SESSION 4: Working with Culturally Diverse Populations

1. SESSION 4:Working with Culturally Diverse Populations

2. Common Denominators of Culture • age-grading • art: theater, drama, visual arts, music • bodily adornment • child rearing • cooperative labor • courtship/dating • dancing • death and dying • education • ethics • etiquette • family; feasts, celebrations • folklore • food: customs, taboos, meal times

3. Common Denominators of Culture(2) • funeral rites • games • gender roles • gestures • greetings • hospitality • holidays • housing • hygiene, health, cleanliness • joking • kinship: relations among relatives • language, slang • law, authority, punishment, prison terms

4. Common Denominators of Culture(3) • literacy: oral and written • marriage • medicine, medical providers, healers • mind-altering substances • modesty; privacy about the body • music • personal and family names • pregnancy and labor • pre- and post-natal care • problem-solving • property rights

5. Common Denominators of Culture(4) • puberty customs • religious beliefs and rituals • sexual customs, roles, restrictions • social organizations • sports • status differentiation, prestige, credibility • trade, economics, money, barter • visiting, socializing Can you think of anymore?

6. Cultural Identification Primary cultural identity • Age • Ethnicity/race • Gender • Language • Physical abilities and qualities

7. Cultural Identification(2) Primary cultural identity (continued): • Sexual and affectional orientation • Childhood experiences and family factors (family religion, place of birth and household location, family social class, parents’ occupations, etc.)

8. Cultural Identification(3) Secondary cultural identity • Education • Geographic location • Income • Marital/relationship status and history • Military experience

9. Cultural Identification(4) Secondary cultural identity (continued): • Parental status and history • Religion • Work experience 9. Current social class and class status history 10. Political affiliation and perspective

10. Cultural Identification(5) Tertiary cultural identity • Experiences with immigration, exile, refugees, etc. • Lifestyle (e.g., gay culture, new age) • Degree of acculturation/assimilation

11. Cultural Identification(6) Tertiary cultural identity (continued): • Degree of recovery • Recreational drug use • Health consciousness • Gender identification; change in gender

12. Using an Interpreter Potential problems with interpreters: • May not state accurately what health care worker and/or patient have said • Might add their own ideas of what has been said

13. Using an Interpreter(2) Potential problems (continued): • Might have difficulty translating effectively to and from the English language • Patient might be uncomfortable talking about personal information with interpreter present

14. Using an Interpreter(3) Guidelines for interpreters: • Ask for patient’s permission to use an interpreter • Meet with interpreter before seeing the patient to give instructions and guidance

15. Using an Interpreter(4) Guidelines for interpreters (continued): • Remind the interpreter that all information discussed is confidential • Ask interpreter not to add his/her own comments

16. Using an Interpreter(5) Guidelines for interpreters (continued): 5. Ask interpreter to interpret the patient’s and the health care worker’s words as exactly as possible: add nothing, omit nothing, change nothing

17. Using an Interpreter(6) Guidelines for interpreters (continued): 6. Arrange to sit or stand so health care worker is facing and talking to patient, not the interpreter

18. Using an Interpreter(7) Guidelines for interpreters (continued): 7. Ask the interpreter to explain questions or answers that are not clear 8. Keep messages simple and factual; use short phrases and focus on one topic at a time

19. Using an Interpreter(8) Guidelines for interpreters (continued): 9. Give interpreter time to interpret each phrase before continuing; do not interrupt 10. Give patient enough time to answer questions 11. Ask the interpreter to be sure to use the first person.

20. Using an Interpreter(9) Who should interpret? • Trained medical interpreters • Other health care workers who speak the patient’s language

21. Using an Interpreter(10) Who should interpret? (continued) 3. A community or family member of the patient • Potential problems with confidentiality, unfamiliarity with medical terms

22. Using an Interpreter(11) Who should interpret? (continued) • If family member must be used, do not use children; they will hear personal information and may be asked to interpret things that the family believes children should not discuss

23. Using an Interpreter(12) When an interpreter is not available: • Call the office for interpretation over the telephone • If available and approved by program management, use commercial telephone interpretation service

24. Using an Interpreter(13) When an interpreter is not available: • Learn and use a few greetings and key TB words in the patient’s language • Use materials/instructions written in the patient’s language • Other ideas?

25. Review Questions • What are 5 ways that people can culturally identify themselves? • What are 4 ways to learn more about a patient’s culture and health beliefs?

26. Review Questions(2) • What are 3 guidelines for using an interpreter when providing DOT to a non-English-speaking patient? • What are 3 guidelines for providing DOT to non-English-speaking patients without the assistance of an interpreter?