Cultural Competency Exam 1

4 areas necessary for lifelong change of health educator

Awareness Knowledge Experience Skills

What population has the highest life expectancy of any other racial or ethnic group in the US? non-Hispanic men Asian women African American women Hispanic men

Asian women

What is NOT one of the three key elements in health promotion? Health literacy Good governance for health Health equity Healthy cities

Health equity

What is the leading cause of death among the White population? Unintentional injuries Cancer Stroke Heart disease

Heart disease

Diversity

A dynamic philosophy of inclusion based on respect for culture, beliefs, values, and individual differences

Major social determinants of health

Access to care Insurance coverage Employment Education Access to resources Income Housing Transportation Economic stability Neighborhood and Built environment Health and Health care Social and community context

What is a method that a dominant culture may use to consolidate their power? Money Fear Force All of the answers are correct

All of the answers are correct

Who should be involved in developing a culturally-competent practice? Patients Advocacy Groups Family Members All of the answers are correct.

All of the answers are correct.

What is the most important thing a person can do to consider the influence of one's own biases and beliefs and the impact it may have on service delivery? Collaborate with other health care professionals. Complete a self-assessment. Integrate the patients' traditions, customs, and values in service delivery. Ask for feedback from your supervisor.

Complete a self-assessment

In the cultural competence continuum, what level of competence is on the most negative end (or the far left side of the continuum)? Cultural Incapacity Cultural Pre-Competence Cultural Destructiveness Cultural Blindness

Cultural Destructiveness

Cultural pre-competence

Desire to deliver quality service, commitment to diversity indicated by hiring minority staff, initiating training and recruiting minority members for agency leadership. Lacks information on how to maximize these capacities. Leads to TOKENISM

HHS

Health and Human Services, under the CDC Made to reduce racial and ethnic health disparities & stress importance of workforce diversity and reduction of racial and ethnic disparities

What is the largest ethnic minority group, and one of the fastest-growing population groups, in the US? American Indians and Alaska Natives Hispanics Native Hawaiians/Pacific Islander Asians

Hispanics

CAM for musculoskeletal pain

Typically for back pain, also neck, joint, and arthritis. Also frequently for head/chest colds (in 2002), less now.

Strategies for developing spiritual competence

self-assessment consultation religious norms epistemological humility

Botanica

typical healer who provides healing products, typically spiritual

Atheism

there is no God

What characteristic is true about Native Hawaiians and other Pacific Islanders? Over 50% of this population reside in Hawaii and Arizona. This population has higher rates of smoking, alcohol consumption, and obesity than other racial and ethnic groups do. A higher percentage of this population is married compared to non-Hispanic whites. In 2010, the median age for this group was 6 years less than the median age of non-Hispanic whites.

This population has higher rates of smoking, alcohol consumption, and obesity than other racial and ethnic groups do.

T/F: cultural competence is achieved at one point and then finished for life.

False. It is an ongoing, complex process that changes with demographics of the population

Health (value)

Group's view of physical, mental, emotional, and social components of person's health

Can CAM help with anxiety/depression, or stomach/intestinal illness? Cholesterol?

Has been used. Usage is decreasing though More usage for cholesterol 2007 than 2002

What are the rankings of languages spoken in US, highest to lowest frequency?

English (80%), Spanish, other Indo-European, Asian-Pacific Islander, and other

How does CAM usage compare by race?

Highest in whites

What causes 1/4 of global disease burden?

environmental factors

Epistemology

ways of learning, cognitive processes

Culture

An integrative pattern of human behavior that includes languages, rituals, and customs

CLAS

Cultural and Linguistically appropriate services Intended to advance health equity, improve quality, and eliminate health care disparities

Morbidity indicators

Environmental quality Mental health Nutrition, physical activity, and obesity Oral health Tobacco

Groups that are less common to attend church/most commonly stopping church now are:

Males Non=married 18-29 Asian

The Ulysses Syndrome forms a gateway between mental health and ____ cultural competence health inequity chronic disease mental disorder

Mental disorder

Which of the following is TRUE regarding data from the U.S. Census Bureau? The majority of the foreign-born population came from Europe. The fastest growing age group is those 45-64 years. The population will become less diverse. The majority of the population will be concentrated in urban areas.

