Experiences of genetic counselors practicing in multiple languages: Progress and places for improvement.

As awareness of the value of genetic counseling services increases, there has been greater recognition of the need to diversify service delivery into different languages. Studies within genetic counseling and related fields have identified complications that can arise from language nonconcordance between provider and patient. A strategy to mitigate language barriers is prioritizing the development of a multilingual workforce of genetic counselors (GCs) who can communicate with patients in their preferred language. This exploratory study assessed the experiences of multilingual GCs who have practiced in a clinical role with the aim to identify relevant challenges and differences when counseling in their nondominant language. Statistical analysis was performed to identify differences in session tasks and emotions experienced when counseling in one's nondominant language versus their dominant language. Data analysis identified an increase in reported difficulty level for most clinical tasks while using a nondominant language, most notably for difficulty with psychosocial counseling, disclosing results, and administrative tasks. Participants were also surveyed on employer support and resources provided. Overall, results suggest that multilingual GCs may benefit from greater support in certain areas within clinical roles to enhance their ability to provide patient care in their nondominant language.

Cultural competence training of dieticians: development and preliminary evaluation.

INTRODUCTION: Training can improve healthcare providers' cultural competence and increase their awareness of bias and discrimination in medical decision-making. Cultural competences training is lacking in the education of dieticians in the Netherlands. The aim of this study was to describe the pilot-implementation of a cultural competence training for dieticians and preliminary evaluation of the training. METHODS: A training was developed based on Seeleman's cultural competence framework and previously held interviews with migrants, dieticians, and experts. The training consisted of a mixture of didactic and experiential methods, alternating knowledge transfer with exercises to increase awareness, reflection, and feed-back on recorded consultations, and communication training with migrant training actors. The training was piloted in 8 participating dieticians and preliminary mixed-method evaluation was done using a Cultural Competence Questionnaire, Experience Evaluation Questionnaire, and consultation observations. RESULTS: The questionnaires showed that dieticians were positive about the training. They found it valuable and educational. Participants reported an increase in self-perceived cultural competence and attitudes. Knowledge and skills remained approximately the same. The observations showed that dieticians applied the teach-back method and discussed treatment options more often after training. There was no increase in the use of visual materials. CONCLUSION: The training was well appreciated and, although a small-scale pilot, this mixed-method study suggests an ability to change cultural competence. The combination of a self-assessment instrument and consultation observations to evaluate cultural competence was highly valuable and feasible. These encouraging results justify a broader implementation of the training.

Diversity and Inclusion in Anesthesia Practice.

The concept of diversity is vital to the practice of medicine and anesthesia practice due to its beneficial effects on multiple aspects of health care practice. However, the current reality is that the workforce fails to adequately reflect the changing demographics of society and the patient population. This article aims to elucidate the benefits, evaluate and provide suggestions identifying some of the obstacles encountered when attempting to advance diversity efforts, and explore and confront challenges that are on the horizon for diversity efforts.

Pharmacy Students' Self-Reported Cultural Competence in a Pharmacy Curriculum by Academic Year.

OBJECTIVE: This study aims to explore the results of a Cultural Competency Assessment of Pharmacy Students (CCAPS) survey to identify areas where cultural competence content in one college of pharmacy curriculum can be improved. METHODS: The 39-item CCAPS survey was developed and administered to Doctor of Pharmacy (PharmD) students from July 2022 (after the end of the didactic curriculum and at the beginning of experiential rotations for fourth-year students) to October 2022 (at the beginning of the fall semester for first-year, second-year, and third-year students). Self-perception of cultural competency items were selected from the Cultural Competence Assessment Instrument and the Clinical Cultural Competency Questionnaire items. Responses were collected anonymously and analyzed in the aggregate by academic year using SPSS. RESULTS: A total of 541 students participated, with ethnicities including White/European American (26.6%), East/South/Southeast Asian (17%, 18.5%, 5.4%), Arab/Middle Eastern (17.9%), African American/Black (6.7%), and Hispanic (6.1%). Two-thirds of respondents identified as "very or extremely" culturally competent, and 78% reported comfort interacting with culturally diverse patients. Students scored lower on questions that assessed their comfort interacting with patients who have limited English proficiency or who refuse medications due to cultural reasons. Students in the fourth year reported more difficulty practicing skills related to cultural competency in their daily lives compared with students in other years. CONCLUSION: Using the CCAPS survey annually could help evaluate the cultural competency of pharmacy students across different academic years and identify gaps in the curriculum related to cultural competency.

