Culturally safe healthcare: changing the lens from provider control to patient agency.

BACKGROUND AND GOAL: Marginalized patients often feel unwelcome in healthcare. The concept of culturally safe healthcare (CSH) represents an important paradigm shift from provider control to patients who feel safe voicing health concerns and believe that they are heard by providers. This study has five goals: review works describing CSH, identify CSH themes, describe provider behaviors associated with CSH, describe interventions, and discuss how health communication can advance CSH. METHODS: A scoping review was conducted for articles published between 2019 and 2023 following modified PRISMA guidelines. Online databases included Pubmed (Medline), CINAHL, Web of Science, Google Scholar, and Redalyc. Thematic analysis was also conducted. RESULTS: Twenty-one articles meeting inclusion criteria were identified and analyzed. Of these, five explained features of CSH, four were empirical studies, seven were content analyses, and five were interventions. Five themes were identified including (1) how patients perceive CSH, (2) sociocultural determinants of health inequity, (3) mistrust of care providers, (4) issues with the biomedical model of healthcare, and (5) the importance of provider-patient allyship. Care provider communication behaviors fostering CSH were discussed. Three CSH interventions were highlighted. Finally, there was a discussion for how health communication scholars can contribute to CSH. CONCLUSIONS: CSH offers a paradigm shift from provider control to marginalized patients' experience of patient-provider communication. Recommendations for how health communication scholars can contribute to the implementation of CSH included developing guiding theories and measurement, evaluation of CSH outcomes, and conducting focus groups with patients to assess the meaning of cultural safety.

Awe and Trepidation: The Role of Perinatal Care Providers in Black Fathers' Experiences of Childbirth in the U.S.

Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.

Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth.

BACKGROUND: For many years in the United States, there has been an active discussion about whether race concordance between care providers and patients contributes to better health outcomes. Although beneficial provider-patient communication effects have been associated with concordance, there is minimal evidence for concordance benefits to health outcomes. METHODS: A cross-sectional survey was conducted including 200 Black mothers who had given birth within the last 2 years asking about the perceived racial identity of their birth health provider, whether they preferred to have Black women providers, and the intersection between race and gender concordance on birth outcomes. In addition to race and gender concordance, other variables were tested for their impact on birth satisfaction including respect, trust for the care provider, perceived competence, care provider empathy, and inclusive communication. RESULTS: Forty-one percent of the mothers in this study were assisted in birth by a Black woman provider. Although patient-provider concordance did not result in measurable health outcomes, it is clear that compared to other studies of birth satisfaction among Black birthing persons, this study showed relatively higher levels of satisfaction, perceived trust, empathy, perceived provider competence, inclusive communication, and equal respect for both concordant and discordant care providers. CONCLUSIONS: Although many participants showed a preference for race concordance, participants equally valued respect, competence, and trust with their care providers. Further community-based research needs to be conducted to examine whether race, gender, and cultural concordance results in other beneficial health outcomes.

Black mothers' birthing experiences: in search of birthing justice.

OBJECTIVES: Previous studies have suggested that often, Black mothers' birthing experiences are not what they expected because of how they were treated by healthcare providers during labor and birth. Our goal in this study was to ask Black mothers who had recently given birth about the quality of their birthing experiences as well as their level of respect from, trust in, and satisfaction with their maternity healthcare providers. DESIGN: This study gathered data from Black mothers (N = 209) who had given birth within the past two years, using a cross-sectional online survey measuring several variables about the birthing experience including types of healthcare provider communication, provider respect for the mother, trust, birth satisfaction, and emotional responses to birth. RESULTS: Provider-centered communication, although preferred by some mothers, was associated with lower birth satisfaction and stronger negative emotions whereas positive birth satisfaction was linked to patient-centered communication which resulted in positive emotions. While most mothers reported overall satisfaction with their birth experience, nearly half reported experiencing some degree of disrespect from their healthcare providers during labor and birth. Moreover, trust and respect mediated the relationship for patient-centered communication with positive emotion and birth satisfaction. Over one-third of participants gave birth with a certified nurse midwife attending. There were no differences in perception of being respected or the quality of birth given the professional identity of the provider as an Obstetrician/Gynecologist or as a midwife. The advice suggested by Black mothers for their healthcare providers was instructive in identifying ways those providers could better serve their patients during birth. CONCLUSION: This study showed that there is still additional work that needs to be done for racial equity and respect during birth. Practical implications for addressing health inequities are discussed.

Do Brelfies Help to Normalize Breastfeeding in Public: Lewd or Food?

Often, lack of support results in early termination of breastfeeding compromising infant health. Lactivists argue one way to normalize public breastfeeding is by posting brelfies on social network sites. An online experiment tested a 2 × 2 between-subjects factorial design. Participants (N = 296) were randomly assigned to one of the four experimental conditions varying the valence of comments or the control where no user comments were present. Most participants posted supportive comments. Compared to participants who only viewed brelfies, those who read any type of comment posted by other users showed negative attributions and emotions to brelfies. A number of other variables were also measured. Identification with other social media users was associated with approval for posting brelfies and supporting mothers. Emotional arousal and cognitive appraisal may be two sources of stigma about comments for brelfies even though people recognize that breastfeeding is an important health issue.

