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IMPORTANCE OF USING CULTURALLY SENSITIVE TOOLS FOR ACQUIRING PERCEPTIONS OF HEALTH. The Art of Communication. Our Best Tool. The patient’s voice on the perception of their health. Background. - PowerPoint PPT Presentation



  • The Art of Communication

  • Our Best Tool

    The patients voice on the perception of their health

  • BackgroundAs early as the 1920s, it was suggested that individual perceptions of health could be indicators to the onset of disease

    Established standards and empirical results have underscored the importance of incorporating measurement of health perceptions in studies that assess an individuals health, illness, or disease impact.

  • Perceptions of health are internal and subjective within individuals

    At the individual level, they may channel actions

    At the societal level, they may channel policy for change

  • Often individuals perceptions of health are categorized as:EXCELLENTGOODFAIRPOORVERY POOR

    Used by the Behavioral Risk Factor Surveillance System and the National Health Interview Survey

  • Although this is a validated method for obtaining individuals perceptions of health; the cultural meaning of health can be lost

  • How is health defined within the culture?What values are placed on health?What is the contextual placement of good, fair, or poor?What senses and experiences are dominating that culture to form the perception?

    These are important questions to ask the individual

  • Need to go back to foundational experiences of people, and the medical anthropological understanding of disease and illness where culture is embedded and sustained over a period of lifetimes; followed by providing the individual the measurement tool which will help to categorize perceptions of health

  • Qualitative Surveys

    Qualitative SurveysWorld Health Organization Quality of Life Survey (WHOQOL) Believed that the missing element of health was the humanistic elementHealth Perceptions Questionnaire Form II (1976)Nottingham Health Profile (1985)EQ-5D (EuroQol Group) 1990SF-36 Health Survey Questionnaire (1992) Medical Outcome Survey

    Lost its most meaningful contextSF 36MOS 20MOS 12

  • Qualitative Research MethodsReveal underlying meanings and patterns of relationships within a cultureProvides contextual description of how people experience healthIdentify intangible factors such as : social and cultural norm beliefs, rituals and values socioeconomic status gender roles ethnicity religionTHEY BRING THE PATIENTS VOICE TO THE FOREFRONT

  • Methods of Obtaining Qualitative Information

    Focus GroupsOne-to-One InterviewsParticipant ObservationsField Work Observations

  • New Tools

    1. Better Communication, Better Care:Provider Tools to Care for Diverse PopulationsAHRQ Healthcare Innovations Exchange website: .pdf

    2. AHRQ Health Literacy ToolkitAHRQ Pub. No. 10-0046-EF


    DeWalt DA, Callahan LF, Hawk VH, Broucksou KA, Hink A, Rudd R, Brach C. Health Literacy Universal Precautions Toolkit. (Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality. April 2010. H

  • In addition:

    Knowledge of: the cultures history ethnic composition past religious, political, and social forces

    This rich experiential data can help to retain and sustain culture within the health perceptions measurement tool

  • Preliminary information regarding: demographics, social and economic variables, vital statistics, and chronic disease factors can be obtained through:Country websites: United States WHO website: United Nations website:

  • The use of information must be carefully considered because often the information is from an aggregate population, not the subgroup. They may yields very different profiles




  • History of Medicine 4 ancient periods

    1. Medicine under Sri Lankan kings2. The Portuguese period3. The Dutch period4. British period

  • Health Care Systems in Sri Lanka1. Alophatic: dominates Sri Lanka; (basically western medicine) yet people retain some components of the other two systems in their belief when they define health

    2. Ayurveda: originated in India; individuals would maintain that illness and suffering are due to change in Wa (air), Pith (bile), and Sem (mucus)

    3. Indigenous: developed within the context that the king and others should do their best to reduce suffering due to illnesses. This teaching helps people tolerate suffering such as pain

  • The majority of Sri Lankans are Buddhists. The Buddhist philosophy defines health as wealth; yet it also says that people get sick because of their Karma. Elimination of suffering can only be achieved through the person by elimination of any attachment it may have to the subconscious body

  • Other considerations

    95% of people can read and write this will affect your tool design when considering time and budgeting


  • In most homes, health is seen as a luxury Little value is placed on prevention of disease Class separation is very visible/the poor are left uninsured and without care

  • Mexicans value Familismo(the family unit)

  • High value placed on religion, with illness placed in the hands of God

    Curanderos (spiritual healers) are very important in Mexico with their holistic approach to healing

  • The Mexican government plays a role; due to corruption, pharmacies are able to sell medicine with little regulation Mexicans are taught not to complain; most will answer good when asked the question..How are you feeling?Mexican use many different dialects and different words in various parts of the country

  • Cambodia

  • Misconception

    Often Asians in the aggregate present a picture of good health, higher levels of income, and higher family income

    (Koch-Weser S, Liang SL, Grigg-Saito DC)

  • In Cambodia

    March 2008: United Nations reports population at 13,388,910Life expectancy at birth: 59 yrs. old for men 63 yrs. old for womenLiteracy rate in 2004: 73%Infant mortality rate in 2006: 66 per 1,000 births

  • Cambodians have struggled with poverty, corruption and the aftermath of the Khmer Rouge war

  • Many people struggle on a daily basis to have a small meal whether they find it, grow it, or buy it with the small income they receive

    Hunger may be a variable of perceptions of health

  • Most hospitals and clinics are located in Phnom Penh. Many have no means of transportation; the village healer is utilized

  • There is no form of health insurance in CambodiaWhen speaking to a Cambodian, they will say This is the life we live, what options do we have?This is the unfortunate reality of the lifestyle in Cambodia

  • Conclusion Various cultures provide for important variations in:The definition of healthValues placed on healthThe contextual and experiential placement of good, fair, or poorWhat senses dominate the perceptions========================================== ALL WHICH AFFECT PERCEPTIONS OF HEALTH

  • Importance ofConceptual clarity: provides common definitions within the culture that guides the tool Operating from an understanding of the cultures contextual conditions to assure that all questions are locally, culturally, and developmentally appropriate

    Unites the caregiver with the voice of the individual

    = Improved service satisfaction

  • Importance of Culturally Sensitive Measurement Tools

    Key component to formulation qualitative data into quantitative data which my initiate changeHealthcare reform is now at the forefront of Congressional committees in the U.S. Ranked as high priority is the improvement of health of underserved population

  • The Measurement of Health is an Essential Requirement for the Evaluation of Health Policy, Assessment of Intervention Effectiveness, and Measurement of the Efficiency of Health Systems(McDowell, Ian)

    The Patients Voice is Our Greatest Ally

  • Thank you

    Bohoma Sthu-thee-yi

    Gracias Ar kun

    The Art of Communication continues to become increasingly difficult within health care systems as we integrate globalization, efficient patient management, and time constraintsCorrect interpretation across a broad spectrum of individuals requires evolving thought and a good amount of effort.