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1.
JAMA Netw Open ; 3(12): e2027744, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33337491

RESUMEN

Importance: Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. Objective: To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. Design, Setting, and Participants: In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020. Interventions: The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care. Main Outcomes and Measures: The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined. Results: Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03). Conclusions and Relevance: These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months. Trial Registration: ClinicalTrials.gov Identifier: NCT02459691.


Asunto(s)
Terapia Conductista/métodos , Asistencia Sanitaria Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/prevención & control , Sobrepeso/terapia , Programas de Reducción de Peso/métodos , Adulto , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/etiología , Femenino , Hispanoamericanos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones , Sobrepeso/etnología , San Francisco , Resultado del Tratamiento , Pérdida de Peso
2.
Am J Nurs ; 120(9): 48-58, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32858699

RESUMEN

PURPOSE: This project examined nurses' positive and negative perceptions of the technology used in language interpretation for patients who have limited English proficiency (LEP). The intervention was guided by the technology acceptance model, a framework that addresses users' acceptance or rejection of computer-based technology. METHODS: A sample of 47 nurses participated. Nurses' perceptions of an existing telephone-based remote interpretation technology were compared with their perceptions of a video remote interpretation (VRI) system. Instruments included a structured questionnaire to collect nurses' demographic and other characteristics and to measure their perceptions of the technology used in language interpretation; open-ended questions were added on how technology affected nursing care and nurses' rapport and communication with patients. Questionnaires on the telephone-based interpretation technology were administered, and after an eight-week trial of the VRI technology, questionnaires on the VRI system were administered. RESULTS: Overall, positive perceptions of VRI were significantly higher and negative perceptions significantly lower compared with perceptions of telephone-based interpretation technology (P < 0.001 for both). Qualitative findings indicated that VRI technology improved communication and was less time consuming for nurses. CONCLUSIONS: Nurses preferred VRI technology because of its positive effects on time expenditure and communication. VRI technology is likely to be adopted successfully and ensures increased use of professional language interpretation for patients with LEP.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/métodos , Dominio Limitado del Inglés , Relaciones Enfermero-Paciente , Enfermeras y Enfermeros/psicología , Comunicación por Videocoferencia/organización & administración , Adulto , Barreras de Comunicación , Femenino , Humanos , Lenguaje , Masculino , Traducción
3.
BMC Public Health ; 20(1): 840, 2020 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-32493245

RESUMEN

BACKGROUND: Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program. METHODS: We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An iterative-deductive approach was used to analyze focus group data. Qualitative data from advisory groups and community members were compiled and used to finalize the program. RESULTS: Focus group themes were: 1) Community Perspectives on Overall Presentation; 2) Community Opinions and Questions on the Content of the Presentation; 3) Culturally Specific Issues to Participation in Cancer Clinical Trials; 4) Barriers to Clinical Trial Participation; and 5) Perspectives of Community Health Educators. Feedback was documented during reviews by scientific experts and community members with suggestions to ensure cultural appropriateness using peripheral, evidential, linguistic, sociocultural strategies, and constituent-involving. The final program consisted of two versions (English and Spanish) of a culturally-appropriate slide presentation with speaker notes and videos representing community member and researcher testimonials. CONCLUSIONS: Incorporating multiple community engagement approaches into formative research processes can facilitate the inclusion of multiple community perspectives and enhance the cultural-appropriateness of the programs designed to promote cancer clinical trial participation among African Americans and Latinos.


