Optimal health care
can only be provided when staff understand cultural differences that can
create conflicts and misunderstandings (Galanti, 1997). Staff need to
be able to work effectively with racially, ethnically, and culturally
diverse client populations. Bias and discrimination continue to create
disparities especially impacting racial and ethnic minority populations
(Bingham, Porche-Burke, James, Sue, & Vasquez, 2002; The Institute
of Medicine, 2002). Implicit attitudes, unconscious biases, prejudice,
and racism adversely affect the relationship between service providers
and their clients (Dovidio, Gaertner, Kawakami, & Hodson, 2002; Dovidio,
Kawakami, & Gaertner, 2002). The Institute of Medicine (IOM) report
(2002) found that minorities were less likely than whites to receive needed
services for a variety of health problems. Further, this report found
that these differences were not explained by patients’ attitudes
toward healthcare or preferences for treatment. The study considered two
other sets of factors–those related to the health care system and
those related to the clinical encounter. The study concluded that bias,
prejudice, and stereotyping on the part of the health care provider may
contribute to disparities in care (IOM, 2002).
Cultural competency
in adolescent pregnancy prevention programming is an emerging area of
interest for researchers. Values, attitudes, beliefs, and knowledge about
health, sexuality, relationships, contraception, pregnancy, and childbearing
vary among young people across cultural groups. Interventions must match
the culture of the target audience. One pregnancy prevention approach
that works for a certain group of adolescents may be ineffective for other
groups because it does not meet their needs culturally, best practices
in culturally competent teen pregnancy prevention services have yet to
be identified.
Some suggestions to
increase culturally competent service delivery include:
Get to know
your community, including cultural customs, role of the family, religious
beliefs, gender roles, and traditional health beliefs. Respect
and incorporate traditional health beliefs into treatment when possible
(Galanti, 1997). Getting a sense of how community members approach health,
disease, pregnancy, and healthcare will assist you in developing curricula,
creating effective media campaigns, and positively affecting the adolescents
you work with.
Assess the
needs of the community. It is important that programmers perform
a needs assessment of the community they will be working with in order
to incorporate specific cultural needs into new and existing programs.
Additionally, it may be necessary to do an updated needs assessment
as time passes and the communities’ needs or cultural make-up
changes.
Provide cross-cultural
education for all health care providers (IOM, 2002). The diversity
of young clients who access reproductive health care in clinics or in
other pregnancy prevention programs makes training in cultural-competency
essential. Cross-cultural education can increase provider awareness
of the role of social and cultural factors in decisions related to healthcare
in general and pregnancy, sexuality, and sexual behaviors in particular.
Cross-cultural education can be most effective when focusing on knowledge,
skills, and attitudes, and using experiential activities as a teaching
method (IOM, 2002). Agencies must make training in cultural competency
a standing protocol and ensure that their personnel are updated as cultures
develop and change.
Implement an
existing program that has demonstrated effectiveness with a similar
population or design a new program incorporating key characteristics
of other successful programs
(Kirby, 2001). This general standard can be applied to culturally competent
services. However, neighborhoods and communities change, so it is vital
that agencies ensure that their personnel are updated as the cultural
make-up of the youth they serve develops and changes.
Have staff
who reflect community and clientele. It can be helpful for youth
to be able to identify with providers in terms of gender, age, sexual
orientation, religion, or other characteristics to facilitate the development
of trust and comfort with service providers. However, most important
is that all staff be culturally competent.
Build effective
communication strategies (IOM, 2002; Galanti, 1997). Communication
is key to providing culturally responsive services. Avoid using idioms
and acronyms. Use staff who speak the same languages as your patients.
Have both male and female translators available. Provide staff training
in cross-cultural communication skills.
Address broader
issues that affect or disempower young people. Programs should
address not only the sexism that girls may face in their lives, but
realize that many youth face multiple layers of prejudice that hinder
them from achieving their goals, including racism, classism, homophobia,
heterosexism, or other prejudices related to physical ability, size,
or appearance. Youth who have immigrated to the United States may also
face discrimination relating to their immigrant status, language, cultural
background, or ethnicity, and may need assistance adjusting to American
culture and new pressures. Keep in mind that male and female gender
roles may vary according to culture. Youth with learning or physical
disabilities may need special assistance or a different set of materials
and teaching strategies in order to learn. Language barriers also need
to be taken into account and programs should be adjusted to meet the
needs of youth for whom English is not their first language.
Include needs
of lesbian, gay, bisexual, and questioning (LGBQ) youth in program delivery.
Program staff often have no idea which youth may be identifying
as gay, lesbian, bisexual or questioning their sexual identities. Some
youth may attempt to hide their sexual orientation by having sexual
intercourse with members of the opposite sex or by carrying or fathering
a child. Assuming that a self-identified lesbian does not have any need
for birth control may put her at increased risk for STIs or pregnancy.
When staff use language that assumes heterosexuality, they disenfranchise
LGBQ youth and close doors to open and trusting communication with them.
Avoid making assumptions about the gender of sexual partners and choose
gender-neutral language.
Address cultural
stereotypes with staff. Health care providers may not be aware of their
own biases and prejudices (IOM, 2002). People often act on cultural
stereotypes without even knowing it. In best practices, staff need to
be challenged to identify and avoid use of stereotypes that may impede
optimal provision of service to youth. Ensure that time is spent at
regular intervals discussing and exploring attitudes, stereotypes, and
beliefs about culture and about youth. Creating a plan for dealing with
situations that may occur among staff or between staff and young people
will assist programming staff to intervene when a culturally insensitive
incident occurs. Staff will need a genuinely safe atmosphere in order
to explore cultural preconceptions, effects of discrimination, or conflicting
values, in a way that leads to positive change and understanding.
Implementation
Tips
Staff must have
cultural knowledge of youth.
Include training
in cultural competency in the organizational protocols.
Have a staff that
mirrors the cultural backgrounds of the youth served.
Acknowledge all
the prejudice that may serve as barriers to adolescents’ accessing
services.
Perform a needs
assessment to assess the target community’s views.
Avoid use of stereotypes
pertaining to youth culture.