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2.
Ann Surg ; 280(3): 403-413, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-38921829

RESUMEN

OBJECTIVES: This trial examines the impact of the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum on surgical residents' knowledge, cross-cultural care, skills, and beliefs. BACKGROUND: Cross-cultural training of providers may reduce health care outcome disparities, but its effectiveness in surgical trainees is unknown. METHODS: PACTS focuses on developing skills needed for building trust, working with patients with limited English proficiency, optimizing informed consent, and managing pain. The PACTS trial was a randomized crossover trial of 8 academic general surgery programs in the United States: The Early group ("Early") received PACTS between periods 1 and 2, while the Delayed group ("Delayed") received PACTS between periods 2 and 3. Residents were assessed preintervention and postintervention on Knowledge, Cross-Cultural Care, Self-Assessed Skills, and Beliefs. χ 2 and Fisher exact tests were conducted to evaluate within-intervention and between-intervention group differences. RESULTS: Of 406 residents enrolled, 315 were exposed to the complete PACTS curriculum. Early residents' Cross-Cultural Care (79.6%-88.2%, P <0.0001), Self-Assessed Skills (74.5%--85.0%, P <0.0001), and Beliefs (89.6%-92.4%, P =0.0028) improved after PACTS; knowledge scores (71.3%-74.3%, P =0.0661) were unchanged. Delayed resident scores pre-PACTS to post-PACTS showed minimal improvements in all domains. When comparing the 2 groups in period 2, Early residents had modest improvement in all 4 assessment areas, with a statistically significant increase in Beliefs (92.4% vs 89.9%, P =0.0199). CONCLUSIONS: The PACTS curriculum is a comprehensive tool that improved surgical residents' knowledge, preparedness, skills, and beliefs, which will help with caring for diverse patient populations.


Asunto(s)
Competencia Clínica , Estudios Cruzados , Curriculum , Cirugía General , Internado y Residencia , Humanos , Femenino , Masculino , Cirugía General/educación , Estados Unidos , Adulto , Conocimientos, Actitudes y Práctica en Salud , Asistencia Sanitaria Culturalmente Competente , Competencia Cultural , Educación de Postgrado en Medicina/métodos
3.
AIDS Behav ; 28(2): 408-420, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38060112

RESUMEN

Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.


Asunto(s)
Antirretrovirales , Negro o Afroamericano , Asistencia Sanitaria Culturalmente Competente , Infecciones por VIH , Cumplimiento de la Medicación , Minorías Sexuales y de Género , Femenino , Humanos , Masculino , Antirretrovirales/uso terapéutico , Negro o Afroamericano/psicología , Habilidades de Afrontamiento , Asistencia Sanitaria Culturalmente Competente/etnología , Infecciones por VIH/psicología , Homofobia/etnología , Cumplimiento de la Medicación/psicología , Prejuicio/etnología , Racismo/etnología , Minorías Sexuales y de Género/psicología
4.
Int J Equity Health ; 23(1): 118, 2024 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-38844971

RESUMEN

BACKGROUND: Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS: In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS: Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS: This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.


Asunto(s)
Actitud del Personal de Salud , Asistencia Sanitaria Culturalmente Competente , Médicos Generales , Investigación Cualitativa , Humanos , Médicos Generales/psicología , Masculino , Femenino , Asistencia Sanitaria Culturalmente Competente/normas , Persona de Mediana Edad , Adulto , Relaciones Médico-Paciente , Entrevistas como Asunto , Competencia Cultural/psicología
5.
Curr Psychiatry Rep ; 26(8): 422-434, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38884698

RESUMEN

PURPOSE OF REVIEW: Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed. RECENT FINDINGS: Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care.


Asunto(s)
Medicina Integrativa , Humanos , Medicina Integrativa/métodos , Comunicación , Consejo/métodos , Asistencia Sanitaria Culturalmente Competente , Relaciones Médico-Paciente , Competencia Cultural , Terapias Complementarias/métodos
6.
BMC Psychiatry ; 24(1): 506, 2024 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-39014363

RESUMEN

BACKGROUND: Asians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 - 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond. METHODS: This is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews. RESULTS: In total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese). CONCLUSION: Cultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.


