CULTURAL DIVERSITY TRAINING FOR NC PUBLIC HEALTH

NC OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES

Developed by

Office of Minority Health and Health DisparitiesNC Department of Health and Human Services

Raleigh, NC

and

Forest Toms, PhDTraining Research & Development, Inc.

Hickory, NC

Goal of Training

To build the foundation for culturally appropriate health services capable of serving an increasingly diverse population.

WORKSHOP OBJECTIVES

Participants will have an opportunity to:

Increase awareness of their own cultural understanding

Increase awareness of cultural issues when working with minority communities

Learn about changing demographics which are challenging health services

Training Overview

Changing demographicsSelf awarenessAwareness of cultural differencesSocialization patternsRole of value and beliefsOverview of framework for developing cultural competence

“When we think…

of Culture, we think of mainstream America; but when we think of Diversity the tendency is to think of minority groups.”

“American Culture”

White middle – class valuesDominant cultureMainstream cultureEuropean – American (Anglo)

OVERVIEW OF CULTURAL AWARENESS

MULTICULTURAL PROCESS

AWARENESS

KNOWLEDGE

DEVELOPMENT OF SKILLS

ASSUMPTIONS AND APPROACHES TO DIVERSITY

DIVISIVE/PANDORA’S BOX

ONLY BLACK/WHITE

NOT AN ISSUE

SHOULD TREAT EVERYONE THE SAME

RESOURCES

ALREADY DEALT WITH

“Why” of Diversity

What’s In a Name?

African American – Black, Africans, CarribeansHispanic/Latino – Mexican, Peurto Rican, Cuban, Salvadorian, Equadorian, Argentian, Honduran, Dominican, etcEuropean/Anglo – WhiteAmerican Indian – Native American, Alaska Native, AleutianAsian – Chinese, Filipino, Korean, Japanese, Vietnamese, Cambodian, Laotian, Hmong, Pacific Islander (Polynesian, Melanesian, Mecronesian)

USUS Population Composition 1990 - 2050

75.6

60.5

52.8

11.8

13.1

13.6

9.1

18.9

24.5

2.8

6.7

8.2

0.7

0.8

0.9

0 10 20 30 40 50 60 70 80

American Indian

Asian/Pacific IslandHispanic

Black

White

American Indian

Asian/Pacific Island

Hispanic

Black

White

Percentage of US Population

2050

2030

1990

Source: U.S. Census Bureau

American Indian

Asian/Pacific Island

Black

Hispanic

White

POPULATION PROJECTIONS for 2030(US Census Bureau)

Population increases:

White Americans 25%

African Americans 68%

Asians Americans, Pacific Islanders, American Indians 79%

Hispanic/Latinos 187%

North Carolina Racial and Ethnic Minority Population, 2000 Census

Black21.4%

American Indian1.2%

White70.2%

Asian1.4%

Hispanic4.7%

Other1.1%

North CarolinaNorth Carolina Differences in Population by RaceDifferences in Population by Race

TRD,Inc. All Rights Reserved

0

10

20

30

40

50

60

70

80

White Afr. Am Hisp Asian Amer.Ind

19902000

“What” of Diversity

Dimensions of Diversity

Primary– Largely unchangeable human differences– Inborn– Influence our early socialization

Secondary– Can be changed– Differences we acquire, discard and modify

throughout our lives

Primary Dimensions of Diversity

Sexual/AffectionalSexual/AffectionalOrientationOrientation

UnchangeableDifferences

AgeAge

RaceRace

PhysicalPhysicalAbilities/QualitiesAbilities/Qualities

GenderGenderEthnicityEthnicity

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Secondary Dimensions of Diversity

EducationalBackground Geographic

Location

Income

Marital Status

MilitaryExperience

HouseholdComposition

ReligiousBeliefs

Work Experience

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Defining andDefining and UnderstandingUnderstanding

CULTURE

CultureCulture Behavior patterns, arts, beliefs,

institutions, and all other products of human work and thought American Heritage Dictionary, 1991

A view of the world and a means of adapting to the world Bilingual Health Initiative Task Force, 1994

Is reflected in, and influences beliefs and values, communication styles, health beliefs and practices

Culture

Integrated Pattern Of Behavior

ThoughtThought

ArtifactsArtifactsActionAction

SpeechSpeech

Culture Helps Us…

Organizes Our Physical

And Social Interaction

Forms Our

Identity Shapes Our

Understanding

And Perceptions

Culture Defines

Family Roles

Family Relationships

Family Structure

Attitudes

And

Practices

Styles Of

Communication

Beliefs

Political

Economic

Goals

CultureCulture

Views OfTruth

SocialRelationships

Visual

Arts

Literature

Actions

PersonalHabits

CommunicationStyles

Performing

Educational

Social

ExperiencesBeliefs

Includes

Includes

Includes

Includes

Includes Includes

Reflects

May Result In

Influences Influences

Concepts: CultureConcepts: Culture

Beliefs and Values

Beliefs and Values

What we are used to thinking and doingWhat we feel or know is right, good , importantComplex concepts with many dimensionsInfluence all other area of life and activityAffect how people think, feel, actCan cause conflict if people’s beliefs and values are not incorporated in health recommendations