Asunto(s)
Afroamericanos/educación , Ensayos Clínicos como Asunto/psicología , Asistencia Sanitaria Culturalmente Competente/métodos , Educación en Salud/métodos , Hispanoamericanos/educación , Sujetos de Investigación/educación , Adulto , Afroamericanos/psicología , Anciano , Investigación Participativa Basada en la Comunidad , Femenino , Grupos Focales , Hispanoamericanos/psicología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias , Investigación Cualitativa , Sujetos de Investigación/psicología
4.
J Pediatr Orthop ; 40(6): 310-313, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32501928

RESUMEN

INTRODUCTION: Given the rapidly increasing population of Spanish-speaking patients in the United States, medical providers must have the capability to effectively communicate both with pediatric patients and their caregivers. The purpose of this study was to query the Spanish language proficiency of pediatric orthopaedic surgeons, assess the educational resources available to Spanish-speaking patients and their families, and identify the barriers to care at academic pediatric orthopaedic centers. METHODS: The Web sites of medical centers within the United States that have pediatric orthopaedic surgery fellowships recognized by the Pediatric Orthopaedic Society of North America (POSNA) were accessed. Web sites were investigated for a health library as well as the availability of interpreter services. Profiles of attending surgeons within each Pediatric Orthopaedic Department were evaluated for evidence of Spanish proficiency as well as educational qualifications. Centers were contacted by phone to determine if the resources and physicians who could converse in Spanish were different than what was readily available online and if automated instructions in Spanish or a person who could converse in Spanish were available. RESULTS: Forty-six centers with 44 fellowship programs were identified. The profiles of 12 of 334 (3.6%) surgeons who completed pediatric orthopaedic fellowships indicated Spanish proficiency. Seventeen physicians (5.1%) were identified as proficient in Spanish after phone calls. Thirty-eight pediatric orthopaedic centers (82.6%) noted interpreter service availability online, although services varied from around-the-clock availability of live interpreters to interpreter phones. When contacted by phone, 45 of 46 centers (97.8%) confirmed the availability of any interpreter service for both inpatient and outpatient settings. Sixteen centers (34.8%) had online information on orthopaedic conditions or surgical care translated into Spanish. Twenty centers (43.5%) did not have automated phone messages in Spanish or live operators that spoke Spanish. CONCLUSIONS: There is a scarcity of surgical providers in pediatric orthopaedic centers proficient in Spanish, demonstrating a large discrepancy with the growing Hispanic population. Interpreter services are widely available, although there is variability in the services provided. Considerable barriers exist to Spanish-speaking patients who attempt to access care by phone or online.


Asunto(s)
Barreras de Comunicación , Asistencia Sanitaria Culturalmente Competente , Becas/métodos , Cirujanos Ortopédicos , Ortopedia , Niño , Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/organización & administración , Femenino , Hispanoamericanos , Humanos , Masculino , Evaluación de Necesidades , Cirujanos Ortopédicos/educación , Cirujanos Ortopédicos/normas , Ortopedia/métodos , Ortopedia/organización & administración , Traducción , Estados Unidos
5.
J Pain Symptom Manage ; 60(2): e44-e47, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32437946

RESUMEN

As coronavirus disease 2019 (COVID-19) continues to impact the seriously ill and their families on a global scale, considerations given to marginalized groups amid the pandemic are essential to ensure the provision of high-quality and dignified care. Lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQ+) persons are particularly vulnerable to health inequities across settings, including palliative care and at the end of life. There is a crucial gap in the literature pertaining to palliative care for LGBTQ+ populations during COVID-19. We aim to fill this gap by providing essential health inequity and social support background pertaining to LGBTQ+ persons and practical recommendations for immediate implementation that support inclusive and respectful care for these populations. Using these recommendations is a pragmatic pathway to promote trust, transparency, patient and family engagement, and value concordant care amid the health system strain caused by COVID-19.