The majority of the population will be concentrated in urban areas.

T/F: CAM practices among Hispanic/Latino populations are highly influenced by religious beliefs

True

What influences demographic shifts?

births, immigration, deaths, emigration (BIDE, or they pair together)

Even though they no longer represent a majority of US society, what population continues to establish the mainstream culture? Asian men White women Hispanic men White men

White men

What would be the ideal health promotion setting for the 26-64 age group? School Private sector Hospital Workplace

Workplace

What modality of traditional and folk modalities of CAM used in the 2007 NHIS uses a traditional health or practitioner with knowledge of the medicinal qualities of plants? Botanica Curandero Hierbero Espiritista

Hierbero

What is the largest minority group in the US?

Hispanics. They are also the fastest growing population

Culture proficiency

Hold culture in high esteem, seek to add to knowledge base of culturally competent practice by conducting research, influence approaches to care, improve relations between cultures. Promote self-determination

What is the first stage of adjustment that newcomers experience when they enter into a new culture? Conformity stage Honeymoon/euphoria stage Dissonance stage Introspection stage

Honeymoon/euphoria stage

Cultural competence

acceptance/respect for difference continuing self-assessment, careful attention to dynamics of difference, continuous expansion of knowledge and resources and adaptation of services for needs of diverse populations.

cultural universals

certain behavioral traits and patterns seen the same in every culture. Look at how art, jewelry, and the classification of people differ with gender and age. Prestige and wealth can be seen differently in different cultures. Relations based on blood relationships and marriages, differentiated by good and bad

Why are social determinants of health important?

they affect up to 40% of overall health of an individual, with education as the largest predictor. Look at root cause instead of result

What are the rankings of ethnic groups in US by population, most to least?

white only, Hispanic/Latino, Black/African alone. If RACIAL groups, Black is second largest (Hispanic is not a race)

The lead federal entity supporting scientific research in CAM areas, the NCCAM, was created in what year?

1998

Estimates are that by 2050, the Hispanic population will account for what percent of the total population? 50% 40% 30% 20%

30%

Adoption

Organizational decision to adopt CLAS standards

What is NOT an appropriate practice in respecting the rights of patients? Persuade the patient to follow your treatment recommendations. Be willing to incorporate cultural practices into treatment plans. Show respect for the dignity of all patients. Treat all patients with the same level of respect.

Persuade the patient to follow your treatment recommendations.

Which of the following would be considered a natural product? Acupuncture Light therapy Probiotics Massage therapy

Probiotics

T/F: Age group of 65+ is increasing by the greatest percentage each year

TRUE! (Baby boomers are growing up)

Civil Rights Act of 1964

Title VI: non one shall be denied benefits or subjected to discrimination on the basis of race, color, or national origin under any program or activity receiving federal financial assistance

Curandero

Traditional folk healer, treat with supernatural forces, herbal remedies, and other medicines

Conventional medicine

biomedicine or allopathic care body of scientific knowledge practiced by doctors of medicine, doctors of osteopathic medicine, and allied professionals

integrative medicine

combination of conventional practices and CAM therapies

Steps to culturally competent practice (4)

conduct initial assessment evaluate capacity define goals implement changes

Findings from the gap analysis performed by the joint commission

consistency between standards for CLAS recognized that accreditation standards were less prescriptive and therefore inadequate for evaluating hospital compliance with CLAS

Espiritista

traditional healer. Assesses patients condition, recommends herbs or amulets to improve the person's physical or mental help, or to help them overcome a personal problem.

Hierbero/Yerbera

traditional healer/practitioner, knowledge of medicinal properties of plant

agnostic

unknown or unsure of God's identity or presence

An orthopedic clinic created a committee to review evidence-based practices regarding the actual use of CLAS in patient care and was asked to provide recommendations on their possible use in the clinic. This would be an example of what in the conceptual model? Improved Patient Outcomes Implementation Adoption System Readiness

Implementation

What is necessary when considering the financial constraints of the organization in developing a culturally-competent practice? Resources needed for building a culturally-competent practice should be analyzed on an "as needed" basis. Move forward with culturally-competent care regardless of resources. Incorporate financial resources for translators into the annual budget. Implement culturally-competent practices on funding rather than priorities.

