Incorporating Cultural Beliefs Into Treatment

The Patient-Centered Medical Home has become the vehicle that helps promote patient-centered care, patient-safety and to incorporate cultural beliefs into treatment.  As part of NCQA effort to ensure that patients from a diverse cultural and linguistic background receive appropriate, equality of care, require for health care organizations pursuing the NCQA PCMH 2011 recognition to pay special attending to PCMH 2011 Standard 1: Enhance Access and Continuity (http://www.ncqa.org/PCMH2011standards1-3workshop_2.3.12.pdf)
This standard not only addresses cultural and linguistic appropriate services, bt also overlap with some of the other standards such as providing community resources (PCMH 4 Standard 4).
 
Incorporating patients' cultural beliefs as part of their treatment plan is essential in developing a functional care plan that involves the patient and the family in the process.  PCMH is truly the way we will be able to start paying attentions to the patients' need and not being just doctor-centered.  

Write us your questions and comments about this topic.  Let's start a conversation around "Incorporating Cultural Beliefs Into Treatment"
 


About the author:
Helen Dao, MHA
Dao Consulting Services, Inc.
A Public Health Company Connecting Providers and Communities
www.daoconsultingservices.com
Tel. 201-448-2046

Are we talking about literacy, health literacy or cultural competence?

Literacy, health literacy, and cultural competence are 3 levels of competency affecting disparities in health care. One can not be addressed without the other, organizations need to recognize that within their patient population, they may be encountered with either one of these challenges or a combination. Literacy and health literacy could be identified as silence needs or patients, cultural competence may be more of an organization awareness of knowing and understanding the patient's behavior and cultural beliefs. From a patient's perspective, telling organizations about their inability to read and/or write is a sense of shame, humiliation, and loosing face. Therefore, organizations should be able to provide educational materials and organization information in many
different formats (e.g., pictorial, simple language, videos, and verbal). Access to interpreters and cultural brokers is critical for organizations to meet their patients cultural and linguistic needs. Posting availability of services through out the organization will inform patients and make them feel welcome an confident about accessing their health care services. These strategies could help address the PCMH 2011 Standard 1F: Cultural and Linguistic Appropriate Services (CLAS) requirements.

About the author:
Helen Dao, MHA
Dao Consulting Services,Inc.
A Public Health Company
Connecting Providers & Communities
www.daoconsultingservices.com
Phone (201) 448-2046

Dao Management Consulting Services, Inc.: Cultural Brokering- A Sophisticated Communication ...

Dao Management Consulting Services, Inc.: Cultural Brokering- A Sophisticated Communication ...: Cultural brokering is a needed skill and knowledge that care coordinators, social workers, community health educators, p...

Cultural Brokering- A Sophisticated Communication Tool

Cultural brokering is a needed skill and knowledge that care coordinators, social workers, community health educators, physicians, nurses, and other public health staff can learn and implement based on their own cultural identify and the community they serve.

I identified cultural brokering as a historical tool, which was first implemented by anthropologists in order to effectively communicate with natives of specific regions in Africa. This is a tool and/or skill that is easily transferable to the 21st Century.  Because of our multicultural, cross-cultural make up, cultural brokering would be a tremendous asset for health care organizations in helping patients navigate the health care system, but also be a key tool for health care providers to learn more about their patients.  Cultural brokering is a highly sophisticated communication tool between the community and providers because it does not only breakdown communication barriers, but also has the potential to eliminate misunderstanding, profiling, generalization, and stereotyping.

Lets look at some of the most growing populations in the US, according to the Pew Hispanic Center (www.pewhispanic.org), the Hispanic or Latino population, already the nation's largest ethnic group will triple in size and will account for almost of the nation's population growth from 2005 through 2050. Hispanics will make up 29% of the U.S. population in 2050, compared with 14% in 2005. Hispanics immigrants currently comprise 54% of all Hispanic adults in the United States (Lopez & Minushkin, 2008).

According to statistics by the Pew Hispanic Center (2006), 64.1% of the Hispanic resident population in the United States is Mexican, 9% are Puerto Rican, 3.4% are Cuban, and 3.1% are Guatemalan (see http://pewhispanic.org/files/ factsheets/hispanics2006/Table-5.pdf for a complete breakdown of this demographic information).

Clearly, Latinos/Hispanics in the United States are a heterogeneous population and the diversity within various Latino/Hispanic groups is as pronounced as differences between Latinos/ Hispanics and other ethnic groups.

These differences include…

• Language nuances
• Cultural values and beliefs
• Educational attainment
• Attitudes towards social issues affecting their communities

Additionally, there may be significant individuals from different regions within the same country. For example, while Spanish is the primarily language spoken in Mexico, there are some regions of Mexico where individuals speak indigenous languages (Schmal, n.d.).

Therefore, given the tremendous amount of diversity that exists among Latino/Hispanic individuals, it is important to understand the impact that this diversity has on the Latino/Hispanic communities seeking a mutual understanding of each other’s needs.   Each Central American and Latin American country has its own unique history which may impact how individuals resolve conflicts and seek solutions to a problem.   

How is cultural brokering defined?

There are many different definitions of cultural brokering.  Cultural brokering can be defined as…”bridging, linking or mediating between groups or persons of different cultural backgrounds for the purpose of reducing conflict or producing change” (Jezewski, 1990).

What is a cultural broker?

One who advocates on behalf of another individual or group, (Jezewki & Sotnik, 2001).  A critical requisite for a cultural broker is having respect and trust of the community.

Who is the cultural broker?  It can be a person who is well informed and knowledgeable about the communities’ needs, concerns, people, etc. it does not have to be a person from the same culture or community.  However, he/she must understand the community’s unique cultural differences, values, respect, and trust (NCCC, 2004).

According to the National Center for Cultural Competence, a cultural broker should meet the following prerequisites:

 

Characteristics & Attributes of a Cultural Broker:

• Trust & respect of the community
• Knowledge of values, beliefs & traditions
• Social practices of cultural groups
• Experience resolving and finding alternative solutions to social disagreement

Cultural brokering …

• Honors & respects culturaldifferences within communities
•   Is community-driven
• Is provided in a safe, non-judgmental and confidential manner

Knowledge, Skills & Areas of Awareness for Cultural Brokers

AWARENESS

• Own cultural identify
• Cultural identify of members of diverse communities
• Social political & economic factors affecting diverse communities

KNOWLEDGE 

• Values, beliefs & practices related tocommunication, relations, and well-beingof cultural groups
• Social, medical, health care and mental health care systems

SKILLS 

• Communicate in cross-cultural context
• Communicate in 2 or more languages
• Interpret and/or translate information
• Advocate with & on behalf of individual & their families
• Negotiate solutions, options, and communication systems
• Mediate & manage conflict

Implementing & Sustaining Cultural Brokering Programs

• Create a vision and ensure the commitment ofleadership
• Get buy in and acceptance among stakeholders & constituency groups.
• Develop a logic model or framework for the program 
•  Identify and allocate resources

About the Author:
Helen Dao, MHA
Public Health Consultant
Dao Management Consulting Services, Inc.
Connecting Providers and Communities
201-448-2046
helen@daoconsultingservices.com