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Summary Physiotherapy in mental health care and society
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- Universiteit Antwerpen (UA)
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Physio in mental health care & society Loranne den OtterMental health care & society
Diversity in health care
1. Introduction
Diversity = any dimension that can be used to differentiate groups and people from one another. In a
nutshell. It’s about empowering people by respecting and appreciating what makes them different,
in terms of age, gender, ethnicity, religion, disability, sexual orientation, education and national
origin.
Inclusion = an organizational effort and practices in which different groups or individuals having
different backgrounds are culturally and socially accepted and welcomed and equally treated. These
differences could be self-evident such as national origin, age, race and ethnicity, religion/belief,
gender, marital status and socioeconomic status or they could be more inherent, such as educational
background, training, sector experience, organizational tenure, even personality, such as introverts
and extroverts
→ In simple terms, diversity is the mix and inclusion is getting the mix to work well together
1.1. Culture
How many inhabitants of Antwerp have a migrant background?
Intercultural competences
▪ People with a migrant background
Cultural differences
1.1.1. What is culture?
“the ideas, customs, and social behavior of a particular people or society”
“a system of behavior that helps us act in an accepted or familiar way”
1.1.2. Managing cultural differences
An Intercultural Mediator: a person who enables intercultural communication, that is helps
representatives of two different cultural communities communicate and understand each other.
,Physio in mental health care & society Loranne den Otter
Patient case 1
▪ A female patient has just given birth. She is from a culture that has a strong sexual
segregation is not very talkative when she is being informed about breastfeeding in the
presence of her husband.
▪ The intercultural mediator could point out to the health professional that giving this type of
information in the presence of a man, even if it is her husband, causes a lot of
embarrassment for the patient and that this could explain why the patient is not really
cooperating.
▪ The role of intercultural mediator is an added value in this case.
Patient case 2
▪ In the emergency room a Russian patient is mad at a nurse because there are patients who
arrived after him but are being treated before him.
▪ The intercultural mediator can explain to the person involved that it is usual for the most
severe cases to receive priority in the emergency and that this is not a sign of racism.
▪ The role of intercultural mediator is an added value in this case.
1.1.3. Intercultural competence
Research shows that intercultural competence cannot be acquired in a short space of time or in one
module.
It is not a naturally occurring phenomenon but a lifelong process
K: Heb aandacht voor wat er gebeurt in de wereld, voor taal….
S: luisteren, observeren, kijken vanuit andere hun perspectief…
A: respect…
,Physio in mental health care & society Loranne den Otter
1.1.3.1. Intercultural knowledge and competence value rubric
A) Knowledge
1. Cultural self- awareness
Benchmark: (start, eerste review)
“Shows minimal awareness of own cultural rules and biases (even those shared with own cultural
group(s)) (e.g. uncomfortable with identifying possible cultural differences with others.)”
2. Knowledge of cultural worldview frameworks
Benchmark:
“Demonstrates surface understanding of the complexity of elements important to members of
another culture in relation to its history, values, politics, communication styles, economy, or beliefs
and practices.”
B) Skills
1. Empathy
Benchmark:
“Views the experience of others but does so through own cultural worldview.”
2. Verbal and nonverbal communication
Benchmark:
“Has a minimal level of understanding of cultural differences in verbal and nonverbal communication;
is unable to negotiate a shared understanding.”
C) Attitude
1. Curiosity
Benchmark:
“States minimal interest in learning more about other cultures.”
2. Openness
Benchmark:
“Receptive to interacting with culturally different others. Has difficulty suspending any judgment in
her/ his interactions with culturally different others, but is unaware of own judgment.”
, Physio in mental health care & society Loranne den Otter
1.1.3.2. Cross-cultural communication
1.1.3.3. Intercultural competence
The head of the Physiotherapy Department of a hospital in Antwerp told me: Type 2 Diabetes in Oujda
A cultural-sensitive interdisciplinary approach to healthy living
Prof. dr. Abdellatif Maamri1, Prof. dr. Abderrahim Ziyyat1, Laurence Magerat2, Sofie Van Laer2,
“We have a lot of Muslim women with diabetes that will see the endocrinologist dr. Jan Berger3, Dimitri Geelhand4, Enbiya Demirayak4, Sakina Abbou4, Prof. dr. Bart Van Rompaey4,
Prof. dr. Dirk Vissers4
1.
2.
Mohammed I University, Oujda, Morocco
AP University College, Antwerp, Belgium
3. ZNA Stuivenberg, Antwerp, Belgium
and visit the dietician in our hospital, however, they do not enter our exercise 4. University of Antwerp, Antwerp, Belgium
PROJECT SUMMARY
The primary research questions of this 2-year project proposal
CONTEXT
The prevalence of diabetes is increasing worldwide from 171 million in 2000 to 366 million in 2030.1
are: Type 2 diabetes (T2D) is the most common type of diabetes. The most important causes are excess
program. 1. What are the characteristics of patients with type 2
diabetes in the city of Oujda (prevalence, lifestyle, age,
gender,…)
2. What are facilitators and perceived barriers in Muslim
women with diabetes to change to a healthier lifestyle?
body weight, physical inactivity and poor nutrition.2
The prevalence of diabetes mellitus and estimated diabetes numbers among adults aged 20–79 years
in Morocco was 8% of the population in 2010 and is estimated to grow to 10% by 20305, making
Morocco a country with a high number of people with diabetes among Arab countries.
