Cross-cultural Healthcare Quality Quiz

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1. Which of the following statements is TRUE?

Explanation

(Answer: c. The only assured similarity among people from around the world who come to you for care is the fact that they are your patients and they hope to be treated with respect and with concern for their individual health needs. As a health care practitioner, it is important to have a basic understanding of your patients’ cultures—and to recognize the similarities and differences among people from the same region of the world and the same country. Differences in cultures within a region can be pronounced. Each patient is the product of many cultural forces. People from the same continent, the same country, the same part of the country, and even the same city, may have major differences in cultural heritage, traditions, and language, as well as differences in socioeconomic status, education, religion, and sexual orientation. It is the combination of all of these factors that make up a person’s “culture.”)

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About This Quiz
Cross-cultural Healthcare Quality Quiz - Quiz

This quiz offers healthcare professionals an opportunity to self-assess their preparedness for communicating with patients and families who come from different cultural backgrounds.  Please note that this quiz is not... see morea "test!" Your answers will not be shared with anyone. It is also important to note that cultural competence is a process and not an endpoint. A high score on this quiz does not "certify" or qualify you as a culturally competent provider! Rather, the purpose of this quiz is to stimulate your thinking about cultural competence and help you to reflect on your experience, knowledge, and attitudes regarding culturally diverse populations. The quiz takes about ten minutes - there are 23 multiple choice and true/false questions. Upon completion, your score report will appear. Scroll down to view a DETAILED SCORE REPORT that includes complete explanations of the correct answers.  

(This quiz is part of The Provider's Guide to Quality and Culture, a joint project of Management Sciences for Health, the U. S. Dept. Of Health and Human Services, and the Bureau of Primary Health Care. ) see less

2. Providers whose patients are mostly European-American, U.S.-born, and middle-class still need to know about health practices from different world cultures.

Explanation

(True: A growing number of people from majority U.S. cultures are turning to traditional medicines as part of their health care strategies. Providers should be aware of any such practices that may affect their patients’ health.)

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3. In some cultures, it may be appropriate for female relatives to ask the husband of a pregnant woman to sign consent forms or to explain to him the suggested treatment options if the patient agrees and this is legally permissible.

Explanation

(True: In many cultures, men are not involved in the activities surrounding pregnancy or childbirth. Yet they maintain the responsibility for making decisions and giving permission for treatment, medication, and hospital stays. A female relative may have to intervene between the provider and the husband.

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4. When a patient who has not adhered to a treatment regimen states that s/he cannot afford the medications prescribed, it is appropriate to assume that financial factors are indeed the real reasons and not explore the situation further

Explanation

(False: In addition to exploring payment options with the patient, it is important for the provider to inquire about cultural and psychological factors that may impede adherence to the prescribed treatment regimen.)

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5. When a patient is not adhering to a prescribed treatment after several visits, which of the following approaches is NOT likely to lead to adherence?

Explanation

(Answer: b. Non-adherence can be the result of many different factors that may require a variety of interventions. Simply repeating the instructions may not address the real issues that are keeping the patient from adhering to the regimen. In fact, repetition of instructions may be inappropriate and quite offensive if the patient has a communication disability. Family members can provide valuable support. It may also be necessary to set small, realistic goals in order to achieve long-term behavioral change. Finally, an understanding of the patient's beliefs about other remedies may offer valuable clues to her/his reluctance to adhere to treatment.)

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6. Because Hispanics have a lower incidence of certain cancers than the majority of the US population, their mortality rate from these diseases is correspondingly lower.

Explanation

(False: Despite the lower rate of breast, oral cavity, colorectal, and urinary bladder cancers among Hispanics, their mortality rate from these cancers is just as high as that of the rest of the population.)

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7. Which of the following statements is NOT TRUE:

Explanation

(Answer: c. Health and healing has been a part of Arab tradition since the earliest historical recordings. Not only has Arab medicine been in existence for over one thousand years, but Arab medical texts and practices were very influential in the development of Western medical tradition.)

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8. Cross-cultural misunderstandings between providers and patients can lead to mistrust and frustration, but are unlikely to have an impact on objectively measured clinical outcomes.