Incorporate financial resources for translators into the annual budget.

What agency provides a comprehensive health delivery system for American Indians and Alaska Natives? Indian Health Service Centers for Medicaid and Medicare Services Office of Minority Health Centers for Disease Control and Prevention (CDC)

Indian Health Service

Focus areas of disparities

Infant mortality Cancer screening and management Diabetes HIV Infection and AIDS Immunizations

Cultural destructiveness

Intentional attitudes/policies/practices, destructive to cultures and consequently individuals within the cultures

What point along the cultural competence continuum is characterized by the belief that helping approaches traditionally used by the dominant culture are universally applicable? Cultural Pre-Competence Cultural Incapacity Cultural Blindness Advanced Cultural Competence

Cultural Blindness

In the conceptual model approach for dissemination of the presentation of innovations related to cultural competency, which of the following would NOT be a system antecedent? The reduction of errors Human resources Administration leadership Performance measurement system

The reduction of errors

List examples of health values

Traditional western medicine Preventative medicine May not disagree with recommendation of health care providers, even if they do not agree/believe Illness is God's will Oldest family member may make decisions of other family members Illness viewed as imbalance between ill person and supernatural force

5 Major goals of HHS

Transforming health care (holistic at social determinants of health) Strengthening infrastructure and workforce Advancing health, safety, and well-being of American people Advancing scientific knowledge and innovation Increasing efficiency, transparency, and accountability

What would NOT be an ideal step in improving cultural competency? Moving away from the belief that one's way of life is more desirable and superior to others. Take time to learn about a patient's culture, language, experience, and history. Demonstrate respect for the patient by integrating personal preferences into assessment and treatment. Treating all patients the same, regardless of cultural beliefs.

Treating all patients the same, regardless of cultural beliefs.

T/F: diversity of US is increasing

True

T/F: Tobacco is most preventable indicator of morbidity.

True. Also the most costly

What race is Type II Diabetes more common in? Type I?

Type II Diabetes more common in Native Americans. Type I most common with African Americans

Which of the following is TRUE regarding developing cultural competency? Developing cultural competency is a simple process. Understanding one's own culture is the first step in developing cultural competence. Learning cultural competency is a one-time process. Interactions with individuals from various cultures do little to expand knowledge of cultural competency.

Understanding one's own culture is the first step in developing cultural competence.

In relationship to cultural competency, what does the acronym CLAS stand for?

Culturally and linguistically appropriate services

Is the Catholic population increasing or decreasing?

increasing, due to Latin American immigration. Christian overall is decreasing.

System antecedents

Core management and clinical structures and process, barriers and facilitators of CLAS. What's there before process of cultural competency begins?

T/F: self-assessment is optional

False. It is necessary, important to know your own biases

Highest use of CAM therapies by racial and ethnic groups in order

American Indian/Alaska Natives Native Hawaiian and other Pacific Islanders Non-Hispanic Whites Asians Black/African Americans Hispanics

3 dimensions of spiritual competence as defined by Hodge

Awareness of one's personal worldview Understanding of client's spiritual worldview and psychological appreciation for it, holistic understanding Ability to design and implement intervention strategies that are appropriate, relevant, and sensitive to clients spiritual worldview

Edburg's Perspectives

Classic Symbolic Ideologic Materialistic Linguistic Mental or Cognitive Cultural and Biocultural (these define culture) Can Some Idiots Mean Literally Milk Chocolate?!

OMH (Office of Minority Health) opinion of what culture and language may influence

Health & healing belief systems Perception of illness and causes Behaviors of patients in seeking care Patient attitudes towards healthcare providers Attitude of healthcare provider to patient

IS CAM popularity increasing or decreasing overall? What is CAM?

