User:Am.nalula/sandbox

Original Text

Original text that I will be removing or changing

My text

Bold Text: Talia's edits

Michael S. edits

Immigrant health care in the United States

Healthy Migrant Theory
Although immigrant populations have increasingly become the foci for analyzing health disparities, the issue of providing care within the context of the patient’s cultural background was contested by studies that completely denied the presence of rising health issues in immigrants due to inadequate health services. In 1986, theorists Kyriakos Markides and Jeannine Coreil developed the idea of the Healthy Migrant theory that thought of migration to include an inherent selection process due to the physical and psychological demands of travel, searching for employment, and adjusting to new cultural norm. This paradox theorized that despite the social disadvantages of transitioning into a new country especially for ethnic minority groups, there is an inherent physical and psychological robustness in immigrants compared to populations in both their home country and the United States. This Healthy Migrant theory contradicts the need for more money and resources to be allocated into hospitals and cultural sensitivity measures because it denies the need for adjusted health services for immigrants in the first place. This last sentence might not be a neutral enough tone, since it is slightly discrediting the Healthy Migrant Theory.

Although the data that supported the Healthy Migrant theory converged on the idea that general immigrants arrived to the United States healthier than native-born Americans, the theory does not take into consideration the populations that immigrate to the United States for necessity, such as refugees, undocumented immigrants, or families looking for academic or financial opportunity. The Healthy Migrant theory assumes that immigrants are able to successfully transition their lives in America, become fluent in English, or retain their health status. Consequently, continuous studies have found evidence of the uniform decline of immigrants’ health advantage as the number of years in the U.S. increases until about 10 years in when health conditions align with the level of foreign born populations, and become of this, the presence of cultural barriers could perpetuate the decline especially in immigrant populations that suffer from acculturative stress in their new country.

Looks good, and fits really well into the "Barriers to Care" section in the article.

STATUS: IMPORTED

Cultural Competence in Healthcare

Definition
'' Cultural competence is defined as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and that enables thk effectively in cross-cultural situations.   (***ADDING: Cultural competence is a practice of values and attitudes that aims to optimize the healthcare experience of patients with cross cultural backgrounds . ***) Essential elements that enable organizations to become culturally competent include valuing diversity, having the capacity for cultural self-assessment, being conscious of the dynamics inherent when cultures interact, having institutionalized cultural knowledge, and having developed adaptations to service delivery reflecting an understanding of cultural diversity. By definition, diversity includes differences in race, ethnicity, age, gender, size, religion, sexual orientation, and physical and mental ability. Accordingly, organizations should include these considerations in all aspects of policy making, administration, practice, and service delivery.''

''Cultural competence involves more than having sensitivity or awareness of cultures. It necessitates an active process of learning and developing skills to engage effectively in cross-cultural situations and re-evaluating these skills over time. Cultural competence is often used interchangeably with the term cultural competency.''

Awareness
The awareness aspect of cultural competence relates to the consciousness of one's personal reactions to people who look or exhibit different practices from cultural norms. According to the American Sociological Association, culture itself is understood as the the languages, customs, beliefs, rules, arts, knowledge, collective identities, and memories shared by members of a social group that form the foundations of motives or actions. In measuring cultural competence in health care, one must recognize their own implicit biases toward patients or employees. Lack of awareness causes cultural discrimination during patient care. An analysis by researchers at UC San Francisco, UC Berkeley, and Stanford University found that almost one in five patients with chronic conditions over the age of 54 reported feeling discrimination within health care in a national survey that took place between 2008 to 2014.

Rewording of last sentence / check for grammar; maybe change the last part to "reported feeling discrimination within healthcare from a national survey..." (*update: EDITED!)

STATUS: IMPORTED

Attitude
Paul Pedersen, a pioneer in multicultural competence, theorized a framework of culturally competence practices that consisted of three factors: awareness, knowledge, and skills. The Diversity Training University International (DTUI) included an attitude component that is delineated from the other factors increasing the analysis of general biases and beliefs as a scheme in one's daily life. This differs from an exercise that forces students to examine their own values and beliefs of cultural differences. '''Try rewording this last sentence, it has a lot of info so it's a little confusing. Might help to break it into two sentences.''' (*update: edited!)

STATUS: IMPORTED

Knowledge
The problem of cultural incompetency lies in a the lack of familiarity of the cultural and social experiences of the patient. Social psychologist Patricia Devine and her colleges conducted research that found that low-scorers on a cultural familiarity test tended to exemplify more discriminatory actions or speech in cross-cultural interactions. When awareness, attitudes, and knowledge are given prominence in these encounters, ethnocentrism, racism, and inequitable relations are no longer present.

Knowledge of culture also includes awareness of the structural, social, and environmental barriers that give meaning to certain actions in patients' lives. In the Cross-cultural Counseling Inventory, practitioners are examined by their understanding of "the current socio-political system and its impact on the client". In 2017, there was an estimated 20.5 million Black, Hispanic, and Native Americans living below the poverty line. Without taking aspects like socioeconomic status, immigrant status, and environment into consideration, physicians often resort to stereotyping or biases in their behavior.

