Final Exam
What inclusive choice should be used in forms, assessments, and conversations to display cultural sensitivity?
"Relationship status"
LGBTQ General Findings
-HIV/AIDS -Substance abuse -Depression and mental health issues -Suicide -Violence -Access to affordable health care Heterosexism and homophobia
Suggestions for working with diverse groups among the aging population
1. Assessments, including a self-assessment questionnaire to survey an individual provider's knowledge of services and identify training needs 2. Identifying community resources 3. Tailoring services 4. Program evaluation
Describe the stages of the health communication model
1. Planning and Strategy Development 2. Developing and Pretesting Concepts, Messages, and Materials 3. Implementing the Program 4. Increasing effectiveness and making refinements
The need for cultural and linguistic competence
1. To respond to current and projected demographic changes in the United States. 2. To eliminate long-standing disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds. 3. To improve the quality of services and health outcomes 4. To meet legislative, regulatory, and accreditation mandates 5. To gain a competitive edge in the marketplace. 6. To decrease the likelihood of liability or malpractice claims.
Approximately how many children are being raised in LGBTQ families?
2 million
National Assessment of Adult Literacy (NAAL) demographic characteristics:
53% of adults had Intermediate, 22% basic, 14% below basic and 12% proficient women scored 6 pts higher than average for men Hispanic adults had lower averages 65 and older have lower health literacy
National Assessment of Adult Literacy (NAAL) who is at risk for low health literacy
80 million Us adults
What organization, in 1994, became the leader in promoting cultural sensitivity among health educators through a well-known publication?
AAHE
Literacy Level basic
Adults at the basic level have the skills necessary to perform simple, everyday activities such as reading and understanding information in short, commonplace texts. An adult at this level might be able to state two reasons a person with no symptoms of a disease should be tested for the disease, based on information in a clearly written pamphlet.
Literacy Level below basic
Adults at the below basic level have the most elementary literacy skills. These skills range from being nonliterate in English to being able to locate easily identifiable information in short, commonplace prose text. An adult at this level might be able to locate and circle the date of a medical appointment on a hospital appointment slip.
Literacy Level Intermediate
Adults at the intermediate level have the literacy skills necessary to perform moderately challenging activities, such as summarizing written text, determining cause and effect, and making simple inferences. An adult with this level of skill might be able to determine a healthy weight range for a person of a specified height on the basis of a graph that relates height and weight to body mass.
Literacy Level Proficient
Adults at the proficient literacy level have the skills to perform complex activities, such as integrating, synthesizing, and analyzing multiple pieces of information. An adult might find the information required to define a medical term by searching through a document.
The negative stereotype and discrimination based on age is called:
Ageism
An ideal partner in planning a health education program for the aging population would be _________________.
American Caregiver Association Meals on Wheels Area Agencies on Aging YMCA Public Health Department YWCA
What is NOT a way to continually assess and evaluate the level of of cultural and linguistic competence in programs?
Annual Assessments
Reasons why some policies and practices may further disadvantage marginalized populations (article)
Asking homeless population to stay away from shelters if they are sick even though winter Goals in public health policy and practice, especially those that we often take for granted and that are supported by epidemiological evidence, ought to be critically evaluated with respect to how they might perpetuate disadvantage among those already disadvantaged. Uses utilitarianism w/o knowing
What is NOT a way that health educators can provide a welcoming, supportive, and inclusive environment for the LGBTQ community?
Assume that all persons in the LGBT community portray the same behaviors
What is NOT a stage in the Health Communication Process published by the National Cancer Institute:
Budget Planning
Historical Perspectives
Communication across cultures has been a dominant and recurrent theme throughout human history. Misunderstanding and mistrust among communities due to lack of effective communication can result in internal or external conflicts. Other people's cultures need to be viewed both as wholes and as made of their own diverse parts rather than stereotypically.
Health educators should place emphasis on what national standard on culturally and linguistically appropriate services?
Communication and Language Assistance
What is a strategy that health educators can use to collect racial, ethnic, or cultural group-specific demographics?
Conduct a needs assessment
Health educators should involve ___________ from the targeted racial and ethnic group during the development of health education programs.
