Services
PublicPublic
PrivatePrivate SectorSector CommunityCommunity
OrganizationsOrganizations
NGOsNGOs
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and Promotion
Over 40 community clinics serve
neighborhoods with high
concentration of Ethiopian residents
Scope
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and Promotion
Needs
Significant adjustment problems due to
cultural disparities exist particularly regarding
health and health care; navigation of the
primary health care system
Problems with diagnosis and treatment – distress among the community
and the providers
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and Promotion
Objectives - 1997
• Significant improvement of services that are given in the primary care setting - culturally appropriate
• Improved participation of the Ethiopian member with regard to self-care and follow-up
• Prevent detrimental changes in lifestyle, through health education and promotion – according health literacy
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and Promotion
HealthHealth
EmpowermentHealth Literacy
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and Promotion
Western Medicine
Cause (Specific or Non-specific)
Symptom Diagnosis Treatment/Cure
Time
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and Promotion
Cause
Treatment/Cure
Traditional Medicine
Symptom DiagnosisSocio-Cultural Identity
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and Promotion
1. employing Ethiopian immigrant facilitators on a full
time basis, who have been trained to work as health
liasons and inter-cultural mediators between
patients and physicians
2. training clinical staff with the aim of changing their
attitudes and thus bridging inter-cultural gaps, by
increasing awareness and sensitivity regarding Ethiopian
perception of health and dis-ease causation
3. cooperatively implementing health
education activities for new immigrants
“Refuah Shlemah”
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and Promotion
Partners
• The program was initiated by Clalit Health Services and the Joint Distribution Committee.
• Detroit and Palm Beach Federations.• National Insurance Institute • Ministry of Absorption• Maccabi and Leumit Health Services • Ministry of Health.
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and Promotion
Partners
• Clalit Health Services
• Ministry of Health
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and Promotion
The Program
• Clinics were chosen for the program based on the size of the Ethiopian community they serve, and the average age of the group
• Cultural mediators/liasons were recruited.
• A training program was immediately established, and has continued for 10 yrs.
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and Promotion
The Program
• Training of the primary care staff to learn how to work with the cultural liason/mediator was the fist challenge
• Maintaining the objective of bridging the cultural gap and not just translating was and is a challenge
• After several months, the cultural liasons became an integral part of the team
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and Promotion
Evaluation
• Was conducted by in two phases the Brookdale Institute
• Examined the effect of the intervention on Ethiopian immigrants
• The first phase looked at the general population that visited primary care clinics
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and Promotion
The program was effective in:
1. Improving physician-patient relations,
2. Improving availability and accessibility of
medical services and
3. Improving the ability to navigate the health
system
4. No significantly increase in expenditure on
services was incurred.
The Major Findings
Brookdale Institute, 2002
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and Promotion
Selected Health Education Programs
• Care of children with fever
• Healthy lifestyle for diabetics
• Use of prescription medication
• Prevention examinations
• Care of child with asthma
• Home accident prevention
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and Promotion
The results include:
improved perception of general health
status among the experimental clinics,
no perceived difference in perceived
well being among the diabetics and asthmatics.
some aspects of self care were more positive
as a result of the program, for example physical
activity, etc.
Second Phase of Evaluation
Brookdale Institute, 2002
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and Promotion
1. A health mediator in primary care clinics can
significantly bridge the communication gap in a multi-
cultural setting supporting and empowering an
immigrant population.
2. Specific improvements for asthmatics and diabetes in
the present ecclectic model showed initial improvement.
3. A model is needed in which the health mediators
concentrate specifically on these groups with special
health needs.
Conclusion
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and Promotion
Conclusions
The cultural liasons/mediators are vital in order to facilitate communication with, and treatment of, Ethiopian residents.
The integration of a cultural liason/mediator should not be temporary, rather must be sustained as an integral part of the service and a vital contribution to the community.
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Conclusions
“Secret of success” – collaborative inter-disciplinary and inter-organizational efforts, including pooling financial and professional resources
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and Promotion
Thank you for your attentionThank you for your attention!!
[email protected]@clalit.org.il