Explanation

(False: Low levels of cultural competence can impede the process of making an accurate diagnosis, cause the provider to order contraindicated medication, and reduce patient adherence to recommended treatment.)

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9. When the patient and provider come from different cultural backgrounds, the medical history obtained may not be accurate.

Explanation

(True: Because of language and cultural barriers, the patient may not understand the questions or may be reluctant to report symptoms; in turn, the provider may misunderstand the patient’s description of symptoms.)

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10. Which of the following is NOT TRUE of an organization that values cultural competence:

Explanation

(Answer: d. Even the most conscientious, committed staff who have been trained in cultural competence may need periodic reminders. In a busy practice, it is easy for providers to seek shortcuts, slipping into assumptions about the diverse populations they serve and failing to take the time needed to fully understand the health beliefs and values of each patient.)

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11. If a family member speaks English as well as the patient’s native language, and is willing to act as interpreter, this is the best possible solution to the problem of interpreting.

Explanation

(False: This is an inappropriate responsibility for families to take on and may actually place the provider in violation of the Civil Rights Act of 1964 and the August 30, 2000 Office for Civil Rights (OCR) Policy Guidance. The rationale for using professional interpreters is clear. Professional interpreters have been trained to provide accurate, sensitive two-way communication and uncover areas of uncertainty or discomfort. Family members are often too emotionally involved to tell the patient’s story fully and objectively, or lack the technical knowledge to convey the provider’s message accurately.)

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12. A female Muslim patient may avoid eye contact and/or physical contact because:

Explanation

(Answer: c. Modesty is a very important aspect of a Muslim's life. Handshakes between unrelated men and women are inappropriate according to Islamic norms. In addition, eye contact will often be avoided, especially in mixed-gender situations.)

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13. Some symbols—a positive nod of the head, a pointing finger, a “thumbs-up” sign—are universal and can help bridge the language gap.

Explanation

(False: Each of these symbols has a very different meaning in different cultures, and may be offensive.)

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14. Which of the following statements is NOT TRUE?

Explanation

(Answer: c. A large percentage of Africans are Muslims, most of them living in North and West Africa, but there are also many Muslims in East Africa.)

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15. Which of the following statements in NOT TRUE?

Explanation

(Answer: b. The longitudinal NI-HON-SAN study and Honolulu Heart Program showed that dietary changes contributed to a significant increase in coronary heart disease among Japanese men who migrated to Hawaii and California. It highlighted the role that environmental factors can play in counteracting predispositions to disease.)

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16. When a provider expects that a patient will understand a condition and follow a regimen, the patient is more likely to do so than if the provider has doubts about the patient.

Explanation

(True: This is an adaptation of the “Pygmalion theory” which has proven that students generally live up—or down—to the expectations of their teachers. (Rosenthal and Jacobson 1968).

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17. Minority and immigrant patients in the US who go to traditional healers and use traditional medicines generally avoid conventional Western treatments.

Explanation

(False: In the US, some individuals from minority and immigrant groups use traditional treatments before turning to conventional Western medicine, or use both concurrently.)

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18. A really conscientious health provider can eliminate his or her own prejudices or negative assumptions about certain types of patients.

Explanation

(False: Most of us harbor some assumptions about patients, based on race, ethnicity, culture, age, social and language skills, educational and economic status, gender, sexual orientation, disability/ability, and a host of other characteristics. These assumptions are often unconscious and so deeply rooted that even when an individual patient behaves contrary to the assumptions, the provider views this as the exception to the rule. A conscientious provider will not allow prejudices to interfere with making an accurate diagnosis and designing an appropriate treatment plan.)

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19. During a medical interview with a patient from a different cultural background, which is the LEAST useful technique?

Explanation

(Answer: b. Although the provider may be tempted to correct the patient’s different beliefs about illness, this may lead the patient to simply withhold his/her thoughts in the future and interfere with building a trusting relationship. It is more effective to be nonjudgmental about differences in beliefs. The provider should keep in mind two goals: 1) the patient should reveal her/his medical history and symptoms to help the provider make an accurate diagnosis, and 2) the patient should develop trust in the provider’s medical advice and be willing and able to adhere to that advice. To accomplish these goals, it is essential to treat the patient with respect, openly discussing differences in health beliefs without specifying “correctness” or “incorrectness.”

