The Need for Culturally Competent Care Within Gastroenterology Services: Evidence from Research with Adults of South Asian Origin Living with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: It is widely acknowledged that the incidence of inflammatory bowel disease [IBD] is rising within South Asian populations, yet research into the experiences of this group of patients is rare. In this study the lived experiences of UK South Asian adults with IBD, including support from gastroenterology services, was investigated. METHODS: A sample of 33 patients representing the diversity of the UK South Asian population were recruited through five gastroenterology clinics in England. In-depth semi-structured interviews were conducted, audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Although many experiences align with those of the general IBD population, participants believed that South Asian cultures and/or religions can lead to additional challenges. These are linked to: family and friends' understanding of IBD; self and family attributions regarding IBD; stigma surrounding ill health; the taboo of bowel symptoms; managing 'spicy food'; beliefs about food and ill health; roles within the family; living with extended family; the use of complementary and alternative therapies; and visits to family overseas. Religious faith helped many to cope with having IBD, but symptoms could hamper their ability to practise faith. Gastroenterology services were viewed positively, but unmet needs were identified, some of which were culturally specific. CONCLUSION: Gastroenterology services have an important role to play in helping patients to overcome the challenges they encounter in their everyday life, both by providing individual patients with culturally appropriate care and advice, and via interventions to increase awareness and understanding of IBD within wider South Asian communities.

Athletes for life: Rationale and methodology of a community- and family-based randomized controlled trial to promote cardiovascular fitness among primarily Latino families.

BACKGROUND: Community-based programs have had modest success in combating obesity in Latino populations. Latino families' norms and beliefs about weight often hold larger body sizes to be normal, leading to lower engagement in weight-focused programs. Because improvements in cardiorespiratory fitness confer health benefits, regardless of weight, they offer an alternative to obesity-focused approaches. We describe the rationale and design of Athletes for Life (AFL), a community- and family-based intervention for Latino families. METHODS/DESIGN: This two-group randomized controlled trial will test the efficacy of AFL for improving cardiorespiratory fitness and diet in 6- to 11-year-old children (N = 160) and their parents, relative to a wait-list control group. Children will participate in 12 weeks of semiweekly sports skill programing and nutrition sessions. Concurrently, parents will participate in sports-focused activity and behavior change sessions that focus on nutrition, chronic disease prevention, and healthy eating. Cardiovascular fitness will be measured by the 1-mile run and 3-min step-test for both parents and children. Secondary outcomes include changes in objectively measured physical activity, dietary measures, body composition, and cardiometabolic risk (waist circumference, blood pressure, blood lipids, glucose, insulin, and C-reactive protein). DISCUSSION: AFL, implemented with a strong community partnership, will provide a test of the efficacy of culturally tailored intervention programming to promote positive health behaviors and improve health outcomes in Latino families. Intervention content, structure, and messaging will provide guidance for future methods to engage Latino families in health promotion programs that highlight their cultural norms, and beliefs. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT03761589 (12/3/2018).

Integrated care clinic: Creating enhanced clinical pathways for integrated behavioral health care in a family medicine residency clinic serving a low-income, minority population.

INTRODUCTION: Research examining the implementation and effectiveness of integrated behavioral health (BH) care in family medicine/primary care is growing. However, research identifying ways to consistently use integrated BH in busy family medicine/primary care settings with underserved populations is limited. This study describes 1 family medicine clinic's transformation into a fully integrated BH care clinic through the development of an Integrated Care Clinic (ICC) and enhanced clinical pathways to promote regular use of behavioral health clinicians (BHCs). METHOD: We implemented the ICC at the Broadway Family Medicine Clinic serving a low-income (<$25,000 annual income/year) and minority population (>70% African American) in Minnesota. We conducted a pre- and postevaluation of the ICC during regular clinic activity. RESULTS: Pilot findings indicated that the creation of ICC and the use of enhanced clinical pathways (e.g., 5-2-1-0 obesity prevention messages, Transitional Care Management, postpartum depression screening visits, warm hand-offs) to facilitate regular use of integrated BH care resulted in 6 integrated care visits per BHC per clinic half-day. In addition, changes in the behavioral/mental health therapy appointment time slot (from 60 to 30 min) reduced therapy no-show rates. Transitional Care Management (TCM) visits also showed improved pre- and postchanges in patient and clinician satisfaction and reductions in patient hospital readmission rates. DISCUSSION: The transformation into a fully integrated BH family medicine clinic through the creation of ICC and enhanced clinical pathways to facilitate regular integrated BH care showed promising pilot results. Future research is needed to examine associations between ICC and patient outcomes (e.g., weight, depressive symptoms). (PsycINFO Database Record

