Joe an 85 year old African American male was diagnosed with hypertension 15 years ago Joe exhibits dramatic fluctuations with his blood pressure due to noncompliance with prescribed treatment regimens Joersquos physician discusses how Joe should manage his ldquohypertensionrdquo

1 What wording could the physician have used to help Joe understand his condition

2 What other disciplines may have been involved in helping Joe manage his hypertension better

CASE VIGNETTE JOECASE VIGNETTE JOE

CULTURAL HUMILITYCULTURAL HUMILITY

ldquoWith so many factors to consider how does one move forward with developing cultural competence without being overwhelmed with the complexity and the dangers of stereotyping or reifying the culture of others Practicing ldquocultural humilityrdquo is the keyrdquo

California Health Advocates 2009

1 Identify your own cultural and family beliefs and values

2 Define your own personal cultureidentity ethnicity age experience education socio-economic status gender sexual orientation religionhellip

3 Are you aware of your personal biases and assumptions about people with different values than yours

4 Challenge yourself in identifying your own values as the ldquonormrdquo

5 Describe a time when you became aware of being different from other people

California Health Advocates 2009

GROUP EXERCISEGROUP EXERCISE

Cultural Humility DefinedCultural Humility Defined

A lifelong process of self-reflection and self-critique ldquoThe starting point for such an approach is not an

examination of the clientrsquos belief system but rather having health careservice providers give careful consideration to their assumptions and beliefs that are embedded in their own understandings and goals of their encounter with the client

In practicing cultural humility rather than learning to identify and respond to sets of culturally specific traits the culturally competent provider develops and practices a process of self-awareness and reflectionrdquo

Dr Melanie Tervalon and Jann Murray-Garcia California Health Advocates 2009

CULTURAL HUMILITYCULTURAL HUMILITY

ldquoWith so many factors to consider how does one move forward with developing cultural competence without being overwhelmed with the complexity and the dangers of stereotyping or reifying the culture of others Practicing ldquocultural humilityrdquo is the keyrdquo

California Health Advocates 2009

1 Identify your own cultural and family beliefs and values

2 Define your own personal cultureidentity ethnicity age experience education socio-economic status gender sexual orientation religionhellip

3 Are you aware of your personal biases and assumptions about people with different values than yours

4 Challenge yourself in identifying your own values as the ldquonormrdquo

5 Describe a time when you became aware of being different from other people

California Health Advocates 2009

GROUP EXERCISEGROUP EXERCISE

Cultural Humility DefinedCultural Humility Defined

A lifelong process of self-reflection and self-critique ldquoThe starting point for such an approach is not an

examination of the clientrsquos belief system but rather having health careservice providers give careful consideration to their assumptions and beliefs that are embedded in their own understandings and goals of their encounter with the client

In practicing cultural humility rather than learning to identify and respond to sets of culturally specific traits the culturally competent provider develops and practices a process of self-awareness and reflectionrdquo

Dr Melanie Tervalon and Jann Murray-Garcia California Health Advocates 2009

1 Identify your own cultural and family beliefs and values

2 Define your own personal cultureidentity ethnicity age experience education socio-economic status gender sexual orientation religionhellip

3 Are you aware of your personal biases and assumptions about people with different values than yours

4 Challenge yourself in identifying your own values as the ldquonormrdquo

5 Describe a time when you became aware of being different from other people

California Health Advocates 2009

GROUP EXERCISEGROUP EXERCISE

Cultural Humility DefinedCultural Humility Defined

A lifelong process of self-reflection and self-critique ldquoThe starting point for such an approach is not an

examination of the clientrsquos belief system but rather having health careservice providers give careful consideration to their assumptions and beliefs that are embedded in their own understandings and goals of their encounter with the client

In practicing cultural humility rather than learning to identify and respond to sets of culturally specific traits the culturally competent provider develops and practices a process of self-awareness and reflectionrdquo

Dr Melanie Tervalon and Jann Murray-Garcia California Health Advocates 2009

Cultural Humility DefinedCultural Humility Defined

A lifelong process of self-reflection and self-critique ldquoThe starting point for such an approach is not an

examination of the clientrsquos belief system but rather having health careservice providers give careful consideration to their assumptions and beliefs that are embedded in their own understandings and goals of their encounter with the client

In practicing cultural humility rather than learning to identify and respond to sets of culturally specific traits the culturally competent provider develops and practices a process of self-awareness and reflectionrdquo

Dr Melanie Tervalon and Jann Murray-Garcia California Health Advocates 2009

Cultural Humility ValuesCultural Humility Values

Openness Appreciation Acceptance Flexibility

Mia Luluquisen Katherine Schaff amp Sandi Galvez Alameda County Public Health Department (2009)