Professional values, cultural competence, and moral sensitivity of surgical nurses: Mediation analysis and structural equation modeling.

BACKGROUND: Developing a framework that illustrates causal relationships and an in-depth comprehension of contextual elements is essential for steering the development of ethical interventions to enhance nurses' ethical decision-making. RESEARCH AIM: To examine the relationship between cultural competence, professional nursing values, and moral sensitivities of surgical nurses with a mediation analysis and structural equation model. RESEARCH DESIGN: This study is descriptive and correlational. PARTICIPANTS: and research context: This study was conducted with a total of 201 surgical nurses from two university hospitals in Konya, Türkiye. Data were gathered face-to-face between June and October 2023 with the Moral Sensitivity Questionnaire (MSQ), Nurses Professional Values Scale-Revised (NPVS-R), and Nurse Cultural Competence Scale (NCCS). ETHICAL CONSIDERATIONS: Ethical approval from X University Ethics Committee was obtained (Number: 2023/419). RESULTS: In this study, the mean scores for the surgical nurses were as follows: 89.3 ± 19.33 on the MSQ, 113.1 ± 20.74 on the NPVS-R, and 72.06 ± 18.61 on the NCCS. Nurses' cultural competence level significantly affected their professional nursing values (ß = 0.192; p = .007; R2 = 0.04), and their professional nursing values, in turn, had a significant effect on their moral sensitivities (ß = -0.363; p < .001; R2 = 0.16). However, it was determined that the direct effect of nurses' cultural competence level on their moral sensitivity was not statistically significant. In contrast, the indirect effect of nurses' cultural competence level on their moral sensitivity, mediated by their professional nursing values was seen to be statistically significant (B = -0.070; p = .008). CONCLUSIONS: This study showed that there is a significant positive relationship between the professional nursing values and cultural competence levels of surgical nurses and that as professional nursing values increase, their moral sensitivity also rises. Sensitivity with higher professional nursing values. Additionally, it was found that nurses' professional values served as a mediating factor between their levels of cultural competence and moral sensitivity. Therefore, it is crucial to enhance the cultural competence, professional nursing values, and moral sensitivity of nursing students and registered surgical nurses and to improve their reasoning and decision-making skills in ethical dilemmas.

Reducing health disparities in providing care services in the intensive care unit: a critical ethnographic study.

OBJECTIVE: The intensive care unit, with its structural complexity and the exposure of critically ill patients to various disparities, presents a significant setting for health disparities. This critical ethnographic study sought to uncover cultural knowledge and ethical practices for reducing health disparities in providing care services within the intensive care unit. The focus was on understanding how ethical considerations and cultural competence can address and mitigate these disparities effectively. METHODS: This critical ethnographic study was conducted in 2022-2023 at intensive care units in western Iran. Three interrelated phases were used to collect and analyze the data. More than 300 h of observation were done during the first phase. A horizon analysis was carried out in the next phase. To further enhance the dataset, 18 informants participated in semi-structured interviews and informal conversations. Following that, the analysis procedure was conducted to identify a culture of health disparities and factors that reduce it, as it had been in the prior stage. Trustworthiness data collection methods were implemented to ensure the validity and reliability of the study. FINDINGS: Two key themes emerged from the study: (A) Improved cultural competence, which encompassed empathy towards patients and their families, effective communication, prioritization of continuous learning, appropriate knowledge and awareness, sensitivity to cultural and religious beliefs, staff attitude and personality, and the delivery of customized care tailored to each patient's needs. (B) Supporting role and compensating for disparities involved recommendations for upholding ethical standards, compensatory actions, maintaining professional behavior despite external factors, addressing gaps and deficiencies, and actively defending and supporting patients. CONCLUSION: The findings indicate that staff with high cultural competence can ethically mitigate health disparities through their supportive roles. Managers and health policymakers should create barriers to health disparity by improving staff cultural competence and knowledge about health disparities.

Nutrition and Training Recommendations for Transgender and Gender-Diverse Athletes Involved in Strength Sports and Resistance Training: A Case Series of Nine Athletes Assigned Female at Birth.

