Developing Cultural Competency with Senior African Americans, Latinos, and Native Americans

1. Developing CulturalCompetency with Senior African Americans, Latinos, and Native Americans A Web-Based Seminar to Assist Senior Medicare Patrols in Educating and Reaching out to Diverse Older Populations Posted 4/3/07

2. Presenters • Dr. Michele Yehieli Associate Professor and Executive Director Iowa Project EXPORT Center of Excellence on Health Disparities University of Northern Iowa • Dr. Mark Grey Professor and Executive Director New Iowans Program University of Northern Iowa

3. Outline of Seminar Topics • Review • Working with Hispanic populations • Working with African American Populations • Working with Native American Populations

4. Review

5. Review of Previous Training • Changing Demographics • Special Needs of Diverse Seniors • Culture as Barrier to Care • Cultural Competency as Strategy to Address Barriers to Care • Individual and Organizational Recommendations for Providing Culturally Competent Care

6. Working with Hispanic Older Adults

7. Overview • Latinos represent largest minority population in the U.S. • Growth demonstrated in border states • Growth demonstrated in rural states • 700% - 1,200% increase • Diversity within Latino culture

8. Language and Religion • Primary language is Spanish • Dialects may vary by: • Ethnicity, Country, Region • Use of terms: • Latino – Latin America, Western hemisphere • Hispanic – of Spanish-speaking origin • Religious practices primarily Christianity • Catholicism • Traditional Beliefs

9. Family and Social Structure • Strong tradition of family and extended family • Tremendous family support • Identified roles within family by age and gender • Emphasis on pride, self-respect, and family honor • Great value of children

10. Older Adults • Should be treated with honor and respect • Age is valued • Elders appreciated for their knowledge and wisdom • Elders may be somewhat reserved upon first contact

11. Older Adults • Helpful to offer a word or phrase in the native language • Important to clearly explain the purpose of the visit, presentation, or program • Good to review discussion information often, to ensure clear communication

12. Communication Style • Generally warm, hospitable, and expressive • Use humor, expression, touching, and emotion in communication • Tend to have closer body spacing and make eye contact with others • Face-to-face interactions and family connections valued • Marketing and referrals are made most effectively by word-of-mouth

13. Barriers: Money Language Transportation Un- & Under-insured Difficulty accessing health facilities Health Conditions: Diabetes Occupational Injuries Dental Care Acculturation Stress Maternal-Child Health Barriers to Care and Common Health Conditions

14. Bereavement • Practices vary by custom and culture • Catholic practices • Priest is notified if a patient has died or is very ill • Priest offers prayers for healing and performs “last rites” on the dying patient • Many parishes have Spanish speaking priests

15. Bereavement • Funerals are held for the deceased • Large gatherings of family and friends are common at funerals • Grief is openly displayed • Many Latino cultures remember and honor the souls of the dead (i.e. dia de los muertos)

16. Traditional Health Practices • Many individuals, including seniors practice traditional medicine methods • Herbal healing, energy balancing rituals, harmonizing illness through hot and cold foods • Curanderos - traditional healers in Mexican culture • Many Latinos, especially seniors, may want to combine traditional health practices with Western medicine

17. Working with African American Older Adults

18. Overview • African Americans experienced a unique history, which has profoundly affected their socio-economic and health status • African Americans were the only major ethnic group that came to the Western Hemisphere against their will

19. Overview • Implications of historical events on the health status and use of services among African Americans

20. Language and Religion • Majority of African Americans speak English as their native language • Subtle dialects are common • Urban, inner city, or rural Southern communities • Majority practice Christianity • Increasing number of Black Muslims

21. Family and Social Structure • Family is the foundation of African American society • Family revolves around the mother, her elders, her siblings, and children • In general, families are large and caring • Black women are recognized for their strength and nurturing • Increasing number of Black women in the workforce • Expanding middle class

22. Family and Social Structure • Often Black communities are organized around neighborhood associations or local churches • Effective outreach programming should be coordinated with the leaders of these groups

23. Older Adults • Highly respected members of the family • Often heavily influence decisions made within the extended family • May serve as primary caretaker for grandchildren • Most likely family will take care of ill relatives and friends at home

24. Communication Style • Openly expressive • Display: • Direct eye contact • Close body spacing • Higher levels of physical touch • Often open expression of emotion • Ask questions and share opinions more openly • During programming, provide ample opportunity for discussion, problem solving, and hands-on learning

25. Barriers: Cost of services Mistrust within the traditional health care system Health Conditions: As a group, health status is among the worst in the nation Forms of discrimination likely contribute to higher levels of stress, which can negatively effect health status Barriers to Care and Common Health Conditions