Asunto(s)
Infecciones por Coronavirus/terapia , Cuidados Paliativos/métodos , Atención Dirigida al Paciente/métodos , Neumonía Viral/terapia , Minorías Sexuales y de Género , Asistencia Sanitaria Culturalmente Competente/métodos , Equidad en Salud , Disparidades en Atención de Salud , Humanos , Pandemias , Guías de Práctica Clínica como Asunto , Apoyo Social
6.
Soins Pediatr Pueric ; 41(313): 20-22, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32446551

RESUMEN

The device Dedyco is a mixture of two practices clinical storytelling workshops and cross-cultural therapy consultation for families. Tales, graphic productions, staging games allow mothers and their children to share a moment out of time, in the footsteps of wonderful characters.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/métodos , Relaciones Madre-Hijo , Narración , Niño , Femenino , Humanos
7.
BMC Palliat Care ; 19(1): 52, 2020 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-32321494

RESUMEN

BACKGROUND: Measuring functional status in palliative care may help clinicians to assess a patient's prognosis, recommend adequate therapy, avoid futile or aggressive medical care, consider hospice referral, and evaluate provided rehabilitation outcomes. An optimized, widely used, and validated tool is preferable. The Palliative Performance Scale Version 2 (PPSv2) is currently one of the most commonly used performance scales in palliative settings. The aim of this study is the psychometric validation process of a Polish translation of this tool (PPSv2-Polish). METHODS: Two hundred patients admitted to a free-standing hospice were evaluated twice, on the first and third day, for test-retest reliability. In the first evaluation, two different care providers independently evaluated the same patient to establish inter-rater reliability values. PPSv2-Polish was evaluated simultaneously with the Karnofsky Performance Score (KPS), Eastern Cooperative Oncology Group (ECOG) Performance Status (ECOG PS), and Barthel Activities of Daily Living (ADL) Index, to determine its construct validity. RESULTS: A high level of full agreement between test and retest was seen (63%), and a good intra-class correlation coefficient of 0.85 (P < 0.0001) was achieved. Excellent agreement between raters was observed when using PPSv2-Polish (Cohen's kappa 0.91; P < 0.0001). Satisfactory correlations with the KPS and good correlations with ECOG PS and Barthel ADL were noticed. Persons who had shorter prognoses and were predominantly bedridden also had lower scores measured by the PPSv2-Polish, KPS and Barthel ADL. A strong correlation of 0.77 between PPSv2-Polish scores and survival time was noted (P < 0.0001). Moderate survival correlations were seen between KPS, ECOG PS, and Barthel ADL of 0.41; - 0.62; and 0.58, respectively (P < 0.0001). CONCLUSION: PPSv2-Polish is a valid and reliable tool measuring performance status in a hospice population and can be used in daily clinical practice in palliative care and research.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/normas , Cuidados Paliativos/normas , Psicometría/normas , Anciano , Anciano de 80 o más Años , Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Polonia , Psicometría/instrumentación , Psicometría/métodos , Reproducibilidad de los Resultados , Traducción
8.
Infant Ment Health J ; 41(3): 356-377, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32275084

RESUMEN

Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.


Asunto(s)
Educación no Profesional/métodos , Práctica Clínica Basada en la Evidencia/métodos , Salud Mental , Responsabilidad Parental/psicología , Poblaciones Vulnerables , Adulto , Preescolar , Asistencia Sanitaria Culturalmente Competente/métodos , Femenino , Accesibilidad a los Servicios de Salud , Hispanoamericanos , Humanos , Lactante , Masculino , Pobreza , Evaluación de Programas y Proyectos de Salud , Poblaciones Vulnerables/etnología , Poblaciones Vulnerables/psicología
9.
Women Health ; 60(6): 676-691, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-31814531

RESUMEN

Black women typically lose small amounts of weight in behavioral weight loss interventions, partially due to low engagement in physical activity. Culturally relevant enhancement of the physical activity component may improve weight loss. This study compared the effectiveness of a culturally-relevant, physical activity-enhanced behavioral weight loss intervention to a standard behavioral weight loss intervention in Black women (n = 85) over 6 months. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Participants had an average age of 48.30 ± 11.02 years with an average body mass index of 36.46 ± 4.50 kg/m2. Standard and enhanced groups' weight change (-2.83 kg and -2.08 kg, respectively) and change in physical activity (43.93 min/ week and 15.29 min/week, respectively) did not differ between groups. Significantly more standard group participants lost 5% of baseline weight compared to enhanced group participants. This study produced typical weight loss results in Black women. Behavioral weight loss treatment remains moderately effective for Black women. Strategies to increase attendance and self-monitoring, and the inclusion of cultural contexts to weight-related behaviors are needed to improve outcomes.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Ejercicio Físico , Obesidad/terapia , Pérdida de Peso , Adulto , Índice de Masa Corporal , Peso Corporal , Estudios de Cohortes , Asistencia Sanitaria Culturalmente Competente/métodos , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , North Carolina
10.
J Fam Psychol ; 34(3): 353-363, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31414865

