Title: Why Should Anyone Believe that Cultural Competency Training Could Help Close the Black-White Gap in Wisconsin Birth Outcomes? Beloit LIHF Pathways to Healthy African American Families Project Wisconsin Health Improvement and Research Partnerships
1Why Should Anyone Believe that Cultural
Competency Training Could Help Close the
Black-White Gap in Wisconsin Birth
Outcomes?Beloit LIHF Pathways to Healthy
African American Families ProjectWisconsin
Health Improvement and Research Partnerships
ForumSeptember 14-16, 2011Linda Denise Oakley,
PhDProfessor
2- Culture is often described as the combination of
a body of knowledge, a body of belief and a body
of behavior. It involves a number of elements,
including personal identification, language,
thoughts, communications, actions, customs,
beliefs, values, and institutions that are often
specific to ethnic, racial, religious,
geographic, or social groups. - NIH Health Literacy Initiative Clear Communication
3- Cultural competency has a positive effect on
patient care delivery by enabling providers to
deliver services that respectful of and response
to the health beliefs, practices, and cultural
and linguistic needs of diverse patients. - NIH Health Literacy Initiative Clear Communication
4Office of Minority HealthUS Health and Human
ServicesNational Standards for
Culturally-Linquistically Appropriate Services in
Health Care 2001
- Defined 14 National Standards for Care
- Standard 1 Health care organizations should
ensure that patients/consumers receive from all
staff members effective understandable and
respectful care that is provided in a manner
compatible with their cultural health beliefs and
practices and preferred language
5Georgetown University National Center for
Cultural Competence Fetal-Infant Mortality Review
ProgramOrganizational Self-Assessment to Plan
Cultural Competency 2009
- Self-Assessment addresses attitudes, behaviors,
policies, structures, and practices of an
organization, including those of its boards,
advisory groups, staff, and volunteers - Self-Assessment process can include structure
instrument, focus groups, structured interviews,
analysis of community, regional, and state
demographic data, and review of the
organizations values, mission, policies,
procedures, budget, and web/ print documents - Four-Phase approach is establish a structure to
guide the work, create a shared vision and shared
ownership, collect, analyze, disseminate data,
develop and implement a plan of action
6Beloit LIHF Collaborative
- A Wisconsin Partnership Program (WPP) initiative
to address the disparity in the African American
infant mortality rate in Beloit
7Collaborative Mission
- The mission of the Collaborative is to build a
Beloit Community Collaborative to close the
black-white gap in birth outcomes by improving
the health and well-being of African American
Families and communities, and addressing social
and economic inequalities. - .
8Our Presentation Aims
- We present the results of the Collaborative
self-assessment and cultural competency training
and address the following implementation question - Why should anyone believe that cultural
competency training could help close the
Black-White gap in Wisconsin birth outcomes?
9Wisconsin Infant Mortality2008
White 315 deaths for 53,561births IM Rate is 5.9 per 1,000
Black 100 deaths for 7,236 births IM Rate is 15.2 per 1,000
Hispanic 49 Deaths for 7,025 births IM Rate is 6.5 per 1,000
Healthy People 2010 Goal 4.5
10Wisconsin Black-White IMR Gap 2010
- Black19.2 Deaths/1,000 Births
- White 3.5 Deaths/1,000 Births
- Tom Schlenker, MD
- Dane County Department of Public Health
- WSJ, 4/22/2011
11Wisconsin Black Infant Mortality
2002-2006Richard Allan Aronson, MD for WPP, 2008
City IMR/ 1,000
Madison 7.15
Milwaukee 17.3
Kenosha 18.0
Beloit 19.2
12Rock County Black Prenatal Care
Start 2008 Births 137
Start Prenatal Care 1st Trimester 109
Start Prenatal Care 2nd Trimester 17
Start Prenatal Care Unknown 11
13Beloit Collaborative (N 55)Individual
Self-Assessment
- Aurora Chang, PhD
- Beloit College
- Returned Individual Surveys (n 36, rate of 65)
- Completed Individual Interviews (n 9)
- Two Focus Groups (n 6)
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22Beloit Collaborative Self-Assessment Findings
- Cultural competency trainings dont always leave
a lasting impact - When talking about culture, it leads to talking
about traditions, not necessarily disparities
between race and class - People in power having the power to remove
themselves - Change happens by force, not voluntarily
- Lack of interracial interaction comes from lack
of jobs
23Beloit CollaborativeCultural Competency Training
- Pre-Post Test (n 33)
- Individual Training Expectations
- Individual Assessment Expectations
- Domain Groups Initiatives Identified
- Conversation with a Black infant
- Conversation with Colleagues
- Conversation with your values
- Health and Racism
- Social Determinants and Risk Factors
- Cultural Competency
- Post-Test (n 28)
- Evaluation Forms (n 25)
24Beloit Collaborative Cultural Competency
Training Incorrect Pre-Test Items (2/10)
- Income level predicts the health of African
Americans and Caucasians,(n 30, false) - Researchers have shown that social stress can
produce unhealthy changes in amniotic fluid in
pregnant black women (n9 dont know, false)
25Beloit Collaborative Cultural Competency
TrainingPersonal Training Expectations
- To better understand how one individuals
behavior can impact so many lives
26Beloit Collaborative Cultural Competency
TrainingWhat Appreciative Inquiry Question
would I ask myself about the Beloit Black IMR?
