Culturally Responsive
Health Care: How to Meet
the Challenge
Jeffrey Ring, Ph.D.
Director of Behavioral Sciences and Cultural Medicine
White Memorial Med. Ctr. Family Medicine
Los Angeles, California
Presenter Disclosure Information
In compliance with the accrediting board policies, the
American Diabetes Association requires the following disclosure
to the participants:
Name of Presenter: Jeffrey Ring, Ph.D.
Speaker’s Bureau: Merck & Co., Inc.
(not product division)
 Other: Author of a book for Radcliffe
Oxford Publishing

Objectives
By the conclusion of this presentation,
participants will:
Be able to articulate a strong rationale for
providing culturally responsive care
 Deepen their capacity for self-reflection
 Enhance their understanding of health
disparities

Culturally Responsive Care
Patient-centered care with an attention to
the patient’s culture, beliefs, health
behaviors and world view.
Why provide culturally responsive
care?
Exploring Similarities and Differences
Imagery Exercise
Exploring Health Inequities
U.S.Diabetes Mortality Rates (2007)
White Non-Hispanic
 African American
 Latino/a
 Am. Indian/Alaska Native
 Asian/Pacific Islander

U.S.Diabetes Mortality Rates* (2007)
White Non-Hispanic
 African American
 Latino/a
 Am. Indian/Alaska Native
 Asian/Pacific Islander

* Age adjusted
www/cdc/gov/nchs/data/hus07.pdf
22.3/100,000
48
32.1
43.7
16.6
Sources of Health Inequities
Patient Factors
 Health Care System Factors
 Society Factors
 Practitioner Factors

Culturally Responsive Communication
Strategies

Q2 (A. Kleinman)

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How do you believe you got sick?
What do you believe will help you heal?
LEARN (Berlin and Fowkes, 1983)

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Listen with empathy and understanding
Explain your perception of the problem
Acknowledge and discuss similarities/differences
Recommend treatment
Negotiate agreement (Getting to Yes, Fisher and Ury,
1983)
Motivational Interviewing
(Miller and Rollnick, 2002)
Patient-Centered Model
 Identify and Resolve Ambivalence/Barriers
 Diagnose the Patient’s State of
Mind/Change

 Precontemplation
 Contemplation
 Action
 Maintenance

(Relapse)
Resist the Righting Reflex
QUICK CASE

Patient with high sugars is obese,
depressed, does no exercise…
 Advice?
“…people almost never change without first
feeling understood.” (Stone, 1999)
QUICK CASE

Patient with high sugars is obese,
depressed, does no exercise…
 Motivational
 What
Interviewing Questions?
are the benefits of not exercising?
 If your heart was failing, might you change then?
 Have you thought about what exercise you might
try?
 What are the sources of strength and support in
your life?
Commitment to Act
List two commitments/covenants to further
your capacity to provide culturallyresponsive care, based on today’s
discussions
Resources
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Ring, Nyquist et al. (2008) Curriculum for
Culturally Responsive Health Care, Radcliffe
www.vimeo.com/15822032 Addressing Culture
and Language for Medical Assistants
www.diversityrx.org
http://minorityhealth.hhs.gov/
Medscape.com (Health Diversity Resource
Center)
Jeffrey Ring, Ph.D. ring@usc.edu