RESUMEN

This study evaluated the effectiveness of a culturally attuned group cognitive-behavior therapy (CBT) intervention for Chinese adolescents at risk for anxiety disorders in Hong Kong and the additive effects of parental involvement. A randomized controlled design was adopted. Assessments were gathered at pre- and posttreatment, and 6-month follow-up. Participants (N = 136) were randomly assigned to (a) CBT plus parental involvement (CBT-PI) (n = 46), (b) CBT (n = 45), and (c) social activity (n = 45) conditions. Data were analyzed according to the intention-to-treat principle using multilevel modeling. The CBT-PI condition showed a greater reduction in physical injury fears compared with the CBT condition. The current findings suggest that involving parents in CBT for Chinese adolescents with anxiety problems may provide a small improvement in treatment efficacy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Padres/psicología , Adolescente , Adulto , Trastornos de Ansiedad/psicología , Niño , Asistencia Sanitaria Culturalmente Competente/métodos , Femenino , Estudios de Seguimiento , Hong Kong , Humanos , Masculino , Psicoterapia de Grupo/métodos , Resultado del Tratamiento , Adulto Joven
11.
BMJ Support Palliat Care ; 10(1): e8, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28676498

RESUMEN

OBJECTIVES: 001225The aim of this qualitative study is to better understand, through the experiences and insights of hospital interpreters, how people from culturally and linguistic diverse (CALD) communities might respond to advance care planning (ACP) and end-of-life discussions. METHODS: Hospital interpreters from five Melbourne metropolitan health services were recruited for in-depth semi-structured interviews that explored the question, 'What can be learnt from hospital interpreters about cultural issues related to ACP and end-of-life decision-making?' Thirty-nine interpreters, representing 22 language groups, were interviewed. Analysis of the transcribed interviews used qualitative description. RESULTS: Thematic analysis identified three major themes: (1) moral difference; (2) health and death literacy; and (3) diversity within culture. CONCLUSION: A value-based approach to ACP is recommended as a way to capture the person's individual values and beliefs. Health and death literacy have been identified as areas that may be over-estimated; areas that can be addressed and improved, if recognised. Health and death literacy is a particular area that needs to be assessed and addressed as a pre-requisite to ACP discussions.


Asunto(s)
Actitud Frente a la Muerte/etnología , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente/métodos , Alfabetización en Salud , Chaperones Médicos/psicología , Adulto , Planificación Anticipada de Atención , Toma de Decisiones , Femenino , Hospitales , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Investigación Cualitativa
12.
Matern Child Health J ; 24(2): 121-126, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31832910

RESUMEN

OBJECTIVE: In July 2018 the Academy of Nutrition and Dietetics released a benchmark encouraging early care and education (ECE) programs, including child care centers and family child care homes, to incorporate cultural and religious food preferences of children into meals. We examined the extent to which states were already doing so through their ECE licensing and administrative regulations prior to the release of the benchmark. This review may serve as a baseline to assess future updates, if more states incorporate the benchmark into their regulations. METHODS: For this cross-sectional study, we reviewed ECE regulations for all 50 states and the District of Columbia (hereafter states) through June 2018. We assessed consistency with the benchmark for centers and homes. We conducted Spearman correlations to estimate associations between the year the regulations were updated and consistency with the benchmark. RESULTS: Among centers, eight states fully met the benchmark, 11 partially met the benchmark, and 32 did not meet the benchmark. Similarly for homes, four states fully met the benchmark, 13 partially met the benchmark, and 34 did not meet the benchmark. Meeting the benchmark was not correlated with the year of last update for centers (P = 0.54) or homes (P = 0.31). CONCLUSIONS: Most states lacked regulations consistent with the benchmark. Health professionals can help encourage ECE programs to consider cultural and religious food preferences of children in meal planning. And, if feasible, states may consider additional regulations supporting cultural and religious preferences of children in future updates to regulations.


