Best Practices in TB Control Key Concepts in Working with Diverse Populations Bill L. Bower, MPH Director of Education & Training Charles P. Felton National TB Center at Harlem Hospital Assistant Clinical Professor Heilbrunn Department of Population & Family Health Mailman School of Public Health, Columbia University Why this seminar? Training needs assessment findings

National and state standards about culturally and linguistically appropriate services in health care Epidemiology of TB among foreign-born persons in the Northeast Polling Question Insert selected CDC Surveillance slides in CDC format Percent Cases Among Foreign-Born

in NE RTMCC by State, 2007 (N=3087) 80 70 60 50 40 30 20 10 0 DE NH



Why is culture important? Culture can affect . . . Experience of psychological distress, description of symptoms and communication about these Health-seeking behavior Perceived causes of illness, understanding of disease process, treatment expectations, and decisions Understanding of infection, transmission and who contacts are, names and relationships of contacts Interaction with health care system and professionals Attitudes towards helpers, authorities, revealing contacts

People are diverse in ways other than . . . . . . national origin, regional identity, race or ethnicity. Aspects of culture can be affected by gender, religion, economic class, age, language, and experiences . . . Certain subcultures are defined by sexual orientation, substance use, homelessness, experience in correctional institutions, etc. A place of employment may have its special culture Wall Street, politicians, military, police, hospital History, political values, experience with oppression or discrimination Degree of opposition to acculturation, and response of

majority culture To be culturally competent doesnt mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and willing to accept that there are many ways of viewing the world. Okokon O. Udo, B.D., Ph.D., CPCC Culture-General vs. Culture-Specific Approach

GENERAL SPECIFIC Broad concepts Assumptions/fixed ethnic traits Generalizable principles Focus on learner Emphasis on attitude Reduced to skills

Cookbook Dos/Donts Can lead to stereotyping Four Elements 1. Awareness of ones own cultural values Are you attentive your own preconceived notions of other cultural groups? 2. Awareness and acceptance of cultural differences Do you look for opportunities to meet and interact with individuals who are from cultures other than your own? 3. Development of cultural knowledge

Are you familiar with the worldviews of cultural groups other than your own? 4. Ability to adapt practice skills to fit the cultural context of the client Do you have the know-how to navigate cross-cultural patient interactions? Cultural Competency Continuum Advanced Cultural Competence Basic Cultural Competence Cultural Pre-competence Cultural Blindness

Cultural Incapacity Cultural Destructiveness Cross Model of Cultural Competency by Terry Cross, 1988 In your clinic . . . If we were to reduce the steps of culturally informed care to one activity that even the busiest clinician should be able to find time to do, it would be to routinely ask patients (and where appropriate family members) what matters most to them in the experience of illness and treatment.

Kleinman A, Benson P (2006) Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It. PLoS Med 3(10): e294

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