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1.
JMIR Res Protoc ; 13: e56957, 2024 Sep 02.
Article in English | MEDLINE | ID: mdl-39222345

ABSTRACT

BACKGROUND: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. OBJECTIVE: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. METHODS: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. RESULTS: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. CONCLUSIONS: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. TRIAL REGISTRATION: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56957.


Subject(s)
Feasibility Studies , Internet-Based Intervention , Refugees , Suicidal Ideation , Humans , Refugees/psychology , United Kingdom , Syria/ethnology , Male , Female , Adult , Culturally Competent Care , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/ethnology
2.
Child Adolesc Psychiatr Clin N Am ; 33(4): 541-556, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39277311

ABSTRACT

Amidst a national youth mental health crisis, comprehensive school mental health systems offer an opportunity to promote positive mental health for all students. To advance health equity, schools benefit from a culturally responsive, antiracist, and equitable (CARE) framework to address the youth mental health crisis. This article describes how to integrate CARE practices within a multi-tiered system of support for mental health in schools. The strategies align with a trauma-informed approach and aim to enhance the capacity of comprehensive school mental health systems to promote positive mental health and well-being for all students.


Subject(s)
School Mental Health Services , Humans , Adolescent , Child , Culturally Competent Care , Racism/prevention & control , Mental Health , Health Equity , School Health Services/organization & administration , Cultural Competency
3.
J Sch Psychol ; 106: 101344, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39251308

ABSTRACT

Social-emotional skills are a growing area of focus for early childhood educators due to their contributions to young children's school readiness and long-term positive outcomes. Current research also highlights the need to confront biases leading to the overestimation of challenging behaviors in racially and ethnically minoritized children. When enacted into policy and practices, biases and overestimation of challenging behaviors result in disproportional, exclusionary disciplinary practices towards children from racially minoritized and economically marginalized backgrounds in early childhood educational settings. Thus, it is necessary to select and implement social-emotional learning interventions that have been designed for or culturally adapted to meet specific needs of children from these backgrounds. In the present study, we uncovered the characteristics of social-emotional learning (SEL) interventions that have been designed or culturally adapted for racially and ethnically minoritized preschool-aged children (ages 3-5 years). Using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with no restrictions on study dates, we conducted a systematic review of the literature. Our results indicate the implementation of culturally adapted SEL programs among preschool-age children from racially and ethnically minoritized backgrounds is in the preliminary stages with only six studies meeting inclusionary criteria. Overall, children demonstrated improved outcomes after participation in SEL programs. There were significant variations in the SEL curricula used. Frequent types of adaptions included reviewing the program from the original intervention, ensuring that the intervention is delivered in children's home language, and selecting or training qualified implementers.


Subject(s)
Culturally Competent Care , Early Intervention, Educational , Social Skills , Child, Preschool , Humans , Emotions , Social Learning , Ethnic and Racial Minorities
5.
Nurs Leadersh (Tor Ont) ; 37(1): 21-28, 2024 06.
Article in English | MEDLINE | ID: mdl-39087271

ABSTRACT

Although culturally appropriate care is vital to quality of care, many barriers exist to implementing culturally appropriate care in practice. Nurse leaders are in a position where they can act toward addressing some of the barriers and engage nursing staff in strategies to promote the implementation of culturally appropriate care practices on a unit. This article is an opinion piece wherein the authors illustrate leadership strategies that advocate for and nurture a practice where nursing staff are supported to apply their culturally appropriate skills in practice.


Subject(s)
Culturally Competent Care , Leadership , Nurse's Role , Humans , Culturally Competent Care/standards , Nurse's Role/psychology , Nurse Administrators/trends , Cultural Competency
6.
Adv Emerg Nurs J ; 46(3): 274-282, 2024.
Article in English | MEDLINE | ID: mdl-39094089

ABSTRACT

Transcultural nursing is a discipline that emphasizes culturally competent care for diverse populations, recognizing the influence of culture on health beliefs, values, practices, and outcomes. It requires nurses to respect cultural differences and similarities, but faces challenges in curriculum design, faculty development, and student assessment. This paper explores transcultural nursing education's current state and future directions, addressing the American Association of Colleges of Nursing essentials for integrating cultural content into nursing curricula, reviewing Madeleine Leininger's transcultural nursing theory, diversity, equity, and inclusion concepts, and discussing the main challenges of transcultural nursing education, including lack of student diversity, training, and resources. Strategies to overcome these challenges include interprofessional collaboration, cultural immersion, and evidence-based practice. The paper concludes with how emergency department nurses should incorporate this into practice.