- Why is the black IM rate important to me? How can
I be part of the solution? - I watched my sister bury her 3-month old son. She
did everything right in her pregnancy and with
him after he was born. We are white. I dont
understand. Im sorry. I try. Why Anyone wouldnt
do everything they could for the health of their
child. Yes there are barriers-Fight them! So my
question for myself, am I prejudice?
27Beloit Collaborative Cultural Competency
TrainingOne reason I doubt that racism affects
the health of African Americans is
- I know healthy African Americans in communities
with much racism - Free healthcare is provided for African
Americans to access health care - One reason I doubt racism affects health of
African Americans is that sometime we do not get
the same treatment and care as another race would
28WPP Risk Factors
29Risk Factors Non-Modifiable (LIHF WPP)
- African-American Race
- Prior Preterm Birth
- Maternal Age lt18 or gt40 Years
- Poor Nutrition
- Poor Vitamin Intake Prior to Pregnancy
- Low Socioeconomic Status
- Cervical- Uterine Anomaly
- Premature Cervical Dilatation or Effacement
- Multiple Pregnancy
- Polyhydramnios (excessive amniotic fluid)
30Risk Factors Modifiable (LIHF WPP)
- Use of tobacco, alcohol, medications,
recreational drugs - Short interpregnancy interval
- Absent prenatal care
- Anemia
- Infection bacteriuria/urinary tract infection
(UTI), Sexually-transmitted infection (STI),
such as gonorrhea, Chlamydia, bacterial
vaginosis, Group B ß-hemolytic streptococcus,
HIV/AIDS Periodontal Disease) - Chronic Disease (diabetes, hypertension/
preeclampsia/ eclampsia, asthma, and obesity) - Depression (prenatal and post-partum), other
mental-health conditions - Strenuous work
- High environmental stress
31What does the research say?
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33Cytokines
344. Cytokines (Kunz-Ebrecht, Mohamed-Ali,
Feldman, Kirschbaum, Steptoe, 2003)
- Repeated episodes of acute stress and chronic
stress affect immune system - Stress can cause chronic release of
pro-inflammatory cytokines - Inflammatory response to stress increases risk of
infection - Cytokines in vaginal fluid and infection are
associated with PTB in black women
353. Pro-inflammatory Immune Response(Woodworth,
Grenache, Gronowski, 2011)
- Corticosteroid (anti-inflammatory medication)
given 48 hours prior to PTB decreases the risk
of infant morbidity and mortality - Biomarkers in vaginal fluid are used to predict
time to PTB - Two biomarker s Fetal Fibronectin and
Pro-inflammatory cytokine IL-6. This study tested
both markers in 343 black women and 324 white
women - Cytokines in fluid is associated with vaginal
bacterial infection and chorioamninonitic
membranes - Study found cytokines associated with delivery in
black women--with and without symptoms of preterm
labor no cytokine association with delivery in
white women. - Conclusion Cytokine test markedly improved
prediction of delivery in black women
36Question
- Why should anyone believe that cultural
competency training could help close the
Black-White gap in Wisconsin birth outcomes?
37Answer
- The data supports competency models aimed at
make effective treatment, effective for black
women
38Thank you