Perturbing Status of Vitamin B12 in Indian Infants and Their Mothers.

BACKGROUND: Vitamin B12 deficiency in early life can adversely affect the growth of developing brain with myriad of neurodevelopmental manifestations. At this age, the deficiency is usually the result of low maternal levels. OBJECTIVES: To assess the vitamin B12 status of healthy exclusively breast-fed Indian infants aged 1 to 6 months and their mothers. METHODS: One hundred term exclusively breast-fed infants aged 1 to 6 months attending pediatric outpatient department were recruited. Hemogram, serum B12, folate, and ferritin levels were obtained from each infant-mother pair. RESULTS: The prevalence of B12 deficiency in infants was found to be 57%. Forty-six percent of mothers were deficient. There was a positive correlation ( r = .23) between the B12 levels of the infants and their mothers. CONCLUSION: There is a high prevalence of vitamin B12 deficiency in Indian infants and their mothers. There is an urgent need to supplement our population with vitamin B12, and the best time to do this would be antenatal.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion.

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

American Indians' Family Health Concern on a Northern Plains Reservation: "Diabetes Runs Rampant Here".

OBJECTIVES: The objective was to identify significant family health concerns from the perspective of adult tribal members residing in a reservation setting on the Northern Plains of the United States. Findings were used to cocreate culturally appropriate strategies to address the most significant family health concern. DESIGN AND SAMPLE: A focused ethnography within a participatory framework was employed. An advisory council, comprised of seven tribal members, guided the research team. A purposive sampling technique with a snowball process was used. Twenty-one adult tribal members volunteered to participate. MEASURES: Face-to-face, audio-recorded, semi-structured interviews were conducted and transcribed verbatim. Other data sources included field notes of approximately 100 hours of field work, windshield surveys, and a focus group. Data were analyzed using Spradley's guidelines. RESULTS: The significant family health concern was "diabetes runs rampant here" with inter-related cognitive, emotional, and behavioral responses. These responses were compounded by accumulated emotional trauma from witnessing premature deaths and severe comorbidities associated with diabetes. Contextual factors shaping "diabetes runs rampant here" were identified. CONCLUSION: Holistic approaches are urgently needed in diabetes prevention and management programs. Implications for public health nurses are discussed and recommendations are provided for future research.

Stunting rates in infants and toddlers born in metropolitan Quetzaltenango, Guatemala.

OBJECTIVE: Guatemala has the highest prevalence of stunting (54% of children under age 5 years) in the Americas and the fifth highest in the world. The aim of this study was to describe the stunting prevalence and the association with early feeding practices, morbidity patterns, and socioeconomic status (SES) in a sample of infants and toddlers from urban Quetzaltenango. METHODS: We recruited 299 children (149 boys), ages 6-23 mo from two public health clinics in metropolitan Quetzaltenango. Data on SES, early feeding practices, and morbidity were collected by means of a single face-to-face interview. Recumbent spine length was measured according to standardized procedures and height-for-age (HAZ) z-scores were calculated. HAZ <-2 SD of the World Health Organization's 2006 Growth Standards was considered stunting. Multiple logistic regression analysis was used to examine determinants of stunting. RESULTS: The overall mean HAZ z-score was -1.89 ± 1.11 and 135 (45%) children were stunted. The results of the crude odds ratios showed that place of interview (suburban), being male, being ages 13-18 mo, being born at home, having a mother with a low level of education, being of Mayan (indigenous) ethnicity, having a mother with short stature, and having ever received iron supplementation were strongly and significantly (P < 0.05) associated with stunting. None of the other variables, such as supplement use and morbidity rates, contributed to the predictive model. We did not observe an association between early feeding practices or morbidity and stunting. CONCLUSION: The stunting prevalence exceeds the cut-off of 40% stunting, indicating a community with a high level of malnutrition.