Subject(s)
Curriculum , Transcultural Nursing , Humans , Transcultural Nursing/education , Culturally Competent Care , Cultural Competency/education , Cultural Diversity , United States
7.
Healthc Manage Forum ; 37(1_suppl): 23S-27S, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39194273

ABSTRACT

Umbrella Multicultural Health Co-op is a community health centre serving cultural communities of immigrants/refugees in British Columbia. It uses Cross Cultural Health Brokers (CCHBs), multicultural workers bridging patients and the healthcare system, to better meet the primary care needs of immigrant/refugee populations. Through the Team Primary Care initiative, Umbrella Co-op: (1) added new CCHBs alongside allied health practitioners; and (2) implemented team workshops and evaluation for quality improvement. The learning health system framework guided project activities. Comprehensive, culturally responsive primary care for immigrants and refugees benefits from a team-based approach that includes the integration of CCHBs. Team development activities improved team function. Co-developing evaluation with the interprofessional team enabled meaningful participation. Health system design for equity-oriented team-based primary care for immigrants and refugees should include resources for CCHBs and team development infrastructure.


Subject(s)
Emigrants and Immigrants , Primary Health Care , Refugees , British Columbia , Humans , Primary Health Care/organization & administration , Culturally Competent Care , Cultural Competency , Community Health Centers/organization & administration , Quality Improvement
8.
Indian J Med Ethics ; IX(3): 202-206, 2024.
Article in English | MEDLINE | ID: mdl-39183606

ABSTRACT

BACKGROUND: Culturally competent healthcare improves patient satisfaction and clinical outcomes. Many drugs, dressings and implants have human or animal-derived content which may conflict with patients' religious beliefs, and may even have medicolegal implications. METHODS: This cross-sectional study (anonymous web-based survey) was done to understand the informed consent process followed by paediatricians and neonatologists in India, their views regarding disclosure pertaining to the animal origin of exogenous surfactants to patients' families, and their willingness and ability to provide alternative surfactants based on parental preferences. RESULTS: A total of 114 neonatologists/paediatricians involved in neonatal care and using surfactants in their practice responded to the survey. Although 61(53.5%) neonatal care units stocked two or more brands of surfactant in their inventory, only 38(33.3%) units had both bovine and porcine preparations. Most (104, 91.2%) of the doctors always take parental consent before administering surfactants; but only a few (12,10.5%) said they always inform parents about its animal origin. None of the respondents offer parents a choice between bovine or porcine-origin surfactants, most (73, 64%) presuming that it would be irrelevant for the parents. However, many respondents (27, 23.7%) mentioned that they want to offer the choice to parents but are unable to do so because they do not stock both bovine and porcine preparations. CONCLUSION: Although most parents might agree to a life-saving medicine in emergency situations, this does not mean they do not want to be informed. Healthcare professionals should not have a dismissive attitude to parental belief systems. They must use the antenatal period to take the cultural/spiritual history and the necessary consent.


Subject(s)
Culturally Competent Care , Informed Consent , Humans , India , Cross-Sectional Studies , Informed Consent/standards , Informed Consent/ethics , Culturally Competent Care/standards , Female , Male , Surveys and Questionnaires , Pulmonary Surfactants/administration & dosage , Parental Consent , Infant, Newborn , Animals , Neonatology/ethics , Neonatology/standards , Adult , Parents/psychology , Pediatrics , Cattle , Attitude of Health Personnel , Cultural Competency , Swine
9.
JMIR Res Protoc ; 13: e55507, 2024 Aug 12.
Article in English | MEDLINE | ID: mdl-39133532

ABSTRACT

BACKGROUND: Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. OBJECTIVE: This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. METHODS: A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100% of the targeted sample (N=30), with 20% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80% (n=38) or more of sessions attended by participants. RESULTS: Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. CONCLUSIONS: Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. TRIAL REGISTRATION: ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55507.


