WELCOME

New York State Department of Health HIV Oral Health Regional Resource Center Cheryl Stolarski, DMD Dental Co-Director 914-391-4883 [email protected]

Howard Lavigne Program Director 315-477-8479 [email protected]

Oral Health Cultural Competency for HIV/AIDS 2010

Cheryl R. Stolarski,DMD Co-Dental Director NY/NJ AIDS Education & Training Centers Elias J. Llerandi, DMD Staff Dentist, U.S. Dept. of Veterans Affairs Consultant, NYS Dept. of Health Attending Dentist, The Brooklyn Hospital Center

OBJECTIVES

 Define and Recognize Fundamental Characteristics of Culture  Identify Standards and Steps Towards Cultural Competence  Discuss the Importance of Understanding Cultural Variation in the Dental Setting

Definition of Culture

“Integrated patterns of human behavior that include language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic religious or social groups”

Cross et al (1989)

Why is it Important that Oral Health Care Providers be Culturally Competent?

 Closes disparities between patient and provider  Respect of culture and language can bring about positive treatment outcomes  Patient behaviors/attitudes  Lack of minority providers

Oral Health Care for HIV/AIDS Patients can include these Populations

     Racial & Ethnic Minorities Women Substance Users Gay/Lesbian/Bisexual/Transgender Adolescents • Female • MSM

Cultural Competence Standards and Steps  National Standards on Culturally and Linguistically Appropriate Services (CLAS) http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15  Cultural Competence Continuum http://nccc.georgetown.edu/projects/sids/dvd/continuum.pdf

 LEARN Model http://www.diversityrx.org/html/MOCPT2.htm

Cultural Competence Continuum

Cultural Destruction Cultural Incapacity Cultural Blindness Cultural Pre-Competence Cultural Competence C u l t u r a l P r o f i c i e n c y

“LEARN” MODEL

LISTEN – Identify Yourself Is Interpreter needed Ask Open ended questions EXPLAIN- Clear and easy language Pictures ACKNOWLEDGE- Find Common Ground RECOMMEND- Tx that involves both Doctor and Patient NEGOTIATE- Decide on a Plan that is Agreeable to both Doctor and Patient

Berlin&Fowkes1989

Dental Providers should remember  Cultural factors may influence a patients and/or providers views  Communication must be on the patients level -Language barriers -Examples and illustrations might be needed

   Examples of Cultural Views at the Provider Level HCP are reluctant to offer Tx plan option to pts they believe will be non-compliant MDs are more likely to Rx HAART to those perceived to be likely to be adherent MDs were more likely to tx African Americans as non-adherent

(Bogart et al 2001)

DO NOT LIMIT TREATMENT PLAN CHOICES BASED ON ASSUMPTIONS ABOUT A CULTURAL GROUP…

Body Language Speaks Volumes         Verbal vs. Non-Verbal Touch (What is Appropriate?) Personal Space Eye Contact Be Direct Sit at the Patient’s height or below Shaking Hands Avoid crossing your arms and legs

Cultural Factors Limiting Compliance  Language  Limited Health Literacy  Indigenous Beliefs  Trust in the Medical/Dental Profession

Burroughs,et al National Pharm Council & National Medical Assoc. 2002.

Health Literacy

Dental Providers should

   Respect differences Expand Cultural Knowledge Adapt service modifications: -language barriers -use appropriate terminology -use illustrations when necessary -seek staff who represent the community -develop good patient rapport

Linking Communication to Outcomes Communication leads to: Patient Satisfaction Adherence Better Health Outcomes

Joseph Betancourt MD. Harvard University

Final Thoughts

If you miss being understood by laymen and fail to put your hearers in this condition, you will miss reality.

Hippocrates

Ancient Medicine

Adapted from Rose Jones PhD, Medical Anthropologist TX/OK AETC

Additional References

 CULTURE AND CLINICAL CARE EDITED BY JULIENE G. LIPSON/SUZANNE L. DIBBLE UNIVERSITY OF SANFRANCISCO Nursing press 

ACHIEVING CULTURAL COMPETENCY A CARE-BASED APPROACH TO TRAINING

HEALTH PROFESSIONALS, EDITED BY LISA A. HARK, HORACE M. DELISSER. WILEY BLACKWELL PUBLISHING 

GUIDE TO CULTURALLY COMPETENT HEALTH

CARE, SECOND EDITION, LARRY D. PURNELL