Innovations in clinical training for cultural competence

The proposed presentation describes one of the first cultural competence training programs offered in a developing country. In 2007, the US Agency for International Development funded two organizations, Engender Health and Management Sciences for Health, to develop and deliver a pilot training program in cultural competence for health providers in Bolivia. The tension between the social classes in Bolivia, largely a conflict between European descendents and indigenous populations, affects the relationship between providers and clients and has recently caused social unrest.
Twenty reproductive health providers participated in a 2-day training program. The program combined face-to-face activities with the use of a CD-ROM. Providers learned how ethnicity, the social hierarchy, and culture can impede communication and lead to low utilization of reproductive health services. Many concepts in the course can be applied to providers of any cultural group working with clients of any other cultural group. That having been said, the real strength of the program is in how specific problems between this targeted group of providers and clients were integrated into the curriculum. To identify problem areas, focus groups and interviews were conducted at the beginning of the project. Client focus groups were conducted in Spanish and Aymara. Skilled facilitators engaged clients in discussing what they like and dislike about the services they receive. Providers were interviewed about what they thought about their clients. Lay health promotors discussed their interactions with doctors and community members. Issues raised were woven into the curriculum with dialogues demonstrating appropriate and inappropriate provider-client interaction. Quotes of clients complaining about the cultural insensitivity of their providers were included.
The curriculum is based on a model that divides cultural competence into three areas: internal cultural competence, communicative cultural competence, and knowledge-specific cultural competence. [1] Internal cultural competence allows one to recognize and manage prejudices so as to act independently of them. It’s an internal dialogue. Communicative cultural competence has a goal - the client will: understand what the provider asks and recommends; feel at ease to speak openly about her medical history; and be willing to voice concerns about recommended treatment or contraceptive. The provider will help the client speak about conflicts between traditional beliefs and modern medicine in order to negotiate an appropriate compromise. Internal and expressive cultural competence do not require knowledge of a particular culture. This is important to convey because people who are new to cultural competence often focus exclusively on understanding local health beliefs and customs. Only the third category, knowledge-based cultural competence, relates to having specific information about the beliefs and practices of the cultural group with whom the provider is working.
The program was evaluated through a provider pre/post-test and client interviews. These results will be presented as well as problems with the methodology. To guide others in adapting the program for different populations, the focus group questions will be presented, as well as a sample of the responses. The author will discuss how she integrated this material into the curriculum.

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[1] Model developed by Gail Price-Wise

Presentation Information:

Program: Main Conference Concurrent Workshops
Primary Category: Cultural Competence Training
Subtopics: Assessing learning/performance on cultural competence/disparity reduction, Distance learning, Curricula development

Region Addressed by Presentation: South America
Organization: Community-Based Organization
Population/Demographic: Indigenous populations in Bolivia
Keywords: International, Reproductive Health, Developing Country, Training, Distance Learning


Website: http://www.msh.org/culturalcompetence/

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Gail Price-Wise, MS , Management Sciences for Health, Coral Springs, FL

Consultant
Management Sciences for Health
5195 NW 112th Terrace
Coral Springs FL, USA 33076

Phone: 954-649-7183
Fax: 954-346-0358
Email Address: gpricewise@bellsouth.net

Biographical Sketch: Gail Price-Wise has spent her career initiating projects to improve the health of racial and ethnic minorities. For Management Sciences for Health, she led the development of the "Provider's Guide to Quality and Culture," (erc.msh.org/qualityandculture) which was recommended in the Institute of Medicine’s report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health.” Ms. Price-Wise has lectured on cultural competence in the US and Australia. She is the technical lead on a project of the US Agency for International Development to introduce cultural competence to Bolivian health care providers who work with indigenous populations. She served as President of Harvard School of Public Health Alumni Council where she initiated a partnership between HSPH and Tehran University. She was President of the Harvard Club of Broward County. Ms. Price-Wise has written about international policies affecting women’s health for Our Bodies, Ourselves. She speaks Spanish fluently and has traveled in 24 countries.


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