One of the reason for not participating we often hear is that the exercise
3. What are facilitators and perceived barriers in health Education and promoting a healthy lifestyle are cornerstones in preventing and treating T2D and should
professionals to work together in the management of be tailored to the Moroccan population. The cornerstone of treatment of type 2 diabetes is the adoption
type 2 diabetes? of a healthy diet and increased physical activity.2 Several randomized control trials have shown that the
A secondary goal will be to bring together all involved risk of developing type 2 diabetes can be significantly reduced by adopting healthier lifestyles, with or
stakeholders and to create a platform to share existing and without the use of medications.4-6 The recognition of the influence of religion in a population is important
to be able to deliver health care that responds to every individual’s need for knowledge.7,8 Moreover,
program is organised during the daytime and that there is a mixed group of men
newly acquired knowledge and expertise.
according to a Cochrane systematic review, culturally appropriate health education has short- to
medium-term effects on glycemic control and on knowledge of diabetes and healthy lifestyles.9
METHODS It has been suggested that Morocco needs pragmatic and efficient measures to overcome the problems
In this 2-year project a qualitative study will be done using of regional disparities, social inequalities and health inequities.10 In a region such as Eastern Morocco,
semi-structured interviews and focus groups to identify
and women.
that has struggled to create sufficient jobs, especially for the young, and is the source of large
barriers, facilitators and perceived benefits in T2D patients diasporas, the development of a multidisciplinary approach to T2D could help tackle the burden of T2D
and health professionals towards an interdisciplinary lifestyle and create jobs for health care providers such as physiotherapists.
intervention.
The high frequency of diabetes and obesity in the east of Morocco require the adoption of a global,
The quantitative part will include a screening in the local
urgent and effective strategy by the ministry of health, which must involve all the organizations and
health centers and the diabetes reference center of Oujda will
We have always organised our exercise training sessions like that and we are not
interested people of the civil society.11
be done to assess the prevalence of T2D and to identify the
characteristics of T2D patients. 1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):
1047-1053
Stakeholder meetings will create the opportunity to acquire 2. International Diabetes Federation. Cost-effective solutions for the prevention of type 2 diabetes. Brussels, Belgium. 2016
3. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4-14
knowledge about the potential contribution to the prevention
4. Palmer AJ, Roze S, Valentine WJ, Spinas GA, Shaw JE, Zimmet PZ. Intensive lifestyle changes or metformin in patients with impaired glucose tolerance:
and treatment of T2D of various (para-)medical disciplines
about to change that.”
modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom.
Clin Ther. 2004;26(2):304-321
such as general practitioners, physiotherapists, occupational
5. Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish
therapists and dietitians or nutritionists. Diabetes Prevention Study. Lancet. 2006;368(9548):1673-1679.
6. Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year
follow-up study. Lancet. 2008;371(9626):1783-1789.
7. Gupta A. Culturally-sensitive health education for Muslims with diabetes. Br J Gen Pract. 2015;65(638):475.
8. 13. Hjelm K, Bard K, Nyberg P, Apelqvist J. Religious and cultural distance in beliefs about health and illness in women with diabetes mellitus of different origin
living in Sweden. International Journal of Nursing Studies. 2003;40(6):627-643
9. Attridge M, Creamer J, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2
diabetes mellitus. Cochrane Database Syst Rev. 2014(9):CD006424
10. Boutayeb A. Social inequalities and health inequity in Morocco. Int J Equity Health. 2006;5:1.
11. Ziyyat A, Ramdani N, Bouanani Nel H, et al. Epidemiology of hypertension and its relationship with type 2 diabetes and obesity in eastern Morocco.
Springerplus. 2014;3:644.
IMPACT AND IMPLICATIONS
This project is the first step of a larger project that aims improve the
management of type diabetes and concurrently create jobs for
physiotherapists, occupational therapists, dieticians and nurses in Eastern
Morocco by developing and implementing a multidisciplinary approach in the
management of type 2 diabetes (T2D), based upon international guidelines
Centre de Réference but adapted to the regional socio-economic and cultural context and with a
De Diabétologie d’Oujda focus on empowerment of women.
More info: dirk.vissers@uantwerp.be
▪ The Chartered Society of Physiotherapists (UK) in their Rules of Professional Conduct
includes the requirement to ‘respect and uphold the rights, dignity and individual sensibilities
of every patient’.
▪ The American Physical Therapy Association requires members to ‘respect the rights and
dignity of all individuals and provide compassionate care’.
▪ The Canadian Physiotherapy Association’s Rules of Conduct state that therapists are to
respect the client’s ‘rights, dignity, needs, wishes and values’.
The obligations set out in each of these codes support the need to be respectful of a patient’s
cultural perspective.
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