Beliefs Concept Map

Views Of Truth

Religion

Supernatural

BeingsGod

Human Nature

Values

One

Redeemable

ManyBad

Good

BeliefsBeliefs

InterpersonalRelations

TimeOrientation

Focus Of Human Activity

RelationshipWith Nature

Influence

Include

Include

Include

May BeConsidered

MayInclude

May Focus On

May Be Perceived As

Include Influence

Overview of BeliefsComparison of Common Values

Anglo-Americans– Mastery over nature– Personal control over the environment– Doing-activity– Time dominates– Human equality– Individualism/privacy– Youth– Self-help– Competition– Future orientation– Informality– Directness/openness/honesty– Practicality/efficiency– Materialism

Other Ethnocultural Groups– Harmony with nature– Fate– Being– Personal interaction dominates– Hierarchy/rank/status– Group welfare– Elders– Birthright inheritance– Cooperation– Past or present orientation– Formality– Indirectness/ritual/”face”– Idealism– Spiritualism

Culture and Healthcare

Patients

Health Status – Minority Groups

High risk for :– Heart disease, diabetes, cancer,

homicides, infant mortality – African Americans

– Stroke/diabetes, MVA, infant mortality American Indian

– Diabetes, MVA, homicide - Hispanics

– Diabetes - Asians/Pacific Islanders

Teen pregnancy– African Americans– American Indians– Hispanics

Barriers to Health Services

High rates of povertyUnemploymentCost of careLack of insuranceLocation and hours of servicesLack of transportationLack of informationLanguageCultural differences between providers and clients

Visions of a Culturally Competent Healthcare System

Definition of Cultural Competence

The process is ongoing and continuous.

Cultural competence is a dynamic, developmental process and a state towards which we should strive, it takes a long-term and consistent commitment to achieve.

It is not something that comes to the individual,the agency, or the system through a one-shot, quick-fix approach.

MOVING TOWARDS THE GOAL

In order to move towards cultural competence, there must be a willingness and courage to confront all the feelings and attitudes that cultural competence and change indicate for the individual, the agency, and society in general.

As Pinderhughes (1989) states, the multicultural staff

engages in dialogue about their differences in perceptions and experiences.

OUTCOMES

Failure to provide the opportunity to understand and process these differences among a multicultural staff can produce two outcomes:

staff will cover over the conflict in perceptions and orientation and block off the confusion, frustration, and strong feelings.

conflict can erupt and staff will become burned out and fatigued.

BEFORE TAKING ACTION

Before developing programs and policies, agencies should

understand cultural dynamics and the significance of cultural identify for themselves, their clients, and their work together.

Opportunities for sharing and dialogue must be built into the structure of the agency or organization seeking to become more culturally competent.

UNDERSTANDING THE AGENCY ENVIRONMENT

As part of the agency’s commitment, it should be recognized that cultural diversity and cultural competence require an understanding of the sociopolitical environment in which an agency operates.

Cultural Competency Continuum

Cultural destructiveness -- attitudes, policies, and practices that are harmful to cultures and hence to individuals within the culture.

Cultural incapacity -- the system or agencies lack(s) the capacity to help minority clients or communities. There is much bias.

Cultural blindness -- the system and agencies provide(s) services with the belief that they are unbiased. The premise is that services are universally applicable.

Cultural Competence Continuum continued

Cultural pre-competence -- agency recognizes its limitations in serving minorities and tries to improve services for a specific population.

Cultural competence -- agencies are characterized by acceptance and respect for difference, continuing self-assessment regarding culture, careful attention to the dynamics of difference, continual expansion of cultural knowledge and resources, and various adaptations to service models to better meet the needs of minority populations.

Cultural proficiency -- advanced cultural competence. Characterized by holding culture in high esteem.

QUIZ1. T or F Race, age, gender and ethnicity are primary diversity differences that

cannot be changed.2. T or F Cultures have the same beliefs and values.3. Thought, artifacts _________ and ___________ are integrated patterns of

culture behavior.4. T or F High poverty rates is not a barrier to health services.5. T or F This agency should recognize that cultural diversity and cultural

competence require an understanding of the socio-political environment in which it operates.

Name:_________________________________ Date:__________________

(Fax Quiz to Wanda Vaughan, Personnel Officer at 358-7869)