Asunto(s)
Jardines Infantiles/legislación & jurisprudencia , Asistencia Sanitaria Culturalmente Competente/métodos , Regulación Gubernamental , Gobierno Estatal , Jardines Infantiles/tendencias , Preescolar , Estudios Transversales , Asistencia Sanitaria Culturalmente Competente/tendencias , Femenino , Promoción de la Salud/legislación & jurisprudencia , Humanos , Masculino , Religión , Estados Unidos
13.
J Natl Black Nurses Assoc ; 31(2): 71-78, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33617711

RESUMEN

Cardiovascular disease is a serious problem in the United States. It is the most common cause of death among African-Americans. Heart failure is associated with poor health outcomes and a diminished quality of life. Some of the issues that affect the health of African-Americans with heart failure are cost of health care, their access to care, and the quality of that care. The aim of this paper is to identify those issues that are related to cost, quality, and access to health care in African-Americans with heart failure. African-Americans with heart failure usually have less access to health care services than Whites do; moreover, they are also faced with higher costs and a lower quality of care.


Asunto(s)
Afroamericanos , Asistencia Sanitaria Culturalmente Competente , Insuficiencia Cardíaca , Asistencia Sanitaria Culturalmente Competente/métodos , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud , Insuficiencia Cardíaca/etnología , Insuficiencia Cardíaca/terapia , Humanos , Calidad de la Atención de Salud
15.
Nutr J ; 18(1): 84, 2019 12 06.
Artículo en Inglés | MEDLINE | ID: mdl-31810479

RESUMEN

BACKGROUND: Czech nutrition recommendations prioritize health aspects without considering affordability. Low socio-economic groups have the highest risk of nutrition-related noncommunicable diseases and cost has been identified as an obstacle to achieve a healthy diet, making the implementation of affordability into dietary guidelines necessary. The aim of this study was to develop a food basket (FB) for a low income Czech family of four that is nutritionally adequate, health-promoting and culturally acceptable at an affordable price. METHODS: Linear programming optimisation was used to ascertain that the FB covered the recommended nutrient intakes from the Czech Nutrition Society and from the World Health Organization (WHO). Cost of the FB was calculated on the basis of more than 3900 prices of 330 foods. Within a given cost constraint, all FBs were optimized for the highest possible similarity to the reported food group intake according to the most recent Czech National Food Consumption survey, which was used as a proxy for cultural acceptability. RESULTS: The optimised FB affordable at a daily food budget for a Czech family on minimum wage (CZK 177, ~ € 6.8) contained 76 foods and had an average relative deviation of 10% per food category from reported intake. The main deviations were: 72% less sweets and confectionery; 66% less salt; 52% less meat; 50% less milk products; 8% less potatoes; and 484% more milk; 69% more oils and fats; 20% more cereals; and 6% more vegetables. CONCLUSIONS: The optimised FB can help to guide the development of food-based dietary guidelines for low income households in Czech Republic.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/métodos , Dieta/economía , Dieta/métodos , Promoción de la Salud/métodos , Política Nutricional/economía , Pobreza/economía , Adolescente , Adulto , Niño , República Checa , Femenino , Promoción de la Salud/economía , Humanos , Masculino , Persona de Mediana Edad , Valor Nutritivo
16.
BMJ Open ; 9(11): e033524, 2019 11 24.
Artículo en Inglés | MEDLINE | ID: mdl-31767598

