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March 24, 2010 World TB Day Conference -
Providence, RI
Cultural
CompetencyPresented by:
Chioma Nnaji, MPH, MEd Program Director
Multicultural AIDS Coalition
Community Health NEXUS
Africans For Improved Access (AFIA) Program
March 24, 2010 World TB Day Conference -
Providence, RI
Why?
have healthier, more satisfied clients;
increase staff competency and satisfaction;
improve business;
become more marketable when responding
to RFRs;
comply with anti-discrimination laws;
protect your federal funding; and
improve your ability to secure funding.
March 24, 2010 World TB Day Conference -
Providence, RI
Objectives
At the end of the presentation, participants
should be able to:
1. Define Cultural Competency
2. Explain the phases of cultural competency
development
3. Identify ways to implement each phase of
cultural competency development
March 24, 2010 World TB Day Conference -
Providence, RI
What is Cultural
Competency?
The ability to interact effectively with
people of different cultures.
Cultural Sensitivity
Cultural Responsiveness
Cultural Awareness
Cultural Effectiveness
Cultural Humility
Cultural Literacy
March 24, 2010 World TB Day Conference -
Providence, RI
Culture
… integrated patterns of human
behavior that include the language,
thoughts, communications, actions,
customs, beliefs, values, andinstitutions of racial, ethnic,
religious, or social groups
March 24, 2010 World TB Day Conference -
Providence, RI
Culture cont’d
Everyone has a
culture
Culture is
complicated
by multiple
layers of
identity
There is
diversity
within
cultures
Cultures
evolve
March 24, 2010 World TB Day Conference -
Providence, RI
Phases of Cultural
CompetencyCognitive Phase
Awareness of one’s
own cultural views
Awareness of one’s
attitude towards
different cultures
Affective Phase
Knowledge of
different cultural
values, beliefs,
and practices
Respecting
cultural
differences
Active Phase
Cross-cultural skills
Cross-cultural tools
Cross-cultural
strategies
March 24, 2010 World TB Day Conference -
Providence, RI
Cognitive Phase
Attitudes, Beliefs, Bias,
Prejudices, Unconscious Bias,
Isms …
March 24, 2010 World TB Day Conference -
Providence, RI
We must learn to
become comfortable
with the uncomfortable
and uncomfortable with
the too comfortable.
-- David Tulin
March 24, 2010 World TB Day Conference -
Providence, RI
Forms of Oppression
BELIEFs
• Stereotype
• Prejudice
• Bias
• Ethnocentrism
FEARs
• Homophobia
• Addictophobi
a
• Xenophobia
ACTIONs
• Sexism
• Racism
• Transgender
Oppression
• Heterosexism
• Classism
• Ableism
• Religious
Oppression
• Ageism/Adultis
m
March 24, 2010 World TB Day Conference -
Providence, RI
Definitions of Racism
system of advantage based on race
prejudice plus power
culturally sanctioned beliefs, which, regardless of
intentions involved, defend the advantages whites have
because of the subordinated position of racial minorities
a highly organized system of 'race'-based group privilege that
operates at every level of society and is held together by a
sophisticated ideology of color/'race' supremacy
… not just the sum total of all the individual acts that discriminate,
harass, stereotype, or otherwise mistreat people of color. The
accumulated effects of centuries of racism have given it an
institutional nature that is more entrenched than racial prejudice.
hatred of one person by another
March 24, 2010 World TB Day Conference -
Providence, RI
Racism is …
1. A legacy
2. Privilege and Power
3. Superior and Inferior
Operates on different levels:
1. Individual
2. Institutional/Societal
3. Internalized
March 24, 2010 World TB Day Conference -
Providence, RI
Education
Job
Opportunity
Socioeconomic
Status
Environmental
Exposure
Health Behaviors
Access to
Health Services
Safe and Affordable
Housing
Reducing Violence
Health
Racism Outcomes
Boston Public Health Commission
http://www.bphc.org/programs/healthequitysocialjustice/Pages/Home.aspx
Social Determinants of Health
Disparities
March 24, 2010 World TB Day Conference -
Providence, RI
Ways to Implement
Cognitive PhaseSelf Reflection
• What was I told about certain social or cultural
groups?
• What was my first interaction with/introduction
to a certain social or cultural group?
• How do I perceive my race/ethnicity?
• Who are a part of my personal, social and
professional interactions?
• How have I experienced oppression (the
oppressed or oppressor)?
