understanding indian health culture
TRANSCRIPT
Culture and Health Understanding Indian
Health Culture
Arindam Basu MB BS MPH PhD
School of Health Sciences
University of Canterbury
Christchurch New Zealand
arinbasugmailcom
Outline of the Presentation
bull South AsianIndian Health Culture
bull Health Profiles of South AsiansIndian Immigrants in NZ
bull Communication and Understanding
South Asia
India and Neighbouring
Countries (India Pakistan
Bangladesh Nepal Sri Lanka
Bhutan Maldives)
Total Population ~ 17 Billion
About 9 Trillion US Dollar
Economy
Major
Languages and
ReligionsHindi Bengali Urdu Punjabi
Worldrsquos second largest English
Speaking Country
Diversity of religions - Hinduism
Islam Christianity Buddhism
Sikhism
Distribution of Death and Disability Adjusted Life Years
Infectious Cardiovascular Neonatal Respiratory and
Behavioural Diseases are Top 5 Serious Risks in India
0
22500
45000
67500
90000
Infectious andparasitic
Neonatal Mental andBehavioural
Diseases
MalignantNeoplasms
DigestiveDiseases
NeurologicalConditions
GenitourinaryDiseases
Diabetes Mellitus MaternalConditions
NonmalignantNeoplasms
Distribution of DALYs based on Disease Conditions
Distribution of DALYs from Noncommunicable
Communicable and Injuries in India 2012 In India currently death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases the burden of
injuries is still low
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Outline of the Presentation
bull South AsianIndian Health Culture
bull Health Profiles of South AsiansIndian Immigrants in NZ
bull Communication and Understanding
South Asia
India and Neighbouring
Countries (India Pakistan
Bangladesh Nepal Sri Lanka
Bhutan Maldives)
Total Population ~ 17 Billion
About 9 Trillion US Dollar
Economy
Major
Languages and
ReligionsHindi Bengali Urdu Punjabi
Worldrsquos second largest English
Speaking Country
Diversity of religions - Hinduism
Islam Christianity Buddhism
Sikhism
Distribution of Death and Disability Adjusted Life Years
Infectious Cardiovascular Neonatal Respiratory and
Behavioural Diseases are Top 5 Serious Risks in India
0
22500
45000
67500
90000
Infectious andparasitic
Neonatal Mental andBehavioural
Diseases
MalignantNeoplasms
DigestiveDiseases
NeurologicalConditions
GenitourinaryDiseases
Diabetes Mellitus MaternalConditions
NonmalignantNeoplasms
Distribution of DALYs based on Disease Conditions
Distribution of DALYs from Noncommunicable
Communicable and Injuries in India 2012 In India currently death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases the burden of
injuries is still low
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
South Asia
India and Neighbouring
Countries (India Pakistan
Bangladesh Nepal Sri Lanka
Bhutan Maldives)
Total Population ~ 17 Billion
About 9 Trillion US Dollar
Economy
Major
Languages and
ReligionsHindi Bengali Urdu Punjabi
Worldrsquos second largest English
Speaking Country
Diversity of religions - Hinduism
Islam Christianity Buddhism
Sikhism
Distribution of Death and Disability Adjusted Life Years
Infectious Cardiovascular Neonatal Respiratory and
Behavioural Diseases are Top 5 Serious Risks in India
0
22500
45000
67500
90000
Infectious andparasitic
Neonatal Mental andBehavioural
Diseases
MalignantNeoplasms
DigestiveDiseases
NeurologicalConditions
GenitourinaryDiseases
Diabetes Mellitus MaternalConditions
NonmalignantNeoplasms
Distribution of DALYs based on Disease Conditions
Distribution of DALYs from Noncommunicable
Communicable and Injuries in India 2012 In India currently death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases the burden of
injuries is still low
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Major
Languages and
ReligionsHindi Bengali Urdu Punjabi
Worldrsquos second largest English
Speaking Country
Diversity of religions - Hinduism
Islam Christianity Buddhism
Sikhism
Distribution of Death and Disability Adjusted Life Years
Infectious Cardiovascular Neonatal Respiratory and
Behavioural Diseases are Top 5 Serious Risks in India
0
22500
45000
67500
90000
Infectious andparasitic
Neonatal Mental andBehavioural
Diseases
MalignantNeoplasms
DigestiveDiseases
NeurologicalConditions
GenitourinaryDiseases
Diabetes Mellitus MaternalConditions
NonmalignantNeoplasms
Distribution of DALYs based on Disease Conditions
Distribution of DALYs from Noncommunicable
Communicable and Injuries in India 2012 In India currently death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases the burden of
injuries is still low
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Distribution of Death and Disability Adjusted Life Years
Infectious Cardiovascular Neonatal Respiratory and
Behavioural Diseases are Top 5 Serious Risks in India
0
22500
45000
67500
90000
Infectious andparasitic
Neonatal Mental andBehavioural
Diseases
MalignantNeoplasms
DigestiveDiseases
NeurologicalConditions
GenitourinaryDiseases
Diabetes Mellitus MaternalConditions
NonmalignantNeoplasms
Distribution of DALYs based on Disease Conditions
Distribution of DALYs from Noncommunicable
Communicable and Injuries in India 2012 In India currently death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases the burden of
injuries is still low
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Distribution of DALYs from Noncommunicable
Communicable and Injuries in India 2012 In India currently death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases the burden of
injuries is still low
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Organisation of Health Care Services in India Note that patients
