The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review.

Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.

Treinamento aos agentes comunitários de saúde frente à assistência aos usuários de álcool / Entrenamiento de agentes de salud con respecto a la asistencia a usuarios de alcohol / Community health agent training regarding assistance to alcohol users

Objetivo: avaliar as percepções, conhecimentos e atitudes antes e após a realização de um treinamento aos Agentes Comunitários de Saúde (ACS). Método: estudo quase experimental e quantitativo, realizado no interior do estado de São Paulo. Para a coleta de dados foi utilizado ficha de identificação sociodemográfica, Seaman & Manello e Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados em 31 ACS de serviços de Atenção Primária à Saúde. O estudo foi submetido e aprovado pelo Comitê de Ética. Resultados: as percepções foram positivas, mas ainda existem dificuldades para trabalhar na prática, os conhecimentos apresentaram mudanças em relação aos sinais e sintomas relacionados ao uso de álcool e as atitudes. Não foram observadas mudanças significativas após o treinamento. Conclusão: o treinamento é uma estratégia que possibilita mudanças nas práticas de saúde para a assistência integral e que deve ser incorporada nas rotinas das unidades de Atenção Primária à Saúde (APS).

Objetivo: evaluar percepciones, conocimientos, y actitudes antes y después de un entrenamiento de Agentes Comunitarios de Salud (ACS). Método: estudio cuasiexperimental y cuantitativo, realizado en el interior del estado de São Paulo. Para colectar a los datos se utilizó un formulario de identificación sociodemográfica, el Seaman & Manello y el Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados a 31 ACS en servicios de atención primaria a la salud. El estudio fue aprobado por el comité de ética. Resultados: las percepciones fueran positivas, pero hay dificultades en la práctica del trabajo. Los conocimientos cambiaron con respecto a las señales y síntomas relacionados al uso de alcohol y a las actitudes. No se observó cambios significativos después del entrenamiento. Conclusión: el entrenamiento posibilita cambios en las prácticas de salud para la asistencia integral, y debe ser incorporado en las rutinas de las unidades de atención primaria a la salud (APS).

Objective: To evaluate the perceptions, knowledge, and attitudes, before and after a training session provided to community health workers (CHW). Method: Quasi-experimental, quantitative study, carried out in the countryside of the state of São Paulo. For data collection, we used Seaman and Manello's sociodemographic identification form and the Short Alcohol and Alcohol Problems Perception Questionnaire, applied to 31 CHWs of primary health care services. The study was submitted and approved by the research ethics committee. Results: Perceptions were positive, but there are still practical obstacles regarding the actual work. The knowledge related to signs and symptoms of alcohol use and related attitudes was changed, as were the attitudes. There were no significant changes after training. Conclusion: training is a strategy that enables changes in health practices for integral care. It should be incorporated in the routine of Primary Health Care (PHC) units.

Quality indicators of pharmacists' services in community pharmacies in Paraná State, Brazil

ABSTRACT Pharmacists and their pharmacies have been evolving in their roles as health promoters in Brazil. Some examples are the recent legislation reaffirming the role of Brazilian pharmacies as health institutions, rather than having only a commercial profile, giving greater clarity to pharmacists about their roles as health care providers. This evolution came with the recognition that is already seen in other developed countries, confirming the need for the pharmacist as a health promoter, and not simply a dispenser of drugs in society. This study has obtained the profile and activities of community pharmacists, as well as the quality indicators of private community pharmacies throughout the State of Paraná through the application of an online survey sent to pharmacists in the state. Out of all pharmacists surveyed, 533 were part of the final analysis, being the pharmacists to complete the survey in full. Participants were mostly female (69.4%) and were, on average, 35.2 ± 9.2 years old. Of these, 60% worked in pharmacy chains and just 37% of all pharmacist respondents were issuing the Declaration of Pharmaceutical Services. The current study showed that many pharmaceutical services are not adopted by pharmacies as these services bring no significant financial reward. Regarding the structure, the Paraná State showed that pharmacies present a good overall structure. The kind of pharmacy (chain or independent) influenced the pharmaceutical services provided and the available structure, where the independent pharmacies provide a wider range of services and have better structure. This study was able to identify the profile and behaviors of pharmacists and also the quality indicators of pharmacies in Paraná State.

Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.