Increasing. natural products, deep breathing exercises, meditation, chiropractice care, yoga, massage, and diet-based therapy. They are medical/health care practiced, systems or products not included in conventional medicine, and thereby not typically covered by insurance

What trends have been found in very religious and moderately religious people for their health practices?

More likely to have healthy behaviors More likely to be non-smokers More likely to report 5+ servings of fruits/vegetables

Improved patient outcomes

REDUCE ERRORS w/language and culture REDUCE HEALTH DISPARITIES IMPROVE PATIENT EXPERIENCE with care, either bc of satisfaction at being heard or more culturally appropriate

Folk medicine

Treatment of illnesses through remedies and therapies based on experience and knowledge transmitted through generations

Spirituality

emotional/experiental expression of "feelings or experiences of awe, wonder, harmony, peace, or connectedness with the universe or a higher power"

Hill-Burton Act

enacted by congress in 1946 encouraged the construction and modernization of public and nonprofit community hospitals and health centers

pantheism

god is everywhere

deism

higher power, no personal God

Is religious non-denominational identity increasing or decreasing in the US?

increasing (more Christian than Catholic). Decline of overall church attendance

Implementation

often waves/priorities. Actual use of standards in health care organizations

Community based participatory research model

partnership-based research model begins with a research topic important to the community. community is a central part of the research

Religion

practice or participation in culturally based activities, including prayer, meditation, attendance at services, reading religious texts, and performance of rituals

Emergency Medical Treatment and Active Labor Act (EMTALA)

requires hospitals that receive medicare dollars to treat all emergency patients including pregnant women without regard for their ability to pay

epistemological humility

same as CULTURAL humility

Latino Paradox

AKA Hispanic Paradox, or Healthy Immigrant Effect Epidemiological finding, Hispanic and Latino americans have paradoxically comparable or high health outcomes to non-Hispanic Whites, despite lower than average income/education. Longer in US, worse health becomes

A lack of cultural competency may result in which of the following? Liability/Malpractice claim Miscommunication between provider and patient Lack of adherence to treatment plan All of the answers are correct

All of the answers are correct

Activities such as drumming and chanting, dancing, use of herbs, and acupressure would be common CAM practices among what racial/ethnic group? Latinos/Hispanics African Americans Asian and Pacific Islanders American Indian and Alaska Natives

American Indian and Alaska Natives

What would NOT be considered a factor in culture and cultural diversity? Gender identity Veteran status Language Annual salary

Annual Salary

Which population places a high significance on extended family, where the oldest male in the family is often the decision maker and spokesperson? Whites American Indians/Alaskan Natives Asians/Pacific Islanders Hispanics

Asians/Pacific Islanders

According to the National Health Interview Survey (2007), the highest percentage of adults used CAM therapies for what musculoskeletal condition? Neck pain Back pain Joint pain Arthritis

Back pain

Cultural blindness

Belief that service/helping approaches used by dominant culture are universally applicable regardless of race/culture. Services ignore cultural strengths and encourage assimilation

What modality of CAM as defines for the 2007 NHIS uses simple electronic devices to teach clients how to consciously regulate bodily functions? Hypnosis Alexander technique Biofeedback Chelation therapy

Biofeedback

Which state has the largest percentage of residents who speak a language at home other than English? New Mexico California Florida Texas

California

What did Walter say was most important recommendation for working with diverse groups?

Developing trust

In the conceptual model for dissemination of standards into clinical practice, which behavioral theory is used within the framework? Theory of Planned Behavior Diffusion of Innovation Social Cognitive Theory Health Belief Model

Diffusion of Innovation

Across all ethnic/minority groups, which category of CAM was used the least? Manipulative and Body-Based Practices Energy Medicine Biologically-Based Practices Mind-body Medicine

Energy Medicine

In the values framework, the area of difference based on cognitive process or affective domain is called: Ontology Epistemology Axiology Concepts of self

Epistemology

T/F: The use of CAM therapies is lesser for children whose parents have used CAM therapies.

False

List 5 ways to avoid stereotyping

Learn characteristics/preferences of different racial ethnic groups. Become aware of how they ask questions of individuals when addressing their needs. Educate others how stereotypes affect the process of health education. Create safe environment environment where individuals feel free to discuss any health issues/concerns without judgement. Reflect on other ways, not just health education but general life.

