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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
1 (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 world views 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:

  • Knowledge
  • 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
  • Visitors

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 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.]


21  [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?