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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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Slide Number

508 Compliance Text


(Title Slide).Cultural and Diversity Considerations


Learning Objectives

After this session, participants will be able to:

Define cultural competency

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

Awareness of one’s own cultural values

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

Awareness and acceptance of cultural differences

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

Development of cultural knowledge

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

Ability to adapt to the cultural context of the case

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

First, middle, last?

Two last names?

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 Guidefrom 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.]



What is cultural competency?

What are the four elements of cross cultural communication?

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