Health Systems – Access to Care and Cultural Competency

Tonetta Y. Scott, DrPH, MPHFlorida Department of HealthOffice of Minority Health

2

Objectives

Define culture.Define and discuss culturally and

linguistically appropriate services.Understand how culturally competent

healthcare systems affect access to care.

Understand the principles of culturally competent health systems as it relates to HIV/AIDS services.

3

The demographics of Florida are changing…

0.2

3.0

0.6

23.2

15.9

57.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Native Hawaiian andOther Pacific Islander

Asian

American Indian andAlaska Native

Hispanic / Latino

Black / AfricanAmerican

White

Percentage (%) of Florida's Total Population

U.S. Census Bureau, 2012

4

Access to Care

Health insuranceDelayed or sacrificed careCommunicationPreventive careFamilies’ financial well-beingSocietal effects

5

Culture

The integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated, wholly or partially, with racial, ethnic, or linguistic groups, as well as with religious, spiritual, biological, geographical, or sociological characteristics.

Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetime.

Think Cultural Health, 2013

6

What do you see?

7

What do you see?

8

9

Cultural and Linguistic Competence

A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.

CulturalCompetency

CulturalSensitivity

Cultural Awareness

Cultural Knowledge

10

Stages of Cultural Competency

Cultural Knowledge Familiarization with selected cultural characteristics,

history, values, belief systems, and behaviors of the members of another ethnic or cultural group.

Cultural Awareness Developing sensitivity and understanding of another

ethnic or cultural group. Involves internal changes in terms of attitudes and values.

Cultural Sensitivity Knowing that cultural differences as well as

similarities exist, without assigning values to those cultural differences.

11

Levels of Cultural Competency

Destructiveness

Incapacity

Blindness

Pre-competence

Competence

Proficiency

12

National CLAS Standards

Intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.

Adoption of these Standards will help advance better health and health care.

Think Cultural Health, 2013

13

Health Care Systems

A well functioning health system responds in a balanced way to a population’s needs and expectations by: Improving the health status of individuals, families,

and communities. Defending the population against what threatens its

health. Protecting people against the financial consequences

of ill-health. Providing equitable access to people-centered care.

World Health Organization, 2010

14

Culturally Competent Healthcare

A culturally diverse staff that reflects the community(ies) served.

Providers or translators who speak the clients’ language(s).

Training for providers about the culture and language of the people they serve.

Signage and instructional literature in the clients’ language(s) and consistent with their cultural norms.

Culturally specific healthcare settings.Anderson et al., 2003

15

Cultural Competency and HIV/AIDS

National Minority AIDS Education and Training Center (NMAETC)BE SAFE – A Cultural Competency Model

African AmericansAmerican Indians, Alaska Natives, and Native

HawaiiansAsians and Pacific IslandersLatinos

16

BE SAFE

Barriers to CareEthics

Sensitivity of the ProviderAssessmentFactsEncounters

17

Becoming Culturally Competent

Addressing overt and covert barriers to care. Assessing their level of awareness and

sensitivity toward culturally diverse patients with HIV/AIDS.

Conducting a cultural assessment. Obtaining knowledge about this cultural

group. Maintaining effective clinical encounters.

18

Cultural Competency Strategies

1. Provide interpreter services.

2. Recruit and retain minority staff.

3. Provide training to increase cultural awareness, knowledge, and skills.

4. Coordinate with traditional healers.

5. Use community health workers.

Center on an Aging Society, 2004

19

Cultural Competency Strategies

6. Incorporate culture-specific attitudes and values in health promotion tools.

7. Include family and community members in health care decision making.

8. Locate clinics in geographic areas that are easily accessible for certain populations.

9. Expand hours of operation.10. Provide linguistic competency that extends

beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials.

Center on an Aging Society, 2004

20

Outcomes of Health Systems Providing CLAS

Decrease in miscommunicationIncreased provider sensitivity to their

own beliefs and behaviorsIncreased ability of providers to

understand and treat a culturally diverse clientele with varied health beliefs and practices

21

Outcomes of Health Systems Providing CLAS

Increased trust and confidence of clients in accessing health care.

Increased client satisfaction.Increased access to quality health care

services by diverse populationsIncreased adherence to treatment and

recommendations

22

Conclusions

Providing culturally competent services has the potential to: Improve health outcomes. Increase the efficiency of staff.Result in greater client satisfaction with

services.

23

Take Home Points

Strengthening of health systems through cultural and linguistic competence is a necessary prerequisite for improving the prevention of HIV infection and the care of HIV-infected persons.

Cultural competence is a journey – not a destination.A process of becoming competent, not

being culturally competent.

24

Contact Information

Tonetta Y. Scott, DrPH, MPH

State Partnership Grant Program Manager

Tonetta_Scott@doh.state.fl.us

www.doh.state.fl.us/minority/SPG

StatePartnershipGrant@doh.state.fl.us

850-245-4941