Transgender and gender diverse (TGGD) athletes have distinct nutrition and training considerations. Guidance for nutrition and sport professionals working with TGGD athletes is lacking, especially when addressing sex-specific data. The purpose of this case series was to depict nutrition and training assessment approaches and recommendations for TGGD athletes involved in strength sports or resistance training. Six types of data informed each case presentation, including: demographic, anthropometric, health history, and survey data (Eating Competence Scale, Exercise Benefits and Barriers Scale); a 3-day food and physical activity record; and an in-depth interview. Nine TGGD athletes assigned female at birth (AFAB) presented with a range of gender identities, experiences, sport involvement, and transition journeys. Most athletes consumed inadequate energy and fiber, adequate or marginally high levels of saturated fat and added sugars, and high levels of sodium. Most athletes scored low on the Eating Competence Scale and high on the Exercise Benefits and Barriers Scale. Nutrition and sports professionals can individualize the care they provide for TGGD athletes when addressing sex-specific data and help athletes ensure they are meeting their nutrient needs.

It Is Leadership, but (Maybe) Not as You Know It: Advocating for a Diversity Paradigm in Sports Leadership and Beyond.

The need to 'rethink leadership' is on the radar of many, from global finance and auditing organisations (e.g., Deloitte) and global sports organisations (e.g., the International Olympic Committee) to national and local sports organisations concerned about the decreasing numbers of participants or the lack of women coaches. Yet, is the dominant Western leadership orthodoxy fit for purpose in the 21st century? The purpose of this article is two-fold. First, to advocate for ways of 'rethinking leadership' that challenge the current dominant ethnocentric, gender-biased, leader-centric orthodoxy. Second, to introduce an expanded global and diverse leadership paradigm that is underpinned by clearly delineated dimensions of diversity and cultural competence, which recognises the importance of the organisational and cultural contexts. The literature discussed in this article draws from leadership studies generally and sports leadership and sports coaching more specifically. Key to this article is the discussion of the implications of adopting a diverse leadership paradigm for policy, practice, development, and research of leadership. This advocacy article does not end with a definitive conclusion but rather with an invitation to participate in a journey to realise the potential of diverse leadership.

Healthcare professionals' experiences of delivering pain science education to adults from ethnically minoritised groups.

BACKGROUND: Pain Science Education (PSE) seeks to increase patients understanding of their pain, to improve clinical outcomes. It has been primarily developed and tested within western cultures. There is a lack of research exploring its use with people from ethnically minoritised groups. OBJECTIVE: To explore Healthcare Professionals (HCPs) experiences of delivering PSE to people with persistent pain from ethnically minoritised groups. METHODS: In this qualitative study semi-structured interviews were carried out with a convenience sample of 14 HCPs who routinely deliver PSE to patients from ethnically minoritised groups. The interviews were analysed using reflexive thematic analysis. RESULTS: Three themes were identified: 1) Biomedical model or disengagement, 2) Pain is a taboo topic, and 3) The importance of cultural competence. Participants believed that people from ethnically minoritised groups disengaged with PSE sooner in comparison to non-ethnically minoritised groups and this was rooted in a strong biomedical understanding of pain and preference for biomedical treatments. Addressing patients' beliefs was deemed difficult as participants felt that pain was considered a taboo amongst some ethnically minoritised groups and HCPs lacked sufficient training in cultural competency to confidently address their pain-related misconceptions. CONCLUSIONS: Overall, HCPs found that many people from ethnically minoritised groups held strongly biomedical views and/or a cultural reluctance to discuss pain. These factors made pain discussions challenging leading to disengagement from PSE and a preference for passive care. Cultural competency training and access to culturally competent PSE resources may facilitate engagement with PSE for people from ethnically minoritised background.

Evaluating the Effectiveness of Indigenous Health Curricula: Validation and Application of the NOSM CAST Instrument.

