Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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However, race, ethnicity, and/or country of origin are not synonymous with culture. Theterm culture is much broader than racial and ethnic background, and includes sharedattitudes, behaviors, and traditions that are grounded in many other groupings, such as:sex or gender; stage of life (e.g., elderly); socioeconomic status; sexual orientation;religion; physical limitations or disabilities including impaired hearing; or literacy level.With this recognition, the term culture is used in this project in the more limited way, i.e.,most often referring to characteristics and experiences related to individuals’ racial andethnic backgrounds and/or countries of national origin.Culture influences the way we communicate with each other. Language is a methodof communication that uses a system of sounds, symbols, and gestures that are organizedin a patterned way to express and communicate thoughts and feelings. Language is a partof culture and involves both verbal and written communications. Language dissonance(when two individuals—e.g., physician and patient—speak a different language) is onlyone type of language barrier that may be experienced in the health care setting. Othertypes of verbal communication barriers may include: lack of linguistic clarity (wherephysician and patient speak the same language, but an unfamiliar or heavy accent impedesunderstanding); limited or lack of health literacy (where health concepts conveyed by thephysician are unclear, or too complex, for patient understanding); or physician use oftechnical language or jargon (where medical terms used are unfamiliar to the patient,resulting in diminished or total lack of understanding).Regarding culturally appropriate health care, studies have shown that cultural factorsinfluence how individuals perceive the symptoms of illness, how they seek care when ill,and how they respond to treatment regimens (Saint-Germain and Longman 1993). Illnessbehavior directly affects the health system insofar as it influences the illnesses for whichpeople seek care, the timing of care, and the treatment process. Culture influences anindividual’s perception of the risk of becoming ill and the utility of treatment andprevention services (Frye 1993; Saint-Germain and Longman 1993). Cultural perceptions,thus, influence when a symptom is defined as a health problem, the severity of theproblem, and whether advice or care must be sought. Culture also contributes to anindividual’s understanding of the cause of disease. Understanding cultural perceptionsabout disease is critical to effectively engaging individuals in disease prevention andtreatment activities.Health care providers should recognize that in some cultures, Western medicine isoften supplemented or mixed with traditional remedies. Therefore, if providers recognizethe need to provide treatment that is in some way compatible with traditional health carebeliefs, there is a greater opportunity for more effective care. Also, a provider’s awarenessabout his or her own values and how they may bias interactions with individuals fromdifferent cultures is viewed as key to providing culturally sensitive care (Dilworthandersonet al. 1993; Eliason 1993; May 1992). Price and Cordell (1994) suggest that providersCOSMOS Corporation, December 2003 2-3
assess their own beliefs and have knowledge of general ethnic, regional, and religiousbeliefs and practices before discussing health care issues with patients.Linguistically appropriate health care services—i.e., the provision of translatedwritten materials and oral interpretation services—are vital for a patient’s understanding,compliance, and positive health outcomes. Perhaps the most critical component of qualityhealth care is the patient’s ability to understand and be understood. Key consequences oflanguage barriers in the health care setting include: 1) inadequate communication fromthe patient to the provider, making it difficult to relay a complete medical history or toaccurately report symptoms; and 2) inadequate communication from the provider to thepatient, which interferes with accurately informing (or educating) the patient about theillness and treatment (Woloshin et al. 1995).Also, studies suggest that accurate communication between patient and providerdecreases unnecessary diagnostic testing and increases proper diagnosis, patientcompliance, and the retention and use of appropriate services (National Committee forQuality Assurance NCQA 1995). Within this context, researchers raise several points inarguing the need for CLAS. When utilizing the health care system, non-English speakingindividuals encounter communication challenges that hinder access to care and effectivetreatment (Putsch 1985). In addition to language, researchers note that cultural issues arerelevant throughout the health care delivery system. Although some studies havesuggested reduced access to medical care may be due to language barriers or lowsocioeconomic status (Brach and Fraser 2000; Gany and Thiel de Bocanegra 1996; TheHenry J. Kaiser Family Foundation 1999), in