Cultural Brokers
LGBT youth
Depression, family rejection, suicide, substance abuse, homelessness, prostitution, truancy(stay away from school)
Bridging health literacy and culture recommendations
Differentiate among culture, race, and ethnicity Avoid stereotypes Be cognizant of language preference Understand what translation and interpretation are Incorporate CLAS standards Avoid jargon Ascertain acculturation levels Incorporate diversity in teaching methods Use narratives
What framework emphasizes the interrelations of aging, ethnicity and health, and transculture health in collaboration with the field of geriatrics and ethno gerontology?
Ethnogeriatrics
Health promotion interventions found to be effective in one population will always be effective with another group.
False
Health risk communication is a one-way process from health educator to intended audience.
False
The older population is evenly distributed over the 50 states.
False
The rate of HIV infection among among all persons has increased over the past few years.
False
Which population accounts for over half of new and existing HIV cases?
Gay and bisexual men
Gay and Bisexual men
HIV/AIDS, STI, Substance use and abuse, stress, eating disorders
Video: What are the speaker's recommendations, or "tips" to get across borders?
Having curiosity
What is the term for one population to have a disproportionate level of morbidity and mortality compared to another population?
Health disparity
Health Promotion for People with Disabilities: Consequences
Improved health, being empowered, enhanced quality of life, reduced health disparities
What strategies did The Hearthstone use to celebrate different cultures?
In additional to monthly Culture Days, each department honors many cultures during the holidays, inviting staƨ to share their food and holiday traditions with residents. Plans are underway to set up ESL (English as a second language) classes for interested staƨ to be taught by an experienced resident.
Which of the following is not one of the six domains that contribute to interprofessional patient-related care?
Individual functioning
What is NOT one of the six areas that the federal government has committed resources to to eliminate long-standing health disparities?
Influenza
Transgender communities
Lack of access to healthcare, attempted suicide, high unemployment, Risks from injection silicone use, risks from illegally acquired sex hormones
Health Literacy tools
Large font. Assists individuals with visual impairments to read. It is much easier to read a 14 point font than it is to read a 10 point font. Use clear headings. Short subheads in bold break up the text and have a greater visual appeal than a sea of paragraphs without any breaks. Simple words. It is worth repeating that easy-to-understand terminology (e.g., cancer rather than carcinoma) improves the understanding of written material. White space with pictures. The use of culturally appropriate graphics encourages readers to stay with the materials. Be sure to obtain copyright permission before including graphics in your materials; availability on the Web does not mean it is free. Bright contrasting colors. The use of color increases the visual appeal of written materials, although it also increases reproduction costs. Short sentences. While professors and bosses may be impressed with complex and long sentences, the literature suggests that short sentences are better for health education messages. How to. Don't forget to include a how-to section to enable the reader to practice the skills that have been introduced. Simplified Measure of Gobbledygook (SMOG) Readability Formula To use the SMOG formula, researchers do not have to evaluate the entire written document; a sample of thirty sentences is sufficient. The sample consists of ten sentences from the beginning of the material, ten from the middle, and another ten from the end. In this sample, any word with more than three syllables is circled. The circled words are tallied, and the nearest number that equals a perfect square root of this figure is found. Finally, the square root is added to a constant that is equal to 3. The number that is the sum is the grade level required to understand the reading material Readability Assessment Instrument (RAIN) This instrument measures the readability of health-related materials comprehensively; it looks at components of text unity, graphic placement, font color and size, coherence, vocabulary, cultural appropriateness, and so on. To start the evaluation process, investigators must list all the components to be evaluated. Studies found this method effective and easy to administer Fry Readability Method In this method, researchers obtain three samples of one hundred words from a document, omitting 252 headings, and determines the number of syllables in the sample. The average numbers of syllables and sentences are calculated from the three samples and the results used to plot a point on the Fry graph. The x-axis represents the number of syllables in the sample average, and the y-axis represents the number of sentences in the sample average. The graph has a curve with markers that represent grade levels, permitting researchers to identify the grade level of the plotted point that represents the sample Flesch-Kincaid Readability Formula (FK) The FK readability formula (Flesch, 1945) measures vocabulary difficulty. The literature shows that this formula has been used to test the readability of health information materials, although it was not designed to evaluate health materials only. The result of the application of the formula is identification of the grade-school level at which a person can read and understand the text Flesch Reading Ease Score (FRE) The FRE measures the average number of syllables per word and the average number of words per sentence. The score ranges from 0 to 100. It is widely available through a built-in Microsoft Word adequate readability tool. This feature is not turned on by default; therefore, the user must be sure to check the "show readability statistics" function Gunning Fog Index This index measures the average number of words per sentence and percentage of words with more than two syllables. It requires less time to administer than the FRE and FK Readability formula. However, it cannot measure the reading difficulty of text in tables The New Dale-Chall Readability Formula This formula measures the number of syllables per sentence and the percentage of difficult words. It is developed primarily for health education materials with the highest validity when tested for reader comprehension. It is not available in word processing software Suitability Assessment of Materials This tool measures the suitability of print, media, and audiovisual tools. It appears to be the only tool that can assess the influence of illustrations on comprehension. Completing the assessment process can exceed thirty minutes
Examples of specific laws on public health problems
Law: School entry vaccination Public Health issue: herd/individual immunity How law works: require parental behavior Law: Smoking bans/restrictions Public health issue: exposure to smoke Law works: requires behavioral change to alter environment
What are the three branches of the federal government?