What is NOT a way that health educators can avoid stereotyping? Educate others on how stereotypes affect the process of health education Become aware of how they ask questions of the individual Make a judgement about a client prior to meeting with them Learn the characteristics of the different racial and ethnic groups

Make a judgement about a client prior to meeting with them

What strategy would be appropriate when delivering services to marginalized populations? Offer services from 8am-5pm to ensure consistency Do not take religious holidays into consideration, avoiding favoritism It's not necessary to have policies and procedures in place Make sure medical intake forms are inclusive, with gender-neutral language

Make sure medical intake forms are inclusive, with gender-neutral language

According to the 2007 NHIS, what was the highest use of CAM therapies among the African-American population? Energy-healing therapies Mind-body therapies Manipulative and body-based therapies Biologically-based therapies

Mind-body therapies

Which state has the largest African American population in the US? New York Maryland Texas Illinois

New York

Clinicians have a responsibility to advocate on behalf of families and communities at risk for health disparities. What is an example of advocacy specific to cultural competency? Leave cultural competence to public health practitioners only. Work in isolation in clinical practice to treat patients. Provide appropriate and culturally relevant consumer information and marketing materials. Pay little attention to the impact of state and federal legislation on service delivery.

Provide appropriate and culturally relevant consumer information and marketing materials.

Continuum of cultural completeness

Range of one race/white race to embracing diversity w/cultural competency Cultural destructiveness Cultural incapacity Cultural blindness Cultural pre-competence Cultural competence Culture proficiency (driving illegal buggies pesters cops and police)

Specific positive patient outcomes that may result from implementing CLAS errors and culturally-competent care (4 answers)

Reduced medication errors Reduce emergency department use Follow treatment plan Reduced misdiagnosis

Ulysses Syndrome

Series of symptoms that affect migrants confronted with multiple chronic levels of stress. Gateway between mental health and mental disorder Must advocate for sociocultural approach w/culturally-sensitive health educators to help newly arrived migrant experiencing Ulysses Syndrome

The individual or organization's receptiveness to change refers to which component of the conceptual model? Implementation Adoption System Antecedents System Readiness

System Readiness

Steps to build culturally competent practice

System antecedents System readiness Adoption Implementation Improved patient outcomes

Where is infant mortality most common among high income countries?

The US. Especially true based on mother race, not infant's

Race

The categorization of parts of a population based on physical appearance due to historical, social, and political forces

Dominant culture

culture of group "in power". Dictates accepted values when there is a difference in basic values within cultures. Dominant cultures use a variety of methods to consolidate power, (fear, money, force, etc.)

Concept of time

cyclical or event or clock based?

Health disparities

difference in incidence and prevalence of health conditions and health status between groups based on race/ethnicity, socioeconomic status, gender, disability status, or a combination

3 components of Health Promotion

good governance of health health literacy healthy cities

ethnicity

group sharing common and distinctive culture, religion, language, etc.

Ethos

independence vs interdependence, regard for self, need for control

axiology

interpersonal values. Do you compete or cooperate? Communication

Cultural competency

involves understanding and appropriately responding to unique combinations of cultural variables and full range of dimensions of diversity that professional and client/patient/family bring to interactions. Not limited to racial/ethnic differences, also disabilities, aging population, gender identity, country of origin, and veteran status. Cultural knowledge is needed in developmental health interventions for targeted populations and treating patients based on religious/cultural/spiritual beliefs and customs

Cultural incapacity

lack of capacity to help minority clients/communities, extremely biased beliefs and paternal attitude toward non-mainstream culture

System readiness

organizational and front-end user buy in

Health equality

person's ability to attain full potential without interferene from social position or ethnic/racial background Health inequality=health disparity

Ethnicity

pertaining to a group of people sharing a common and distinctive culture, religion, or language

Ontology

spiritual or objective. Some believe in supernatural, or is evidence needed?

Demographic shift

statistical changes in the socioeconomic characteristics of a population or consumer group. "population" =religion, age, gender, etc.