PROVIDING A CULTURALLY COMPETENT DIABETES EDUCATION PROGRAM. Sheila A. Gittens, RD, MS, CDE, CDN

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1 PROVIDING A CULTURALLY COMPETENT DIABETES EDUCATION PROGRAM Sheila A. Gittens, RD, MS, CDE, CDN CHCANYS: Diabetes Research and Demonstration Project Coordinator

2 Today s Discussion Diabetes as a Cultural Challenge. Review basics of cultural competence. Describe the components of a culturally competent Diabetes Self-management Patient Education program for a culturally diverse population. Discuss strategies to achieve behavior goals.

3 An Economic Challenge Diabetes is a costly, lifelong chronic disease that disproportionately affects racial and ethnic minorities. These represents the largest percentage of the poor and underserved of the population.

4 . An Epidemic It s projected, that by the year 2050 there will be 48.6 million cases of diabetes in the US: 481% increase in Hispanics 208% increase in AF/Blacks 113% increase in non-hispanic whites

5 Ethnic Minorities and the Health Care System Low socioeconomic status Health Disparities Low rates of health Insurance Low literacy level Communication barriers Most immigrants predominantly speak their native language at home. Inadequate materials in other languages, along with lack of translators and bi-lingual health professionals. Physician-patient relationship

6 Diabetes and Income

7 Death due to Diabetes

8 Health Belief System How long have you had diabetes? What is Diabetes? What Caused your Diabetes? How did you get diabetes? Susto (frightening experience). Coraje (anger, unpleasant experience). Destiny, fate (fatalism) Ate too much sugar, (candy, sweetened beverages or foods).

9 What is Cultural Competence? A set of congruent behaviors, attitudes, and policies, that come together in a system, agency, or among professionals, and enable that system, agency or those professions to work effectively in crosscultural situations. Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards a Culturally competent System of Care Vol 1. Washington, DC: Georgetown Univ. Child Dev. Center, CASSP Tech Assistance Center.

10 Steps to Cultural Competence Value diversity and similarities among all people. Understand and effectively respond to cultural differences. Engage in cultural self-assessment at the individual and organizational levels. Make adaptations to the delivery of services and enabling supports. Have institutionalized cultural knowledge.

11 The Patient Education program The most important component of a culturally competent patient education program is appropriate Staffing.

12 Health Educator Assistants Recruit from the community At least bi-lingual Americorp Interns Language, dialects, habits, values, subtle meaning to words and Phrases. Familiarity with beliefs, knowledge of Folklores.

13 Health Educator Assistants Roles: Outreach in the waiting areas Assist with patient navigation Blood Glucose meter instructions. Deliver basic patient education. Appointment reminder calls Health Fairs and community workshops Input data into tracking system. Maintain stock of educational materials This frees up clinician s time for more direct patient care.

14 Health Educator Assistants Better understanding of the root of myths and misunderstandings. Food Choices. Lifestyle. Value added - Employing their children or relatives. Health Care Providers are recognized on the streets where they live.

15 Disease Management Team

16 Diabetes Self-Management Group Session

17 Address Socio-economic Barriers Fear of deportation prevents undocumented patients from accessing health care, even though they will not be questioned about immigration status. Assure them that they will receive health care without questions regarding their legal status. Assist them in accessing needed services such as podiatry, retinal exams and dental care. Help to reduce acute and chronic complications of diabetes by assisting patients with access to equipment, medications and supplies. Provide referrals to Community Based Organizations for assistance other day-day needs.

18 Address Literacy Appropriate Translation of Educational materials. Reading levels linguistically and culturally appropriate. Graphics used are readily identifiable and a reflection of the community: Language Color Artwork Literacy

19 Address Health Literacy We must assess what our patients are doing and understand why they do it, if we wish to help them (achieve selfmanagement goals). In this effort, our language is as powerful a tool as the medications prescribed *. * Steiner JF MA: Lingua medica: the language of medication taking. Ann Intern Med 132: , 2000.

20 Address Health Literacy I know you think you understand what you believe I said, but what you don t know is that what you heard is not what I meant * Tell them. Tell them what you told them. Tell them again. (Diabetes Educator) *Annon.

21 Encourage Provider Interaction Engage the provider (Lunch n learn). Encourage patients to communicate their concerns to their provider ex: The ABCs of diabetes. Encourage patients to adopt good selfmanagement behaviors. Remember: Knowledge does not always lead to change in behavior.

22 Avoid provider Burnout Diabetes Self-Management is a behavior that is subject to many influences: Personal Choice Unacceptable side effects Cost Decision that the medication/task is not necessary Difficulties filling a Prescription Myths or misunderstandings about the condition. It s a full-time job trying to get people to change

23 Apply LEARN Model LISTEN EXPLAIN with sympathy and understanding to the patient s perception of the problem. your perceptions of the problem ACKNOWLEDGE and discuss the differences and similarities. RECOMMED treatment NEGOTIATE agreement

24 SOME SUCCESSFUL STRATEGIES Accommodate patients with same day referrals and unscheduled visits to the education staff or for case management. Evening sessions during Daylight Saving Time. Provide patient incentives: Pedometers (when available). Free Blood glucose meters (strips, lancets etc.). Diabetes ID bracelets upon completion of diabetes selfmanagement education classes. Local Pharmacy for discounted BG strips.

25 .. MORE SUCCESSFUL STRATEGIES Model for Improvement: Use PDSA cycles to see what works Class size, length of time. Time of day Format (Ppt Presentations, overheads) Supporting materials Mono or bi-lingual

26 SUPPORT GROUP Offers: Opportunity to meet others who are experiencing similar challenges. Share emotional support Share personal experiences Provide a sense of healing and empowerment Improved self-management skills

27 Contribution of Cultural Competency Improve quality of services and outcomes Improve utilization of Health Services Decrease Alienation of the Patient and Family from the Health Care System Increase Patient Satisfaction Improve Time and Efficiency Decrease Misdiagnosis Decrease Medical Errors Meet Accreditation/Contract/Regulatory requirements.

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