26. Barriers to Care and Common Health Conditions • Poor health status is due to: • Genetics • High poverty and unemployment levels • Low levels of education and literacy • Institutional racism • Single parent families • Limited financial and cultural access to health care • Lifestyle factors

27. Barriers to Care and Common Health Conditions • African Americans are disproportionately represented on federal and state assistance programs • Slower to access health care services • Much higher morbidity and mortality rates • Common health concerns: • Hypertension • Diabetes • Breast cancer • Unintentional and intentional injuries

28. Bereavement • In general, Christian rituals are followed • Large numbers of family and friends, particularly women, will likely visit the ill or deceased

29. Traditional Health Practices • Differing health beliefs and attitudes about various medical conditions • External locus of control • Belief in a higher sense of fate and destiny • Faith and spirituality are sources of strength • Respect for the traditional health practices and knowledge

30. Working with Native American Older Adults

31. Overview • Among the most diverse minority population in the U.S. • Only indigenous population in U.S. • 500 separate tribes or nations • Most tribes are very unique • Native Americans reside throughout the entire U.S. living in urban cities, on reservations, and settlements • “Blood quantum” rules

32. Overview • Long, rich, and proud history • Most Americans are unfamiliar with history • Diverse cultural practices among each tribe

33. Language and Religion • English is primary language • Indigenous words and phrases incorporated in daily speaking • Most elders speak their native language • Younger generations often know English, but maybe some of native language • Many tribes did not have a written language

34. Language and Religion • Many practice a form of Christianity or other religion • Native American spirituality • Not considered a “practiced religion” • Approach life in a sacred and holistic manner

35. Family and Social Structure • Genuinely love large number of children • Word for children in Lakota – “sacred being” • Great emphasis on family • Extended family extremely important • Aunts and Uncles – second parents • Families sometimes headed by single women with multiple fathers of children

36. Family and Social Structure • Patriarchal vs. Matriarchal • Emphasis on individuality and equality • Tribal group consensus • Honor extremely important to the tribe and family

37. Older Adults • Elders valued for their knowledge, wisdom, and age • Elders should be treated with sincere and genuine respect • Elders have input and help raise children in the community • Effective form of communication through “storytelling”

38. Communication Style • Thoughtful, reserved, and subtle • Saving face and avoiding conflict are important • Staff members should ask open-ended questions and allow adequate time to respond • Little emphasis placed on strict timeframes

39. Barriers: Limited financial means Geographic and transportation barriers Traditional healing practices valued Lack of Trust Access to medical care Health Conditions: Diabetes Alcoholism Accidents Intentional injury Barriers to Care and Common Health Conditions

40. Bereavement • Very diverse depending on tribes and religions • Support from extended family during time of illness • Various rituals and ceremonies conducted • Reserved expression of grief and sadness • View of death as sacred and natural part of life

41. Bereavement • Honor spirits of deceased • Beginning of another journey into the next world • Certain dietary, spiritual, and behavior practices occur during grieving process • Religious practices may be interwoven at funeral ceremonies

42. Traditional Health Practices • Strong sense of connection to the earth and universe • Respect for all living and non-living things – valued equally for their role in the universe • View life in a holistic manner • People should be responsible caretakers of self, family, tribe, and earth

43. Traditional Health Practices • Well-developed traditional health system • Combines physical, mental, emotional, and spiritual well-being • Harmony and a sense of balance important for wellness • Circular vs. cause-effect health beliefs

44. Traditional Health Practices • Belief that traditional medicine good for healing the soul • Herbal remedies • Healing ceremonies • Ritual purification • Sweat ceremonies • Belief that Western medicine is good for healing symptoms in the body

45. Conclusions

46. Conclusion • Information in this presentation is a general overview; Recognize individuality • Important to learn more in-depth information about specific groups within each cultural community • Cultural mistakes are inevitable and are a part of learning • Cultural competency skills require time, patience, and genuine interest to learn

47. Thank You! For more information on this presentation, please contact: The Iowa Project EXPORT Center of Excellence on Health Disparities University of Northern Iowa 220 WRC Cedar Falls, IA 50614-0241 (319) 273-7965 www.iowahealthdisparities.org Dr. Michele Yehieli, Executive Director Dr. Mark Grey, Associate Director

48. This presentation has been brought to you by… Shirley Merner, Co-Director Jolie Crowder, Co-Director Andrea Fehring, Associate Director Candice Griffin, Coordinator 877.808.2468 info@smpresource.org This presentation is archived at www.mshow.com