Subject(s)
Cognitive Dysfunction , HIV Infections , Health Promotion , Hispanic or Latino , Humans , Hispanic or Latino/psychology , Pilot Projects , Male , Female , HIV Infections/psychology , HIV Infections/prevention & control , HIV Infections/ethnology , Cognitive Dysfunction/ethnology , Cognitive Dysfunction/prevention & control , Health Promotion/methods , Middle Aged , Aged , Culturally Competent Care
10.
Health Expect ; 27(4): e14160, 2024 08.
Article in English | MEDLINE | ID: mdl-39087742

ABSTRACT

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.


Subject(s)
Interviews as Topic , Mental Health Services , Perinatal Care , Humans , Female , Adult , United Kingdom , Mental Health Services/organization & administration , Pregnancy , Culturally Competent Care , Qualitative Research , Minority Groups/psychology , Cultural Competency , Ethnicity/psychology , Ethnic and Racial Minorities , State Medicine
11.
BMJ Open ; 14(8): e087437, 2024 Aug 28.
Article in English | MEDLINE | ID: mdl-39209487

ABSTRACT

INTRODUCTION: Despite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long wait times and negative care experiences. A competency framework for mental health clinicians working with youth can be a tool to increase the capacity of the health workforce to deliver culturally responsive care. This scoping review aims to comprehensively summarise the existing literature on competency frameworks for mental health clinicians and youth service providers, assessing how these frameworks align with culturally responsive care and examining their development, evaluation and implementation methods. METHODS AND ANALYSIS: This review protocol is guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines and registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF). The search strategy, developed with an Information Specialist, comprises a three-step process: preliminary searches in two databases, expansion of the search across Medline, CINAHL, EMBASE, PsycInfo, CENTRAL and dissertations and theses databases and examination of reference lists and hand-searching for additional sources. The search strategy was reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible English language articles will be selected through title and abstract screening (level 1) and full-text review (level 2). The search dates are 18 July and 21 August 2023, as well as 19 January 2024. Data from eligible articles will be extracted in duplicate and independently using a data extraction form. The data will then be summarised descriptively and qualitatively using content analysis mapped to the four evidence-based conceptual frameworks and presented in a table. ETHICS AND DISSEMINATION: As the scoping review involves gathering and describing existing literature, it is exempt from ethical approval requirements. The findings of this scoping review will be presented at relevant local and international conferences and published in a peer-reviewed journal. The findings will also be disseminated and shared with professional organisations to enhance healthcare workforce capacity and drive systemic change. Furthermore, the findings will be used to inform doctoral work and future mental health and health education research related to underserved youth.


Subject(s)
Mental Health Services , Adolescent , Humans , Canada , Clinical Competence/standards , Culturally Competent Care/organization & administration , Culturally Competent Care/standards , Health Personnel/standards , Mental Health Services/organization & administration , Mental Health Services/standards , Research Design , Review Literature as Topic
12.
Am J Speech Lang Pathol ; 33(5): 2266-2279, 2024 Sep 18.
Article in English | MEDLINE | ID: mdl-39110812

ABSTRACT

PURPOSE: Caregivers play a critical role in their children's development and serve as their primary communication partners. Family interactions provide the most naturally occurring opportunities for children with complex communication needs to learn language in the context of family routines. A growing body of research suggests that caregivers can effectively support their children's use of augmentative and alternative communication (AAC) systems when provided with appropriate training and coaching through caregiver-implemented interventions (CIIs). However, the efficacy of these interventions remains untested among culturally and linguistically diverse caregivers. Given the increasing diversity in the United States, there is a pressing need to develop CIIs that align with the cultural and linguistic preferences of diverse families. METHOD: Using the Ecological Validity Framework and the Checklist for Cultural Adaptations, this tutorial explores considerations for culturally adapting caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. The aim is to ensure that interventions are relevant, meaningful, and respectful of cultural and linguistic practices. Through carefully crafted cultural adaptations, interventions can achieve greater acceptance by caregivers. RESULTS AND DISCUSSION: This tutorial suggests a series of cultural adaptations to ensure accessibility, sustainability, and success of caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. By incorporating cultural and linguistic considerations into the intervention design, we can enhance its acceptability among Latinx caregivers. This, in turn, can lead to improved outcomes in AAC implementation within the home environment.