Asunto(s)
Asiático , Investigación Participativa Basada en la Comunidad , Emigrantes e Inmigrantes , Grupos Focales , Humanos , Boston , Femenino , Asiático/psicología , Adulto , Masculino , Emigrantes e Inmigrantes/psicología , Persona de Mediana Edad , Primeros Auxilios/métodos , Trastornos Mentales/etnología , Trastornos Mentales/terapia , Servicios de Salud Mental , Competencia Cultural , Salud Mental/etnología , Asistencia Sanitaria Culturalmente Competente
7.
Can J Psychiatry ; 69(1): 54-68, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-37376808

RESUMEN

BACKGROUND: South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions. METHOD: The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design. RESULTS: Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors. CONCLUSIONS: Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.


Asunto(s)
Terapia Cognitivo-Conductual , Servicios Comunitarios de Salud Mental , Asistencia Sanitaria Culturalmente Competente , Trastornos Mentales , Humanos , Canadá , Pueblo Asiatico
8.
BMC Womens Health ; 24(1): 304, 2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38778359

RESUMEN

BACKGROUND: Female genital mutilation (FGM) is defined as all procedures involving partial or total removal of the external female genitalia, or other injuries to them for non-medical reasons. Due to migration, healthcare providers in high-income countries need to better understand the consequences of FGM. The aim of this study was to elucidate women's experiences of FGM, with particular focus on perceived health consequences and experiences of healthcare received in Sweden. METHODS: A qualitative study was performed through face-to-face, semi-structured interviews with eight women who had experienced FGM in childhood, prior to immigration to Sweden. The transcribed narratives were analyzed using content analysis. RESULTS: Three main categories were identified : "Living with FGM", "Living with lifelong health consequences" and "Encounters with healthcare providers". The participants highlighted the motives behind FGM and their mothers' ambivalence in the decision process. Although the majority of participants had undergone FGM type 3, the most severe type of FGM, the lifelong health consequences were diverse. Poor knowledge about FGM, insulting attitude, and lack of sensitive care were experienced when seeking healthcare in Sweden. CONCLUSIONS: Our findings indicate that FGM is a complex matter causing a diversity in perceived health consequences in women affected. Increased knowledge and awareness about FGM among healthcare providers in Sweden is of utmost importance. Further, this subject needs to be addressed in the healthcare encounter in a professional way.


Asunto(s)
Circuncisión Femenina , Migrantes , Humanos , Investigación Cualitativa , Circuncisión Femenina/etnología , Circuncisión Femenina/psicología , Suecia , Actitud del Personal de Salud , Adulto , Asistencia Sanitaria Culturalmente Competente , Entrevistas como Asunto
9.
BMC Geriatr ; 24(1): 79, 2024 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-38245703

RESUMEN

BACKGROUND: The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) is a tool that systematically guides decision-making and reporting of adaptations made to evidence-based interventions. Using FRAME, we documented the process and outcomes of adapting the Savvy Caregiver Program (SCP) for Korean American dementia caregivers. METHODS: Sequential adaptation was initiated with linguistic attunement, followed by pilot implementation and full adaptation. Our data-driven adaptation with multiple data sources and a feedback loop among multiple stakeholders yielded a total of 32 modifications, and each was coded according to the eight domains of FRAME: (1) what was modified, (2) who participated in recommending and deciding the modification to be made, (3) when the modification occurred, (4) whether the modification was planned, (5) whether the modification was fidelity-consistent, (6) whether the modification was temporary, (7) at what level of delivery, the modification was made, and (8) why the modification was made. RESULTS: The areas of adaptation were evenly distributed across context (37.5%), content (31.2%), and training (31.2%). The primary reasons for modification were for engagement (62.5%), followed by fit with recipients (43.8%) and outcome improvement (31.1%). About 66% of the modifications were applied to the entire target group, and all modifications were fidelity-consistent. CONCLUSIONS: The FRAME categorization provided a detailed understanding of the process and nature of adapting the SCP and served as a foundation for further implementation and scale-up. FRAME not only serves as a guide for adapting evidence-based interventions but also promotes their replicability and scalability.