March 24, 2010 World TB Day Conference -
Providence, RI
Ways to Implement
Cognitive Phase cont’d
Resources
What Is Race?
http://www.pbs.org/race/001_WhatIsRace/001
_00-home.htm
White Privilege: Unpacking the Invisible
Knapsack
Peggy McIntosh
http://www.slcan.org/whiteness_handouts.pdf
March 24, 2010 World TB Day Conference -
Providence, RI
Cultural KnowledgeCommon Attitudes, Beliefs and Practices Related to TB
Disease Experience
• Knowledge about TB
• Perception of
Causes
• Common names for
TB
• Stigma/Taboos
• Cures/Treatments
Social and Cultural
Context
• History of country
• Health care system
• Politics of country
• Communication
• Religion
• Immigration
• Language
• More …
March 24, 2010 World TB Day Conference -
Providence, RI
Disease Experience
Example …
African & Haitian Immigrants
• Incidence of TB in Africa and Haiti is high
• Mortality rates of TB in Africa and Haiti is high
• TB is associate with HIV/AIDS
• TB has a physical causation, natural
(biomedicine) causation, supernatural causation
• Cures and treatments for TB vary:– Possession– Fasting– Praying– Talismans– Home remedies
– Spiritual cleansing
March 24, 2010 World TB Day Conference -
Providence, RI
Health Care System
Example …
African & Haitian Immigrants
• Limited free/subsidized health insurance
• Lack of confidentiality laws governing health
information
• Walk-in
• Limited choices
• Curative care
• Time
March 24, 2010 World TB Day Conference -
Providence, RI
Social
ContextLite racyLite racy
Lan gu ageLan gu age
Im m igration
Statu sIm m igration
Statu s
Eth n ic
Grou pEth n ic
Grou p
Cou n try of
OriginCou n try of
Origin
Cu ltu ral
P ractice sCu ltu ral
P ractice sRe lig ionRe lig ion
Socia l
Stru ctu reSocia l
Stru ctu re
Re sou rce sRe sou rce s
He alth
Be lie fsHe alth
Be lie fs
Trau m aTrau m a
Lite racyLite racy
Lan gu ageLan gu age
Im m igration
Statu sIm m igration
Statu s
Eth n ic
Grou pEth n ic
Grou p
Cou n try of
OriginCou n try of
Origin
Cu ltu ral
P ractice sCu ltu ral
P ractice sRe lig ionRe lig ion
Socia l
Stru ctu reSocia l
Stru ctu re
Re sou rce sRe sou rce s
He alth
Be lie fsHe alth
Be lie fs
Trau m aTrau m a
Example …
African & Haitian Immigrants
March 24, 2010 World TB Day Conference -
Providence, RI
Communication
Example …
African & Haitian Immigrants
• Language
• Speak in idioms/proverbs/folk tales
• Interaction with authority
• Trust and confidentiality
• Community/family values
• Decision Making
March 24, 2010 World TB Day Conference -
Providence, RI
Ask
questions!
Ways to Implement
Affective Phase• Staff gatherings
• Community gatherings
• Media & literature
(ethnic)
• Community leaders
• More …
elicit the specifics of the client
Client-Centered Approach
March 24, 2010 World TB Day Conference -
Providence, RI
Active Phase
Effective Cross-Cultural
Interactions
March 24, 2010 World TB Day Conference -
Providence, RI
Cross-Cultural Skills
• Communication
• Outreach
March 24, 2010 World TB Day Conference -
Providence, RI
Cross-Cultural Skills:
CommunicationInappropriate• Affectionate words,
such as “honey” and “sweetheart”
• Loud voice• Eye contact• Interrupting• Dressing
Appropriate• Speak in low tones• Addressing clients by
appropriate name (considering age, gender and relationship)
• Speak at a slow pace• Maintain positive
reputation and be sincere
• Be aware of meeting surroundings
Example …
African & Haitian Immigrants
March 24, 2010 World TB Day Conference -
Providence, RI
Cross-Cultural Skills:
OutreachAdditional Skills
• Community (defined by community)
• Culture
• Gatekeepers –vs-Movers/Shakers
• Group Dynamics (ethnic, social, and gender)
• Social competence
Basic Skills
• Patience
• Interaction
• Tactfulness
• Cultural sensitivity
• Listening
• Effective communication
• Motivational
• Positive interpersonal relationships
• Inter-group relationships
Example …
African & Haitian Immigrants
March 24, 2010 World TB Day Conference -
Providence, RI
Cross-Cultural Tools
• Collecting racial/ethnic data
• Client Assessments
• Staff/Organizational Assessments– Cultural and Linguistic Competence Policy Assessment
(CLCPA)
– Cultural Competence Health Practitioner Assessment
(CCHPA)
March 24, 2010 World TB Day Conference -
Providence, RI
Cross-Cultural
Strategies• Incorporate social and cultural
principles
• Language access
• Link to other diseases and
services
• Building and maintaining
community relationships
March 24, 2010 World TB Day Conference -
Providence, RI
Resources (limited list)
National Center for Cultural Competence
EthnoMed
National Standards for Culturally and Linguistically
Appropriate Services in Health Care
(Office of Minority Health)
Southeastern National Tuberculosis Center
National Prevention Information Network
March 24, 2010 World TB Day Conference -
Providence, RI
Resources cont’dMaking CLAS Happen: Six Areas for Action (June 2009)
MDPH – Office of Health Equity
A guide to implementing the CLAS Standards in a variety of
public health settings.
To view and
download the guide,
go to
www.mass.gov/dph/
healthequity
March 24, 2010 World TB Day Conference -
Providence, RI
Chioma NnajiProgram Director
Multicultural AIDS Coalition
Tel: 617.238.2421
Email: [email protected]