Subject(s)
Caregivers , Communication Aids for Disabled , Communication Disorders , Hispanic or Latino , Humans , Caregivers/psychology , Hispanic or Latino/psychology , Child , Communication Disorders/rehabilitation , Communication Disorders/therapy , Culturally Competent Care , Cultural Characteristics , Cultural Competency , Child, Preschool
13.
N Z Med J ; 137(1601): 63-73, 2024 Aug 23.
Article in English | MEDLINE | ID: mdl-39173163

ABSTRACT

AIM: Through exploring Maori experiences when presenting acutely to hospital, we aimed to identify specific aspects of culturally safe care that we could incorporate into healthcare professionals' training and hospital processes. METHODS: Using Kaupapa Maori approaches, we undertook semi-structured interviews and thematic analysis to collect and analyse data from diverse groups of Maori participants. RESULTS: We interviewed 17 participants, with 16 follow-up interviews. We found a lack of trust, and perceptions of unequal treatment for Maori. Our participants highlighted the following key needs: the importance of whanaungatanga in building trusting relationships with patients and whanau; creating safe spaces for patients and whanau; improved staff cultural safety; exploring individual patient and whanau needs, avoiding assumptions about cultural requirements or stereotypical characteristics; upholding the mana of all patients with respectful interactions; and empowering Maori as partners in their care. CONCLUSION: By sharing their personal experiences, participants have highlighted specific aspects of their interactions with hospital staff and the healthcare system that could and should be improved. These insights can guide our efforts to enhance cultural safety for Maori patients and whanau through targeted staff training and structural changes.


Subject(s)
Culturally Competent Care , Maori People , Adult , Aged , Female , Humans , Male , Middle Aged , Attitude of Health Personnel , Cultural Competency , Interviews as Topic , New Zealand , Qualitative Research , Trust
14.
Semin Oncol Nurs ; 40(5): 151723, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39214768

ABSTRACT

OBJECTIVES: First, to understand Papua New Guinea (PNG) oncology nursing issues perceived through the nurses' lens of unmet supportive care needs of people affected by cancer and to identify nurses' self-perceived educational priorities in cancer care. Second, to evaluate the tailored bidirectional learning and knowledge transfer among the participants of the Australia Capital Territory Health and PNG Oncology Nursing Development Program hosted in Australia in June 2023. METHODS: A qualitative descriptive study was conducted. Two focus groups were audio-recorded, transcribed, and analyzed using inductive thematic analysis. Based on PNG oncology nurses' experiences and self-assessed educational needs, the findings were analyzed and presented separately for Time 1 before the PNG Oncology Nursing Development program and Time 2 following the completion of the program. RESULTS: The findings from the Time 1 focus group identified four themes: (1) educational priorities, (2) system-wide challenges, (3) patient unmet care needs, and (4) cultural beliefs. After the completion of the educational program, there were four emergent themes: (1) new educational experiences, (2) learnings into practice, (3) culturally sensitive nursing, and (4) leadership (PNG nursing trailblazers). This study, for the first time, provided the PNG RNs with a "voice," to empower them to take more leading roles in important decision-making regarding care structures and management. CONCLUSION: Policymakers, government officials, and international cancer organizations must continue to work together to support cancer control in PNG in light of the current and projected limited resources and barriers to timely cancer diagnosis and treatment in PNG. IMPLICATIONS FOR NURSING PRACTICE: Through observing and learning from a modern cancer department, PNG oncology nurses have gained insight into what is needed for a safe cancer service for both patients and nurses. Oncology nursing education in PNG needs to be further developed, enhanced, and supported for sustainability of cancer nurses in the long term.


Subject(s)
Education, Nursing , International Cooperation , Oncology Nursing , Female , Humans , Culturally Competent Care , Education, Nursing/standards , Focus Groups , Leadership , Oncology Nursing/education , Papua New Guinea , Patient Care
15.
Multimedia | Multimedia Resources | ID: multimedia-13487

ABSTRACT

El texto aborda la elaboración e implementación de modelos como la Guía de Servicios de Salud y el modelo de Fortalecimiento de la Salud, la capacitación en Qi Gong realizada en diferentes estados, y el desarrollo del Modelo de la Dieta de la Milpa en colaboración con diversas comunidades y especialistas. Destaca la capacitación para formar replicadores en varios estados y la promoción de una metodología educativa intercultural basada en teorías pedagógicas reconocidas. Durante la pandemia, se realizaron talleres online para continuar con la formación, y se promovió activamente la Dieta de la Milpa a través de diversos materiales educativos. Además, se implementaron estos modelos en unidades de salud con la colaboración de autoridades tradicionales y se reconocieron experiencias exitosas en centros de salud que incluyeron actividades físicas y promoción de alimentos saludables.