Asunto(s)
Asiático , Cuidadores , Asistencia Sanitaria Culturalmente Competente , Humanos , Cuidadores/educación
10.
Health Expect ; 27(4): e14160, 2024 08.
Artículo en Inglés | MEDLINE | ID: mdl-39087742

RESUMEN

BACKGROUND: Current research has identified how ethnic minority women experience poorer health outcomes during the perinatal period. In the United Kingdom, specialist perinatal mental health services provide mental health treatment for women throughout the perinatal period. Service users have previously highlighted that perinatal services are hard to access and lack cultural sensitivity, whereas healthcare professionals have described limited opportunities and resources for developing cultural competency. OBJECTIVES: We explored the experiences of ethnic minority women with National Health Service (NHS) specialist perinatal teams and identified what culturally sensitive perinatal mental health care means to this group. DESIGN: Individual semi-structured interviews were conducted, and an interpretative phenomenological analysis framework was used to analyse the interview transcripts. SETTING AND PARTICIPANTS: Participants were recruited from NHS specialist perinatal teams and online via social media. RESULTS: Six women were interviewed. Four group experiential themes central to the experiences of participants emerged: (1) strengthening community networks and peer support; (2) valuing cultural curiosity; (3) making sense of how culture, ethnicity, race and racism impact mental health; and (4) tailoring interventions to ethnic minority women and their families. DISCUSSION AND CONCLUSIONS: The findings capture how ethnic minority women experience specialist perinatal teams and offer insights into practising culturally sensitive care. Perinatal mental health professionals can support ethnic minority women by strengthening their access to community resources and peer support; being curious about their culture; helping them to make sense of how culture, ethnicity, race and mental health interact; and applying cultural and practical adaptations to interventions. PATIENT OR PUBLIC CONTRIBUTION: A Lived Experience Advisory Group (LEAG) of women from ethnic minority groups contributed to the design and conduct of this study. The LEAG had lived experience of perinatal mental health conditions and accessing specialist perinatal teams. The LEAG chose to co-produce specific aspects of the research they felt fit with their skills and available time throughout five group sessions. These aspects included developing the interview topic guide, a structure for debriefing participants and advising on the social media recruitment strategy.


Asunto(s)
Entrevistas como Asunto , Servicios de Salud Mental , Atención Perinatal , Humanos , Femenino , Adulto , Reino Unido , Servicios de Salud Mental/organización & administración , Embarazo , Asistencia Sanitaria Culturalmente Competente , Investigación Cualitativa , Grupos Minoritarios/psicología , Competencia Cultural , Etnicidad/psicología , Minorías Étnicas y Raciales , Medicina Estatal
11.
Aust N Z J Psychiatry ; 58(6): 498-505, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38641869

RESUMEN

OBJECTIVE: Culturally safe service provision is essential to improving social and emotional wellbeing among Aboriginal and Torres Strait Islander communities, and to eliminating health inequities. Cultural safety is about ensuring that all people have a safe and healing journey through services, regardless of their cultural background. In this project, we aim to (1) understand how Aboriginal and Torres Strait Islander peoples conceptualise cultural safety, and (2) co-design a qualitative interview for the next phase of this project, where we plan to learn about experiences of cultural safety within mental health services. METHODS: We conducted six focus groups (in one metro and two regional areas, Western Australia). Following an Aboriginal Participatory Action Research methodology, we yarned with Aboriginal and Torres Strait Islander mental health service users, carers, community members, mental health professionals and Cultural Healers about cultural safety. RESULTS: Participants described a culturally safe service as one where Aboriginal cultural knowledges, life experiences, issues and protocols are understood and acknowledged, and reported that mainstream mental health services are not currently culturally safe. Participants emphasised the importance of building trust, rapport, reciprocity and following appropriate relational processes when designing a qualitative interview for the next phase. CONCLUSIONS: A lack of cultural safety in mental health services is likely to contribute to the disparity in outcomes between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Embedding cultural safety into research design allows for authentic community engagement and facilitates knowledge sharing around ways to improve cultural safety in mental health services.