STATUS: IMPORTED

-I think merging this part under knowledge to "awareness" would also work.

-For the third sentence, I'm not sure if you meant to leave out a citation there or if it still needs one. (update: edited!)

- I think it would be helpful to consider adding a transition line or starting a new paragraph with the last sentence and add another sentence as it doesn't seem to connect too well with the rest of the paragraph. (update: edited!)

Skills
The skills aspect of cultural competence involves implementing the practices of cultural knowledge, sensitivity, and awareness into daily experiences with patients. One aspect of developing skills is learning respectful and effective communication strategies whether within an organization or between individuals. "An important factor" might be a bit of an un-neutral tone, maybe replace with "One aspect of developing skills..." (update: edited) Learning communication practices includes examining communication through body language and other non-verbal cue as some gestures may have extreme variations and meanings from one culture to another. Developing skills is an active process that requires reexamining one's own internal belief system.

STATUS: IMPORTED

Language Barriers
''Linguistic competence involves communicating effectively with diverse populations, including individuals with limited English proficiency (LEP), low literacy skills or are not literate, disabilities, and individuals with any degree of hearing loss. According to the U.S. Census in 2011, 25.3 million people are considered limited English proficient, accounting for 9% of the U.S. population . Hospitals frequently admit LEP patients for treatment. With cultural and linguistic barriers, it is not surprising that it is hard to achieve effective communication between the health care providers and the LEP patients.''

'' In order to improve communication and mutual understanding, health care systems have used the professionally trained interpreters to help health care providers to communicate with patients whose English proficiency is limited. Studies have shown that trained professional interpreters or bilingual health care professionals have a positive effect on LEP patients' satisfaction, their quality of care, and outcomes. ''

''The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care developed by the Office of Minority Health (OMH) are intended to advance health equity, improve quality and help eliminate health care disparities. The three themes of the fifteen CLAS standards areGovernance, Leadership, and workforce; Communication and Language Assistance; and Engagement, Continuous Improvement, and Accountability. The standards clearly emphasized that the top levels of an organizational leadership hold the responsibility for CLAS implementation, and that language assistance should be provided when needed, and quality improvement, community engagement, and evaluation are importance. that is a very good resource for healthcare systems and organizations to follow to become culturally and linguistically competent in the delivery of health care.''

*** MOVE SECOND PARAGRAPH DOWN TO BECOME THIRD PARAGRAPH SO THERE IS BETTER FLOW**** NEVERMIND I'M ACTUALLY GOING TO JUST DELETE IT FOR BETTER FLOW INTO THE SUBSECTION***

(*note: added a citation to a previous editor's content because it lacked citations)

Variability in interpreter use
Though the standard of interpreter use in medical discourses has been perceived to be the solution for cross-linguistic encounters within the hospital flow, a close analysis of the social role of the translator uncovers varying effects on the quality of care and accuracy of medical advice. A previous study of 83 U.S. public and private hospitals reported an average of 11 percent of the patient population requiring interpreter services, and. A t one particular hospital, only seven full-time Spanish-English interpreters were hired to attend to the linguistic needs of 33,000 patients in need of Spanish interpretation. The high demand but low value for this position generates interpreters who may be ill-fit for the responsibility, consistently running late and not having the adequate training to perfectly translate the patient’s needs or the doctors orders. Ad hoc translators were found to display a higher level of error frequency in their patient interactions with 77% of the translations being found to some level of inaccuracy. This is relatively higher compared to professional medical translators. Ad hoc translators are nurses, family members, or other available bilingual staff that are utilized on the spot for translation purposes. However, in the same study, professional translators were still found to exhibit error in 53% in their evaluated interactions. In a review of 28 in-site research studies conducted, use of professional interpreters was associated with overall improved clinical care in four categories: communication, utilization, clinical outcomes, and satisfaction. Of the twenty-eight, only six were found to have an overall patient rating of "satisfactory" or higher in the context of their clinic care with the use of a professional translator.

Edit: "Ad hoc translators were found to display a higher level of error frequency in their patient interactions with 77% of the translations being found to some level of inaccuracy. This is relatively higher compared to professional medical translators. (update: edited!)

STATUS: IMPORTED

Diversity
One factor that impinges on delivery culturally competent care is the degree in which the leadership and workforce of the physician population reflect the rates of minority groups in the United States. Research has shown that for minority patients, racial similarity between patient and physician correlates with a greater sense of patient satisfaction. On a study conducted on a cohort of 147,815 primary care physicians, the Black, Hispanic, and Native American groups together constituted 13.4 percent of the population as compared. However, since 2018, these groups comprised a total of 33 percent of the population of the United States. Despite the small pool of Black and Hispanic physicians, studies show that 25 percent of Black patients participating in a study and 23 percent of the Hispanic patients had primary care physicians that coincided with their racial identity. Given their connections and experiences, minority health professionals are more likely to develop care models that more effectively meet the needs of the communities they serve. The lack of diversity and sociocultural awareness risks the the chance of stereotyping patients or having lack of attentiveness to the individual needs of their patients. STATUS: IMPORTED