|
| A) | diversity. | ||
| B) | reflexivity. | ||
| C) | explicit bias. | ||
| D) | cultural humility. |
Cultural humility refers to an attitude of humbleness, acknowledging one's limitations in the cultural knowledge of groups. Practitioners who apply cultural humility readily concede that they are not experts in others' cultures and that there are aspects of culture and social experiences that they do not know. From this perspective, patients are considered teachers of the cultural norms, beliefs, and value systems of their group, while practitioners are the learners [5]. Cultural humility is a lifelong process involving reflexivity, self-evaluation, and self-critique [6].
| A) | True | ||
| B) | False |
Intersectionality is a term to describe the multiple facets of identity, including race, gender, sexual orientation, religion, sex, and age. These facets are not mutually exclusive, and the meanings that are ascribed to these identities are inter-related and interact to create a whole [12].
| A) | True | ||
| B) | False |
An alternative way of conceptualizing implicit bias is that an unconscious evaluation is only negative if it has further adverse consequences on a group that is already disadvantaged or produces inequities [20,28]. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages [28].
| A) | Uncertainty | ||
| B) | Cognitive dissonance | ||
| C) | Time pressure to make a rapid decision | ||
| D) | Heavy workload and feeling behind schedule |
Specific conditions or environmental risk factors have been associated with an increased risk for certain implicit biases, including [130,131]:
Stressful emotional states (e.g., anger, frustration)
Uncertainty
Low-effort cognitive processing
Time pressure
Lack of feedback
Feeling behind with work
Lack of guidance
Long hours
Overcrowding
High-crises environments
Mentally taxing tasks
Juggling competing tasks
| A) | Race | ||
| B) | Economic stability | ||
| C) | Health care access and quality | ||
| D) | Social and community context |
Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. Healthy People 2030 groups social determinants of health into five categories [34]:
Economic stability
Education access and quality
Health care access and quality
Social and community context
Neighborhood and built environment
| A) | Spirituality | ||
| B) | Community | ||
| C) | Family/kinship | ||
| D) | All of the above |
Historical adversity and institutional racism contribute to health disparities in this group. For the Black population, patient assessment and treatment planning should be framed in a context that recognizes the totality of life experiences faced by patients. In many cases, particularly in the provision of mental health care, equality is sought in the provider-patient relationship, with less distance and more disclosing. Practitioners should assess whether their practices connect with core values of Black culture, such as family, kinship, community, and spirituality. Generalized or Eurocentric treatment approaches may not easily align with these components of the Black community [42]. Providers should also consider the impact of racial discrimination on health and mental health among Black patients. Reports indicate that expressions of emotion by Black patients tend to be negatively misunderstood or dismissed; this reflects implicit or explicit biases.
| A) | True | ||
| B) | False |
Listening is an important aspect of rapport building with Native American patients, and practitioners should use active listening and reflective responses. Assessments and histories may include information regarding patients' stories, experiences, dreams, and rituals and their relevance. Interruptions and excessive questioning should be avoided if at all possible. Extended periods of silence may occur, and time should be allowed for patients to adjust and process information. Practitioners should avoid asking about family or personal matters unrelated to presenting issues without first asking permission to inquire about these areas. Native American patients often respond best when they are given suggestions and options rather than directions.
| A) | risk avoidance. | ||
| B) | emotional demonstration. | ||
| C) | denying pain and weakness. | ||
| D) | teamwork and help-seeking. |
An increasing amount of research is supporting a relationship between men's risk for disease and death and male gender identity, and the traditional male role has been shown to conflict with the fostering of healthy behaviors [62,63]. Male gender identity is related to a tendency to take risks, and the predilection for risky behavior begins in boyhood [63,64,65]. In addition, boys are taught that they should be self-reliant and independent and should control their emotions, and societal norms for both boys and men dictate that they maintain a strong image by denying pain and weakness [62,64,65].
| A) | negative feelings toward oneself and self-hatred. | ||
| B) | a negative attitude or fear of non-straight sexuality or GSM individuals. | ||
| C) | considering sexual identity and determining that one does not want to think further about it. | ||
| D) | the stigmatization in thinking and actions found in cultural institutions, such as educational and legal systems. |
The subtle and pervasive ways that discomfort with GSM individuals may be manifested have been examined and, in some instances, categorized as "cultural heterosexism," which is characterized by the stigmatization in thinking and actions found in our nation's cultural institutions, such as the educational and legal systems [80]. "Cultural heterosexism fosters individual antigay attitudes by providing a ready-made system of values and stereotypical beliefs that justify such prejudice as natural" [81]. Perhaps the paucity of information about the GSM community in basic professional education has been a reflection of cultural heterosexism. Writers, funding sources, and publishers have been exposed to the same cultural institutions for many years.
