Workshops
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Workshop
B-4: Meeting people where they are: culturally competent health promotion
and disease prevention
Non-Traditional
Approaches to Addressing Cultural Competency and Community Health Empowerment
This presentation will focus on the use of personal care establishments
(beauty salons and barber shops) for behavioral health interventions.
Using breast and prostate cancer as case studies, presenters will describe
the methodology, testing and effectiveness of two beauty salon and barbershop
based cancer control programs. The presenter will highlight the role of
stylists and barbers as health messengers and the cultural tailoring of
health messages for African-American and Afro-Caribbean customers. Lessons
learned from the Arthur Ashe Institute for Urban Health’s Soul
Sense of Beauty Program and Prostate Cancer Control Program for Community
Barbers will be shared.
Critical and seemingly intractable health problems in urban underserved
communities suggest that standard approaches to behavioral health interventions
are inadequate. Non-traditional approaches to community health empowerment,
that facilitate individual efforts to act proactively on behalf of their
own health and that of their communities, have shown tremendous success
in (1) expanding reach, (2) cultural tailoring of health messages, (3)
recruitment, training and employment of indigenous and “lay”
leadership, (4) community health advocacy, and (5) cultural acceptability
of health promotion and disease control techniques in diverse urban settings
Emphasis will be placed on the lessons learned from service, research
and training models in non-traditional venues and utilization of indigenous
lay leadership in the cultural tailoring of health communications and
the conduct of behavioral health interventions.
Participants will learn how these approaches to community health empowerment
(1) directly influence the cultural acceptability of disease control and
wellness promotion, (2) contribute to the clarity and acceptability of
important health information delivery techniques for urban African-American,
Latino and Caribbean urban populations
Ruth Browne is the Executive Director of the Arthur Ashe Institute
for Urban Health (AAIUH), serving as the organization’s principal
fundraiser, and creator of AAIUH’s full complement of health promotion
projects. The Institute's research and educational programs are built
on a model of community empowerment that helps people to lead their own
efforts to be healthy. Dr. Browne has created behavioral health intervention
programs in low income communities of color that make use of lay leadership
in churches, schools, beauty salons, barbershops, tattoo and body piercing
salons and laundry mats. She is the principal investigator of two National
Cancer Institute grants leading a team of researchers who are developing
a culturally tailored training curriculum for hair stylists and barbers
to promote breast health messages with their clients. Dr. Browne is an
assistant clinical professor in the Department of Preventive Medicine
at SUNY Downstate Medical Center and teaches in Downstate’s current
program in public health. She was recently appointed to the National Institutes
of Health Director’s Council of Public Representatives
Ruth Browne, ScD
Executive Director
Arthur Ashe Institute for Urban Health, Inc.
450 Clarkson Avenue, Box 1232
Brooklyn, NY, 11203-2098
Phone 718-222-5953
Phone: (718) 270-3101
Fax: (718) 270-2602
ruth.browne@downstate.edu
http://www.arthurasheinstitute.org
Alison Alfonzo Pence, BA
Community Services Director
Cross Cultural Health Care Program, Seattle Washington
The Cross Cultural Health Care Program (CCHCP) is a non-profit organization
dedicated to recognizing the diversity of culture and the different ways
to health. Our vision is to serve as a bridge between communities and
health care institutions to ensure full access to quality health care
that is culturally and linguistically appropriate.
CCHCP’s Community Health & Nutrition Demonstration Project
is focusing on diabetes, cardiovascular disease, hypertension and obesity
in underserved and un-served communities in the Seattle/King County area.
Currently, we are working in marginalized communities in the greater Seattle/King
County area. In most cases, we are working in communities where no mainstream
organization has ever ventured. We are teaching community members about
the affects of diabetes and related diseases in a culturally and linguistically
appropriate manner. We are working with the Tongan, Samoan, Native Hawaiian,
Filipino, Native American and Alaska Native Communities.
Because we were using the City of Seattle’s senior nutrition sites
to perform our outreach, we began encouraging the City of Seattle Nutritionist
to monitor the foods that were being served to the senior citizens/elders
for lunch. Although we understood that the meals could not be meals for
a diabetic, by subsidizing the nutrition programs we were able to encourage
fresh fruits and vegetables, 100 percent fruit juices and periodically
serve traditional foods in each of the communities. At every luncheon
site, hundreds of nutritious lunches have been served to senior citizens/elders
each year who were unable to afford the $2 donation per lunch. Also, by
making sure the lunches were nutritious, we were able to help the elders
make wise food choices and portion control.
In any community, the word “exercise” will usually provoke
groans and grimaces. In our program we do not use the word “exercise”.
Instead, we promote traditional dance and movements. With the permission
of the senior citizens/elders we have taught hula dancing. Both men and
women join in the traditional dances. It helps to obtain buy in from the
community leaders. Members like to see their leaders dance and somehow
they are not as shy to dance. In each of the communities we teach hula
to able bodied as well as those in wheelchairs and walkers. Hula can be
done in a sitting position too!
The Health & Nutrition Team was fortunate to learn a Samoan dance
taught by elders. We incorporated their native dance into our hula class.
We felt fully accepted into the community when the asked us if they could
teach us their dance.