Migration in far west Nepal: intergenerational linkages between internal and international migration of rural-to-urban migrants.

In Nepal, international labor migration to India and overseas, as well as internal migration to the rural Nepalese lowlands, is of high socioeconomic significance. Scholarly debates about migration in Nepal have gradually shifted from an economic to a more holistic perspective, also incorporating social dimensions. However, little evidence has been generated about internal migration to urban destinations and the potential linkages between international and internal migration. This article draws on Bourdieu's "Theory of Practice" and sees migration as a social practice. Accordingly, migration practice is regarded as a strategy social agents apply to increase or transfer capitals and ultimately secure or improve their social position. Evidence for this argument is based on a qualitative case study of rural to urban migrants in Far West Nepal conducted in July and August 2009. The study at hand addresses linkages between internal and international migration practices and provides insight about a social stratum that is often neglected in migration research: the middle class and, more precisely, government employees. The authors show that social relations are crucial for channeling internal migration to a specific destination. Furthermore, they unveil how internal migration is connected to the international labor migration of former generations. Finally, the authors examine how migration strategies adopted over generations create multi-local social networks rooted in the family's place of origin.

Development of the concentric sphere family environment model and companion tools for culturally congruent family assessment.

The article presents development of a nursing model for holistically understanding the family environment that acts on family well-being as well as of tools based on this model to assess family well-being. These were constructed by using qualitative, quantitative, and literary approaches, such as the Delphi technique, a literature review, semistructured interviews with families, and ethnographic studies in Japan, Hong Kong, and the United States. In the "Concentric Sphere Family Environment Model," a three-dimensional logical space is formed by the three assessment axes of relationships (structural distance, functional distance, and temporal distance) and five systems (supra system, macro system, micro system, family internal environment system, and chrono system) located therein. The "Family Environment Assessment Index" comprises 37 items for assessing the family well-being, and for each of their specifications useful sample questions are provided to conduct the culturally congruent family assessment.

What adult worker model? A critical look at recent social policy reform in Europe from a gender and family perspective.

Analyses regularly feature claims that European welfare states are in the process of creating an adult worker model. The theoretical and empirical basis of this argument is examined here by looking first at the conceptual foundations of the adult worker model formulation and then at the extent to which social policy reform in western Europe fits with the argument. It is suggested that the adult worker formulation is under-specified. A framework incorporating four dimensions­the treatment of individuals vis-à-vis their family role and status for the purposes of social rights, the treatment of care, the treatment of the family as a social institution, and the extent to which gender inequality is problematized­is developed and then applied. The empirical analysis reveals a strong move towards individualization as social policy promotes and valorizes individual agency and self-sufficiency and shifts some childcare from the family. Yet evidence is also found of continued (albeit changed) familism. Rather than an unequivocal move to an individualized worker model then, a dual earner, gender-specialized, family arrangement is being promoted. The latter is the middle way between the old dependencies and the new "independence." This makes for complexity and even ambiguity in policy, a manifestation of which is that reform within countries involves concurrent moves in several directions.

The role of cultural practices and the family in the care for people living with HIV/AIDS among the Igbo of Anambra State, Nigeria.