Asunto(s)
Servicios de Salud del Indígena , Servicios de Salud Mental , Adulto , Femenino , Humanos , Masculino , Aborigenas Australianos e Isleños del Estrecho de Torres , Investigación Participativa Basada en la Comunidad , Competencia Cultural , Asistencia Sanitaria Culturalmente Competente/etnología , Grupos Focales , Investigación sobre Servicios de Salud , Servicios de Salud del Indígena/organización & administración , Investigación Cualitativa , Australia Occidental
12.
BMC Health Serv Res ; 24(1): 669, 2024 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-38807150

RESUMEN

BACKGROUND: Parent-infant interaction is highly recommended during the preterm infant hospitalisation period in the Neonatal Intensive Care Unit (NICU). Integrating culturally sensitive healthcare during hospitalisation of preterm infants is critical for positive health outcomes. However, there is still a paucity of evidence on parental experience regarding cultural practices that can be integrated into preterm infant care in the NICU. The study explored and described the cultural determinants of parents that can be integrated into the care of preterm infants in the NICU. METHODS: A descriptive qualitative research design was followed where twenty (n=20) parents of preterm infants were purposively selected. The study was conducted in the NICU in Limpopo using in-depth individual interviews. Taguette software and a thematic analysis framework were used to analyse the data. The COREQ guidelines and checklist were employed to ensure reporting standardisation. RESULTS: Four themes emerged from the thematic analysis: 1) Lived experienced by parents of preterm infants, 2) Interactions with healthcare professionals, 3) Cultural practices concerning preterm infant care, and 4) Indigenous healthcare practices for preterm infants. CONCLUSIONS: The study emphasised a need for healthcare professionals to understand the challenges parents of preterm infants face in NICU care. Furthermore, healthcare professionals should know indigenous healthcare practices to ensure relevant, culturally sensitive care.


Asunto(s)
Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Padres , Investigación Cualitativa , Humanos , Recién Nacido , Femenino , Padres/psicología , Masculino , Adulto , Entrevistas como Asunto , Asistencia Sanitaria Culturalmente Competente/normas
13.
Ethn Health ; 29(6): 720-744, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38867355

RESUMEN

OBJECTIVES: Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. DESIGN: A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. RESULTS: Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. CONCLUSION: When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Fotograbar , Refugiados , Humanos , Femenino , Refugiados/psicología , Embarazo , Adulto , Victoria , Mianmar/etnología , Atención Prenatal , Asistencia Sanitaria Culturalmente Competente , Competencia Cultural
14.
Med Teach ; 46(10): 1278-1283, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38422994

RESUMEN

In recent years, discourse on topics like cultural humility, social determinants of health (SDOH), and health disparities and inequities has greatly increased in medical education as attention to their impact on health has magnified. Unfortunately, traditional medical education models may fail to optimize learning in this area. To address these complex social health issues, we must find innovative ways to engage students in an educational partnership in which they are challenged to critically think and reflect on their attitudes, role, and actions in health equity and culturally responsive care. Through reviews of existing literature coupled with our own experience with iterative implementation of a model that includes interpersonal engagement paired with individual self-directed learning, we assembled 12 tips on how to prepare diverse students to practice lifelong cultural humility and provide culturally and socially responsive care in an ever-changing social landscape.


Asunto(s)
Estudiantes de Medicina , Humanos , Estudiantes de Medicina/psicología , Competencia Cultural , Determinantes Sociales de la Salud , Diversidad Cultural , Educación Médica/organización & administración , Educación Médica/métodos , Asistencia Sanitaria Culturalmente Competente
15.
Res Nurs Health ; 47(2): 234-241, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38281085

RESUMEN

The purpose of this study was to examine the impact of a culturally based intervention, the Intertribal Talking Circle program, compared to a standard alcohol and drug abuse education, the Be A Winner program. Community-based participatory research was used to implement a two-condition, quasi-experimental study. The sample included 540 Native American youth ages 10-12 years old from three tribal areas in the United States. Data were collected at baseline, 6 and 12-months post-intervention for both the intervention and control groups using demographic, cultural identity, alcohol use, and drug use questionnaires. Regression models evaluated participants' improvement in decreasing alcohol and drug use and increasing cultural identity. Findings revealed that alcohol and drug use decreased more significantly among youth who participated in the Intertribal Talking Circle (ITC) intervention program than youth who participated in a standard alcohol and drug abuse education Be A Winner (BAW) program. Cultural identity also increased more significantly among participants who completed the Talking Circle intervention program. Native American youth ages 10-12 years old respond positively to a culturally based intervention for the reduction of alcohol and drug use. The findings highlight the importance of cultural values and identity and their significance in preventing and reducing alcohol and drug use among Native American youth.