Cultural Skills Across DomainsCultural Skills Across Domains

Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

Cultural Skills Across DomainsCultural Skills Across Domains

Personal Ability to regularly conduct self-evaluation about how

values and beliefs impact worldviews

Interpersonal Ability to communicate with others who have different

language and worldview

Capability to translate ways of seeing and behaving from one culture into another

Cultural Skills Across DomainsCultural Skills Across Domains

Program Planning Ability to show respect for another culturersquos values and

identity Capacity to include the cultural social and environmental

influences on communities in program design Talent for building trust developing relationships and

working with culturally diverse community members

Organizational Ability to establish organizational vision and leadership that

promotes a positive multicultural work environment Capability to create and implement policies and procedures

to foster diversity and inclusion

Cultural Skills Across DomainsCultural Skills Across Domains

Policy and Advocacy Capability to assess and revise existing policies

and procedures in the planning delivery and evaluation of comprehensive programs and services for diverse populations

Capacity to review and revise policies that allocate resources for culturally diverse populations such as translation and interpretation services

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

Cultural Skills Across DomainsCultural Skills Across Domains

Policy amp Advocacy

Organizational

Program Planning

Interpersonal

Personal

Cultural Skills Across DomainsCultural Skills Across Domains

Personal Ability to regularly conduct self-evaluation about how

values and beliefs impact worldviews

Interpersonal Ability to communicate with others who have different

language and worldview

Capability to translate ways of seeing and behaving from one culture into another

Cultural Skills Across DomainsCultural Skills Across Domains

Program Planning Ability to show respect for another culturersquos values and

identity Capacity to include the cultural social and environmental

influences on communities in program design Talent for building trust developing relationships and

working with culturally diverse community members

Organizational Ability to establish organizational vision and leadership that

promotes a positive multicultural work environment Capability to create and implement policies and procedures

to foster diversity and inclusion

Cultural Skills Across DomainsCultural Skills Across Domains

Policy and Advocacy Capability to assess and revise existing policies

and procedures in the planning delivery and evaluation of comprehensive programs and services for diverse populations

Capacity to review and revise policies that allocate resources for culturally diverse populations such as translation and interpretation services

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

Cultural Skills Across DomainsCultural Skills Across Domains

Personal Ability to regularly conduct self-evaluation about how

values and beliefs impact worldviews

Interpersonal Ability to communicate with others who have different

language and worldview

Capability to translate ways of seeing and behaving from one culture into another

Cultural Skills Across DomainsCultural Skills Across Domains

Program Planning Ability to show respect for another culturersquos values and

identity Capacity to include the cultural social and environmental

influences on communities in program design Talent for building trust developing relationships and

working with culturally diverse community members

Organizational Ability to establish organizational vision and leadership that

promotes a positive multicultural work environment Capability to create and implement policies and procedures

to foster diversity and inclusion

Cultural Skills Across DomainsCultural Skills Across Domains

Policy and Advocacy Capability to assess and revise existing policies

and procedures in the planning delivery and evaluation of comprehensive programs and services for diverse populations

Capacity to review and revise policies that allocate resources for culturally diverse populations such as translation and interpretation services

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

Cultural Skills Across DomainsCultural Skills Across Domains

Program Planning Ability to show respect for another culturersquos values and

identity Capacity to include the cultural social and environmental

influences on communities in program design Talent for building trust developing relationships and

working with culturally diverse community members

Organizational Ability to establish organizational vision and leadership that

promotes a positive multicultural work environment Capability to create and implement policies and procedures

to foster diversity and inclusion

Cultural Skills Across DomainsCultural Skills Across Domains

Policy and Advocacy Capability to assess and revise existing policies

and procedures in the planning delivery and evaluation of comprehensive programs and services for diverse populations

Capacity to review and revise policies that allocate resources for culturally diverse populations such as translation and interpretation services

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

Cultural Skills Across DomainsCultural Skills Across Domains

Policy and Advocacy Capability to assess and revise existing policies

and procedures in the planning delivery and evaluation of comprehensive programs and services for diverse populations

Capacity to review and revise policies that allocate resources for culturally diverse populations such as translation and interpretation services

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

Cultural Competency amp Cultural HumilityCultural Competency amp Cultural Humility

Cultural Competency can include mandates laws rules policies standards practices attitudes

Cultural Humility is a process and a lifelong commitment to self-evaluation and critique to improve relationships and outcomes