The HIV/AIDS pandemic is one of the worst epidemics that have been experienced by humankind. It is indeed a major event of our time. The pandemic has killed so many people around the world and Sub-Saharan Africa is the worst hit. The nature of the pandemic lent it to stigma and discrimination, which have made caring for people living with HIV/AIDS (PLWHA) a big problem. It has also brought so much suffering on PLWHA around the world. This article examines the role of culture and the family in the care for PLWHA in Anambra State. Quantitative and Qualitative data collection methods (questionnaire and in-depth interviews) are used to elicit information from respondents. A total of 1000 copies of a questionnaire were administered on adult males and females and 914 were completed and analyzed. Furthermore, in-depth interviews were conducted on 10 opinion leaders using an interview guide. Data were analyzed in themes based on the objectives and the data from in-depth interviews were used to support data from the questionnaire. The results showed that certain cultural practices such as cultural obligations to sick, blood relations, collective ownership of children, affinity to blood relations, and strong marital bond enhance care and support for PLWHA. Also, the burden of care for PLWHA was found to be on the family in the study area. In conclusion, cultural practices and the family play major roles in the care for PLWHA in the area and should be harnessed in order to make life more comfortable for PLWHA.

A roadmap for authentic community/academic engagement for developing effective community preterm birth education.

Evidence-based care, behavioral interventions, and new technologies applied during the perinatal period are insufficient by themselves to reduce or eliminate racial/ethnic disparities in infant mortality. Traditional health and behavioral interventions, and the structures through which they are delivered, do not facilitate adherence to behavioral or health recommendations at home or in the community. The translation of research into practice in the absence of community involvement often results in interventions that are irrelevant to community needs, insensitive to existing culture, inconsistent with the resources available, and strain existing community assets. Using a community-partnered participatory research (CPPR) process, the Healthy African American Families project in Los Angeles developed a multilevel, risk communications strategy to promote awareness about preterm birth in the local community. This paper provides a roadmap, giving insight into the CPPR model and processes involved in the development of the risk communications strategy.

Primary health care nurses' promotion of involuntary migrant families' health.

BACKGROUND: Involuntary migrant families in cultural transition face a number of challenges to their health and to family cohesion. Primary health care nurses (PHCNs) therefore play a vital role in the assessment and promotion of their health. AIM: The aim of this study was to describe the promotion of health in involuntary migrant families in cultural transition as conceptualized by Swedish PHCNs. METHOD: Interviews were conducted with 34 strategically chosen PHCNs covering the entire range of the primary health care sector in two municipalities of Southern Sweden. A contextual approach with reference to phenomenography was used in interpreting the data. FINDINGS: There are three qualitatively different descriptive categories epitomizing the characteristics of the PHCNs' promotion of health: (1) an ethnocentric approach promoting physical health of the individual, (2) an empathic approach promoting mental health of the individual in a family context, and (3) a holistic approach empowering the family to function well in everyday life. CONCLUSIONS: For nurses to promote involuntary migrant families'health in cultural transition, they need to adopt a holistic approach. Such an approach demands that nurses cooperate with other health care professionals and community authorities, and practise family-focused nursing; it also demands skills in intercultural communication paired with cultural self-awareness in interacting with these families. Adequate knowledge regarding these skills should therefore be included in the education of nurses, both at under- and at post-graduate level.

Primary care at the Alaska Native Medical Center: a fully deployed "new model" of primary care.

OBJECTIVES: Beginning in the 1940s health care for Alaska Native people was delivered by the United States Indian Health Service. The transition to Alaska Native ownership was completed in 1998-9 with the transfer of the Alaska Native Medical Center to Alaska Native corporations. METHODS: The Native leaders of Southcentral Foundation made a conscious decision to redesign the medical primary care system around the core premise of optimizing long-term, trusting, accountable relationships. The medical system was reoriented to optimize these relationships, assure whole system intentional and integrated design, and remove barriers to these relationship being formed. RESULTS: . The transformed system allowed Alaska Native individuals and families to choose a primary care provider, enter into long-term trusting relationship with the provider, and partner in the journey towards wellness. It was a fully integrated approach that used every part of the system to best advantage, put the power in the hands of the individual and family, and effectively focused on the underlying determinants of health. CONCLUSIONS: The primary care system created and managed by Southcentral Foundation at the Alaska Native Medical Center demonstrated a system built on similar premises to the "New Model" of family medicine.

The perceptions of Taiwanese families who have children with learning disability.

