Culturally Responsive Culturally Responsive Health Care: How to Health Care: How to Meet the ChallengeMeet the Challenge

Jeffrey Ring, Ph.D.Jeffrey Ring, Ph.D.Director of Behavioral Sciences and Cultural Director of Behavioral Sciences and Cultural

MedicineMedicineWhite Memorial Med. Ctr. Family Medicine White Memorial Med. Ctr. Family Medicine

Los Angeles, CaliforniaLos Angeles, California

Presenter Disclosure Presenter Disclosure InformationInformation

Speaker’s Bureau: Merck & Co., Inc.Speaker’s Bureau: Merck & Co., Inc.

(not product division)(not product division) Other: Author of a book for Radcliffe Other: Author of a book for Radcliffe

Oxford PublishingOxford Publishing

In compliance with the accrediting board policies, theAmerican Diabetes Association requires the following disclosure

to the participants:

Name of Presenter: Jeffrey Ring, Ph.D.

ObjectivesObjectives

By the conclusion of this presentation, By the conclusion of this presentation, participants will:participants will:

Be able to articulate a strong rationale Be able to articulate a strong rationale for providing culturally responsive carefor providing culturally responsive care

Deepen their capacity for self-reflectionDeepen their capacity for self-reflectionEnhance their understanding of health Enhance their understanding of health

disparitiesdisparities

Culturally Responsive CareCulturally Responsive Care

Patient-centered care with an attention Patient-centered care with an attention to the patient’s culture, beliefs, to the patient’s culture, beliefs, health behaviors and world view.health behaviors and world view.

Why provide culturally Why provide culturally responsive care?responsive care?

Exploring Similarities and Exploring Similarities and DifferencesDifferences

Imagery ExerciseImagery Exercise

Exploring Health InequitiesExploring Health Inequities

U.S.Diabetes Mortality Rates U.S.Diabetes Mortality Rates (2007) (2007)

White Non-HispanicWhite Non-HispanicAfrican AmericanAfrican AmericanLatino/aLatino/aAm. Indian/Alaska NativeAm. Indian/Alaska NativeAsian/Pacific IslanderAsian/Pacific Islander

U.S.Diabetes Mortality Rates* U.S.Diabetes Mortality Rates* (2007) (2007)

White Non-HispanicWhite Non-Hispanic 22.3/100,00022.3/100,000African AmericanAfrican American 4848Latino/aLatino/a 32.132.1Am. Indian/Alaska NativeAm. Indian/Alaska Native 43.743.7Asian/Pacific IslanderAsian/Pacific Islander 16.616.6

* Age adjusted* Age adjusted

www/cdc/gov/nchs/data/hus07.pdfwww/cdc/gov/nchs/data/hus07.pdf

Sources of Health InequitiesSources of Health Inequities

Patient FactorsPatient FactorsHealth Care System FactorsHealth Care System FactorsSociety FactorsSociety FactorsPractitioner FactorsPractitioner Factors

Culturally Responsive Culturally Responsive Communication StrategiesCommunication Strategies

Q2 (A. Kleinman)Q2 (A. Kleinman) How do you believe you got sick?How do you believe you got sick? What do you believe will help you heal?What do you believe will help you heal?

LEARN (Berlin and Fowkes, 1983)LEARN (Berlin and Fowkes, 1983) Listen with empathy and understandingListen with empathy and understanding Explain your perception of the problemExplain your perception of the problem Acknowledge and discuss similarities/differencesAcknowledge and discuss similarities/differences Recommend treatmentRecommend treatment Negotiate agreement (Getting to Yes, Fisher and Negotiate agreement (Getting to Yes, Fisher and

Ury, 1983)Ury, 1983)

Motivational InterviewingMotivational Interviewing(Miller and Rollnick, 2002)(Miller and Rollnick, 2002)

Patient-Centered ModelPatient-Centered Model Identify and Resolve Identify and Resolve

Ambivalence/BarriersAmbivalence/BarriersDiagnose the Patient’s State of Diagnose the Patient’s State of

Mind/ChangeMind/ChangePrecontemplationPrecontemplationContemplationContemplationActionActionMaintenance (Relapse)Maintenance (Relapse)

Resist the Righting ReflexResist the Righting Reflex

QUICK CASEQUICK CASE

Patient with high sugars is obese, Patient with high sugars is obese, depressed, does no exercise…depressed, does no exercise…Advice?Advice?

“…“…people almost never change without people almost never change without first feeling understood.” first feeling understood.” (Stone, 1999)(Stone, 1999)

QUICK CASEQUICK CASE

Patient with high sugars is obese, Patient with high sugars is obese, depressed, does no exercise…depressed, does no exercise…Motivational Interviewing Questions?Motivational Interviewing Questions?

What are the benefits of not exercising?What are the benefits of not exercising?If your heart was failing, might you change If your heart was failing, might you change

then?then?Have you thought about what exercise you Have you thought about what exercise you

might try?might try?What are the sources of strength and What are the sources of strength and

support in your life?support in your life?

Commitment to ActCommitment to Act

List two commitments/covenants to List two commitments/covenants to further your capacity to provide further your capacity to provide culturally-responsive care, based on culturally-responsive care, based on today’s discussionstoday’s discussions

ResourcesResources

Ring, Nyquist et al. (2008) Curriculum for Ring, Nyquist et al. (2008) Curriculum for Culturally Responsive Health Care, RadcliffeCulturally Responsive Health Care, Radcliffe

www.vimeo.com/15822032 Addressing www.vimeo.com/15822032 Addressing Culture and Language for Medical Culture and Language for Medical AssistantsAssistants

www.diversityrx.orgwww.diversityrx.org http://minorityhealth.hhs.gov/http://minorityhealth.hhs.gov/ Medscape.com (Health Diversity Resource Medscape.com (Health Diversity Resource

Center)Center) Jeffrey Ring, Ph.D. ring@usc.eduJeffrey Ring, Ph.D. ring@usc.edu