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

On-line Resources On-line Resources

Administration of Aging Achieving cultural competency A guidebook for providers of services to older Americans and their families httpwwwaoagovprofadddivculturaladdiv_cultasp

Alzheimerrsquos Association Diversity Toolbox Caring for Diverse

Populationshttpwwwalzorgprofessionals and researchers_caring_for_diverse_populationsasp

National Center for Cultural Competence httpncccgeorgetowneduindexhtml

Cultural Competence httpwwwalzorgResourcesDiversitydownloadsGEN_EDU-10stepspdf

Multicultural Outreach Manual httpwwwalzorgnationaldocumentsGEN_OUT-MulticulturalManualpdf

On-line Resources On-line Resources

American Geriatrics Society Position Statement on Ethnogeriatrics

httpwwwamericangeriatricsorgproductspositionpapersethno_committeeshtml

Use of Interpreter During Clinical Encounters Position Statement

httpwwwamericangeriatricsorgproductspositionpapersinterpreter_022307PFshtml

American Psychiatric Association Ethnic Minority Elderly Curriculum

httpwwwaagponlineorgprofpdfs08cultcompcurpdf

American Psychological Association Task Force on Diversity Education Resources Teaching and Learning about Aging (2008)

httpteachpsychorgdiversityptdeagingphp

On-line Resources On-line Resources

Stanford University Geriatric Education Center Curriculum in Ethnogeriatrics httpsgecstanfordeduresourcesethnohtml

Ethnogeriatric Educational Resources including emergency preparedness mental health and diabetes and on line training manuals on improving communication with elders of different cultures and diversity healing and healthcarehttpsgecstanfordeduresources

Our Ethnogeriatric Imperative Powerpoint by G Yeo httpsgecstanfordedupdf-wordGwen_AAHPMpdf

On-line Resources On-line Resources

Initiative to Eliminate Racial and Ethnic Disparities in Health (httpraceandhealthhhsgov)

Health Disparities Collaborative (httpwwwhealthdisparitiesnethdchtmlhomeaspx)

American Public Health Association ldquoEliminating Health Disparities Toolkitrdquo (2004) httpwwwaphaorgNPHWtoolkit-PHW04-LRpdf

Suggested Future ReadingsSuggested Future Readings

American Society on Aging (2002) Recognizing diversity in aging moving toward cultural competence Generations 26(3)

Jackson JS Brown E and Antonucci TC (2004) A cultural lens on biopsychosocial models of aging In P Costa amp I Siegler (Eds) Advances in Cell Aging and Gerontology Vol 15 (pp 221-241) New York Elsevier

Xakellis G Brangman S A Ladson Hinton W Jones V Y Masterman D Pan C X Rivero J Wallhagen M amp Yeo G (2004) Curricular framework Core competencies in multicultural geriatric care Journal of the American Geriatric Society 52 137-142

Yeo G amp Gallagher-Thompson D (Eds) (2006) Ethnicity and the dementias (2nd ed) NY Taylor amp Francis

Suggested Future ReadingsSuggested Future Readings

LaVeist TA (2005) Minority Populations and Health An Introduction to Health Disparities in the United States San Francisco CA Jossey-Bass Publication

Williams DR Collins C (2001) Racial residential segregation A fundamental cause of racial disparities in health disparities Public Health Reports 116 404-416

Baicker K Chandra A Skinner JS Wennberg JE(2004) Who are you and where you live How race and geography affect the treatment of Medicare beneficiaries Health Affairs (wwwhealthaffairsorg)

Lu MC amp Halfon N (2003) Racial and ethnic disparities in birth outcomes A life course perspective Journal of Maternal Child Health 7 (1) 13 130

Satcher D amp Pamies RJ (2006) Multicultural Medicine and Health Disparities New York NY McGraw-Hill Medical Publishing Division 2006

Suggested Future ReadingsSuggested Future Readings

LaVeist TA (2005) Minority Populations and Health An Introduction to Health Disparities in the United States San Francisco CA Jossey-Bass Publication

Williams DR Collins C (2001) Racial residential segregation A fundamental cause of racial disparities in health disparities Public Health Reports 116 404-416

Baicker K Chandra A Skinner JS Wennberg JE(2004) Who are you and where you live How race and geography affect the treatment of Medicare beneficiaries Health Affairs (wwwhealthaffairsorg)

Lu MC amp Halfon N (2003) Racial and ethnic disparities in birth outcomes A life course perspective Journal of Maternal Child Health 7 (1) 13 130

Satcher D amp Pamies RJ (2006) Multicultural Medicine and Health Disparities New York NY McGraw-Hill Medical Publishing Division 2006