Navigating Living Kidney Donation and Transplantation Among South Asian Canadians: The ACTION Project.

RATIONALE & OBJECTIVE: South Asian (SA) Canadians with kidney failure have a 50%-77% lower likelihood of kidney transplant and are less likely to identify potential living donors (LDs). This study aimed to identify health system-, patient-, and community-level barriers and facilitators for accessing LD kidney transplantation in the SA community to inform the development of health system- and community-level interventions to address barriers. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: 20 SA recipients of an LD or deceased-donor kidney transplant, 10 SA LDs, and 41 general SA community members. ANALYTICAL APPROACH: In-depth multilingual interviews were conducted with recipients and LDs. Gender-, language-, and age-stratified focus groups were conducted with general SA community members. Summative content analysis was used to analyze the data. RESULTS: Hesitancy in approaching potential donors, fear about the health of potential LDs, information gaps, language barriers, and challenges evaluating out-of-country donors were highlighted as significant barriers by recipients, and financial concerns and information gaps were identified by donors. Cultural barriers in the SA community were highlighted by donors, recipients, and community members as critical factors when considering donation and transplant; women and elderly SA Canadians highlighted nuanced challenges. Participants reported generally a favorable perception of their health care teams, citing SA representation in the teams as important to providing culturally and linguistically sensitive care. LIMITATIONS: Limited geographic, race, and cultural representation and reliance on virtual data collection. CONCLUSIONS: This study highlights several culturally relevant barriers to donation and transplant that are potentially modifiable through patient-, health system-, and community-focused engagement and education.

Brain Death and Organ Transplantation in Nepal: Navigating Cultural, Legal, and Ethical Landscapes.

Organ transplantation after brain death is challenging in Nepal due to cultural beliefs, legal frameworks, and ethical considerations. The Human Body Organ Transplantation (Regulation and Prohibition) Act (HBOTA) has not met with substantial success after its amendment. This review critically appraises the current state of brain death and organ transplantation in Nepal. It explores challenges, evaluates progress, and provides recommendations. Literature review of databases was conducted to find articles on brain death, organ donation, and transplantation in Nepal. Analysis of cultural, legal, ethical, and practical factors influencing implementation. Key challenges include limited awareness, religious beliefs, infrastructure gaps, and family consent barriers. HBOTA amendments in 2016 enabled brain death donations, however, donation rates remain low. Strategies are needed to improve public education, resources, personnel training, and collaboration. Cultural sensitivity and stakeholder engagement are crucial. A multifaceted approach addressing cultural, legal, ethical and practical dimensions is essential to improve organ donation rates in Nepal. Despite progress, substantial challenges persist requiring evidence-based strategies focused on awareness, capacity building, policy improvements, and culturally appropriate community engagement.

Physicians' experiences of intercultural differences in communication with Ukrainian refugees during the Russian-Ukrainian armed conflict.

The aim of the study was to identify and explore barriers to communication between refugees from Ukraine and physicians providing health care, the perspective of physicians was embraced. The focus of the work reflects on the arrival of many forced migrants from Ukraine in 2022. Further, it focuses on the pressure that the presence of migrants' places on the Czech healthcare system, especially in doctor-migrant patient communication. The objectives of this study are also motivated by existing international evidence that misunderstandings and poor-quality communication can lead to lower patient satisfaction and adherence, and consequently poorer healthcare outcomes. The research was carried out in the form of qualitative research, 16 in-depth semi-structured interviews were conducted with physicians providing health care to Ukrainian refugees. Informants were selected using a purposive sampling method to obtain as diverse a sample as possible. The resulting data were analysed by applying thematic coding. The results showed that four main areas of intercultural barriers play a key role in the relationship between physicians and Ukrainian patients. These are: (1) language, (2) differences in healthcare systems, (3) different attitudes towards health and illness and (4) prejudice. The major source of misunderstanding was the difference between the Czech and Ukrainian healthcare systems, which leads to a different position of the patient in the healthcare system. The conclusions prove that intercultural barriers play a significant role in the provision of health care to Ukrainian refugees but can be addressed to a large extent. The current situation in Czechia and the increasing diversity in society call for the need to acquire intercultural competencies in undergraduate and continuing medical education. Similarly, the adoption of measures that promote culturally competent health care is needed.

Silent Mourning: Infant Death and Caring for Iranian Parents Under the Influence of Religious and Socio-cultural Factors.