OBJECTIVES: In recent years, Indigenous health curricula have been integrated into medical education in response to international calls to improve Indigenous health care. Instruments to evaluate Indigenous health education are urgently needed. We set out to validate a tool to measure self-reported medical student preparedness to provide culturally safe care to Indigenous Peoples. We then applied the tool to evaluate the effectiveness of the Northern Ontario School of Medicine University's (NOSM U) Indigenous health curriculum. METHODS: We conducted psychometric testing of a 46-item draft NOSM Cultural Competency and Safety Tool (CAST). Testing included principal components analysis, subscale and item analysis, and the use of paired sample t-tests to examine pre- and posttest change to measure learner outcomes. The NOSM CAST was transposed to create a retrospective pre-posttest survey with single-point-in-time scoring. RESULTS: Respondents included five cohorts of first-year undergraduate medical students, with 305 of 320 participating (response rate of 95.3%). The validated survey subscales included knowledge, confidence/preparedness, attitudes, intentions for advocacy, antidiscrimination, and self-reflective practice, measured using 36 scale items. Cronbach's alpha showed good to excellent internal consistency for the scales (α range = 0.82-0.91). Composite reliability values were acceptable. The pre-posttest analysis showed statistically significant increases on four scales: knowledge [t(254) = 15.10, P < .001], confidence/preparedness [t(254) = 15.85, P < .001], intentions for advocacy [t(251) = 3.32, P = .001], and self-reflective practice [t(254) = 8.04, P < .001]. The largest mean increases were for knowledge (d = 1.07) and confidence/preparedness (d = 1.15). CONCLUSIONS: The NOSM CAST tracks student progress in Indigenous health curricula. NOSM U's classroom and immersion-based Indigenous health curriculum enhanced students' self-reported preparedness for culturally safe care. NOSM CAST implemented together with an assessment of Indigenous patient experiences with the same learners constitutes a rigorous evaluation approach to Indigenous health curricula.

Primary Care Perceptions Among Spanish-Speaking Populations: A Comprehensive Review.

This literature review explores the substantial impact of language barriers on healthcare outcomes for Spanish-speaking populations, emphasizing the need for improved language support systems. While this review emphasizes the growing Hispanic/Latino population in Kansas as a case study, the findings underscore broader challenges faced by individuals with limited English proficiency in accessing and utilizing healthcare services across similar rural settings in the United States. Language barriers hinder effective communication between patients and healthcare providers, affecting patient care, satisfaction, and outcomes. Despite federal regulations requiring language assistance, the availability and quality of interpreter services remain inconsistent, exacerbating healthcare disparities. A comprehensive literature search was conducted across electronic databases including PubMed, SageJournals, Science Direct, and Springer Link for studies published from 2004 to 2024. The search was conducted from April 10, 2024 to May 31, 2024 using the following terms: "language concordance," "health outcomes," "Spanish, language barriers," "primary care," and "rural settings." The search terms were combined using Boolean operators: "Spanish OR Hispanic" for ethnic identification, "language concordance AND health outcomes" to explore the relationship between language alignment and patient results, and "Spanish AND primary care AND language barriers" to narrow the focus to specific healthcare settings. The review calls for continued research and the implementation of robust language support systems to ensure equitable healthcare access and improved health outcomes for Spanish-speaking populations in rural Kansas.

Incorporating multiracial and multiethnic experiences into genetic counseling practice and research: A necessary opportunity.

The conflation of race and genetic ancestry can have harmful consequences. Biological conceptualizations of race have long been used to justify inequities and distract from social structures that afford opportunities to some that are unjustly denied to others. Despite recent efforts within the scientific community to distinguish between the sociopolitical constructs of race and ethnicity and the biological constructs of genetic ancestry and genetic similarity, their conflation continues to influence genomic research and its translation into clinical care. One overlooked aspect of this problematic conflation is the extent to which discrete monoracial and monoethnic categorization systems persist and perpetuate unequal benefit-sharing in the clinical translation of genomic technologies. In genetic service delivery, reliance on discrete racial and ethnic categories undermines the clinical translation of genomic technologies for large segments of the global population. For multiracial and multiethnic individuals, who have complex identities that defy discrete categorization systems, the potential benefits of genomic discoveries are especially elusive. Scholars have recently begun to call for the inclusion of multiracial, multiethnic, and admixed individuals in race, ethnicity, and ancestry frameworks in genetics and genomics. However, little work has been done to explore and address the unique challenges and opportunities posed by multiracial/multiethnic individuals in genetic counseling specifically. We discuss how conceptualizing diversity along discrete racial and ethnic lines perpetuates inequitable patient care and limits efforts to increase inclusion and belonging within genetic counseling. Moreover, we argue that ongoing efforts to mitigate racial inequity must actively challenge the paradigm of monoracial and monoethnic categories to accomplish their goal.