Legislature, executive, judicial
Which of the following statements is true regarding the health of lesbian and bisexual women?
Lesbians are less likely to obtain regular Pap smears.
Linguistic competence includes the use of?
Linguistic competence includes the use of communication strategies that are developed from cultural ideals.
List a challenge for partnerships in learning and collaborative efforts to develop effective programs. This question will be manually graded.
Low levels of health literacy is a challenge for partnerships in learning and collaborative efforts to develop effective programs.
What are the CLAS standards?
National Standards for Culturally and Linguistically Appropriate Services in Health Care: provides the framework for all health care organizations to best serve the nation's increasingly diverse communities Principal Standard: 1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. Governance, Leadership, and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources. 3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area. 4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. 7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement, Continuous Improvement, and Accountability 9. . Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations. 10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. 13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness. 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints. 15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.
Explain the concepts representative to all cultures
Paralanguage: language without the words, and it is more vast than the spoken word (loudness, body language, looks, rate, inflections, the use of the active or passive voice, the frequency of the use of I, pauses, and silences) Proxemics: , which refers to the perception and use of personal and interpersonal space, is determined by cultural background There is four interpersonal distance zone characteristics of US culture: intimate, personal, social, and public Nonverbal Language: tends to operate at an unconscious level of awareness but may be more trusted than words
List the three factors in communicating across cultures about health and disease Communication and: Personal health, Community health, Marketing techniques, Language barriers
Personal Health: be mindful of cultural factors on the clients knowledge base, attitude, and behavior, a person must have motivation to change, help individuals who are in situations similar to their by encouraging them (group therapy) Community Health: have to get through to individuals, new releases, radio and tv, and advertisements are good ways to reach a big population, physical environment changes can help people exercise Marketing techniques: brochures, mailings, ads, commercials and social media, necessary to determine target audience prior, people think in different ways, consider dominant culture and subculture cultures Language barriers: language issues play a major role in quality of health care, health care people must have skill in listening, speaking, empathizing, probing, advocating, confronting, conveying, immediacy, caring, and showing concern while responds to needs, language barrier needs to be addressed
What is NOT a factor when communicating across cultures about health and disease?
Place of Employment
What term refers to the perception and use of personal space?
Proxemics
What is a key health indicator among older adults?
Quality of Life
Lesbian and Bisexual women
Reproductive cancers, less likely to receive regular care, inadequate by providers, obesity, heart disease
What is NOT one of the three essential function of a health educator?
Research
Which of the following are the biggest issues common to LGBTQ communities?
Smoking tobacco Using drugs Drinking alcohol All of the answers are correct.
What is a common way to interpret and express the spoken word in many cultural rituals?
Songs and Dances
Racially and Ethnically diverse communities
Subjected to racism and stigma, limited access to healthcare, low SES(household income), Cultural Factors, Legislation
Describe the ways in which Thrive serves seniors and their communities
The 7 major topic areas in Thrive include questions designed to stimulate discussion among your leadership team and board of directors. Thrive also includes resources such as white papers, articles, tools, presentations and business intelligence
Health Promotion for People with Disabilities: Findings from concept analysis
The findings showed that there is a clear need for further research to arrive at a more precise and differentiated understanding of the concept with regard to people with ID
Which health care model would be most appropriate when prescribing physical therapy for a patient who is recovering from hip surgery?
