Week 7 - Cultural Diversity and LGBT health Flashcards
Define culture
- Culture is defined by each person in relationship to the group or groups with whom he or she identifies
- An individual’s cultural identity may be based on heritage as well as an individual’s circumstances and personal choice
- Cultural identity may be affected by such factors as:
- – Race
- – Ethnicity
- – Age
- – Language
- – Country of origin
- – Economic status
- – Religious/spiritual beliefs
- – Physical abilities
- – Occupation
- – Etc.
- These factors may impact behaviours such as:
- – Communication styles
- – Diet preferences
- – Health beliefs
- – Family roles
- – Lifestyle
- – Rituals
- – Decision-making processes
- All of these beliefs and practices can in turn influence how patients and health care professionals perceive health and illness and how they interact with one another
How can service presentation be influenced by culture?
- The way they think about mental health and mental health problems
- The way they make sense of certain symptoms and behaviours
- Their view potential services and the services they choose to accept
- The treatment and management strategies they find acceptable
- The way in which those who have mental health problems are perceived
- Issues of access; experience of service; visibility of services
What can happen if culture is not respected in a healthcare relationship?
- Patient-provider relationships are affected when understanding of each other’s expectations is missing
- Miscommunication
- Non-compliance and not understanding patient perspective
- Rejection of the healthcare provider
- Conflict or isolation within staff groups
What actions can we consider for appreciating culture within a healthcare setting?
- To provide a sensitive and respectful service acknowledging cultural need and belief
- – Using history taking
- To respect cultural individuality whilst maintaining patient-centred curiosity
- – Using care planning and/or cultural information sharing without making assumptions or falling back on stereotypes
How is diversity important in healthcare?
- Increasing diversity of populations
- Increasing albeit limited evidence that taking a patient-centred approach improves outcomes
- Huge disparities in care accessed
- Differential outcomes
- Legislative frameworks
How can discrimination of LGBT people lead to poorer health?
- Increased stress
- Low self esteem
- Isolation
- Increased conflict
- Sub-culture
- Distrust of authorities
- – E.g. trans people not reporting mental health problems
- Discriminatory healthcare
- – E.g. lesbians refused smears
What is sexual orientation?
A term used to describe what gender you are attracted to
- May be life-long from early age or vary over a lifetime
What is sexual attraction?
Includes feelings, behaviour and identity
What is sexual identity?
Gay, lesbian, bisexual
- Polite terms to describe these self-identified groups in public life
- Some people prefer no labels or different labels
- Someone’s internal perception and experience of their gender
What is sexual behaviour?
- Men who have sex with men (MSM)
- Women who have sex with women (WSW)
- Behaviour is not the same as identity
What is gender role/expression?
The way the person lives in society and interacts with others
What does transgender mean?
It is an umbrella term for those whose gender identity and/or gender expression differs from their birth sex
- May include: transsexuals, transvestites, cross-dressers, gender-queer
What does transsexual mean?
Someone who feels a consistent and overwhelming desire to transition and fulfil their life as a member of the opposite sex
- Some transsexual people undergo reassignment under medical supervision
- Not all trans people are transsexual
- – Many people do not conform to gender norms and do not wish to surgically alter their bodies to ‘fit’ either gender category
How can stereotypes about LGBT patients affect their healthcare?
- Inappropriate questions and comments
- Prejudice
- Not respecting confidentiality
- GPs sometimes reluctant to help trans people seeking help with their trans orientation
- Assumptions you might make about a patient who comes to see you:
- – E.g. assuming a patient has an opposite sex partner
- – E.g. assuming a married man does not have anal sex
Describe the specific health needs that are prevalent in the LGBT community
- Mental health
— LGBT people experience higher levels of stress-related mental health problems than average
— Seems to be worse amongst bisexual and transgender people than amongst lesbians and gay men
— 35% suffer anxiety
— 52% suffer depression - Substance use
— LGBT people have higher rates of substance use
• Smoking (50%), alcohol, recreational drugs (37%) - Cancer
— Lesbians should have smears
• Many lesbians have had sex with men
• HPV can be transmitted between women
• 10% of lesbians have abnormal smears
— MSM are more likely to contract anal cancer
• Risk doubles if HIV positive - STIs
— MSM: HIV and syphilis more common
— WSW can and do contract STIs even if they have only had sex with women in last 5 years