Despite all the advances in healthcare technology and all the care services in the field of neonates, many infants die in neonatal intensive care units (NICUs). This qualitative study investigated socio-cultural factors influencing the care for bereaved parents in three main NICUs of northwest Iran between March 2018 and April 2019. The purposeful sampling method with the maximum variation was used, and data collection was continued until obtaining rich data to answer the research question. Twenty-eight interviews were conducted with 26 healthcare providers. The thematic analysis method was applied to analyze the data, and two main themes, including "Religious context as a restriction on the parental involvement in the infant's end-of-life care" and the "Socio-cultural challenges of the grieving process among parents", were generated accordingly. The religious and socio-cultural contexts in the NICUs of Iran are a restriction to the presence of parents at their infants' end-of-life phase, and health care providers are less inclined to have parents in the NICU at the time of infant death.

Barriers in surgical research: A perspective from the developing world.

Research in surgery has led to significant advances over the last century in terms of how medicine is practised in and outside the operating rooms today. Surgical research in the developed countries is responsible for most of this advancement, but it is often inapplicable in resource-limited settings in the developing world. Lower- and middle-income countries are in a unique position to take this work further, but they are limited by certain barriers. These barriers could broadly be classified under social and cultural, infrastructure, financial, ethical, and personal categories. These barriers are often not fully realised, but can potentially be addressed with concerted efforts to continue the advancement of medicine for everyone.

From urban waste to urban farmers: Can we close the agriculture loop within the city bounds?

As urbanisation intensifies in Brazilian cities, life quality in urban centres becomes a challenge for policymakers, and transitioning urban systems to sustainability is required. Circular economy concepts may contribute to face them, especially those owing to municipal solid waste (MSW) management. Curitiba, a Brazilian municipality known for its innovative initiatives towards sustainability. Despite a long tradition in recycling inert waste, MSW system struggles to promote composting even considering a decade in force national law. Decentralised composting through the Urban Agriculture Program (UAP) is the city's strategy to tackle this struggle. This strategy faces difficulties as, even if urban agriculture facilities seem to be a promising context, closing the agricultural loop within the city bounds was not possible in the 24 urban farmers communities trained in composting techniques. The literature has shown difficulties in government experiments to promote practices in the long run and several experiences in Brazil are already described. This study reveals cultural barriers that influence adoption of domestic composting, by following a secondary data review on past experiences with interviewing and observing participatively urban farms communities. From the fieldwork, cultural perspectives from four different relevant actor roles in the UAP were elaborated and conflicts between them revealed cultural barriers hindering composting practices adoption. Recommendations based on these barriers argue for bottom-up approaches for transition experiments and recognising the sense material and technical support makes to practitioners.

"Mental Health Is for Crazy People": Perceptions and Barriers to Mental Health Service Use among Refugees from Burma.

Good mental health is essential to successful integration for refugee populations that resettle in the U.S. We explored perceptions of mental illnesses and barriers to mental health service use as well as solutions to current mental health problems from the perspective of refugees. The interviews with a convenience sampling of 11 community leaders (6 men and 5 women) from various Burmese ethnic communities revealed three major categories, including sources of mental illnesses (e.g. traumatic experiences and post-resettlement challenges), barriers to service use (e.g. lack of understanding about mental health, linguistic challenges, cultural stigma, alternative treatments, and unresponsive system), and proposed community solutions (e.g. community education, culturally-competent providers, and beyond mental health treatment). The findings suggest that the ethnic community can be a source of potential solutions to mitigate barriers to mental health service use.

Eliciting culturally and medically informative family health histories from Marshallese patients living in the United States.

The United States (U.S.) resident Marshallese population is growing rapidly. Subsequent to this growth, Marshallese patients experience language and cultural barriers when attempting to access medical care in the U.S. This study: (a) documents how the Marshallese refer to biological and adopted family members; (b) identifies barriers encountered by Marshallese when seeking medical care; and (c) describes effective communication strategies for healthcare providers to use when treating Marshallese patients. Six key informant interviews were conducted in English with bicultural (U.S. and native Marshallese) informants, the majority of whom were women who worked in a healthcare setting. Participants were recruited through the Center for Pacific Islander Health in Arkansas and through personal contacts within the Marshallese community. Based on the study findings, examples of how providers can make genetic services more accessible and meaningful for Marshallese patients are also provided. This study is particularly relevant to genetic counselors as the number of Marshallese patients and families needing their services is growing.

Contemporary public image of the nursing profession in Saudi Arabia.