other studies, the same disparities have beenobserved in racial and ethnic minorities of any socioeconomic status (Brach and Fraser2000; Smedley et al. 2002).Culture influences the way patients perceive illness (Landrine and Klonoff 1994;Landrine et al. 1994), seek care (Geissler 1991), and participate in and respond totreatment (McCormick 1993; Pilowsky 1993). Receipt of equal care may also be inhibitedby biases and stereotypes (HRSA 2000; The Henry J. Kaiser Family Foundation 1999;Smedley et al. 2002).2.1.4 CLAS Address Disparities in Health CareEvidence suggests that interaction of genetic differences, environmental factors, andhealth behaviors propagates health care disparities. These elements include biases ofhealth care workers toward racial and ethnic minorities, lack of prevention messagestailored to specific populations, lack of physician awareness of higher risk factors for someillnesses in particular populations (HRSA 2000), lack of physician knowledge oftraditional remedies and folk practices, and diagnostic errors due to miscommunication(Brach and Fraser 2000).COSMOS Corporation, December 2003 2-4
Page 1 and 2: Developing a Self-Assessment Toolfo
Page 3 and 4: ContentsChaptersPage1. Introduction
Page 5 and 6: Chapter 1Introduction
Page 7 and 8: While many LPHAs currently provide
Page 9 and 10: LPHAs include: adult and child immu
Page 11 and 12: Professions Education Partnership A
Page 13 and 14: Chapter 2Methodology for Developing
Page 15: Public Health Practice Program Offi
Page 19 and 20: communicate with, and clearly under
Page 21 and 22: 2.1.6 Identifying Key Components of
Page 23 and 24: Given these persistent disparities
Page 25 and 26: (Exhibit 2-2, Continued)DOMAIN / KE
Page 27 and 28: limited to the actual clinical enco
Page 29 and 30: Chapter 3Project Results and Recomm
Page 31 and 32: local board of health. PEP and PAG
Page 33 and 34: numerous promising CLAS practices a
Page 35 and 36: References
Page 37 and 38: Becker, M.H., and L.A. Maiman, “S
Page 39 and 40: Frye, B., “Health Care Decision M
Page 41 and 42: Marin, G., “Defining Culturally A
Page 43 and 44: Perkins, Jane, “Overcoming Langua
Page 45 and 46: U.S. Bureau of the Census, “Censu
Page 47 and 48: Appendix AMembership Lists of the P
Page 49 and 50: Appendix A-1Developing a Self-Asses
Page 51 and 52: Appendix A-2Developing a Self-Asses
Page 53 and 54: Appendix B-1Overview of Eight CLAS
Page 55 and 56: Domain 3: Culturally Inclusive Heal
Page 57 and 58: understanding of diversity issues i
Page 59 and 60: Appendix B-2Conceptual Framework fo
Page 61 and 62: Appendix CLPHA Director or Designee
Page 63 and 64: Pre-Interview Script for LPHA Direc
Page 65 and 66: 3b. Which of the following are refl
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6. Does your agency have a formal p
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10. Which of the following describe
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Post-Interview Script for LPHA Dire
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Appendix DStaffing Questionnaire
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A. QUALITY MONITORING AND IMPROVEME
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B. MANAGEMENT INFORMATION SYSTEMS (
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7. Please indicate, if you know, th
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1c. Please indicate for which categ
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6. Please indicate for which catego
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10. Which of the following topical
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17. Which of the following benefits
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4. Which of the following strategie
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Appendix EClient Services Questionn
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A. QUALITY MONITORING AND IMPROVEME
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6b.Which of the following community
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3. Please report or estimate what p
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3. Which of the following practices
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Oral Interpretation Services10. Whi
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16. At which of the following key e
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3. Which of the following kinds of
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Appendix FPilot Test Response Form
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RESPONDENT EVALUATIONOF THE QUESTIO
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Appendix GCLAS in MCOs Study Data C
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position, as titles will likely var
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complex and uncertain at the time t
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1. Incorporate a confirmation pre-c
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Exhibit 2DATA COLLECTION PROCESSSen
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