MULTICULTURAL

ASPECTS OF SELF-
CARE
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Introduction
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Culture influences beliefs toward the health
care system and may impact patients
decisions regarding self-care.
The ability of pharmacists to assess patient
complaint, guide patients product selection,
and/or advise patients to seek care from
another health care provider is an important
component of pharmaceutical care.
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Through data collection and proper
assessment of patients symptoms, important
health issues can be identified and solved.
However, if cultural issues are not taken into
account during the patient interview, it may be
difficult for health care provider to assess or
counsel a patient effectively
Definition of culture
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Culture is defined as the sum total of socially
inherited characteristics of human group, and
comprised socially transmited assumptions
about the nature of the physical, social, and
supernatural world
Cultural identity is developed based on
characteristics such as ethnicity, gender, age,
race, country of origin, language, religious and
spiritual beliefs
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There is a great risk in making
generalizations or assumptions that a person
within a group will always behave in the same
manner. This is known as stereotyping.
Culture can influence an individuals beliefs
and attitudes towards health, illness, and
treatment, which will influence the persons
decisions regarding health issues
Incongruent beliefs and expectations between
the practitioner and the patient may lead to
misunderstandings, confusion, and ultimately,
to undesirable therapeutic outcomes.
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Techniques that have been suggested to
improve care in cross-cultural settings:
LEARN
Listen with sympathy and understanding to the patients
perception of the problem
Explain your perceptions of the problem
Acknowledgement and discuss the differences and
similarities
Recommend treatment
Negotiate agreement
Recommended actions to develop cultural
sensitivity:
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Acknowledge that diversity exists
Understand that culture is part of what make individuals unique
Respect people or cultures that may be unfamiliar or different than
ones own
Conduct a self-assessment to identify ones own cultural beliefs and
biases
Recognize that there are differences in the way people define and
value health and illness
Be patient, flexible, and willing to modify health care delivery to
meet the cultural need of the patient
Allow for differences among members of the same cultural group
Appreciate the richness of culture
Embrace diversity
Understand that cultural beliefs and values are difficult to change
and in many instances are learned from birth
Guidelines for communicating with culturally
diverse patients:
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Assess your personal beliefs surrounding persons from
different cultures
Assess your own biases and prejudices
Assess communication variables from a cultural
perspective (language barriers, nonverbal
communication, use of interpreters, beliefs and feelings)
Plan care besed on communicated needs and cultural
needs of the patient
Modify communication approaches to meet cultural
needs (use more than one method to communicate the
stated plan)


Communication strategies:
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Use a caring tone of voice and facial expression
(demonstate your interest in the patient)
Speak slowly and clearly, but NOT loudly. Do not yell
Use gestures, pictures, and other role-playing
techniques to help the patient understand
Repeat the message in many different ways, using
different communication approaches
Avoid using medical terms, slang terms or jargon, and/or
abbreviations
Keep the message simple, and repeat it in several
different way
Assessment of cultural issues on patient
compliance:
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Pharmacists can assess the role that culture
may play in a patients acceptance of the
diagnosis and treatment of an illness by
following the recommendations (table 1)
Tabel 1.
Cultural assessment of diagnosis and treatment of illness
Diagnosis
What is the patients
understanding of the diagnosis?
What dose this diagnosis mean
to the patient?
How does the patient interpret
the illness? Does the patient
believe that the diagnosis is
terminal?
How is the patient accepting the
diagnosis? Is the patient in
denial?
How will the diagnosis affect the
patients social status or social
acceptance within their culture?

Treatment
What motivates the patient to
recover?
What are the patients feelings
and beliefs about the treatment?

What is the role of the family in
the treatment?
What effect does the treatment
have in the patients religious or
cultural beliefs?
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Decision making and OTC
Products
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The market for OTC drugs is expanding and
patient autonomy concerning health care
extends to taking part in the decison making.
The improper use of OTC products make an
increased risk for adverse drug reactions,
drug-drug interactions, and toxicities due to
long-term exposure
Contributing factors to the increased harmful
effects of overuse of OTC products
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Patient with poor health status, low education, and low
income are most likely to decrease consumption of
prescription drugs when costs of those deugs increase
Many uninsured patients seek OTC products as
alternatives to prescription drugs
These same patients may seek medical care only for the
most recognizable and urgent symptoms
Many medical condition are considered silent such as
hypertention and hyperlipidemia
The more serious conditions may not be diagnosed until
the patient experiences a negative consequence or
complication
Non compliance impact
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Therapy failure
Relaps
Toxicity
Higher costs
Direct medical cost
Direct non medical cost
Indirect non medical cost
Intangible cost
Opportunity cost
Non compliance costs
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Direct medical cost
Add medicine
Physician fee
Ambulatory cost
Lab tests
Indirect medical cost
Loss of salary, lack of time, dll
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Intangible cost
Illnesses complaint, sorrow
Opportunity cost
Opportunity lost
Job lost
Causes of medication self-regulation:
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Health beliefs
Perceived lack of seriousness of the disease and outcomes of nontreatment
Perceived ineffectiveness of the treatment
Lack of social support
Complex medication regimens
Lengthy therapies
Presence of adverse effects
Communication
Low degree of medical supervision
Lack of instruction
Lack of strategies
Low patients satisfaction
Little or no interaction
Health professional is perceived as unfriendly, lacking concern
Pharmacists doesnt allow involvement of patient in decisions

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Psychological
Desire to test the efficacy of the drug
Desire to assert control over the doctor-patient
relationship
Lacking or negative experience with medication
Approach to reducing noncompliance
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Communication
Patient satisfaction
Manner
Nature
Content
Frequency
Method
Provision of information
Persuasiveness
Information regarding use
Information regarding illness
Side effects
Special technique
Quantity and level

Determining factors contributing to
noncompliance
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The patient
The medication
Spouse/family/peers
The patient-health professional relationship
Strategies to motivate the patient
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Explain benefit of medication
Raise awareness of body cues
Explain ways to self-evaluate
Help develop coping mechanisms


Technique and tools to resolve
noncompliance
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Compliance aids
Enlisting support
Increase supervision
Social-service intervention
Alternative dosing
Behavioral modification tech.
Controlling therapy/self monitoring program
SEKIAN...
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