Exploring cultural competence barriers in the primary care sexual and reproductive health centres in Catalonia, Spain: perspectives from immigrant women and healthcare providers.

BACKGROUND: Immigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services. METHODS: An exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach. RESULTS: Language barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles. CONCLUSION: This study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

Cultural humility training interventions for healthcare students to improve care for gender and sexual minority groups: Protocol for a systematic review and a proposed meta-analysis.

Introduction: To deliver comprehensive and efficient care, it is crucial to understand and address the unique healthcare needs of gender and sexual minority (GSM) groups. Implementing cultural humility training may enhance healthcare students' sensitivity, awareness, and proficiency in serving patients. However, there's a necessity to thoroughly evaluate the impact and effectiveness of these interventions, especially in relation to addressing the distinct healthcare requirements of GSM groups. This protocol describes the steps in conducting a systematic review (SR) to investigate if cultural humility training interventions for medical students enhance care of GSM groups. This SR aims to guide the creation of focused interventions and instructional plans to support fair healthcare delivery for GSM populations. Methods and Analysis: The objective of this SR encompass a comprehensive examination across multiple databases such as PubMed (NCBI), Scopus (Elsevier), Cochrane (Wiley), Web of Science (Clarivate). Using keywords and MeSH phrases, the search method will find relevant research from each database's launch from January 1, 2000, until August 30, 2024, emphasizing English-language publications. To ensure comprehensiveness, reference lists of qualifying papers will be thoroughly reviewed. We shall extract the data and use the appropriate Joanna Briggs Institute (JBI) checklist to evaluate the quality of the included study. By synthesizing the data, the findings will illuminate the value and efficacy of cultural humility training interventions for medical students in enhancing GSM group care. This synthesis will incorporate quantitative studies, to ensure a comprehensive understanding of the interventions' impacts. Ethics and dissemination: Ethics approval is not sought as the review will only synthesize data from published studies. The findings will be presented at conferences and published in peer-reviewed journals. PROSPERO registration number: CRD42024533825 Strengths and limitations of this study:•Our study examines cultural humility training, emphasizing self-reflection and power dynamics, specifically relevant for gender and sexual minority (GSM) groups.•We focus on healthcare students, exploring how early cultural humility training can impact future practice and GSM care.•This is the first systematic review and meta-analysis of cultural humility training for GSM groups, addressing a gap in existing literature.•Our findings aim to inform curriculum and educational policies, addressing a significant need in medical training.•Limiting the review to English-language studies may exclude important research conducted in other languages, potentially missing valuable perspectives and findings that could enhance the understanding of cultural humility training's global applicability.•The review may face challenges in measuring the long-term impact of cultural humility training interventions on healthcare students' competency and attitudes, as existing studies might have a limited follow-up period.

'Where is the diversity in this facility?' Experiences of emergency care among visible minority individuals in Kingston, Ontario.

INTRODUCTION: Visible minorities, a growing segment of Canada's population, have voiced concerns about experiencing racism while receiving care in the emergency department (ED). Understanding the ED care experiences of visible minorities is crucial to improving care and reducing health disparities. METHODS: From June to August 2021, we collected data from participants in Kingston, Ontario using a sensemaking approach. Individuals who had accessed emergency care or accompanied someone else to the ED in the prior 24 months were eligible to participate. After sharing a brief narrative about their care experience, participants interpreted the experience by plotting their perspectives on a variety of pre-determined questions. Here, we conducted a thematic analysis of narratives involving patients who identified as visible minorities and complemented it with quantitative analysis of the participants' interpretative responses. This mixed-methods approach highlighted the distinct experiences of visible minority participants in relation to a comparison group. RESULTS: Of the 1973 unique participants, 117 identified as a visible minority and 949 participants did not identify with an equity-deserving group (comparison group). Visible minority participants were more likely to report that too little attention was paid to their identity and more likely to express a desire for a balance between receiving the best medical care and being treated with kindness and respect. Visible minorities' ED experiences were also more likely to be impacted by how emergency staff behaved. Qualitative analysis revealed negative experiences of feeling uninformed and disempowered, facing judgement and discrimination, and experiencing language barriers. Positive experiences of receiving compassionate care from staff also emerged. CONCLUSION: Visible minority perceptions of ED care were often negative and mainly focused on staff treatment. Cultural competency and language translation services are key areas for improvement to make ED care more accessible and equitable.