Subject(s)
Regional Food , Qigong , Culturally Competent Care , Health Personnel/education , Mexico , Local Health Systems , Healthy Lifestyle , Exercise
17.
Nurs Clin North Am ; 59(3): 371-381, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39059856

ABSTRACT

This article provides practical recommendations for creating and implementing culturally appropriate and culturally congruent healthcare simulation applications for bedside providers that adhere to best practices and reporting standards. Framed within the 11 criteria for simulation design outlined in the Healthcare Simulation Standards of Best Practice, the article provides a summary of these criteria, highlighting the lessons learned from their application in a Health Resources and Services Administration-sponsored public health grant 6 U4EHP46217-01-01, Public Health Simulation-Infused Program.


Subject(s)
Culturally Competent Care , Humans , Culturally Competent Care/standards , Cultural Competency/education , Simulation Training/standards , Simulation Training/methods , Patient Simulation
18.
Acad Pediatr ; 24(5S): 6-15, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38991806

ABSTRACT

The delivery of culturally competent health care is recognized as critical to providing quality, equitable care for marginalized groups. This includes immigrant patients and families who experience significant barriers to health care and poor health outcomes. However, operationalization of cultural competence challenges health care delivery. Complementary concepts have also emerged such as cultural humility, cultural safety, and structural competence, recognizing the need for multi-level approaches involving patients, families, clinicians, health care organizations, the larger community, and policymakers. In this review, we define cultural competency and related frameworks and their applicability to immigrant patients and families. The evolution in terminology reflects an increasingly more comprehensive approach to understanding culture as multidimensional and shaped by social and structural factors. We then highlight strategies at each level, focusing on clinicians and organizations to leverage loci of control most directly within clinicians' reach. Community-level strategies include community engagement (ie, vis-à-vis community health workers or community advisory boards) for clinical and research practice. Organization-level strategies include "immigrant-friendly," or "immigration-informed" policies aimed at reducing immigration-related stressors, like limiting cooperation with immigration enforcement agencies or developing medical-legal partnerships to assist with patients' legal needs. Lastly, policy-level strategies seek to change local and federal policies to address needs beyond health care (eg, education, housing, other social services), taking a "Health in All" policies approach that articulates health considerations into policymaking across sectors. Finally, we conclude with suggestions for future directions that center the experiences of immigrants, with the ultimate goal of sustainably meeting the complex needs of immigrant patients and families.


Subject(s)
Cultural Competency , Emigrants and Immigrants , Humans , Culturally Competent Care , Delivery of Health Care , Family
19.
BMC Oral Health ; 24(1): 864, 2024 Jul 30.
Article in English | MEDLINE | ID: mdl-39080614

ABSTRACT

BACKGROUND: This paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors' social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care. METHODS: The AKction - Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken. RESULTS: Four phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health-oral health cultural safety and clinical education was developed. CONCLUSION: This codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up. TRIAL REGISTRATION: NHMRC PAR 2004389.


Subject(s)
Australian Aboriginal and Torres Strait Islander Peoples , Kidney Diseases , Oral Health , Humans , Culturally Competent Care , Health Services Accessibility , Renal Dialysis , South Australia
20.
BMC Psychiatry ; 24(1): 506, 2024 Jul 16.
Article in English | MEDLINE | ID: mdl-39014363

ABSTRACT

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.


Subject(s)
Asian , Community-Based Participatory Research , Emigrants and Immigrants , Focus Groups , Humans , Boston , Female , Asian/psychology , Adult , Male , Emigrants and Immigrants/psychology , Middle Aged , First Aid/methods , Mental Disorders/ethnology , Mental Disorders/therapy , Mental Health Services , Cultural Competency , Mental Health/ethnology , Culturally Competent Care
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