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    Cultural Competence in Health Care: Is it important for people with chronic conditions?

    Visit profiles to view data profiles and issue briefs from the series Challenges for the 21st Century: Chronic and Disabling Conditions as well as data profiles on young retirees and older workers. The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and […]

    Cultural Competence in Health Care: Is it important for people with chronic conditions?

    Visit profiles to view data profiles and issue briefs from the series Challenges for the 21st Century: Chronic and Disabling Conditions as well as data profiles on young retirees and older workers.

    The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

    Racial and ethnic minorities are disproportionately burdened by chronic illness

    Racial and ethnic minorities have higher morbidity and mortality from chronic diseases. The consequences can range from greater financial burden to higher activity limitations.

    Among older adults, a higher proportion of African Americans and Latinos, compared to Whites, report that they have at least one of seven chronic conditions — asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/ depression.(2) These rank among the most costly medical conditions in America.(3)

    African Americans and American Indians/Alaska Natives are more likely to be limited in an activity (e.g., work, walking, bathing, or dressing) due to chronic conditions.(4)

    The population at risk for chronic conditions will become more diverse

    Although chronic illnesses or disabili- ties may occur at any age, the likelihood that a person will experience any activity limitation due to a chronic condition increases with age.(5) In 2000, 35 million people — more than 12 percent of the total population — were 65 years or older.(6) By 2050, it is expected that one in five Americans — 20 percent — will be elderly. The population will also become increasingly diverse (see Figure 2). By 2050, racial and ethnic minorities will comprise 35 percent of the over 65 pop-ulation.(7) As the population at risk of chronic conditions becomes increasingly diverse, more attention to linguistic and cultural barriers to care will be necessary.

    Access to health care differs by race and ethnicity

    Having a regular doctor or a usual source of care facilitates the process of obtaining health care when it is needed. People who do not have a regular doctor or health care provider are less likely to obtain preventive services, or diagnosis, treatment, and management of chronic conditions. Health insurance coverage is also an important determinant of access to health care. Higher proportions of minorities compared to Whites do not have a usual source of care and do not have health insurance (see Figures 3A and 3B).

    Language and communication barriers are problematic

    Of the more than 37 million adults in the U.S. who speak a language other than English, some 18 million people — 48 percent — report that they speak English less than “very well.”(8) Language and communication barriers can affect the amount and quality of health care received. For example, Spanish-speaking Latinos are less likely than Whites to visit a physician or mental health provider, or receive preventive care, such as a mammography exam or influenza vaccination.(9) Health service use may also be affected by the availability of interpreters. Among non-English speakers who needed an interpreter during a health care visit, less than half — 48 percent — report that they always or usually had one.(10)

    Language and communication problems may also lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care. Spanish-speaking Latinos are less satisfied with the care they receive and more likely to report overall problems with health care than are English speakers.(11) The type of interpretation service provided to patients is an important factor in the level of satisfaction. In a study comparing various methods of interpretation, patients who use professional interpreters are equally as satisfied with the overall health care visit as patients who use bilingual providers. Patients who use family interpreters or non-professional interpreters, such as nurses, clerks, and technicians are less satisfied with their visit.(12)

    Low literacy also affects access to health care

    The 1992 National Adult Literacy Survey found that 40 to 44 million Americans do not have the necessary literacy skills for daily functioning.(13) The elderly typically have lower levels of literacy, and have had less access to formal education than younger populations.(14) Older patients with chronic diseases may need to make multiple and complex decisions about the management of their conditions. Racial and ethnic minorities are also more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities.(15) Low literacy may affect patients’ ability to read and understand instructions on prescription or medicine bottles, health educational materials, and insurance forms, for example. Those with low literacy skills use more health services, and the resulting costs are estimated to be $32 to $58 billion — 3 to 6 percent — in additional health care expenditures.(16)

    Source : hpi.georgetown.edu

    Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in Rural Northern Ghana

    Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health ...

    J Community Health. 2018; 43(1): 157–163.

    Published online 2017 Jul 5. doi: 10.1007/s10900-017-0398-4

    PMCID: PMC5767209 PMID: 28681282

    Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in Rural Northern Ghana

    Eva Krah,1,2 Johannes de Kruijf,3 and Luigi Ragno4

    Author information Copyright and License information Disclaimer

    This article has been cited by other articles in PMC.