RESUMEN

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality, particularly for Maori, which places a large burden on the New Zealand (NZ) health system. We undertook a qualitative study as part of a mixed-methods implementation research project which aimed to determine the barriers and enablers to the provision of accessible high-quality COPD care. SETTING: Southern Health Region of NZ (Otago and Southland). PARTICIPANTS: Thirteen health professional stakeholders and 23 patients with severe COPD (including one Maori and one Pasifika participant). METHODS: Semistructured interviews were undertaken. A thematic analysis using the Levesque conceptual framework for access to healthcare was conducted. RESULTS: Health professional stakeholders identified barriers to providing access to health services, in particular: availability (inadequate staffing and resourcing of specialist services and limited geographical availability of pulmonary rehabilitation), affordability (both of regular medication, medication needed for an exacerbation of COPD and the copayment charge for seeing a general practitioner) and appropriateness (a shared model of care across primary and secondary care was needed to facilitate better delivery of key interventions such as pulmonary rehabilitation and advance care planning (ACP). Maori stakeholders highlighted the importance of communication and relationships and the role of whanau (extended family) for support. Patients' accounts showed variable ability to access services through having a limited understanding of what COPD is, a limited knowledge of services they could access, being unable to attend pulmonary rehabilitation (due to comorbidities) and direct (medication and copayment charges) and indirect (transport) costs. CONCLUSIONS: People with severe COPD experience multilevel barriers to accessing healthcare in the NZ health system along the pathway of care from diagnosis to ACP. These need to be addressed by local health services if this group of patients are to receive high-quality care.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/organización & administración , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Nueva Zelanda , Aceptación de la Atención de Salud/etnología , Enfermedad Pulmonar Obstructiva Crónica/etnología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Investigación Cualitativa
17.
Int J Equity Health ; 18(1): 174, 2019 11 14.
Artículo en Inglés | MEDLINE | ID: mdl-31727076

RESUMEN

BACKGROUND: Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. METHODS: A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Maori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa - Maori Medical Practitioners Association (Te ORA) and consultation with Maori medical practitioners via Te ORA. RESULTS: Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the 'taken for granted' power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming 'competent' in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity. CONCLUSIONS: A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.


Asunto(s)
Competencia Cultural , Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/estadística & datos numéricos , Equidad en Salud/estadística & datos numéricos , Grupos Étnicos , Femenino , Humanos , Nueva Zelanda , Grupos de Población
18.
BMJ Open ; 9(10): e028938, 2019 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-31594872

RESUMEN

INTRODUCTION: Prostate cancer is one of the most frequent cancers among men. However, screening for prostate cancer carries many risks and a small benefit. Thus, based on the available evidence, most medical organisations advocate a shared decision-making process, in which decision aids may play an important role. Nevertheless, to date there is no such instrument to be used by Portuguese men. Our goal is to translate and perform the cultural adaptation of an English language prostate cancer screening decision aid called 'Making the best choice', in web and printed formats, which has been developed and tested by a workgroup from Georgetown University (USA). METHODS AND ANALYSIS: Culturally and technically inappropriate recommendations in the original decision aid will be reviewed by the process coordinator and a linguistic expert. Two forward translations from English to Portuguese will be done, followed by a back-translation and an independent expert review. We will further improve the decision aid through an iterative process of data collection, data analysis and decision aid review. Individual semistructured cognitive interviews will be conducted and audiotaped with 55-69-year-old men recruited from the local community (urban and suburban) of Oporto district. We plan a total sample size of 30 participants (15 interviews per format). All participants will receive written information about the study and will sign individual consent forms. After verbatim transcription of the audiofiles, a thematic categorical analysis will be conducted using Ligre Software. ETHICS AND DISSEMINATION: The study protocol was approved by the Health Ethics Committee from Centro Hospitalar de São João/Faculdade de Medicina da Universidade do Porto. Results from this study will be disseminated in peer-reviewed publications and the Portuguese decision aid will available to Portuguese men.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/métodos , Toma de Decisiones Conjunta , Técnicas de Apoyo para la Decisión , Detección Precoz del Cáncer , Participación del Paciente/métodos , Neoplasias de la Próstata , Anciano , Recursos Audiovisuales , Conducta de Elección , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/psicología , Humanos , Masculino , Persona de Mediana Edad , Sistemas en Línea , Portugal/epidemiología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/psicología , Proyectos de Investigación , Traducciones
19.
BMC Psychiatry ; 19(1): 294, 2019 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-31590642