BACKGROUND: In the Kingdom of Saudi Arabia, the nursing profession faces significant challenges including; failure to recruit high school students into nursing education, poor nursing identity, and lack of awareness about the nursing profession. The level of community awareness and public image of the nursing profession are critical to recruit and retain students into nursing education, and to improve nurses' sense of identity. AIM: To explore the level of community awareness and public image of the nursing profession in Saudi Arabia. METHODS: We conducted a cross-sectional study with a convenient sample of 502 adults including106 males and 396 females, their mean age was 22.93 ± 6.76 years. Data collected included; socio-cultural data, gender preference in getting nursing care, awareness, and perceived socio-cultural barriers to pursue a nursing career. Data were analyzed using SPSS version 21.0. RESULTS: Only 32.5% preferred to get nursing care by Saudis. The nursing profession was not viewed as a respected job as 71.5% of participants would be ashamed of having a nurse in their families. The study revealed a low median knowledge score (50.0, IQR: 50.0-66.7)). The study highlighted a number of socio-cultural barriers to pursue a nursing career including; the gender-mixed working environment (35.9%), delayed marriage of female nurses (20.3%), and the negative effect of nursing profession on social life (64.5%). CONCLUSIONS: Half of the sample had a knowledge score below 50.0 out of 100. This level of poor awareness, in addition to socio-cultural perceived barriers are the main factors contributing to the negative public image of the nursing profession in Saudi Arabia. Understanding these factors could contribute to implementing focused intervention to improve the negative stereotype of the nursing profession among Saudis.

Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications.

Adequate maternal nutrition during the "first 1,000 days" window is critical from conception through the first 6 months of life to improve nutritional status and reduce the risk of poor birth outcomes, such as low birthweight and preterm birth. Unfortunately, many programmes have targeted implementation and monitoring of nutrition interventions to infants and young children, rather than to women during pregnancy or post-partum. A literature review was conducted to identify barriers to food choice and consumption during pregnancy and lactation and to examine how low- and middle-income countries have addressed maternal nutrition in programmes. A literature review of peer-reviewed and grey literature was conducted, and titles and abstracts reviewed by authors. Twenty-three studies were included in this review. Barriers to adequate nutrition during pregnancy included cultural beliefs related to knowledge of quantity of food to eat during pregnancy, amount of weight to gain during pregnancy, and "eating down" during pregnancy for fear of delivering a large baby. Foods considered inappropriate for consumption during pregnancy or lactation contributed to food restriction. Drivers of food choice were influenced by food aversions, economic constraints, and household food availability. Counselling on maternal diet and weight gain during pregnancy was seldom carried out. Programming to support healthy maternal diet and gestational weight gain during pregnancy is scant. Tailored, culturally resonant nutrition education and counselling on diet during pregnancy and lactation and weight gain during pregnancy, as well as monitoring of progress in maternal nutrition, are areas of needed attention.

Navigating Cultural Challenges in Transplant Surgery: Insights from Turkish Surgeons.

To achieve expertise, transplant surgeons in Turkiye undergo rigorous training, including medical school, residency, compulsory service, and extensive training in transplant surgery. Despite their high academic and clinical knowledge level, success in transplant surgery heavily depends on cultural competency. Through semi-structured interviews with 21 transplant surgeons specializing in kidney and liver transplants in Ankara, this study reveals how health illiteracy, culture, and folklore create significant barriers. Surgeons navigate these challenges while enduring harsh working conditions. This research highlights the critical role of cultural competency in transplant surgery, emphasizing the necessity for surgeons to understand and address the diverse cultural needs of their patients. Key findings indicate that surgeons must balance medical expertise with cultural sensitivity to deliver effective care. This study identifies four main cultural barriers: spiritual trust, family politics, health illiteracy, and subcultural incompetency. Effective transplant surgery requires a combination of theoretical proficiency and cultural awareness to meet a patient's needs and improve surgical outcomes.

Cultural barriers to male partners' involvement in antenatal care in Limpopo province.

Background: Participation of male partners in antenatal care (ANC) is a complicated process that involves social and behavioural transformation. It necessitates that males take a more active part in reproductive health. Men's participation in prenatal care has been linked to beneficial health outcomes such as enhanced maternal health outcomes across the world. However, culture has been identified as a barrier to male partners' participation in prenatal care. Aim: The aim of the study was to explore and describe the cultural barriers to male partner involvement in ANC. Setting: The study focussed on selected clinics and hospitals under Vhembe District, Limpopo province. Methods: Qualitative, exploratory, descriptive, and contextual research design was used in this study. Qualitative data were collected through individual semi-structured interviews and Focus Group Discussions (FGDs). A thematic analysis approach was used to analyse the collected data from semi-structured interviews and FGDs. Results: The findings revealed three themes: cultural beliefs and practices that affect male partners' involvement in ANC; gender-related barriers that affect male partners' involvement in ANC; and socioeconomic barriers to male partners' involvement in ANC. Conclusion: The study's findings revealed that certain cultural beliefs and practices are a stumbling block to male partners' involvement in antenatal healthcare. Contribution: Culturally based developed strategy might help in improving the knowledge and practices of male partners in ANC.

