- {Note the ID Code is your Date of Birth and Mother's Maiden Name (ex 010164brown)}
3. Race/Ethnicity:
4. Visited/lived outside US?:
5. Speak other than English?:
- How KNOWLEDGEABLE are you about each of the following subject areas? (select one)
- 1. Demographics of diverse racial and ethnic groups:
- 2. Sociocultural characteristics of diverse racial and ethnic groups:
- 3. Health risks experienced by diverse racial and ethnic groups:
- 4. Health disparities experienced by diverse racial and ethnic groups:
- 5. Sociocultural issues in:
- ---- a. Health Promotion/Disease Prevention ----
- ---- b. Reproductive Health/Pregnancy ----
- ---- c. Child Health ----
- ---- d. Adolescent Health ----
- ---- e. Adult Health ----
- ---- g. Women's Health ----
- 6. Ethnopharmacology (i.e., variations in medication responses in diverse ethnic populations):
- 7. Different Healing Traditions (e.g., Ayurvedic Medicine, Traditional Chinese Medicine):
- 8. Historical and contemporary impact of racism, bias, prejudice and discrimination in health care experienced by various population groups in the United States:
- 9. Office for Civil Rights August 30, 2000 Policy Guidance on the Title VI Prohibition Against National Origin Discrimination as it Affects Person with Limited English Proficiency:
- 10. Office of Minority Health's National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care:
- How SKILLED are you in dealing with sociocultural issues in the following areas of patience care? (select one)
- 1. Greeting patients in a culturally sensitive manner:
- 2. Eliciting the patient's perspective about health and illness (e.g., its etiology, name, treament, course, prognosis):
- 3. Eliciting information about use of folk remedies and/or other alternative healing modalities:
- 4. Eliciting information about use of folk healers and/or other alternative practitioners:
- 5. Performing a culturally sensitive physical examination:
- 6. Prescribing/negotiating a culturally sensitive treatment plan:
- 7. Providing culturally sensitive patient education and counseling:
- 8. Providing culturally sensitive clinical preventive services:
- 9. Asessing health literacy:
- 10. Working with medical interpreters:
- 11. Dealing with cross-cultural conflicts relating to diagnosis or treatment:
- 12. Dealing with cross-cultural adherence/compliance problems:
- 13. Dealing with cross-cultural ethical conflicts:
- 14. Apologizing for cross-cultural misunderstandings or errors:
- How COMFORTABLE do you feel in dealing with the following cross-cultural encounters or situations? (select one)
- 1. Caring for patients from culturally diverse backgrounds:
- 2. Caring for patients with limited English proficiency:
- 3. Caring for a patient who insists on using or seeking folk healers or alternative therapies:
- 4. Identifying beliefs that are not expressed by a patient or caregiver but might interfere with the treatment regimen:
- 5. Being attentive to nonverbal cues or the use of culturally specific gestures that might have different meanings in different cultures:
- 6. Interpreting different cultural expressions of pain, distress, and suffering:
- 7. Advising a patient to change behaviors or practices related to cultural beliefs that impair one's health:
- 8. Speaking in an indirect rather than a direct way to a patient about his/her illness if this is more culturally appropriate:
- 9. Working with health care professionals from culturally diverse backgrounds:
- 10. Working with a colleague who makes derogatory remarks about patients from a particular ethnic group:
- 11. Treating a patient who makes derogatory comments about your racial or ethnic background:
- 1. How IMPORTANT are each of the following factors in contributing to health disparities? (select one)
- ---- e. Educational Status ----
- 2. How IMPORTANT do you believe sociocultural issues are in your interactiions with: (select one)
- ---- b. Health Professional Colleagues? ----
- 3. How AWARE are you of your own: (select one)
- ---- a. Racial, ethnic, or cultural identity? ----
- ---- b. Racial, ethnic, or cultural stereotypes? ----
- ---- c. Biases and prejudices? ----
- 4. How IMPORTANT do you feel it is for health professionals to receive training in cultural diversity and/or multiculural health care? (select one)
- 1. HOW MUCH TRAINING in cultural diversity have you previously had: (select one)
- ---- b. In a Work Setting? ----
- 2. Have you ever visited and made use fo the following websites:
- ---- a. Better Diabetes Care http://www.betterdiabetescare.nih.gov/ISSUESculturalcomptencypractices.htm
- ---- b. Resources for Cross Cultural Health Care? http://www.diversityrx.org
- ---- c. Office of Minority Health's National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care? http://www.omhrc.gov/CLAS
- 3. What are some potential challenges to integrating training about culturally competent health care organizations and clinical practice?
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- 4. Please offer any further comments or suggestions that you may have.
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