Cultural Aspects of Geriatric Care: The Latino

ExperiencePresented by

Gregory A. TalaveraChief of Research

San Ysidro Health Center, Inc

12-4-16

Learning Objectives

• Define issues related to cultural competency in the care of Latinos– Individual level– Systems/Structural/Organizational

• Introduce a Cultural Framework for change• Devise strategies to enhance skills toward the

provision of care in a culturally competent manner

Perspectives

Cultural Destructiveness

Cultural Incapability

Cultural Blindness

Cultural Pre-Competence

Cultural Competence

Cultural Proficiency

Source: NAHH (2007)

Towards Cultural Proficiency for Health Care Organizations

Holding culture in high esteem

Acceptance of and respect for differences

Movement towards reaching out to other cultures

Predominant system… Philosophy of being unbiased

No capacity to help clients from other cultures

Destructive to other cultures

Health Provider Perspective

• Linguistic & Cultural Competency– Individual level– Systems level

Definitions and Concepts

What is Culture?

• How we conceptualize health & illness stems from culturally-derived (culture-bound) health beliefs

• These may be known or unknown to the individual and/or provider

What is Culture?

• System of meaning and symbols that: – frames the way people locate themselves within

the world, – perceives the world, and– finds meaning within the world

• General socio-economic, cultural and environmental level of ecological model.

Culture: 5 Basic Criteria• Common pattern of communication, sound

system, or language unique to the group• Similarities in dietary preferences and

preparation methods• Common pattern of dress• Predictable relationship and socialization pattern

patterns among members of the culture• Common set of shared values, beliefs and

practices• Slonim, 1991 (in Huff and Kline)

Comparison of Common Values

May, 1992

Values and FamilyUnited Way, 1991

MainstreamLatino, other

Cultural Factors

that Affect

Latino Care

Cultural beliefs and

use of complementa

ry and alternative medicine

Traditional gender roles

Level of acculturation (adoption

of mainstream

culture)

Role of religiosity/ spirituality in health

Family-centeredne

ssand decision- making

The Magic

• What we see as science, Native Americans see as magic; what we see as magic, Native Americans see as science.

• Hammerschlag, 1988

notes

Cultures on Parade

Culture on Continuum

Traditional

Health Beliefs

Western

Health beliefs

Acculturation: the European model

Primary culture Secondary culture

(Assimilation)

(Mexican) (American)

Two Dimensional Acculturation

Low American

High American

Low Non-dominant High Non-dominant

III

III IV

Acculturation along Border

Primaryculture

mainstream“American”

Blended/BorderCulture

Border Health Culture• Blended pattern of communication, language

unique to the area (terms and concepts)• Blended dietary preferences, purchasing

patterns and preparation methods• Medication access on both sides• Health seeking behavior: self-limited illness

and self-medication• Culture-bound beliefs and practices related to

alternative remedies• Adapted form Slonim, 1991 (in Huff and Kline)

Ethnocentrism:

• The tendency to view one's own cultural group as the center of everything

• the standard against which all others are judged

• It assumes that one's own cultural patterns are the correct and best ways of acting

Clinically-relevantCulture-bound beliefs

• Examples (later we will discuss approaches)– Susto, Hot and cold theory of illness– Use of complementary & alternative medicine

• Tea for diabetes• Nopales for diabetes

– Concepts of illness prevention– Illness has symptoms

Your Goal: Competence

• Having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs behaviors, and needs presented by consumers and their communities.

• Embracing these differences

Cultural Destructiveness

Cultural Incapability

Cultural Blindness

Cultural Pre-Competence

Cultural Competence

Cultural Proficiency

Source: NAHH (2007)

Towards Cultural Proficiency for Health Care Organizations

Holding culture in high esteem

Acceptance of and respect for differences

Movement towards reaching out to other cultures

Predominant system… Philosophy of being unbiased

No capacity to help clients from other cultures

Destructive to other cultures

Summary

• Where are you on the ethnocentric & cultural competency continuum?

• How does knowledge of the culture improve your communication skills and service to seniors?

• What are you doing to create system change in your environment?