    Go to:

    Abstract

    Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health care. Moving beyond literature, it stresses the importance of trust-relationships between healers and biomedical staff. Insights are based on qualitative research conducted in Ghana’s Northern Region (2013–2014). Five challenges to integration emerged out of the data: a lack of understanding of traditional medicine, discrimination, high turnover of biomedical staff, declining interest in healing as a profession, and equipment scarcity. Besides challenges, opportunities for integration exist, including the extensive infrastructure of traditional medicine, openness to collaboration, and grassroots initiatives. Contemplating challenges and opportunities this paper provides recommendations for integration, including: identify/select healers, promote best practices, institute appropriate forms of appreciation/recognition of healers, provide aid and equipment, use communication campaigns to promote integration and steer attitudinal change towards healers among biomedical staff. Most crucial, we argue successful implementation of these recommendations depends on a concerted investment in relationships between healers and biomedical staff.

    Keywords: Traditional medicine, Ghana, Integration, Rural health care

    Go to:

    Introduction

    Despite progress such as the establishment of the National Health Insurance Scheme (NHIS) in 2004, Ghana’s biomedical health care system continues to face profound challenges. A primary challenge is its accessibility, particularly in smaller rural communities. Recent surveys show that 70% of the Ghanaian population lives in areas with insufficient access to biomedical healthcare [1]. Reports indicate the physician-to-population ratio in Ghana is 1:20,000 [1–3]. In northern rural regions, where this study is situated, this ratio is 1:100,000 [3].

    Traditional1 healing is the most common alternative to biomedicine in Ghana. The traditional healer-patient ratio in rural areas is 1:200 [4]. Evidence shows 80% of the rural populations rely upon traditional medicine (TM) for primary health needs [5, 6]. This can be explained by the accessibility and affordability of TM [1, 7]. Whilst Ghanaian health insurance often proves inadequate, traditional healers usually do not charge in advance. Instead, they are compensated with a small (monetary) gift if patients indeed recover [1, 7, 8]. Furthermore, TM is often considered most effective. Also, unlike biomedicine, it is embedded in cultural and moral value systems and consistent with hegemonic traditions and (religious) beliefs [1, 2, 9].

    Considering the vitality of TM in Ghana, and the challenges of biomedicine, this paper makes an argument for integrating traditional healing and biomedical health care, as an effective and sustainable way of expanding the reach and outcomes of health care in Ghana.2 It adds to the body of literature that, following the WHOs (1978) commitment to promote the inclusion and integration of traditional practitioners in national health programmes [10], assesses collaborations between traditional healing and biomedical health care across sub-Saharan Africa [2, 3, 11–19]. Studies indicate such collaborations are complex and often ineffective [12, 13, 20]. This paper assesses problems hindering integration, while foregrounding opportunities. Recommendations are provided on how to facilitate integration of traditional healers into Ghana’s formal health care system. Our core argument concerns the paramountcy of interpersonal relationships between healers and biomedical staff. For successful implementation of all recommendations, a structural and heavy investment in these relationships is indispensable. Considering parallels in health care across sub-Saharan Africa, the Ghanaian case facilitates understanding of similar cases throughout the region.

    Go to:

    Methods

    Setting

    The principal investigator (PI) conducted 6 months of research in two areas in Ghana’s northern region (NR): Dalon (Tolon-Kumbugu district) and Walewale, the capital of West-Mamprusi. Most data was gathered in Walewale where the PI lived. Its residents are mainly Mampruli-speaking Muslims. The PI travelled almost daily to nearby villages to interview traditional healers in their homes.

    Study Design and Participants Selection

    This study employs ethnographic research methods to gain an in-depth understanding of (often concealed) practices and beliefs concerning traditional healing. Investing time and effort in trust-relationships with healers and patients was crucial. To facilitate this, the secretary of the local Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM) served as an assistant and gate-keeper. He introduced the PI to GHAFTRAM healers through snowball sampling and functioned as a cultural advisor and interpreter. Understanding and trust built over time alleviated the healers’ concerns that the PI was trying to “steal” their herbal concoctions for profit, and enabled respectful and appropriate conduct. Similarly, a local female research assistant interpreted during interviews with predominantly (>95%) female traditional birth attendants (TBAs).

    Source : www.ncbi.nlm.nih.gov

    Nursing 1010 Culture Flashcards

    Start studying Nursing 1010 Culture. Learn vocabulary, terms, and more with flashcards, games, and other study tools.

    Nursing 1010 Culture

    what is culture

    Click card to see definition 👆

    IT IS THE VALUES, BELIEFS, STANDARDS, LANGUAGE, THINKING PATTERNS, BEHAVIORAL NORMS, COMMUNICATION STYLES SHARED BY A GROUP OF PEOPLE.

