6Cross Cultural Adaptation

8/13/2019 6Cross Cultural Adaptation

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Week 6M1L6.1-3

Cross- Cultural Competence:

A Developmental Approach

From Winkelman CASC Ch 5

Supplemental Reading Culture andHealth Chapter 3


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Overview

Describe bases for developing cultural competence in

health care

Present anthropological approaches and personal and

interpersonal strategies for intercultural adaptation Present cultural frameworks for adapting to effects of

culture on health behavior


3/30

Introduction: Cultural

Competence in Health Care Basic Issues

Clinical Relations & Effectiveness

Communication and Relations

Personal DevelopmentCultural Competence


4/30

Cross- Cultural Competence

General Orientation: Major DimensionsKnowledge of the general dynamics of culture,

psychology and cross-cultural relations

General Skills in intercultural relationsAwareness of onesown cultural influences

Specific cultural competencies

Culture specific knowledge of behaviors and

beliefs of group(s)

Personal and social abilities in relating toparticular cultural groups


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Factors in Cultural Competence

Castro (1998) Three-factor model

capacity level

Gross ethnocentrism thru proficiency

specific cultures, subcultures and segments

specialty area

E.g, clinical, community, research, teaching


7/30

Developmental Approaches Ethnocentrism/Denial

Develop cultural awareness of others

Defense

Learn value of cross-cultural relations

Minimization/Universalism Limits of biological explanations

Acceptance

Acquiring another cultures perspectives

Adaptation Developing cultural competency

Integration

Shifting cultural perspectives


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General Levels of Cross-Cultural

Competence

Awareness

Sensitivity (Acceptance)

Responsiveness (Adaptation) Competence (Everyday life)

Proficiency (Teach Others)

Organizational Cultural Competence


9/30

M1 L6.2

Tools for Cross-cultural AdaptationAnthropological Perspectives on Cultural Adaptation

Personal Skills &Attitudes for Cross-cultural Adaptations

Interpersonal Skills for Intercultural Relations

Adapting to General Dynamics of Intercultural Attribution

Interview as Relationship Building and Negotiation*


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Anthropological Perspectives

Culture and Emic Perspectives

Cultural Relativism

Cross-cultural or Etic Perspectives.

Intracultural Variation: Cultural

Characterizations versus Stereotypes

Racial Concepts vs. Ethnicity and Culture

Social versus Cultural Effects


11/30

Personal Skills & Attitudes

Cognitive-Behavioral Approach

Emotional Maintenance:

Culture Shock Adaptation

Personal Change and Transformation

Cultural Self-Awareness

Cognitive Re-organization:

Cultural Attribution


12/30

Interpersonal Skills for Inter-

cultural RelationsAchieving communication competence

Adjusting to the other culture's behavioral

expectations Developing and maintaining interpersonal

relationships.

Interpersonal skills for expressing empathy and

cultural understanding Language Skills

use of Translators and Interpreters

Social Interaction Rules & Communication Styles


13/30

Hmong Social Interaction Rules

Deserve services

Respect & compassion, esp. for elders

Allowing & Respecting their decisions Eye contact and touch

Yes as acknowledgement not acquiescence

Emotional meanings

Passive sick role behaviors Family involvement in care planning

Indirect questioning styles and communication


14/30

Adapting to General Dynamics of

Cross-Cultural Relations

Managing Conflict Managing Cultural Differences

Personal Reactions to Cultural Shock

Personal Projections: Attributions

Prejudice and discrimination

Managing Defense Mechanisms


15/30

Personal Reactions

Culture ShockPhases/Stages of Cultural Shock

Honeymoon, Crises, Adjustment & Adaptation

Causes of Cultural Shock

Cultural Differences

Stress, Fatigue, Personal and Role Shock

Multiple dimensions of shock

Cognitive adaptations


16/30

Meaning: Attribution and Interpretation

Reality as Meaning makingAttribution

Ethnocentrism as most basic

Types of Causal Social Attributions

Personal vs Situational

Dynamics of Attribution: Ingroup vs Outgroup

Interaction of Causes and Group Dynamics

Im Good, Youre Bad

Cultural Attribution Development: Managing Projections


17/30


18/30

Classic and Modern Views of

Prejudice and Discrimination

Prejudice

negative stereotyped attitudesabout a group.

Discrimination

negative and damaging behaviors.

Modern View

Prejudice and Discrimination as Universals

Normative (culturally expected) behaviors


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PREJUDICE

Prejudice-- tendency to prejudge normal part of

relating to world through our prior expectations

Reduce through suspending judgmental approach

Normative Perspectives

People develop prejudices & discriminate as a normal partof cultural learning and values

Social and Psychological Causes

Cultural, social & situational targets

Addressing institutional discrimination

norms, structures and organizations that perpetuate

discrimination


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21/30

Psychodynamic Process in

Intercultural Relations

Projection

Attribution to others: prejudice, discrimination, stereotypes

Ethnocentric and Stereotypes vs.

Cultural/Contextual-- Emic and Situational Perspectives

Managing Transference and Counter-transference

Transferred effects of previous experiences

Defense Mechanisms

reactions to maintain psychological stability in the face of stress


22/30

Minority Defense Mechanisms

Self-Hatred

Denial

Acceptance

Obsessive Sensitivity

Ego Enhancement

Aggression


23/30

Majority Defense Mechanisms

Stereotyping

Prejudice

Denial and Displacement

Minimization

Everybodys the sameHistoricizing

Not learning about cultural and social influences


24/30

Considerations of client culture Salience of cultural identity & background;

Idioms of illness and illness and treatment beliefs;

Explanatory models for conditions, symptoms,significance of condition and proposed treatments;

Clients level of functioning within the cultural-psychosocial environment;

Cultural effects on presentation and client-physician relationships and communication; and

Overall assessment of significance of culture indiagnosis, care preferences and treatmentadherence


25/30

Guidelines for addressing the potential

role of culture in pathology and care Self-assessment by providers of own cultural

biases;

Consultation with family members to determinecultural significance (culture-bound syndromes)and psychosocial functioning of client;

Ask questions using culturally sensitive and

appropriate styles; Determine expectations regarding adherence using

explanatory model;

Identify and resolve conflicts


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Negotiation (cont)

Provider offers compromises to conflicts

and attempts to implement them

Provider as expert advice, patient as finalarbiter

Providers ongoing monitoring of agreement

and participation


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OConnors (1995) strategies to support

the negotiation of treatment plan Providers expression of an attitude of openness

and willingness to cooperated

Giving explanation in everyday language of theproviders recommendations

explication of the reasons for disagreement withthe patients beliefs or preferences

Providers acceptance of patients preferredtreatments not in conflict with patients interest

an ability to engage in shared decision making


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Summary: Cultural Responsiveness as

Enhancing Clinical Relations

Enriching the Provider-Patient Relationship

with Patient Perspectives

Reduce conflict and non-compliance

Enhanced comfort and well-being for both

Using culture to care for providers

Help with coping with culture

Managing communication styles

Enhancing emotional support

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6Cross Cultural Adaptation

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