RESUMEN

BACKGROUND: Research can inform culturally-appropriate care to strengthen social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter, the term 'Indigenous Peoples' is respectfully used and refers to all Aboriginal and/or Torres Strait Islander Peoples of Australia). We acknowledge the cultural diversity of Australia's Indigenous First Peoples and they do not represent a homogenous group.) (hereafter Indigenous) Peoples. We explore the perspectives of primary healthcare staff and Indigenous patients about their willingness to and experiences participating in SEWB research. METHOD: Process evaluation using grounded theory approaches of Getting it Right: The validation study, a national validation designed Indigenous SEWB research project (N = 500). Primary healthcare staff (n = 36) and community members (n = 4) from nine of ten primary healthcare services involved with the research project completed qualitative semi-structured interviews. Interview data were triangulated with participant feedback (responses to structured questions and free-text feedback collected during Getting it Right), study administrative data (participant screening logs, communication logs, study protocol, deviation logs and ethics correspondence) and interviewer field notes. RESULTS: Three themes about staff, patient and community perspectives concerning research participation developed: (1) considering the needs, risk, preferences and impact of participation in research for staff, patients and community; (2) building staff confidence speaking to patients about research and SEWB problems and (3) patients speaking openly about their SEWB. Some staff described pressure to ensure patients had a positive experience with the research, to respond appropriately if patients became upset or SEWB problems were identified during interviews, or due to their dual role as community member and researcher. Patients and staff reported that patients were more likely to participate if they knew the staff outside of the service, especially staff with a shared cultural background, and they perceived SEWB as a community priority. Staff reported their skills speaking to patients about the research and SEWB improved during the research, which built their confidence. Contrary to staff preconceptions, staff and patients reported that many patients appreciated the opportunity to speak about their SEWB and contributing to research that may eventually enhance SEWB in their community. CONCLUSION: Our research project was considered acceptable by most staff and patients. The positive outcomes reported by staff and feedback from patients highlights the importance of providing opportunities for people to speak about their SEWB and for research-informed SEWB PHC care. TRIAL REGISTRATION: Getting it Right is registered on ANZCTR12614000705684 .


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/etnología , Personal de Salud/psicología , Grupo de Ascendencia Oceánica/etnología , Grupo de Ascendencia Oceánica/psicología , Atención Primaria de Salud , Investigación Cualitativa , Adulto , Australia/etnología , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente/métodos , Cultura , Emociones/fisiología , Femenino , Humanos , Masculino , Salud Mental/etnología , Atención Primaria de Salud/métodos , Conducta Social
20.
Aust J Prim Health ; 25(5): 495-500, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31581978

RESUMEN

Lifestyle changes are central to preventing type 2 diabetes. Embarking upon and sustaining change is challenging, and translation of prevention approaches into a wider range of real-world settings is needed. In this study, a locally adapted community-led diabetes prevention program with local young Aboriginal facilitators was created and trialled through the Derby Aboriginal Health Service (DAHS). The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. Ten Aboriginal women and men aged 18-38 years participated in the pilot program. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. Limitations included participant recruitment and attendance difficulties, which were attributed to program timing and competing demands. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Diabetes Mellitus Tipo 2/prevención & control , Servicios de Salud del Indígena , Grupo de Ascendencia Oceánica , Servicios de Salud Rural , Adolescente , Adulto , Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/organización & administración , Femenino , Humanos , Masculino , Proyectos Piloto , Adulto Joven
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