Asunto(s)
Indio Americano o Nativo de Alaska , Trastornos Relacionados con Sustancias , Niño , Humanos , Educación en Salud , Trastornos Relacionados con Sustancias/prevención & control , Encuestas y Cuestionarios , Estados Unidos , Asistencia Sanitaria Culturalmente Competente
16.
Child Care Health Dev ; 50(1): e13176, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-37727080

RESUMEN

BACKGROUND: Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Maori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care. METHOD: The research was concerned with indigenous Maori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Maori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Maori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice. RESULTS: Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Maori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity. CONCLUSIONS: This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Maori tamariki.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Pueblo Maorí , Pediatría , Mejoramiento de la Calidad , Niño , Humanos , Atención a la Salud , Hospitales , Pueblos Indígenas , Nueva Zelanda
17.
Child Care Health Dev ; 50(4): e13299, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38967420

RESUMEN

BACKGROUND: Autism is a complex neurodevelopmental disability with global prevalence of one in 100 individuals. Poor access to interventions in both under-resourced regions of high-income countries and low- and middle-income countries has deleterious effects on the health and wellbeing of individuals with autism and their families. Our objective was to utilize a reciprocal innovation framework and participatory methods to adapt and co-develop a culturally grounded group-based wellbeing and naturalistic developmental behavioural intervention (NDBI) training program for caregivers of young children with autism to be implemented in Kenya and rural Indiana. METHODS: This study was conducted within the Academic Model Providing Access to Healthcare (AMPATH) program. An evidence-informed Naturalistic Developmental Behavioral Intervention (NDBI) previously utilized in Indiana was adapted and iteratively refined using the Ecological Validity Framework (EVF) by a team of US and Kenyan disability experts. Key adaptations to the program were made across the EVF domains of language, persons, metaphors/content, concepts, goals, methods, and context. RESULTS: Substantial cultural adaptations were made to the NDBI following the EVF model, including the addition of traditional Kenyan cultural practices, use of narrative principles, and focus on daily routines over play. Pepea, the adapted program, involves 10 group sessions covering content in basic education on autism, positive caregiver coping strategies, and behavioural skills training to promote child communication and reduce challenging behaviour. Key adaptations for Pepea were integrated back into a US NDBI caregiver training program. CONCLUSIONS: This study fills a critical gap by detailing the adaptation process of a caregiver wellbeing and naturalistic developmental behavioural training program for caregivers of children with autism in low-resource settings. Our next steps are to report on mixed-methods outcomes from pilot implementation. Our long-term goal is to apply these insights to advance sustainable and scalable autism intervention services across the globe.


Asunto(s)
Cuidadores , Humanos , Kenia , Cuidadores/educación , Cuidadores/psicología , Preescolar , Estados Unidos , Masculino , Femenino , Trastorno Autístico/rehabilitación , Trastorno Autístico/terapia , Trastorno Autístico/psicología , Terapia Conductista/métodos , Países en Desarrollo , Indiana , Asistencia Sanitaria Culturalmente Competente , Desarrollo de Programa , Niño
18.
BMC Med Educ ; 24(1): 472, 2024 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-38685005