Building Trust: Strategies for Recruiting Underrepresented Populations in Research during the COVID-19 Pandemic.

The COVID-19 pandemic disproportionately affected racial and ethnic populations within the United States, creating a distinct set of circumstances that exacerbated barriers to research participation for underrepresented communities. This article aims to provide a rationale that validates the impact of the COVID-19 pandemic on these groups and suggests strategies for participant recruitment while sharing lessons learned from our own laboratory. By understanding the barriers that limit the recruitment of intended populations, researchers can implement culturally sensitive strategies and work towards a more inclusive body of literature with improved participation from underrepresented racial and ethnic populations.

The Tribal Health System in India: Challenges in Healthcare Delivery in Comparison to the Global Healthcare Systems.

The tribal health system in India faces unique challenges in comparison to non-tribal health in the nation and global healthcare systems. The tribal health issues are distinct due to the diverse socio-cultural practices, rituals, customs, and languages of the tribal communities. Despite commendable efforts, there are several obstacles that hinder the successful delivery of healthcare services to these underserved populations. These challenges include geographical remoteness and limited infrastructure, language, and cultural barriers; scarcity of healthcare professionals; socioeconomic disparities; and the need for cultural sensitivity and integration of traditional healing practices. Overcoming these challenges requires collaborative efforts between the government, medical specialists, and the indigenous tribes themselves. By addressing these obstacles, it is possible to enhance the accessibility, quality, and cultural appropriateness of healthcare services for tribal groups, leading to improved health outcomes and reduced health inequalities.

Navigating Cultural Diversity in the Selection of Cardiovascular Device Treatments: A Comprehensive Review.

In cardiology, patients' cultural beliefs, linguistic differences, lack of knowledge, and socioeconomic status can create barriers to choosing device treatment. To address this issue, we conducted a thorough literature review using online databases such as PubMed, Google Scholar, and Texas Tech University Health Sciences Center's research portal. Our review found that cultural, religious, and linguistic barriers can contribute to patients' apprehension and reservations about device placement. These barriers can also impact patients' adherence to treatment and clinical outcomes. Patients from lower socioeconomic backgrounds may have difficulty accessing and affording device-based treatments. Additionally, fear and inadequate understanding of surgical procedures can deter patients from accepting device treatment in cardiology. To overcome these cultural barriers, healthcare providers must raise awareness about the benefits of device treatment and provide better training to overcome these challenges. It is crucial to address the unique needs of patients from different cultural backgrounds and socioeconomic statuses to ensure they receive the care they need.

Dialect culture and the utilization of public health service by rural migrants: Insights from China.

The right to health is a fundamental human right for human beings to live in dignity. Everyone has the right to enjoy the fair and accessible highest standard of health by utilizing public health services. However, access to essential public health services also highly depends on the dialect culture. It is believed that the dialect culture also influences the efficiency of public health policies. To explore the phenomenon empirically, the current study utilized data sourced from geographical distribution information of Chinese dialects and the China Migrants Dynamic Survey for 2017. The study employed the Probit, IVprobit, and Eprobit models to estimate the impact of dialect culture on migrants' use of public health services. The findings revealed that the dialect culture significantly hinders the migrants' utilization of public health services. Further, by employing heterogeneity analysis, the findings revealed that the results are more pronounced in migrants, born after 1980, and are female with low educational background and also those migrants having local medical experiences and moving toward non-provincial cities. Finally to explore the mechanism of dialect culture influencing migrants' public health service, the study employed mediation analysis and KHB Method. The findings revealed that information transmission, health habits, social capital, and cultural identity are the potential pathways influencing the migrants' use of public health services. The findings conclude that rural-to-urban migrants' access to public health services is influenced by their cultural adaptation. Hence, the study proposes that the government should amend the policy inefficiency concerns caused by cultural differences and strengthen the regional cultural exchanges to build trust.

"We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province.

