1 dept of health education and promotion diane levin-zamir, mph, ches director, department of health...

1Dept of Health Education

and Promotion

Diane Levin-Zamir, MPH, CHES

Director, Department of Health Education and Promotion

Clalit Health Services

"Refuah Shlema" – Cultural Liasons in Primary Care

Lessons Learned from 10 Years of Implementation

2Dept of Health Education

and Promotion

Since 1984, nearly 80,000 Ethiopians have

immigrated to Israel – new immigrants arrive each

week

A Cross-Cultural Program for Promoting Health Among Ethiopian Immigrants in the Primary Care Setting

Significant adjustment problems due to

cultural disparities exist particularly regarding

health and health care; navigation of the

primary health care system.

“Refuah Shlemah”

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and Promotion

Population in Israel by Culture

Other2.34%

Jews living in

Israel more than 10 years

63.43%

Jews New

Immigrants 16. 01%

Moslem Arabs 14.80%

Druze1.64%

Christian Arabs1.77%

4Dept of Health Education

and Promotion

Clalit Health Services

3.6 million members, 30,000 workers1,350 primary and specialized care clinics14 hospitals416 pharmacies40 diagnostic imaging centers67 laboratory centers83 physiotherapy units30 occupational therapy units87 diet & nutrition consultation units22 mental health clinics20 alternative medicine clinics70 dental clinics

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and Promotion

HospitalHospitalPrimaryPrimary

Care ServicesCare Services

PublicPublic

PrivatePrivate SectorSector CommunityCommunity

OrganizationsOrganizations

NGOsNGOs

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and Promotion

Over 40 community clinics serve

neighborhoods with high

concentration of Ethiopian residents

Scope

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and Promotion

Needs

Significant adjustment problems due to

cultural disparities exist particularly regarding

health and health care; navigation of the

primary health care system

Problems with diagnosis and treatment – distress among the community

and the providers

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and Promotion

Objectives - 1997

• Significant improvement of services that are given in the primary care setting - culturally appropriate

• Improved participation of the Ethiopian member with regard to self-care and follow-up

• Prevent detrimental changes in lifestyle, through health education and promotion – according health literacy

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and Promotion

HealthHealth

EmpowermentHealth Literacy

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and Promotion

Western Medicine

Cause (Specific or Non-specific)

Symptom Diagnosis Treatment/Cure

Time

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and Promotion

Cause

Treatment/Cure

Traditional Medicine

Symptom DiagnosisSocio-Cultural Identity

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and Promotion

1. employing Ethiopian immigrant facilitators on a full

time basis, who have been trained to work as health

liasons and inter-cultural mediators between

patients and physicians

2. training clinical staff with the aim of changing their

attitudes and thus bridging inter-cultural gaps, by

increasing awareness and sensitivity regarding Ethiopian

perception of health and dis-ease causation

3. cooperatively implementing health

education activities for new immigrants

“Refuah Shlemah”

13Dept of Health Education

and Promotion

Partners

• The program was initiated by Clalit Health Services and the Joint Distribution Committee.

• Detroit and Palm Beach Federations.• National Insurance Institute • Ministry of Absorption• Maccabi and Leumit Health Services • Ministry of Health.

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and Promotion

Partners

• Clalit Health Services

• Ministry of Health

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and Promotion

The Program

• Clinics were chosen for the program based on the size of the Ethiopian community they serve, and the average age of the group

• Cultural mediators/liasons were recruited.

• A training program was immediately established, and has continued for 10 yrs.

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and Promotion

The Program

• Training of the primary care staff to learn how to work with the cultural liason/mediator was the fist challenge

• Maintaining the objective of bridging the cultural gap and not just translating was and is a challenge

• After several months, the cultural liasons became an integral part of the team

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and Promotion

Evaluation

• Was conducted by in two phases the Brookdale Institute

• Examined the effect of the intervention on Ethiopian immigrants

• The first phase looked at the general population that visited primary care clinics

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and Promotion

The program was effective in:

1. Improving physician-patient relations,

2. Improving availability and accessibility of

medical services and

3. Improving the ability to navigate the health

system

4. No significantly increase in expenditure on

services was incurred.

The Major Findings

Brookdale Institute, 2002

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and Promotion

Selected Health Education Programs

• Care of children with fever

• Healthy lifestyle for diabetics

• Use of prescription medication

• Prevention examinations

• Care of child with asthma

• Home accident prevention

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and Promotion

The results include:

improved perception of general health

status among the experimental clinics,

no perceived difference in perceived

well being among the diabetics and asthmatics.

some aspects of self care were more positive

as a result of the program, for example physical

activity, etc.

Second Phase of Evaluation

Brookdale Institute, 2002

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and Promotion

1. A health mediator in primary care clinics can

significantly bridge the communication gap in a multi-

cultural setting supporting and empowering an

immigrant population.

2. Specific improvements for asthmatics and diabetes in

the present ecclectic model showed initial improvement.

3. A model is needed in which the health mediators

concentrate specifically on these groups with special

health needs.

Conclusion

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and Promotion

Conclusions

The cultural liasons/mediators are vital in order to facilitate communication with, and treatment of, Ethiopian residents.

The integration of a cultural liason/mediator should not be temporary, rather must be sustained as an integral part of the service and a vital contribution to the community.

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and Promotion

Conclusions

“Secret of success” – collaborative inter-disciplinary and inter-organizational efforts, including pooling financial and professional resources

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and Promotion

Thank you for your attentionThank you for your attention!!

dianele@clalit.org.ildianele@clalit.org.il