AIMS AND OBJECTIVES: To explore the perceptions of families in Taiwan of living with a child who have learning disability and the parents perspectives on the cultural influences on their spiritual experiences. BACKGROUND: Traditionally, the family is the most important unit of society, family functioning is a key field of interest among helping professionals who provide family interventions. DESIGN: This study adopted qualitative research with semi-structured interviews. The study analysis used content analysis which was a process of identifying, coding and categorizing the themes in the data. METHODS: Semi-structured interviews were conducted with 117 parents in their homes and were interpreted by using content analysis to extract key conceptual themes from the transcribed interview texts. RESULTS: The findings revealed that the perceptions of families with learning disability children were wide-ranging. The stressors did not occur in a fixed order, they were different in degree and importance from one family to another. CONCLUSIONS: The results showed that the experience of analysing qualitative data was extremely valuable for parents in that it aided their own understanding of the real-life experiences of the parents and in coming to know the parents in a richer, more meaningful way. In doing so, nurses need to be aware of their own thoughts and environment without letting it influence others. RELEVANCE TO CLINICAL PRACTICE: The nurse should demonstrate knowledge and understanding of the family's culture and be able to show respect for cultural difference to assess and identify culturally acceptable health-care interventions.

Effects of a school-based, early childhood intervention on adult health and well-being: a 19-year follow-up of low-income families.

OBJECTIVE: To determine the effects of an established preventive intervention on the health and well-being of an urban cohort in young adulthood. DESIGN: Follow-up of a nonrandomized alternative-intervention matched-group cohort at age 24 years. SETTING: Chicago, Illinois. PARTICIPANTS: A total of 1539 low-income participants who enrolled in the Child-Parent Center program in 20 sites or in an alternative kindergarten intervention. INTERVENTIONS: The Child-Parent Center program provides school-based educational enrichment and comprehensive family services from preschool to third grade. MAIN OUTCOME MEASURES: Educational attainment, adult arrest and incarceration, health status and behavior, and economic well-being. RESULTS: Relative to the comparison group and adjusted for many covariates, Child-Parent Center preschool participants had higher rates of school completion (63.7% vs 71.4%, respectively; P = .01) and attendance in 4-year colleges as well as more years of education. They were more likely to have health insurance coverage (61.5% vs 70.2%, respectively; P = .005). Preschool graduates relative to the comparison group also had lower rates of felony arrests (16.5% vs 21.1%, respectively; P = .02), convictions, incarceration (20.6% vs 25.6%, respectively; P = .03), depressive symptoms (12.8% vs 17.4%, respectively; P=.06), and out-of-home placement. Participation in both preschool and school-age intervention relative to the comparison group was associated with higher rates of full-time employment (42.7% vs 36.4%, respectively; P = .04), higher levels of educational attainment, lower rates of arrests for violent offenses, and lower rates of disability. CONCLUSIONS: Participation in a school-based intervention beginning in preschool was associated with a wide range of positive outcomes. Findings provide evidence that established early education programs can have enduring effects on general well-being into adulthood.

Crenças populares e recursos alternativos como práticas de saúde / Popular beliefs and alternative resources and health practices

Mesmo diante dos avanços alcançados pela medicina oficial, a medicina popular e as terapias alternativas conseguem obter credibilidade porque respondem, em muitos casos, às necessidades e expectativas da população. Este estudo objetivou analisar a influência das crenças populares e a utilização de recursos alternativos na solução de problemas de saúde entre a comunidade, partindo de percepções de profissionais do Programa de Saúde da Família (PSF), e também ientificar condutas dos profissionais quando se deparam com clientes usuários desses recursos. Pesquisa de abordagem qualitativa, realizada no Centro de Atenção Integrada à Saúde - Amendoeiras, em Goiânia - GO, em 2002. A análise revelou as seguintes categorias: Vantagens e Desvantagens; Cultura e Tradição X Mudança de Hábitos; e A Ênfase no Natural. Os profissionais demosntram respeito, aceitação, reprovação e interesse em conscientizar quanto ao uso de práticas populares. A adoção de terapias alternativas na assistência à saúde pode favorecer o alcance de melhores resultados no processo saúde-doença.