CULTURALLY RESPONSIVE HEALTH PSYCHOLOGY IHPTP Reducing Health Disparities

Culture and Health

Why Culture Matters

Every conversation is a cultural conversation

Provider patient relationships matter for health outcomes

Health beliefs and ideas of health inform health decisions

Misunderstandings

Communications Style

Mistrust Spirituality Definitions of Health Traditions and Culture Gender Issues/Sexual

Health

Culture Influences…

Perceptions of Health Perception of Illness Perception of Presenting

Problems and Disorders Presentations of

problems and complaints Perception of Treatment

and Solutions

Perceptions of Health Perception of Illness Perception of Presenting

Problems and Disorders Presentations of

problems and complaints Perception of Treatment

and Solutions

Provider Patient

Effects of Culture on Disease Course

Appearance of Illness Symptom Manifestation Disease Course

Cultural influences on selecting responses and presentation of symptoms e.g. cultural factors and stress reaction.

Pathoplastic Effects Pathoselective Effects

Pathofacilitative EffectsCultural factors that increase the risk of disease processes e.g. current mag image of beauty in US and its impact on ED.

Pathogenic EffectsCultural factors that directly cause disease processes. Culturally formed anxiety and stress. Cultural disease impacted by role or demand performance.

Ethnic Differences in Response to Medications

First Pass and Liver Enzymes

Compared to Caucasians Asian Americans had 50% less Haldol in blood

This Data Suggests Some Groups in Asian American Community may metabolize Haldol differently then Caucasian

Many studies indicate slower metabolism of Benzodiazipine medications in Asian Americans.

This has been tested on multiple formulations.

Likely slower metabolism

Neuroleptics Benzodiazepine

Microagrressions Chester Pierce 1970

Microassault: an explicit racial derogation; verbal/nonverbal; e.g.: name-calling, avoidant behavior, purposeful discriminatory actions.

Microinsult: communications that convey rudeness and insensitivity and demean a person's racial heritage or identity; subtle snubs; unknown to the perpetrator; hidden insulting message to the recipient of color.

Microinvalidation: communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person belonging to a particular group.

Rates of Microagression In Health Care

In a study of 218 Native Americans 1/3 reported a microagression from health provider. This was correlated with poor health outcomes.

152 individuals of Asian American herritege were assessed 78% reported experiencing microagressions. Daily rate and overall amount of microagressions predicted increased somatic symptoms and negative affect.

Racial Vigilence: A study of 3105 adults found that for African Americans the rate of racial vigilance relates with increased odds of HTN. For each score increase from 1-12 on scale there was a 4% increased risk of HTN

Microagressions are

common and impact health…

Models of Culture in Health Psychology

Culturally Informed Fx

Assess (CIFA) Cultural Identification Level of Acculturation Eliciting PT

conceptualization of problems. Fx

Assessment of factors initiating and maintaining the problems.

Assess causal explanatory model.

Assess progress & process

EFST Model Explanatory

model of health issues.

Social and environmental factors

Fears and concerns

Treatment undertanding

8 Common Microagressions

Death by 1000 Cuts

1. Use of heterosexist and transphobic terminology

2. Endorsement of heteronormative or gender normative culture/behaviors

3. Assumption of universal LGBT experience

4. Exoticization5. Discomfort/disapproval

of LGBT experience6. Denial of societal

heterosexism or transphobia

7. Assumption of sexual pathology/abnormal

8. denial of individual heterosexism/transphobia

Relational Cultural TherapyMovement from disconnection to connection…

…(RCT), “which focuses on relational development, has been applied in clinical settings, educational institutions, organizations, and businesses around the world, and has been recognized by a co-editor at the American Psychological Association as "one of the top ten psychological theories today."

Humans grow through connection and towards connection over the life

span...

Central Relational Paradox In the face of repeated disconnections, people

yearn even more for relationship, but their fear of engaging with others leads to keeping aspects of their experience out of connection (these are protective strategies of disconnection, also known as strategies of survival).

The individual alters herself or himself to fit in with the expectations and wishes of the other person, and in the process, the relationship itself loses authenticity and mutuality, becoming another source of disconnection.

Key Terms RCTRelational Cultural Theory

Controlling Images: Images constructed by the dominant group that represent distortions of the nondominant cultural group being depicted, with the intent of disempowering them.

Disconnections: Interactions in relationships where mutual empathy and mutual empowerment do not occur; usually involves disappointment, a sense of being misunderstood, and sometimes a sense of danger, violation, and/or impasse. Disconnections may be acute, chronic, or traumatic.

Anticipatory Empathy: Using one's attunement and understanding of an individual to predict the possible impact of one's words or actions on another person; a therapist constantly tries to use anticipatory empathy to get a sense of what might ensue following a particular intervention in therapy.