Patients' Perceptions of Their Therapist: Effects of Race, Culture, and Cultural Competency on the Working Alliance.

OBJECTIVE: The purpose of this study was to investigate the extent to which patients feel racially and culturally similar to their therapist, patients' perceptions of their therapist's cultural competence, and how these factors relate to the working alliance in a naturalistic treatment setting. METHODS: Participants were 119 adult patients treated at a large outpatient clinic by clinicians with a range of professional backgrounds (e.g., psychiatric residents, psychologists in training, and staff therapists). Patients were asked to rate the level of racial and cultural similarity between themselves and their therapist and to provide their assessment of their therapist's cultural competency and of the working alliance. RESULTS: Findings suggest that patients' ratings of perceived cultural and racial similarity were not significantly related to the working alliance. However, perceptions of racial and cultural similarity were significantly associated with perceived therapist cultural competence. Perceived cultural competence was also strongly related to the working alliance. Finally, patients' ratings of their therapist's cultural competencies in the areas of awareness and skill, but not knowledge, predicted a strong working alliance after analyses controlled for ratings of racial and cultural similarity. CONCLUSIONS: This study suggests the importance of heightening mental health clinicians' awareness of the influence of culture on the therapeutic relationship and the important role of a therapist's cultural competencies (specifically, awareness and skill) in the working alliance, which may matter more to patients than perceptions of racial or cultural similarity.

A Qualitative Exploration of Refugee Experiences of Access to a Dedicated Multi-Disciplinary Refugee Health Team in an Australian Context: Implication for Future Care.

AIMS: Refugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team. METHODS: An interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach. RESULTS: Participants (n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1-12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence - impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns - influenced by understanding and education. CONCLUSIONS: We identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

Exploring the implicit meanings of 'cultural diversity': a critical conceptual analysis of commonly used approaches in medical education.

Existing approaches to cultural diversity in medical education may be implicitly based on different conceptualisations of culture. Research has demonstrated that such interpretations matter to practices and people concerned. We therefore sought to identify the different conceptualisations espoused by these approaches and investigated their implications for education. We critically reviewed 52 articles from eight top medical education journals and subjected these to a conceptual analysis. Via open coding, we looked for references to approaches, their objectives, implicit notions of culture, and to implementation practices. We iteratively developed themes from the collected findings. We identified several approaches to cultural diversity teaching that used four different ways to conceptualise cultural diversity: culture as 'fixed patient characteristic', as 'multiple fixed characteristics', as 'dynamic outcome impacting social interactions', and as 'power dynamics'. We discussed the assumptions underlying these different notions, and reflected upon limitations and implications for educational practice. The notion of 'cultural diversity' challenges learners' communication skills, touches upon inherent inequalities and impacts how the field constructs knowledge. This study adds insights into how inherent inequalities in biomedical knowledge construction are rooted in methodological, ontological, and epistemological principles. Although these insights carry laborious implications for educational implementation, educators can learn from first initiatives, such as: standardly include information on patients' multiple identities and lived experiences in case descriptions, stimulate more reflection on teachers' and students' own values and hierarchical position, acknowledge Western epistemological hegemony, explicitly include literature from diverse sources, and monitor diversity-integrated topics in the curriculum.

Increasing Oncology Nurse Cultural Knowledge, Sensitivity, and Humility in Caring for the Native Hawai'ian and Pacific Islander Population.

Stress affects people's physiologic and mental well-being. Compounded stress from natural disasters, intergenerational trauma, stigma, and mistrust of the dominant society may lead to illness and potential oncologic disorde.

Exploring health inequalities in Gypsy and Traveller communities in the UK.

Health inequalities between groups of people are often unjust and avoidable and are influenced by social determinants of health, the non-medical factors that influence health outcomes. Gypsy and Traveller communities experience significant health inequalities, including barriers to accessing healthcare services and suboptimal health outcomes compared with the general population. This article provides an overview of health inequalities in relation to Gypsy and Traveller communities and examines three social determinants of health - discrimination and racism, accommodation and access to healthcare - that influence these inequalities. The authors propose that accurate data collection as well as delivery of culturally competent health services and care may facilitate access to healthcare for Gypsy and Traveller communities and potentially reduce health inequalities.