This document discusses diversity, equity, and cultural competence in healthcare. It notes that Toronto is one of the most multicultural cities in the world, with half the population born outside Canada. Providing culturally competent care that addresses health disparities experienced by marginalized groups is important. Barriers immigrants face include lack of language access and healthcare system familiarity. Understanding different cultural contexts and not making assumptions can help improve cross-cultural communication and service excellence.
38. Iceberg Concept of Culture Like an iceberg, nine-tenths of culture is out of conscious awareness. This “hidden” part of culture has been termed “deep culture”.
52. Assigning Meaning What it means to me What it might mean to another Not making eye contact Saying “YES” Spending time on small talk Arriving late for an appt/class/work Needing to consult family
57. Collaborative Conversations 3 2 Key phrases Empathy - Understanding Two concerns I’ve noticed . . . Help me understand . . Tell me more . . Can you explain that a bit more? What else are you thinking? Define the Problem What I’m thinking . . . I’m concerned that . . . I’ve been considering . . Invitation to generate solutions Win/win solutions Would you be open to . . .. Could we consider . . . . What can we do about this? Let’s consider . . . What about . . . I wonder if there is a way . . . .
Facilitation Tips “ The Medicine Box” The following link is to a clip taken from a series called “The Medicine Box- Health Care and New Americans”. The film spotlights the Center for International Health in St. Paul, Minnesota; a primary care clinic that focuses on meeting the health care needs of immigrant and refugee communities. Although it is a U.S. clinic, the discussion of difficult health care decisions is important for participants to consider.. http://video.google.com/videoplay?docid=-5106027191893998854# Instructions for clip: right click on the link and go to “open hyperlink and play from 3:11-5:05
Comment: Canada’s Immigration Policy is an economic policy arrival of skilled workers and professionals is a response to labour market shortages is in response to low birth rates Why immigrate? Families often immigrate to Canada because they are hoping to gain something (i.e. opportunity, education, lifestyle, freedom) and/or leave something behind . Culture Shock: Arises when individuals suddenly find themselves in a culture in which they feel alien, not knowing what they don’t know. New immigrants may also feel conflict over which cultural practices to maintain or change. Culture shock can be decreased if the move is positive and planned and if cultural beliefs can be maintained while integrating into the new culture. Considerations: New immigrants experience challenges in knowing how to access health care as well as problems navigating new, complex healthcare systems. Health care disparities exist in Canada. Based on some of the challenges new immigrants face, reactive symptoms including anxiety and isolation are understandable and should be approached with sensitivity.
Facilitation Tips Comment: Those aspects of culture above the iceberg’s surface are things that are explicit and “visible, such as clothing, food, language etc. The non-visible aspects are habits, assumptions,values and judgments- these are things we know but often can’t or don’t articulate. The more unconscious the rule, often the more intense the emotion attached to it.
Facilitation Tips Comment: Although there may be disagreement about the breadth of the definition of clinical cultural competence, there is agreement that culturally competent care can reduce health disparities.
From Section II – A Cultural Competence Guide for Primary Health Care Professionals in Nova Scotia
Facilitation Tips Ask participants to work at their tables and come up with answers to these questions. Ask them to choose a spokesperson to share with the group.
Facilitation Tips Have participants discuss these cases and then share what they would do.
Facilitation Tips Activity Ask each table to take a couple of minutes to answer what each of these things mean to them, and then what they might mean to someone else. Once they are finished, each table will be asked to discuss their thoughts on one of the issues. Some potential examples include: Not making eye contact- could mean to you that the individual is disinterested or being rude, could mean to another a sign of respect, or may be related to autism or social anxiety Often saying “YES”- could mean to you that the person agrees with you or understands, could mean to another that they actually are not understanding but want to acknowledge the communication
Facilitation Tips Video Play video from 43:40-46:30 Ask the Learners: What did you notice in terms of the ways in which the individuals in the film were communicating? What was the influence of culture on their interactions?
Facilitation Tips Comment: Context of Communication ‘ High-’ and ‘low-context’ does not imply one form of communication is superior to another; they are different ways of communicating. Athough these forms of communication predominate in specific cultures, it doesn’t necessarily mean that low context communication is never utilized in a high-context culture and vice versa. For instance, someone from the U.S. may still use a high-context communication style, although likely not as often as someone from China.
Facilitation Tips Comment: Collaborative Conversations The goal of collaborative conversations is to achieve ‘win/win’ solutions when communicating with patients and their families. The collaborative conversations framework applies to all patients and their families, not just new immigrants. It will also help you resolve problems and conflicts with colleagues. It involves: three steps (empathy, defining the problem, and inviting solutions) two concerns (concerns of the patient, family, colleague or HCP) and potentially key phrases to be utilized when communicating with patients and their families.
Facilitation Tips Comment: Considerations When Communicating Across Cultures Power Dynamics Who has the power in a health care environment? Do most families feel that they have the “right” to have collaborative conversations with the healthcare team? How does culture influence power relations between the healthcare provider and the patient and family? Are the voices of immigrant families heard? How do we minimize cultural silencing? Communication Styles Different communication styles will impact the success of our collaborative conversations and thus how effective we are when communicating across cultures.
Facilitation Tips Comment: Health Literacy Health literacy is not just the ability to understand English; it also includes the ability to access information to make informed decisions. For example, an individual who knows how to speak English but has no knowledge of community resources or how to use the internet to access health information may still be considered at a low level of health literacy.
Facilitation Tips Ask the Learners: How do you use written material with patients and families to help facilitate understanding? Comment: Need to be cognizant of the fact that some families may not be literate in their own language. It is important to ensure that patients and families are able to decode, process and act on the information provided in a pamphlet.
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