Address diversity through training, focus groups

Experts offer guidelines to getting started

Newspaper and magazine articles increasingly discuss the cultural changes expected to accelerate as the nation moves into the 21st century. One of the major changes, demographic researchers say, is that Caucasians no longer will be the majority culture.

Home care agencies, like all health care providers, already have experienced this transition to a multicultural environment, as they treat greater numbers of patients from different countries and hire more bilingual employees.

The home care publishing industry has made some attempts to address the trend by offering patient teaching materials in Spanish and other languages. The problem is that home care agencies in one city are not likely to have patients of the same cultural backgrounds as agencies in another city. America, always a diverse culture, now has a wide variety of immigrant populations.

Understand your patients

How should a home care educator train staff to deal with minority patients? And, more importantly, how can a home care agency be sure it has met the needs of its culturally diverse patients?

The first step may be to form focus groups consisting of people from different cultural backgrounds. The groups could talk about their health care needs, family support, and how they would be likely to use or not use home care services. Later, the information gathered from these focus groups could be used to train home care staff about cultural diversity or to train the families of minorities how to become effective caregivers.

"When you’re framing a new program of any kind, the key is to not assume but to ask questions and to try to understand where each person is coming from," says Nancy B. Emerson Lombardo, PhD, a senior research scientist with Wellesley College and the Center for Research on Women in Wellesley, MA. The center developed a program called the "In-home Skills Training Support System Building Program."

"There’s no magical formula," Lombardo adds. "You try to create a partnership between the people you’re trying to serve and teach."

She and other experts offer these guidelines about how to establish a cultural diversity training and education program:

o Make the best use of a focus group.

Focus groups are a good way to give home care agencies some basic information about a targeted population of potential patients. "You have a service you would like to deliver, but you have to find out if that service you’re thinking about is at all relevant to the people you think need it," she says.

By gathering members of that target population together, a home care agency begins to develop an idea of how successful an education program might be for minority caregivers. Also, a focus group gives home care educators a clear idea of what care issues are most important to various members of a minority group. Since every minority group and culture has some different perceptions and desires regarding health care, it’s a good idea to invite members of all of the most prevalent minority groups to the focus group, Lombardo suggests.

The Research and Training Institute at Hebrew Rehabilitation Center for the Aged in Boston began with a focus group when developing a program to train ethnic family members how to care for patients with dementia, says Pauline Belleville-Taylor, RN, MS, CS, GNP, gerontological research clinical specialist for the Research and Training Institute at the center. "You need to include professionals who work with that community and include some family members and patients themselves," she says.

Also, offer transportation to the focus group meeting if some participants need help in this area. Even in urban areas, transportation can be a problem for some people, she says. "We rotated the sites of the meetings and arranged transportation for focus group members."

Don’t forget to serve food. "Food is always a good idea because they’re giving their time, and you have to make it pleasant for them socially as well," Lombardo says.

Belleville-Taylor says the Boston center decided to scrap its normal practice of not offering food at meetings. Instead the center provided bagels, pastries, coffee, and soda at all meetings with African-American community or church groups. "We were told it’s very important to have some food and fluids. It was amazing how the food broke the ice with people."

Finally, once you have gathered a focus group, make sure it works the way it should by giving everyone an opportunity to review any material you may discuss. And make sure everyone is able to speak, rather than allowing a few more verbose members to run away with the meeting.

o Get to know your city’s minority cultures on their turfs.

It takes time to build trust, so home care agencies should make sure they have a booth or other educational involvement at health fairs, in community groups, and at social gatherings at which minority groups are present. "The key is not to just go there once because it’s usually about the third time that you appear that people begin to trust you and know you," Lombardo says.

Agencies also could develop contact with community ethnic groups by first contacting leaders in those communities to ask their opinions about the proposed program.

Groups have different needs

Bei Wu, MS, a doctorate candidate and research associate with Lombardo, gathered information about minority groups as part of her dissertation. Her preliminary findings showed that Asians would use adult day care or health care support services less frequently than would Hispanics. However, Asians used relatively more home assistance services, such as home care services that help the elderly modify their homes for safety.

Wu also found that health care providers can serve minority populations better if they employ members of minority groups, mostly because of the language barrier. "I did some interviews with Chinese elderly people in Boston, and they told me that they felt comfortable talking with me because I’m also Chinese," Wu says. "I speak Mandarin, and they did too."

o Implement suggestions into the program.

"It’s important when working with a minority community to include people from the target minority group into the actual intervention," Belleville-Taylor says. "Each agency also needs to learn about that culture and their health care practices and how you can adapt your interventions to incorporate some of those important things."

The Center for Research on Women developed a skills training and counseling program for min ority caregivers in their homes, based on input the center received from community leaders. The center’s program involved eight hours of training time, spread throughout a series of one- to two-hour meetings with each family.

"Everybody agreed it would be a good idea to have the training in the home, and it would have been easier to do all of the training in one day of six to eight hours," Lombardo says. But the people the center contacted about the program said they would much rather have it spread out over several weeks because the information would be easier to absorb that way. "They said they would welcome telephone follow-up, and the agency people said we should allow time for crisis calls and subsequent home care visits."

The Hebrew Rehabilitation Center’s caregiver training program focused on providing education about dementia patients through a series of lectures, Belleville-Taylor says. "We recruited two home health agencies to help us with the project, and they received payment. We had others who worked as independent consultants."

The program began by targeting African-Americans and eventually provided training for Hispanics, Vietnamese, Chinese, Koreans, and people from other ethnic groups. For example, there might be a one-day workshop for Hispanic members of the community.

o Evaluate your program.

Home care agencies should evaluate their programs to make sure nothing was missed and to make needed improvements. Lombardo learned, for example, that many of the caregivers in the Wellesley center’s program were depressed. This indicated the program probably should have included some mental health services. "The trainers were not necessarily equipped to get involved with mental health issues."

It’s also a good idea to interview the trainers and find out what feedback they’ve received about the program.


Pauline Belleville-Taylor, RN, MS, CS, GNP, Geron tological Research Clinical Specialist, Research and Training Institute at Hebrew Rehabilitation Center for the Aged, 1200 Centre St., Boston, MA 02131. Phone: (617) 363-8552 or (617) 325-8000, ext. 552. Fax: (617) 363-8936.

Nancy B. Emerson Lombardo, PhD, Senior Research Scientist, Wellesley College, Center for Research on Women, 106 Central St., Wellesley, MA 02481-8203. Phone: (781) 283-2740. Fax: (781) 283-2504.

Bei Wu, MS, Research Associate, Wellesley College, Center for Research on Women, 106 Central St., Wellesley, MA 02481-8203. Phone: (781) 283-2740. Fax: (781) 283-2504.