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TB Contact Investigation Interviewing Skills Course

Day 2: Cultural and Diversity Considerations 508 Compliance

  • Cultural and Diversity Considerations (20 slides)
  • Working with Interpreters (6 slides)

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508 Compliance Text


(Title Slide).  Cultural and Diversity Considerations



Learning Objectives

After this session, participants will be able to:

1.     Define cultural competency

2.     State the four elements of cross cultural communication



The Importance of Cultural Competency

  • Health care workers need to be aware of, and sensitive to, cultural diversity, life situations, and other various factors that shape a person’s identity.
  • The first step is an open, non-judgmental attitude.



What is Culture?


Culture has been defined in a number of ways, but most simply, as the learned and shared behavior of a community of interacting human beings.



What is Cultural Competency?

Cultural competency refers to an ability to interact effectively with people of different cultures.



What are Some Examples of Diversity Categories/Cultural Groups?

  • Geography
  • Culture
  • Gender
  • Spirituality
  • Parental Status
  • Homeless persons
  • Substance users
  • Language
  • Disability
  • Sexual orientation
  • Age
  • Incarcerated persons
  • Profession (e.g., healthcare workers)


Four Elements for Cross-Cultural Communication

1.     Awareness of one’s own cultural values

o   Are you attentive to your own preconceived notions of other cultural groups?

2.     Awareness and acceptance of cultural differences

o   Do you look for opportunities to meet and interact with individuals who are from cultures other than your own?



Four Elements for Cross-Cultural Communication

3.     Development of cultural knowledge

o   Are you familiar with the worldviews of cultural groups other than your own?

4.     Ability to adapt to the cultural context of the case

o   Do you know how to navigate cross-cultural interactions?



What Can Culture Affect? (1)

       Description and communication of symptoms

       Perceived causes of illness; understanding of infection, transmission, and contacts

       Health-seeking behavior

       Understanding of disease process, treatment expectations, and decision making



What Can Culture Affect? (2)

       Interaction with the health care system and health care professionals

       Attitudes towards helpers and authorities; reluctance to reveal contacts

       How a person identifies and describes their contacts



Cultural Diversity Exercise

Refer to Appendix M



Ask Questions to Get to Know the Individual Case

       How do you prefer to be addressed?

       Where were you born?

       How long have you been in the U.S.?

       Are you more comfortable reading information in your native language or in English?

       How are important healthcare decisions are made in your family?

       Are there certain health care procedures and tests that your culture prohibits?



What do You Want to Find Out? (1)

       Language and literacy level

       Health knowledge and health beliefs

       Health seeking behaviors

       Daily routine activities

       Relevant relationships

       Living situation

       Visitors and/or travel



What do You Want to Find Out? (2)

       Decision making preferences

       Perception of and knowledge of U.S. health care system

       Perception of “western” medicine

       Other health belief systems

       Relevant incentives



Use Open-Ended Questions to Generate Helpful Conversation

       How did you feel when you learned you had TB?

       How do you feel about knowing that you may have infected others with TB?

       What matters most as you are being treated for TB?

       Tell me about anything that may affect your treatment, home visits, etc.



Cultural and Diversity Concerns in Contact Investigation (1)

Culture affects:


       Attitudes and beliefs about TB transmission

       Beliefs about the BCG vaccine

       Risks and benefits of LTBI treatment

       Identification of contacts



Cultural and Diversity Concerns in Contact Investigation (2)

Understanding who a contact is:

       Nuclear family, extended family

        Members of a group living situation

        Residents of a nursing home, shelter, or jail

        Fellow drinkers, substance users

        Members of a church, temple, or mosque

        Co-workers, supervisor, or boss




Cultural and Diversity Concerns in Contact Investigation (3)

Cultural background may influence the case’s willingness to reveal names:

       Immigration status

       Reasons not to give correct name

       Reasons to hide someone or not name them

       Reluctance to identify contacts



Naming Systems

       Different cultures have different naming systems

o   First, middle, last?

o   Two last names?

o   Family name first?

       Ask for all names, nicknames, aliases

       Make sure forms and registry can accommodate

       Have the case agree to always use the same name



Cultural Competency Resources

[Image: Front cover of the Country Specific Guides from the Southeastern National TB Center.]

[Image: Front cover of Promoting Cultural Sensitivity - A Practical Guide for Tuberculosis Programs from CDC.]

[Image: Front cover of the CDC TB Education and Training Network (TB ETN) Cultural Competency Resource Guide.]

[Image: Front cover of Beyond Diversity: A Journey to Cultural Proficiency Facilitator's Guide from the Heartland National TB Center.]

[Image: Front cover of Cultural Competency and Tuberculosis Care: A Guide for Self-Study and Self-Assessment from the New Jersey Medical School Global Tuberculosis Institute at Rutgers.]

[Image: First page of the Quick Reference Guide for the Philippines from the Southeastern National TB Center.]


[Title Slide] Working with Interpreters


Language Access Barrier

45 million people in the United States speak a language other than English at home

[Image: Globe]


Impact of Language Barriers

       Less likely to receive care

       Less likely to understand care

       Increased risk of medical errors

       Reduced quality of care

       Less satisfied with care



Using an Interpreter

       Make sure you agree on ground rules with both the case and the interpreter before the interview begins

       Always speak directly to the case

       Ask for clarification as needed

       Children should not be used as interpreters!



Resource for Interpretation

Video and viewer’s guide

Making the Connection:

[Image: Front cover of Making the Connection: An Introduction to Interpretation Skills for TB Control from the Curry International TB Center.]



1.     What is cultural competency?

2.     What are the four elements of cross cultural communication?

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