One Size Does Not Fit All.... Cultural
Competence and Community-Engaged
Research in Healthcare
Presenter: Elleen M. Yancey, PhD,
Associate Clinical Professor,
Community Health and Preventive Medicine,
Morehouse School of Medicine Prevention Research Center
Today’s Objectives….
▪ To generate exposure to issues of cultural competency, cultural diversity and related areas
▪ To present overview of effects of cultural competence on research and healthcare
▪ To encourage personal reflection upon feelings that discussion of cultural competence engenders
▪ To stimulate thinking, initiate learning process & increase awareness of far-reaching impact of cultural issues (professionally & personally)
Data is shared, researchers and community decide its use and dissemination
Researchers own the data & decide how it will be used & disseminated
Researchers own data, control use & dissemination*McDonald, MA. (2008). Practicing community-engaged research. MedEdPORTAL.Publication,4:1127
Researcher & community share control equally
Researchers control research, community representatives may help make minor decisions
Researchers control process, resources & data interpretation
Researchers & community work together to help build community capacity
Researchers gain skills & knowledge, some awareness of helping community develop skills
Researchers gain skills & knowledge
Community organizations are partners with researchers
Community organizations may help recruit participants & serve on Advisory Board
Community organizations may assist
People as participants & collaborators
People as participants People as subjects
Research WITH community as full partner
Research IN the community, or WITH the community
Research IN or ON the community
Community identifies problem or works with researcher to identify problem
Researcher defines problem, community may contribute
Researcher defines problem
Community-Based
Participatory Research
Approach
Research with the
community
Community-engaged Research*Traditional Research Approach
Research WITH community as partner
Principles of Community-Based
Participatory Research
1. Recognizes community as a unit of identity.
2. Build strengths and resources within the community.
3. Facilitates collaborative partnerships in all phases of the research.
4. Integrates knowledge and action for mutual benefit of all partners.
5. Promotes a co-learning and empowering process that attends to social inequities.
6. Involves a cyclical and iterative process
7. Addresses health from both positive and ecological perspectives
8. Disseminates findings and knowledge gained to all partners.
Israel, B.A., Schulz, A.J., Parker, E.A., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. NNUAL Review of Public Health 19(1), 173-202.
Why Cultural Competence?
▪ “Health promotion strategies and interventions that infuse elements and techniques of cultural competence can potentially accelerate the reduction of well-known health disparities among racial and ethnic Americans.”
Boone, L.R., Mayberry, R, Betnacourt, J.R., Coggins, P.C., Yancey, E.M. Cultural Competence in the prevention of sexually transmitted diseases.American Journal of Health Studies. (21) 4, 2006.
Why Cultural Competence?
We have become not a melting pot but a
beautiful mosaic. Different people,
different beliefs, different yearnings,
different hopes, different dreams.
Jimmy Carter
What is Cultural Competence?
▪ Implies having the
CAPACITY to function
effectively among diverse
populations.
Basics of Cultural Competence
▪ Acceptance and respect for difference
▪ Continuing self-assessment regarding
culture
▪ Careful attention to dynamics of
difference
▪ Continuous expansion of cultural
knowledge and resources
CRASH-Course Concepts
▪ Culture
▪ Respect
▪ Assess / Affirm
▪ Sensitivity / Self-awareness
▪ Humility
Rust, G., Kondwani, K., Martinez, R., Dansie, R., Wong, W., Fry-Johnson, Y., & Smothers, H. (2005). A crash-course in cultural
competence. Ethnicity & Disease, 16(2Suppl 3),S3-29
CRASH: Self-Awareness:
▪ Becoming aware of our own
cultural norms, values, and
“hot-button” issues that lead
us to mis-judge or to
“miss-communicate” with
others.
CRASH Humility:
▪ Recognizing that none of us ever fully
attains “cultural competence”
▪ Making a commitment to life-long learning
▪ Peeling back “layers of the onion” of
our own perceptions and biases
▪ Being quick to apologize and accept
responsibility for cultural mis-steps
▪ Embracing the adventure of learning from
others’ first-hand accounts of their own
experience.