RESUMEN

BACKGROUND: Migration is increasing globally, and societies are becoming more diverse and multi-ethnic. Medical school curricula should prepare students to provide high-quality care to all individuals in the communities they serve. Previous research from North America and Asia has assessed the effectiveness of medical cultural competency training, and student preparedness for delivery of cross-cultural care. However, student preparedness has not been explored in the European context. The aim of this study was to investigate how prepared final-year medical students in the Republic of Ireland (ROI) feel to provide care to patients from other countries, cultures, and ethnicities. In addition, this study aims to explore students' experiences and perceptions of cross-cultural care. METHODS: Final-year medical students attending all six medical schools within the ROI were invited to participate in this study. A modified version of the Harvard Cross-Cultural Care Survey (CCCS) was used to assess their preparedness, skill, training/education, and attitudes. The data were analysed using IBM SPSS Statistics 28.0, and Fisher's Exact Test was employed to compare differences within self-identified ethnicity groups and gender. RESULTS: Whilst most respondents felt prepared to care for patients in general (80.5%), many felt unprepared to care for specific ethnic patient cohorts, including patients from a minority ethnic background (50.7%) and the Irish Traveller Community (46.8%). Only 20.8% of final-year students felt they had received training in cross-cultural care during their time in medical school. Most respondents agreed that they should be assessed specifically on skills in cultural competence whilst in medical school (83.2%). CONCLUSIONS: A large proportion of final-year medical students surveyed in Ireland feel inadequately prepared to care for ethnically diverse patients. Similarly, they report feeling unskilled in core areas of cross-cultural care, and a majority agree that they should be assessed on aspects of cultural competency. This study explores shortcomings in cultural competency training and confidence amongst Irish medical students. These findings have implications for future research and curricular change, with opportunities for the development of relevant educational initiatives in Irish medical schools.


Asunto(s)
Estudiantes de Medicina , Humanos , Irlanda , Estudiantes de Medicina/psicología , Masculino , Femenino , Encuestas y Cuestionarios , Educación de Pregrado en Medicina , Actitud del Personal de Salud , Competencia Cultural/educación , Adulto , Asistencia Sanitaria Culturalmente Competente , Adulto Joven , Curriculum , Etnicidad , Competencia Clínica
19.
Child Care Health Dev ; 50(5): e13311, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39056267

RESUMEN

BACKGROUND: Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. METHODS: A multi-methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24-h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group-based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention. RESULTS: Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources. CONCLUSIONS: This is the first study to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group-based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children.


Asunto(s)
Madres , Obesidad Infantil , Humanos , Obesidad Infantil/prevención & control , Obesidad Infantil/etnología , Femenino , Madres/psicología , Madres/educación , Lactante , Arkansas , Adulto , Asistencia Sanitaria Culturalmente Competente , Masculino , Micronesia/etnología , Estudios de Factibilidad , Nativos de Hawái y Otras Islas del Pacífico/psicología , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Estado Nutricional
20.
Int J Health Plann Manage ; 39(2): 447-460, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37990140

RESUMEN

BACKGROUND: New Zealand's older Indigenous Maori people experience poorer health and reduced access to healthcare than their older non-Maori counterparts. Organisational factors (such as leadership or workforce) may influence the attitudes and perceptions of older Maori and their family (whanau) to use aged residential care services. Currently, there is a paucity of research surrounding the organisational barriers that impact the experiences of older Maori people who seek care in aged residential care (ARC) services. METHODS: This study used a Kaupapa Maori qualitative research approach that legitimises Maori knowledge and critiques structures that subjugate Maori autonomy and control over their wellbeing. Interviews regarding their experiences of care were carried out with older Maori (n = 30) and whanau (family) members (n = 18) who had used, or declined to use an aged residential care facility. Narrative data were analysed inductively for themes that illustrated organisational barriers. RESULTS: The key organisational theme was 'Culturally safe care', within which there were three barriers: 'Acceptability and Adequacy of Facility', 'Interface Between Aged Residential Care and Whanau Models of Care', and 'Workforce'. Collectively, these barriers emphasise the importance of an organisational approach to improving the quality of care delivered to older Maori and whanau in ARC. CONCLUSION: Fostering a collective culture of equity within ARC provider services and equipping healthcare leaders and staff with the skills and knowledge to deliver culturally safe care is critical to addressing organisational barriers to ARC.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Hogares para Ancianos , Pueblo Maorí , Anciano , Humanos , Familia , Cooperación Internacional , Nueva Zelanda
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