The medical model
Building culturally appropriate health promotion programs
The medical model views health care as sickness. It requires a diagnosis, a treatment plan, and rehabilitation to meet the needs of patients seeking medical treatment. The social model defines health care more broadly and refers to it as more than the absence of disease. It focuses more on an individual's abilities to function with the support of family and community in the social world where they are most comfortable. The health promotion model focuses on disease prevention and delaying disability.
In the communication model, what may be a barrier to effective communication?
The message is too lengthy Not paying attention to non-verbal behavior The sender not using a clear voice All of the listed answers are correct.
Based on the results from the 2003 National Assessment of Adult Literacy, approximately what percent of the adult population 65 years and older were at the proficient health literacy level?
Three
Funding for professional training in cultural competency and diversity is provided by the Affordable Care Act (ACA).
True
Marketing techniques and strategies must frequently be revised when marketing to multiple cultures.
True
What is a good strategy when presenting information to older adults?
Use a quiet place to talk
Strategies to improve health literacy: Written communication, Presentations
Written Communication: Consider who the audience is (e.g., by gender, educational level). Often there is more than one reader. Consider what the reader needs to know. Organize content to meet these needs. Write for the appropriate reading level. Use common, everyday words whenever possible. Use common, everyday words Use other personal pronouns such as you. Use must instead of shall. Avoid using undefined technical terms. Use positive rather than negative words. Avoid using gender-specific terminology. Avoid long strings of nouns. Use the active voice. Use action verbs. Use the present tense Use parallel construction. Be direct. Organization, short sentences and paragraphs, layout, tables, typography evaluate the document Presentations: Be comfortable, face people at all times, speak slowly and clearly, reduce background noise
Video: What are the key words in the definition of culture?
accepted or familiar
Approximately what percentage of homeless youth identify as LGBT?
between 30 and 40
What is the most significant health disparity that the LGBT community faces?
comparative lack of research
What health outcomes are likely from having low health literacy
elderly, minority, poor, and less than high school education
Increasing cultural sensitivity towards LGBTQ
has specific health needs to be recognized and addressed strive to have a welcoming supportive and inclusive environment Physically welcoming environment Culturally sensitive language Dont make assumptions about history
Strategies to incorporate cultural and linguistic competence into health education
health educators must learn to recognize the importance of culture and respect diversity health educators should maintain a current profile of the cultural composition of their community of interest. health organizations, community-based organizations, schools, work sites, and other health-related agencies should provide ongoing cultural and linguistic competence training to health educators and other health staff health educators must involve cultural brokers from the targeted racial and ethnic groups during the development of health education programs. health educators must ensure that health education programs and services are culturally and linguistically appropriate health educators must continuously assess and evaluate the level of cultural and linguistic competence in programs that are under way as well as the organizations where they work.
List strategies to incorporate cultural and linguistic competence in health education
health educators must understand key aspects of culture influence the audience research target audience to identify messages and images that will resonate 1. Acknowledge culture as a predominant force in shaping behaviors, values, and institutions. 2. Understand and reflect the diversity within cultures. In designing messages that are culturally appropriate, the following dimensions are important: Primary cultural factors linked to race, ethnicity, language, nationality, and religion Secondary cultural factors linked to age, gender, sexual orientation, educational level, occupation, income level, and acculturation to the mainstream 3. Reflect on and respect the attitudes and values of the intended audience—for example: Whether the individual or the community is of primary importance Accepted roles of men, women, and children Preferred family structure (nuclear or extended) Relative importance of folk wisdom, life experience, and value of common sense compared with formal education and advanced degrees Ways that wealth is measured (material goods, personal relationships) Relative value put on different age groups (youth versus elders) Whether people are more comfortable with traditions or open to new ways Favorite and forbidden foods Manner of dress and adornment Body language, particularly whether touching or proximity is permitted in specific situations 4. Are based on concepts and materials developed for and with the involvement of the intended audience. Substituting culturally specific images, spokespeople, language, or other executional detail is not sufficient unless the messages have been tested and found to resonate with the intended audience. Formative research with audience members takes on added importance when planners and designers have cultural backgrounds different from those of the intended audience. 5. Refer to cultural groups using terms that members of the group prefer. For example, many people resent the term minority or nonwhite. Preferred terms are often based on nationality, such as Japanese or Lakota. 6. Use the language of the intended audience, carefully developed and tested with the involvement of the audience.