Kleinman’s 9 Questions to Assess Health Beliefs1. What do you call your problem? (What name does it
have?) 2. What do you think caused your problem? 3. Why do you think it started when it did?4. What does your sickness do to you? (How does it
work? How severe is it?)5. Will it have a short or long course? 6. What do you fear most about your disorder?
7. What problems has your sickness caused for you? 8. What kind of treatment do you think you should
receive? 9. What are the most important results you hope to
receive from the treatment?
Kleinman A. Patients and Healers in the Context of Culture. The Regents of the University of California. 1981.
Self-awareness
▪ When people won’t make eye contact
with me, ______________________.
▪ When clients show up late for their
appointments, ___________________.
▪ When people touch me a lot or get in my
personal space, ___________________.
▪ When dealing with conflict, people should
____________________________.
Case Study in Diversity for Clinical Practice:
A Woman in Labor
▪ A woman in active labor received prenatal care from a female OB. Tonight she is in active labor, the female OB is out of town, and the OB’s male colleague is on call.
▪ The only other OB on staff at your small hospital is male. The woman’s husband says that in her religion she would be defiled by a male health care worker seeing her undressed or touching her and he insists that a female doctor deliver the baby.
▪ The patient is mostly moaning with labor pains, and her cervix is now 8 cm dilated.
What do you do?...
Follow-up Questions
▪ What could/should have been done differently (hint: much earlier!) to prevent this cross-cultural dilemma from developing?
▪ At what point do the values of our own culture require us to resist the cultural preferences of patients or their families (example: Child female circumcision / genital mutilation)
▪ What larger ethical principles should be applied in making such decisions?
Beyond Cultural Competency
Lewis, PH. Beyond Cultural Competency, Race, Ethnicity & Disabilities: State of the Science Conference, Arlington VA. March 2012.
Beyond Cultural Competency
Lewis, PH. Beyond Cultural Competency, Race, Ethnicity & Disabilities: State of the Science Conference, Arlington VA. March 2012.
Critical
Consciousness
The
Development of
a critical
awareness of
how personal
dynamics unfold
with social &
political contexts
Ethics
Respect for
autonomy
+Beneficence
+Non-
malfeasance
+Justice
Entreat health
care providers to
avoid harm
Social Justice
Fair distribution of
society’s benefits,
responsibilities &
their consequences.
Focuses on the
relative position of
one social group in
relationship to others
in society as well as
on root causes of
disparities & what
can be done to
eliminate them.
Culturally Competent System of Care
Acknowledges Importance of...
▪ Culture
▪ Assessment of cross-cultural
interactions
▪ Expansion of cultural knowledge
▪ Adaptation to meet culturally unique
needs
Culturally Competent
Healthcare Professional
▪ Begins with commitment to provide culturally
competent health care and research
▪ Must include
– Awareness/acceptance of cultural
differences
– Awareness of own cultural values
– Understanding of dynamics of difference
– Basic knowledge of health consumer’s
environment(s)
Five Elements of Culturally Competent
Healthcare Professionals
1. Acknowledge cultural differences and become aware of own effect upon clinical services and research
2. Recognize influence of own culture
3. Understand dynamics of difference.
4. Understand meaning of information provided from both provider AND clients’
cultural context
5. Know where and how to obtain necessary information regarding culture of populations involved in clinical service
Summary Comment
▪ “There are… important … considerations that apply uniquely to community-based research. These include the principles that govern relationships between researchers and communities and the principles of cultural competence that prepare researchers to create the community partnerships needed to conduct community-based research.”
Blumenthal, D.S., Yancey, E.M. “Introduction to community-based research”. Community-Based Research: Issues and Methods. D.S. Blumenthal & R.J. DiClemente (eds.), New York, NY: Springer Publishing Co., 2004.
Movement Toward Cultural
Competence
▪ Attitudes must change to become less
ethnocentric and biased.
▪ Policies must change to become more
flexible and culturally impartial
▪ Practices must become more
congruent with cultures
Morehouse School of Medicine
Prevention Research CenterDepartment of Community Health and Preventive Medicine
Elleen M. Yancey, PhD,
Email: [email protected]
PRC Website: www.msm.edu/prc
720 Westview Drive, SW
Atlanta, Georgia 30310
(404)752-1022
(404) 765-9771 Fax
www.msm.edu/prc