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20. Which of the following is good advice for a provider attempting to use and interpret non-verbal communication?

Explanation

(Answer: a. Although smiling is an expression of happiness in most cultures, it can also signify other emotions. Some Britishers, for example, may smile when they are discussing something sad or uncomfortable. The other pieces of advice are incorrect. The use and interpretation of body language depend entirely on the patient’s culture and personal preferences. What is appropriate in one culture may be embarrassing or offensive in another culture. Interpersonal greeting behaviors, for example, vary widely from one culture to another. Beliefs about touching are also highly variable, with some cultures placing a high value on physical contact, and others believing that physical contact of any kind is a sign of intimacy. Similarly, some cultures perceive direct eye contact as a sign of respect, while in other cultures, eye contact with elders and authority figures is to be avoided. Hand gestures in particular can lead to serious misunderstandings. For example, the “ok” sign, widely used in the US, is the symbol for coins or money in Japan. In several other cultures, the gesture represents a bodily orifice and is highly offensive.)

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21. Out of respect for a patient’s privacy, the provider should always begin a relationship by seeing an adult patient alone and drawing the family in as needed.

Explanation

(False: In many of the world’s cultures, an individual’s health problems are also considered the family’s problems, and it is considered threatening to exclude family members from any medical interaction. The provider should ask the patient whether she/he would prefer to be seen alone or with the family. It should be the provider's goal to help the patient to express her/his true preference about this - without offending any family members. The provider might ease any tension around this issue by assuring family members that they will be asked to return to the examining room in a short time.)

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22. Which of the following are the correct ways to communicate with a patient through an interpreter?

Explanation

(Answer: d. Although it may seem natural to look at the interpreter when you are speaking, you want the patient to feel that you are speaking to her/him, so you should look directly at her/him, just as you would if you were able to speak her/his language. It is best to speak in a normal tone of voice, at a normal pace, rather than pausing between words. Because of differences in grammar and syntax, the interpreter may have to wait until the end of your sentence before beginning to interpret. Do pause after one or two sentences to allow the interpreter to speak. When you need further information, or need to clarify what the patient has said, clearly tell the interpreter what you want asked of the patient. Although you may ask the interpreter to add his or her opinion of what the patient really meant, try to get as close as possible to the patient’s actual words and intent.

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23. When taking a medical history from a patient with a limited ability to speak English, which of the following is LEAST useful?

Explanation

(Answer: a. While it may seem easier to ask questions that require a simple “yes” or “no” answer, this technique seriously limits the ability of the patient to communicate information that may be essential for an accurate history and diagnosis. The most effective way to put the patient at ease and to ensure that the patient provides essential information about his or her symptoms is to combine two types of questions: 1) open-ended questions such as “Tell me about the pain in your knee” and 2) more directed questions, such as “What makes the pain get better or worse?” Always get a qualified interpreter when possible.)

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Which of the following statements is TRUE?
Providers whose patients are mostly European-American, U.S.-born, and...
In some cultures, it may be appropriate for female relatives to ask...
When a patient who has not adhered to a treatment regimen states that...
When a patient is not adhering to a prescribed treatment after several...
Because Hispanics have a lower incidence of certain cancers than the...
Which of the following statements is NOT TRUE:
Cross-cultural misunderstandings between providers and patients can...
When the patient and provider come from different cultural...
Which of the following is NOT TRUE of an organization that values...
If a family member speaks English as well as the patient’s native...
A female Muslim patient may avoid eye contact and/or physical contact...
Some symbols—a positive nod of the head, a pointing finger, a...
Which of the following statements is NOT TRUE?
Which of the following statements in NOT TRUE?
When a provider expects that a patient will understand a condition and...
Minority and immigrant patients in the US who go to traditional...
A really conscientious health provider can eliminate his or her own...
During a medical interview with a patient from a different cultural...
Which of the following is good advice for a provider attempting to use...
Out of respect for a patient’s privacy, the provider should always...
Which of the following are the correct ways to communicate with a...
When taking a medical history from a patient with a limited ability to...
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