INTRODUCTION: Doctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction. AIM: The aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses. METHODS: This qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa. The doctors were interviewed on the barriers and facilitators of sexual history taking they experienced during 151 recorded consultations with patients at risk of sexual dysfunction. Interviews were transcribed and line-by-line verbatim coding was done. A thematic analysis was performed using MaxQDA 2018 software for qualitative research. The study complied with COREQ requirements. OUTCOME: Doctors' reflections on sexual history taking. RESULTS: Three themes identifying barriers to sexual history taking emerged, namely personal and health system limitations, presuppositions and assumptions, and socio-cultural barriers. The fourth theme that emerged was the patient-doctor relationship as a facilitator of sexual history taking. Doctors experienced personal limitations such as a lack of training and not thinking about taking a history for sexual dysfunction. Consultations were compromised by too many competing priorities and socio-cultural differences between doctors and patients. The doctors believed that the patients had to take the responsibility to initiate the discussion on sexual challenges. Competencies mentioned that could improve the patient-doctor relationship to promote sexual history taking, include rapport building and cultural sensitivity. CLINICAL IMPLICATIONS: Doctors do not provide holistic patient care at primary health care settings if they do not screen for sexual dysfunction. STRENGTH AND LIMITATIONS: The strength in this study is that recall bias was limited as interviews took place in a real-world setting, which was the context of clinical care. As this is a qualitative study, results will apply to primary care in rural settings in South Africa. CONCLUSION: Doctors need a socio-cognitive paradigm shift in terms of knowledge and awareness of sexual dysfunction in patients with chronic illness. Pretorius D, Mlambo MG, Couper ID. "We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province. Sex Med 2022;10:100565.

Examining Health-Seeking Behaviors of Korean Immigrant Women.

OBJECTIVE: To identify specific factors that potentially influence the willingness of Korean immigrant women to seek preventive health care. DESIGN: A descriptive cross-sectional correlational pilot study examining health-seeking behaviors of Korean immigrant women. SETTING: Participants were recruited from multiple sites, including Korean churches, small businesses, e-mail, and social media. PARTICIPANTS: A convenience sample of 87 Korean immigrant women (i.e., both parents Korean), 18 years or older, able to read and understand English and/or Korean, and currently living in the United States. INTERVENTION/MEASUREMENTS: Data were collected using a 62-item bilingual questionnaire, composed of researcher-developed questions and the Risk Behavior Diagnosis Scale. Pearson's correlations were performed to analyze bivariate relationships between willingness to seek care and outcome variables. RESULTS: Korean immigrant women were significantly more willing to seek preventive health care when they were prompted by outside sources of information and exhibited greater self-efficacy. Significant positive correlations were found between participant's age, years lived in the United States, cues to action, and self-efficacy. CONCLUSION: Promoting preventive health information at every opportunity and fostering self-efficacy in culturally sensitive ways are important to increase health care use among Korean immigrant women. Developing cultural-based interventions to improve the health-seeking behaviors of Korean immigrant women was shown to be imperative.

Why Do We Not Follow Lifesaving Rules? Factors Affecting Nonadherence to COVID-19 Prevention Guidelines in Indonesia: Healthcare Professionals' Perspectives.

This study aimed to understand Indonesian healthcare professionals' (HCPs) perceptions and experiences regarding barriers to both HCP and community adherence to COVID-19 prevention guidelines in their social life. This methodologically qualitative study employed in-depth interviewing as its method for primary data collection. Twenty-three HCP participants were recruited using the snowball sampling technique. Data analysis was guided by the Five Steps of Qualitative Data Analysis introduced through Ritchie and Spencer's Framework Analysis. The Theory of Planned Behaviour was used to guide study conceptualisation, data analysis and discussions of the findings. Results demonstrated that HCP adherence to COVID-19 prevention guidelines was influenced by subjective norms, such as social influence and disapproval towards preventive behaviours, and perceived behavioural control or external factors. Findings also demonstrated that HCPs perceived that community nonadherence to preventive guidelines was influenced by their behavioural intentions and attitudes, such as disbelief in COVID-19-related information provided by the government, distrust in HCPs, and belief in traditional ritual practices to ward off misfortune. Subjective norms, including negative social pressure and concerns of social rejection, and perceived behavioural control reflected in lack of personal protective equipment and poverty, were also barriers to community adherence. The findings indicate that policymakers in remote, multicultural locales in Indonesia such as East Nusa Tenggara (Nusa Tenggara Timur or NTT) must take into consideration that familial and traditional (social) ties and bonds override individual agency where personal action is strongly guided by long-held social norms. Thus, while agency-focused preventive policies which encourage individual actions (hand washing, mask wearing) are essential, in NTT they must be augmented by social change, advocating with trusted traditional (adat) and religious leaders to revise norms in the context of a highly transmissible pandemic virus. Future large-scale studies are recommended to explore the influence of socio-cultural barriers to HCP and community adherence to preventive guidelines, which can better inform health policy and practice.