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

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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

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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

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Outline of Seminar Topics

• Review
• Working with Hispanic populations
• Working with African American Populations
• Working with Native American Populations

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Review
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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

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Working with Hispanic Older Adults
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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

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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

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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

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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

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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

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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

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Barriers to Care and Common Health Conditions

• Barriers
• Money
• Language
• Transportation
• Un- Under-insured
• Difficulty accessing health facilities

• Health Conditions
• Diabetes
• Occupational Injuries
• Dental Care
• Acculturation Stress
• Maternal-Child Health

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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 rights on the dying patient
• Many parishes have Spanish speaking priests

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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)

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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

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Working with African American Older Adults
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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

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Overview

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

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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

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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

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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

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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

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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

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Barriers to Care and Common Health Conditions

• 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

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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

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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

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Bereavement

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

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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

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Working with Native American Older Adults
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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

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Overview

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

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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

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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

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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

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Family and Social Structure

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

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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

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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

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Barriers to Care and Common Health Conditions

• 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

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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

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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

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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

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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

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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

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Conclusions
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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

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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
• [phone]
• www.iowahealthdisparities.org
• Dr. Michele Yehieli, Executive Director
• Dr. Mark Grey, Associate Director

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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_at_smpresource.org This
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