    IT GUIDES DECISIONS AND ACTIONS OF A GROUP THROUGH TIME

    WE HAVE AN OBLIGATION TO BE RESPECTFUL TO A BELIEF SYSTEM THAT ISNOT OUR OWN. HEALTH CARE WORKERS MUST BE CULTURALLY COMPETENT AND COMFORTABLE WITH THOSE THEY SERVE. HEALTH CARE WORKERS

    SHOULD UNDERSTAND HOW THEIR OWN PERSONAL BIAS AND VALUES INFLUENCE COMMUNICATION WITH CLIENTS, FAMILIES AND CO-WORKER

    Click again to see term 👆

    culture competence

    Click card to see definition 👆

    1. Value diversity

    2. Assess themselves

    3. manage the dynamics of difference

    4. Acquire and institutionalize cultural knowledge

    5. adapt to diversity and the cultural contexts of individuals and communities served."

    Click again to see term 👆

    1/66 Created by Sarah_Ali262

    Terms in this set (66)

    what is culture

    IT IS THE VALUES, BELIEFS, STANDARDS, LANGUAGE, THINKING PATTERNS, BEHAVIORAL NORMS, COMMUNICATION STYLES SHARED BY A GROUP OF PEOPLE.

    IT GUIDES DECISIONS AND ACTIONS OF A GROUP THROUGH TIME

    WE HAVE AN OBLIGATION TO BE RESPECTFUL TO A BELIEF SYSTEM THAT ISNOT OUR OWN. HEALTH CARE WORKERS MUST BE CULTURALLY COMPETENT AND COMFORTABLE WITH THOSE THEY SERVE. HEALTH CARE WORKERS

    SHOULD UNDERSTAND HOW THEIR OWN PERSONAL BIAS AND VALUES INFLUENCE COMMUNICATION WITH CLIENTS, FAMILIES AND CO-WORKER

    culture competence 1. Value diversity

    2. Assess themselves

    3. manage the dynamics of difference

    4. Acquire and institutionalize cultural knowledge

    5. adapt to diversity and the cultural contexts of individuals and communities served."

    cultural competence

    • Cultural Competence: the ability of health care providers and organizations to understand and respond effectively to the cultural and language needs brought by the patient to the health care encounter. Cultural competence requires organizations and their personnel to acknowledge the existence of cultural diversity

    ways to achieve cultural competence

    • RECOGNIZE THE UNIQUENESS OF AND DEMONSTRATE RESPECT FOR INDIVIDUALS AND FAMILIES OF CULTURES OTHER THAN YOUR OWN.

    • DEMONSTRATE KNOWLEDGE AND UNDERSTANDING OF THE CLIENT'S CULTURE, HEALTH-RELATED NEEDS, AND MEANING OF HEALTH AND ILLNESS.

    • IF UNFAMILIAR ABOUT THE CLIENTS CULTURE, ASK THE CLIENT. RECOGNIZE SOME CULTURAL

    GROUPS MAY HAVE A DIFFERENT DEFINITION OF HEALTH AND ILLNESS AND HEALING PRACTICES THAN YOUR OWN

    ways to achieve cultural competence

    • RESPECT THE UNFAMILIAR AND LEARN ABOUT IT SO IT BECOMES FAMILIAR. BE OPEN TO CULTURAL ENCOUNTERS. IDENTIFY YOUR OWN CULTURAL BELIEFS AS YOU LEARN ABOUT OTHERS

    • BE WILLING TO MODIFY THE DELIVERY OF HEALTH CARE TO BE MORE CONGRUENT WITH THE CLIENT'S CULTURAL BELIEFS

    cultural desire

    "Motivation of the healthcare professional to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful and seeking cultural encounters; not the "have to".

    cultural awareness

    • The process of conducting a self-examination of one's own biases and possible prejudices when working with specific groups of clients

    towards other cultures and the in-depth exploration of one's cultural and professional background.

    • Cultural awareness also involves being aware of the existence of documented racism and other "ism" in healthcare delivery"

    cultural knowledge

    "the process in which the healthcare professional (or other person) seeks and obtains a sound educational base about culturally diverse groups"

    It is also about understanding the groups world views which will explain how members of a group interpret their illness and how being a part of this group guides their thinking, doing, and being

    cultural skill

    •Is the ability to conduct a cultural assessment to collect relevant cultural data regarding the client's immediate problem as well as accurately conducting a culturally based physical assessment

    cultural encounters

    • "the process which encourages the healthcare professional to directly engage in face-to-face cultural interactions and other types of encounters with clients from culturally diverse backgrounds in order to modify existing beliefs about a cultural group and to prevent possible stereotyping"

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