The project’s goals are to teach community members about the affects
of diabetes and other related diseases in a culturally and linguistically
appropriate manner. We also plan to show ways of avoiding these diseases
through a sensible diet and ways to exercise. This goal can be accomplished
by teaching our basic curriculum and introducing indigenous movement for
exercise.
Communities:
Native American & Alaska Natives
Filipino
Samoan & Tongan
Native Hawaiian
Staff includes:
Alison Alfonzo Pence, Project Director
Rose Reyes Long, Coordinator
Jason Aikona Crying Wolf Sloan, Specialist
Shannon Turner, RD, Registered Dietitian
Gloria Napualani Fujii, Kumu Hula
Jovi Sanchez Swanson, Evaluator
Sue Charles, Videographer
Robert Putsch III, MD, Medical Advisor
Sara Okubo, MPH Candidate, Intern
Budget: $458,000 for two years
When we first began working in the Samoan and Tongan communities we
did not know what barriers we would encounter other than the language
barriers in the communities we are not native to. Not only does this barrier
continue to exist, we did not know that there was only one certified Samoan
interpreter in the whole state of Washington. Unfortunately, the church
politics in this community prevented us from hiring this one interpreter.
Another barrier occurred in the Tongan community. There are no interpreters,
certified or otherwise. Finally, the president of TAPA (Tongan American
and Polynesian Association) whose mother is Samoan and Father is Tongan,
agreed to interpret for us. Being an untrained interpreter posed more
barriers for the Health & Nutrition (H&N) Team. However, this
was one more barrier we overcame in time. Fortunately, another program
within CCHCP trains interpreters. CCHCP has agreed to give a scholarship
to a Samoan woman who is interested in becoming a certified interpreter.
We continue to seek someone to work as an interpreter from the Tongan
community.
In November 2002, an informal survey was taken at TAPA. 15 of the 17
surveyed said they were once diagnosed with diabetes, cardiovascular disease,
or hypertension within the last ten years and only two had medical insurance!
One man told us that he was diagnosed with diabetes about ten years
ago, and was given some pills. He took the pills and never returned to
the doctor. He said he has no money to get more pills. He was hoping that
we (H&N Team) would be able to give him his pills.
Another man said he did not have diabetes but had bad headaches along
with high blood pressure readings. He lost his medical card and wanted
the H&N Team to help him get his card back so he could go see a doctor.
He had all the signs of being diabetic and hypertensive. After many months
of encouraging him to go to one of the local community clinics, he finally
went. He obtained a new medical card with our help, went to a provider
at a clinic we referred him to, and was immediately diagnosed with Type
2 Diabetes and high blood pressure.
All who do not have medical insurance said they go to the emergency
room at the hospital when they are sick.
The two that do have medical insurance said they did not know the names
of the medication they were taking. We encouraged them to bring in their
medications so we could explain to them what they were taking and for
what purpose. With the help of Dr. Bob Putsch, our medical advisor, the
team has been able to seek his medical advice and wisdom. However the
bottom line has always been to encourage the community members to see
a medical provider.
Bio Sketch
Alison has been a community and political activist for over 30
years. Her political activism began when she started advocating for women’s
and children’s issues.
Alison’s years of experience includes working as a staff person
in the Washington State House of Representatives working on issues including
health care for the underserved.
Since coming to CCHCP, Alison has worked with community sexual assault
programs throughout the state. When she was named the Community Services
Director, Alison was at the helm of the Kidshealth.2001 program which
oversaw the outreach to several ethnic communities.
Alison authored the Cross Cultural Community Health and Nutrition Demonstration
Project – a proposal to the state to work in underserved communities
on diabetes, cardiovascular disease, obesity and nutrition.
Alison continues to work with grass roots community groups on issues
that affect immigrant, refugee communities and communities of color.
Alison Alfonzo Pence, BA
Community Services Director
Community Services
Cross Cultural Health Care Program
270 S. Hanford Street, #100 A
Seattle, WA 98134
(206) 860-0329 phone
(206) 860-0334 fax
alisonp@xculture.org
www.xculture.org
Rose Long is a trainer, community health educator, medical interpreter,
translator, and a community advocate. She is currently the Program Manager
for the Cross Cultural Health Care Program’s (CCHCP) Health and Nutrition
Project and the Outreach Institute. She has been with CCHCP since 1995.
She co-designed and helped to implement a demonstration project that provides
health education, physical activity, support and referral services to
several Pacific Islander and Native American communities in the greater
Seattle/King County area. She co-developed training curricula for Cultural
Competency Tools and Skills for Working with Communities as well as Cultural
Competency for Middle School kids. She is a trainer for cultural competence
and Bridging the Gap, CCHCP’s 40-hour medical interpreter training.
Prior to the demonstration project, Rose trained multi-ethnic outreach
workers as well as provided outreach services to educate parents and enroll
at-risk and underserved children in Washington’s statewide children’s
health insurance programs through Kids Health 2001.
Rose Long
Cross Cultural Health Care Program
270 So. Hanford Street, Suite 100
Seattle, WA 98134
Tel: 206 .860.0329
Fax: 206.860.0334
Email: rosel@xculture.org
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