Diversity and Disparity in Health Programs PDF

Examples of Tailoring Throughout the Cycle Stage in the Planning and Evaluation Cycle Examples of Tailoring for Cultural and Ethnic Diversity Community needs assessment Definitions of health and illness; willingness to reveal needs or wants; self-definition in terms of culture, race, or ethnicity...

Examples of Tailoring Throughout the Cycle Stage in the Planning and Evaluation Cycle Examples of Tailoring for Cultural and Ethnic Diversity Community needs assessment Definitions of health and illness; willingness to reveal needs or wants; self-definition in terms of culture, race, or ethnicity; health disparities; experience of disparities in access to or quality of health care Program theory and development Identification of contributing and determinant factors of health disparities; role of discrimination and culturally bound health behaviors in the disparities; culturally acceptable and appropriate interventions Examples of Tailoring, Continued Stage in the Cycle Examples of Tailoring Process or program implementation Culturally and ethnically adjusted program targets; cultural, racial, and ethnic representations and appropriateness of materials; modality of distribution; enticement used Program intervention delivery Intervention type; number and length of sessions Program effect evaluation Language(s) of survey questionnaires; culturally appropriate enticements to participate; access to culturally and ethnically equivalent “control” groups Diversity among the Health Professions Discipline Education Primary Focus Licensure / Certificate Program Contribution Est. # in the US Dentistry Dental doctorate Tooth & gum diagnosis & treatment Licensure Oral health knowledge 196,000 Community health worker HS or Bachelor Education, advocacy, community member assistance Certification varies by state Shares ethnic, linguistic, SES, life experiences with community members 86,000 Dietitian, nutritionist Bachelor Dietary elements of health Licensure & certificate Nutrition knowledge, influence of nutrition on health 96,000 Health administration Master’s Health care org leadership & management Certificate Management & administration N/A Health education Bachelor Development of materials designed to impart health knowledge & change behavior Certificate Social and behavioral knowledge N/A Diversity among the Health Professions, Continued Discipline Education Primary Focus Licensure / Certificate Program Contribution Est. # in the US Medicine Medical doctorate Differential diagnosis & treatment of illness Licensure & certificate Medical pathology, treatment knowledge 863,000 Nursing Baccalaureate (min. associate’s degree) Promotion of health & well-being Licensure & certificate Integration of behavioral & medical knowledge 2,529,000 Physical therapy Baccalaureate Body strength & flexibility restoration & maintenance Licensure Focus on enhancing capability within limitations 198,000 Social work Master’s Licensure Focus on family & psychological factors 698,000 Features of the Cultural Competency Continuum Cultural Destructiveness Cultural Incapacity Cultural Blindness Cultural Openness Cultural Competence Cultural Proficiency Attitude toward other cultures Hostility Dislike, separate but equal Ambivalence, treat all alike Curious, cultural awareness Respect and tolerance, cultural sensitivity Fully comfortable, cultural attunement Knowledge of other cultures Active avoidance of knowledge None Little or none Some Fair amount Extensive Degree of integration across cultures None None None Consideration of potential benefits of integration Some integration Fully multicultural, fusion of cultures Implications for health programs of participants at each stage Programs address consequences of cultural destructiveness Need to have programs provided to separate groups If have multicultural elements, may need to justify and explain Can provide program to participants from multiple cultures but need to provide competence info & role modeling Can provide program to participants from multiple cultures with minimal adjustments Can provide multilingual, multicultural interventions in one program Diversity and Disparities Across the Pyramid • Direct services level – Disparities affect individuals’ health status – Staff cultural competence implementation – Culturally tailored and targeted programs • Enabling services level – Disparities affect families and aggregates – Interventions tailored to the characteristics and preferences of the target aggregate Diversity and Disparities Across the Pyramid, Continued • Population-based services level – Disparities reflected in vital statistics or care utilization – Interventions may be multiple, targeted messages for different subgroups, or a single, generic message • Infrastructure level – Disparities and diversity reflected in health policy and priorities, and organizational processes and culture – Interventions address workforce or organizational diversity and cultural competence