Cultural Competency for Health Care Providers
Chelsea Harris MS-II, Charlotte Reback MD, University of Vermont College of Medicine, Burlington VT
2011 SEARCH Scholars Project
“
When you learn something from
people, or from a culture, you
accept it as a gift, and it is your
lifelong commitment to preserve
it and build on it ~Yo-Yo Ma
Project Goals
”
Resources
•Verify the existence, availability, and relevance of
every listed resource listed in the CVAHEC Cultural
Competency Manual
METHODS
Resources
Source material was evaluated and
subsequently coded on the following scheme:
a. Relevant and current: likely to be used as a
primary source when reformatting the
document
b. Relevant for additional reading: worthy of
inclusion as a hyperlink or pop-out box within
the main document
c. Helpful source to be cited in appendix but
not highlighted in the main text
d. Less relevant and/or out of date
e. Non-existent, not useful, not relevant
A summary of each source, based on
abstract, introduction and discussion was also
included
•Add each source to EndNote® to standardize
citation format and ensure future availability and
reference ease
Structure
•Develop a standardized template for each chapter
to convey population-specific information in a
uniform, streamlined, and easily searchable manner
•Edit existing content for impartiality and consistent
voice
•Identify key points to be highlighted in “pop-out
boxes”
Structure:
We took a tiered approach in determining the new
organization of the manual. We started with the question
“why is cultural competence important?” then
narrowed to address “what are the barriers?” and
finally included chapters on individual populations.
We designed the chapter template to begin with an
almanac/demographic portion followed by a more
detailed cultural profile
Introduction Rewrite
• Emphasize the importance of Cultural Competency
in the context of health disparities
•Address barriers care providers face in treating
refugee/immigrant/or minority populations
New Chapters
• Add chapters on Burmese Refugees and Chinese
Immigrants to reflect Vermont’s changing population
.
Information for chapters on new
populations was obtained via a literature
search and communication with
community members and invested
parties
Why be Culturally Competent?
“Cultural competence is not a panacea that will single-handedly improve
health outcomes and eliminate disparities, but a necessary set of skills for
physicians who wish to deliver high-quality care to all patients.”
The literature is increasingly supporting the idea that, besides
being a worthy goal in and of itself, cultural competency is
improving health outcomes, and may increasingly have a role in
cost saving as well. It is an integral part of any substantial effort
to address health care disparities.
Structural barriers to Care
• Inadequate understanding of patients’
previous health care experience
• Practitioner biases
• Lack of diversity in health care
• Underdeveloped clinic infrastructure
• Poor communication
Spotlight on Burmese Refugees
History: Burma is home to one of the world’s longest running civil wars ,
and consequently a major refugee crisis
Culture: Burma is one of the most ethnically diverse countries in the
world; however most refugees in Vermont and the US are Karen
Religion: Buddhism, Animism Christianity, Islam: along ethnic lines
Diet: rice based, augmented with vegetables and fish paste, “hot” and
“cold” foods play a role in health
Family: prominent social force; tradition of communal child rearing
Education: strong tradition stemming from Buddhist monasteries
Health: varies based on individual refugee experience
Infectious Disease: Intestinal parasites, Hepatitis B, TB
Life Style: Betel Nut, Cigarettes and Alcohol, lead poisoning
Family Planning: low education, acceptable as “child spacing”
Mental Health: frequent history of trauma, stigmatized
Traditional practices: strong history, food plays an integral role
Spotlight on Chinese Immigrants
History: Asian Americans are the fastest growing
demographic in the US, but Chinese immigration has a long
history, that impacts cultural norms today
Culture: built around the central pillars of honor and respect
for family, “saving face” is a major motivator
Religion: Buddhism, Taoism,
Confucianism, Christianity
“Respect for one’s
Diet: rice and noodle based,
parents
is
the
highest
supplemented with fish and
vegetables. All foods have yin
duty of civil life”
or yang properties depending
on their energies
Family: model for all relationships in Chinese Society
Education: highly valued among all socioeconomic levels
Health: approached in a holistic manner, focused on harmony
Infectious Disease: Hepatitis B, TB
Life Style: Cancer, increased chronic illness with
acculturation
Family Planning: still taboo, but changing norms
Mental Health: highly stigmatized, holistic approach
Traditional practices: highly developed though most
immigrants use both Western and traditional medicine
Challenges:
As a small state, there is not a lot of
Vermont –specific data available
Because of limited time frame,
structural changes need be appropriate
to scope so that the manual remains
useable between updates
Diverse populations and experiences
make generalizations difficult
This program is funded by U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)