| A) | Obesity | ||
| B) | Smoking | ||
| C) | Cancer screening | ||
| D) | Breast and lung cancer mortality |
People with disabilities experience many health disparities. Some documented disparities include poorer self-rated health; higher rates of obesity, smoking, and inactivity; fewer cancer screenings (particularly mammography and Pap tests); fewer breast-conserving surgeries when breast cancer is diagnosed; and higher rates of death from breast or lung cancer [104].
| A) | True | ||
| B) | False |
Styles of communication can be classified from high- to low-context [109]. High-context cultures are those cultures that disseminate information relying on shared experience, implicit messages, nonverbal cues, and the relationship between the two parties [107,110]. Members of these cultural groups tend to listen with their eyes and focus on how something was said or conveyed [106,109]. On the other hand, low-context cultures rely on verbal communication or what is explicitly stated in the conversation [107]. Consequently, low-context communicators listen with their ears and focus on what is being said [106,109,110]. Western culture, including the United States, can be classified as a low-context culture. On the other hand, groups from collectivistic cultures, such as Asian/Pacific Islanders, Hispanics, Native Americans, and African Americans, are from high-context cultures [109].
| A) | Use of more informal language | ||
| B) | Speaking more and often raising one's voice | ||
| C) | Assumption that meanings are described explicitly | ||
| D) | Reliance on interpreting eye contact, gestures, and tone of voice |
Communicators from high-context cultures generally display the following characteristics [106,107,110,111]:
Use of indirect modes of communication
Use of vague descriptions
Less talk and less eye contact
Interpersonal sensitivity
Use of feelings to facilitate behavior
Assumed recollection of shared experiences
Reliance on nonverbal cues such as gestures, tone of voice, posture, voice level, rhythm of speaking, emotions, and pace and timing of speech
Assimilation of the "whole" picture, including visual and auditory cues
Emotional speech
Use of silence
Use of more formal language, emphasizing hierarchy between parties
| A) | The practitioner focuses on observed signs and symptoms. | ||
| B) | The practitioner is concerned with identifying the disease pathology. | ||
| C) | The practitioner focuses on the subjective description of the illness. | ||
| D) | The practitioner is not influenced by how the client/patient defines the illness. |
Practitioners may be categorized as either disease-centric or patient-centric [117]. Disease-centered practitioners are concerned with sign/symptom observation and, ultimately, diagnosis. On the other hand, patient-centered practitioners focus more on the patient's experience of the illness, subjective descriptions, and personal beliefs [117]. Patient-centered practice involves culturally sensitive assessment. It allows practitioners to move assessment and practice away from a pathology-oriented model and instead acknowledge the complex transactions of the individual's movement within, among, and between various systems [118].
| A) | security. | ||
| B) | autonomy. | ||
| C) | beneficence. | ||
| D) | maintaining distance. |
Improving access to care can be facilitated, in part, by providing a welcoming environment. The basis of establishing a safe and welcoming environment for all patients is security, which begins with inclusive practice and good clinician-patient rapport. Shared respect is critical to a patient's feeling of psychological well-being. Security can also be fostered by a positive and safe physical setting. For patients who are acutely ill, both the illness experience and treatment process can produce trauma. This is particularly true if involuntary detainment or hospitalization is necessary, but exposure to other individuals' narratives of experienced trauma or observing atypical behaviors from individuals presenting as violent, disorganized, or harmful to themselves can also be traumatic. As such, care environments should be controlled in a way to minimize traumatic stress responses. Providers should keep this in mind when structuring the environment (e.g., lighting, arrangement of space), creating processes (e.g., layout of appointments or care systems, forms), and providing staff guidance (e.g., nonverbal communication, intonation, communication patterns). During each encounter, the patient's perception of safety is impacted by caretakers and ancillary staff.
| A) | True | ||
| B) | False |
Experts recommend the adoption and posting of a nondiscrimination policy that signals to both healthcare providers and patients that all persons will be treated with dignity and respect [128]. Also, checklists and records should include options for the patient defining their race/ethnicity, preferred language, gender expression, and pronouns; this can help to better capture information about patients and be a sign of acceptance to that person. If appropriate, providers should admit their lack of experience with patient subgroups and seek guidance from patients regarding their expectations of the visit.