may have several pathways of entry and interacting with the system
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
An Indian Drugstore patients or ldquopatient partyrdquo submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
A Prescription by an Indian Doctor within India on his
writing pad this sheet is for the patients to keep
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Other Systems HomeopathyIn addition to ldquoWestern Medicinerdquo Indians also rely on Homeopathy Ayurvedic
ldquoUnanirdquo and other systems of ldquohealth servicesrdquo here a homeopathy clinic face is
shown
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
An Ayurvedic procedure named lsquoShirodhararsquo is being conducted
on a patient - I am not sure what that means or why that is done
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
A Unani procedure named ldquoTurkish Bathrdquo is being done
on a patient
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Moving from India to New Zealand
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Healthy Migrant Effect
bull Better quality of health of the
first generation migrants
compared with natives in the
country
bull Possible causes - selection
bias medical tests during
immigration and visa
procedures
bull The effect dissipates in about
10-15 years of adoption in the
new country in some cases
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Patterns of Indian Immigration (Auckland Region 2004-
2011)
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region 2008-2010
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region 2010-2011
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
bull Lower Prevalence of Fruits and
Vegetable Intakes
bull Low Prevalence of Physical
Activities
bull Higher Prevalence of Adult
Obesity
Image Courtesy httpwwwcadiresearchorgwp-contentuploads201110052-Figjpg
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Patterns of Health Services Utilisation among Indians
bull High Coronary Procedure Rates
bull High Needs for Dispensing of Pharmacotherapy for
CVD
bull High Care Plus or Chronic Disease Management
Enrolment
bull High Proportion of Diagnosed Diabetes who receive
annual reviews
bull But also healthy migrant effects
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Barriers Access to Health
Services
bull Language related barriers
bull Lack of Knowledge about NZ
Health System
bull Cultural Differences in
Assessment and Treatment
bull Lack of Cultural Competency
among Caregivers
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
What can be done
bull Develop Cultural Competency
bull Understand the health practices
among Indian immigrants
bull Being Visual or Using Visual
Methods May Work
bull Skills of working with support
persons or guardians
bull Nonverbal messages of
reassurance and good eye
contact
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
2006 Statement on Cultural Competence (Medical Council of New Zealand)
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
A Useful Resource
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Continuum of Cultural Competency
[source httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf]
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Source
httpwwwasianhealthservicesconzdocumentsPublicationsbestpracticeCALDpdf
Competency Instance of Competency Actions
Cultural
DestructivenessGenocideEthnocide Forced Assimilation
Cultural
Incapacity
Lowered Expectations Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others false sense of
accomplishment inconsistent policies
Cultural
Competence
Advocacy on-going education equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence Fight social discrimination
advocate for social diversity
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
Understanding Health Practices among Indian
Immigrants
Example Patients can use a mix of
traditional Indian medical practices
and modern medicine
lsquoA big problem is the management of burns
Application of toothpaste was common
when I worked in Birmingham ndash and it is
also fairly common here to find toothpaste
applied to burns and scars Itrsquos not a good
idea you have to take it all back off again
They need to know how to cool it with water
and use lint free dressing cling film
perhapsTurmeric is a popular one as well
on cuts and grazesrsquo (nurse 7)
[SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in
healthcare Nurs- ing Standard 27(31)35ndash43 2013]
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
The Power of Visual
ldquoMedication was also prepared in Dosette
boxes for patients ndash as required by the (UK)
Equality act 2010 ndash to make it easier for them
to remember to take their medication and to
confirm visually whether or not they had
taken the dose for the time of the day
lsquoVisually it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
labelrsquo (Pharmacist 3)rdquo
Source
SP Taylor C Nicolle and M Maguire Cross-cultural communication barriers in healthcare Nursing Standard 27(31)35ndash43 2013
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial
In Summary hellip
India and South Asia is a complex region with several different ethnic groups languages and culturally diverse communities
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian subcontinent will benefit all concerned
Individuals from the Indian Subcontinent have characteristic health needs and barriers to access some of them have cultural
Understanding language barriers use of visual cues and others can be beneficial