What is the term for the irrational fear or hatred of lesbian, gay, bisexual or transgender people?
homophobia
National Assessment of Adult Literacy (NAAL) assessment findings:
low health literacy is associated with poor communication between patients and health care providers and with poor health outcomes, including increased hospitalization rates, less frequent screening for diseases such as cancer,and disproportionately high rates of disease and mortality associated with increased use of emergency rooms for primary care
Health literacy among older adults
lowest compared to any age group
Ways to acquire linguistic competence
need to understand intricacy of linguistic competence includes use of: bilingual and bicultural or multilingual and multicultural staff; (2) cross-cultural communication approaches; (3) foreign language interpretation services, including distance technologies; (5) sign language interpretation services; (6) multilingual telecommunication systems; (7) print materials in easy-to-read, low-literacy, picture and symbol formats; (8) materials in alternative formats (e.g., audiotape, Braille, enlarged print); (9) materials developed and tested for specific cultural, ethnic, and linguistic groups; (10) translation services; and (11) ethnic media in languages other than English requires those to have capacity respond to health literacy of the population served
Video: What are the challenges in communicating with other nationalities?
people see what they want to see, they don't always see what you see
Describe the ways in which SAGECare provided education on LGBT aging seniors
providers training, technical assistance and educational resources (some in Spanish) through the National Resource Center on LGBT Aging. taught a wide range of senior care staƨ, including those in home care and residential settings, to be more aware of the subtleties of LGBT relationships
Health Promotion for People with Disabilities: Antecedents
situations, events or phenomena that preceded the respective concept Having healthcare access, lack of sensitized healthcare providers,
What are the three recommendations to address the challenges? (article)
support the trend in public health for greater consultation, engagement, and dialogue with marginalized populations in both research and practice there needs to be a greater emphasis on teaching ethics and the philosophy of science in graduate schools or departments of public health health equity impact assessments (HEIA) ought to be considered a viable tool to evaluate the disproportionate impact that proposed public health policies and programs might have on particular populations
Health Promotion for People with Disabilities: Attributes
supporting a healthy lifestyle, providing health education, involving supporters and being person-centered
Cultural and linguistic competence in health education
the field of health education continues to lag in addressing cultural and linguistic competence for its people.
The context of ethnogeriatrics
the interrelations of aging, ethnicity, and health, transculture health in all human cultures—"a transcultural ideal of freedom embracing all the peoples of the world" in collaboration with the field of geriatrics and ethno gerontology.
In regard to personal space, in the United States, most people feel comfortable with a ______ radius of public space.
three-foot
What is the concept of "utilitarianism"?
to act so as to produce the most good for the greatest number of people
Ways to improve health literacy
use plain language, education, and improve access to resources and information
What would be an example of a health educator serving a client at the macro-level?
working with the American Diabetes Association
Major findings from LGBT Survey (Massachusetts), Executive Survey
■Among the LGBT population, the health of bisexual and transgender people is somewhat worse than their heterosexual and non-transgender counterparts ■Lesbians were less likely to have routine pap tests compared with their heterosexual female counterparts ■Transgender persons had worse outcomes with respect to self-reported health, disability status, depression, anxiety, suicide ideation, and lifetime violence victimization ■Legally-married same sex couples were more likely to obtain health insurance through their spouse's employer than non-legally same sex couples
"Why More Hospitals should Prioritize Cultural Competency": Practice II
■Be alert for, and responsive to, mental health challenges -Lessons learned from the response to Hurricane Katrina -Health care responders did not properly screen for mental illness -Geopolitical pressures also affect populations disproportionately -Be proactive -Lack of access to mental health care services
"Why More Hospitals should Prioritize Cultural Competency": Practice I
■Be creative and open about addressing language barriers -Patient safety is compromised when a language barrier makes it impossible to make an initial assessment or diagnosis -Be aware of special challenges -Be aware of the limitations of using family or non-medical staff as interpreters -Identify patients with limited English proficiency; use plain language and other methods to demonstrate points
"Why More Hospitals should Prioritize Cultural Competency": Practice III
■Be mindful of stereotypes -People may feel anxiety or withdraw if they feel they are perceived negatively -This threat impedes successful treatment -Offer ways to reduce stress -Providers should also explore policies and practices that enhance treatment for people from different communities