Chinese International Students' Face Concerns, Self-Stigma, Linguistic Factors, and Help-Seeking Intentions for Mental Health.

Chinese international students (CIS) in American universities encounter serious mental health issues, and they also underutilize campus mental health care services. The current study examined several factors which result in this phenomenon, such as Chinese face concerns, self-stigma of seeking help for mental health services, as well as English proficiency and language discrimination. A survey with 433 CIS in multiple U.S. universities was conducted to analyze the relationships between these factors above, help-seeking intentions, and mental health problems (depression and anxiety). The SEM results suggested that face concerns increased the risk of mental health problems such as depression and anxiety and also increased self-stigma toward seeking mental health services. However, face concerns positively influenced help-seeking intentions. The self-stigma had a negative effect on help-seeking intentions. Perceived English discrimination increased mental health problems while English proficiency increased help-seeking intentions. Meanwhile, both linguistic factors above were significantly associated with face concerns. The theoretical and practical implications are discussed to investigate how to address mental health problems among Chinese international students.

Navigating Uncertain Times: Information Management about Pregnancy and Breastfeeding during the COVID-19 Pandemic.

Pregnant women are especially vulnerable to COVID-19 while the short- and long-term impact of COVID-19 on maternal and infant health is only partially understood. We assessed the amount of uncertainty and anxiety pregnant women experienced about COVID-19 and whether, and the extent to which, they engaged in information seeking about COVID-19. In total, 320 pregnant women from 38 states took part in this research. The results showed that pregnant women experienced uncertainty and anxiety about pregnancy and breastfeeding and engaged in information seeking from their healthcare providers. Pregnant women's uncertainty influenced information seeking via anxiety, but the effect varied depending on participants' assessments of coping, communication, and target efficacy. While healthcare providers need to discuss ways to avoid COVID-19 infection, participants were assured that their providers had a plan to help them if they became infected with COVID-19.

Breastfeeding but not Exclusively: Exploration of Chinese American Mothers' Infant Feeding Practices.

BACKGROUND: Previous qualitative researchers have shown that Chinese American mothers experienced high rates of suboptimal breastfeeding, especially early introduction of other foods before the recommended 6-month period of exclusive breastfeeding. RESEARCH AIMS: (1) To explore attitudes that Chinese American mothers have about the meaning and practice of exclusive breastfeeding; (2) to evaluate the extent of family pressure and support to maintain exclusive breastfeeding; and (3) to examine the influence of breastfeeding self-efficacy and the intention to continue exclusive breastfeeding. METHOD: Guided by the theory of planned behavior, this descriptive cross-sectional prospective online survey was conducted with Chinese American breastfeeding mothers (N = 401). Participants' attitudes, subjective norms, and perceived behavioral control for exclusive breastfeeding behaviors were measured. RESULTS: The M (SD) age of participants was 29.14 (SD = 6.90). Just over 50% reported receiving family support for exclusive breastfeeding. While participants had positive attitudes about exclusive breastfeeding and the value of colostrum, 64% (n = 257) had already introduced foods other than mother's own milk before their infant was 6-months old. Participants also expressed concern that their infants did not receive enough nutrition from exclusive mother's milk. Participants with more than one child had significantly greater intention to continue exclusive breastfeeding compared to participants with only one child. Perception of approval by others for exclusive breastfeeding and breastfeeding self-efficacy were significantly related to behavioral intention to continue exclusive breastfeeding. CONCLUSION: Suboptimal infant feeding is a problem for Chinese American women and may also be a problem for mothers in other ethnic groups. We found a lack of adherence with standard recommendations for sustaining 6-months of exclusive breastfeeding.

Promoting Sustained and Exclusive Breastfeeding among Chinese American Pregnant Women.

This study investigated prenatal goal setting and breastfeeding attitudes and intentions for 210 Chinese American pregnant women. In addition, this study assessed impact of person-centered versus factual messages on breastfeeding attitudes and intentions. While pregnant women reported receiving information about Baby-Friendly designated hospitals from healthcare providers, most received no breastfeeding information from those same providers. Although women had positive attitudes toward breastfeeding, they showed lack of knowledge about colostrum, general approval for using infant formula, as well as early introduction of complementary foods. By extension, these attitudes suggested they misunderstood the meaning of exclusive breastfeeding. No differences were observed based on parity, trimester of pregnancy, level of education or income. Person-centered and factual messages were judged as equally effective messages, but intention to breastfeed was more affected by the factual message. Reasons for this result are discussed. Healthcare providers are positioned to proactively engage in maternal preparedness for exclusive breastfeeding. These results suggested a missed opportunity for healthcare providers to communicate the value of sustained exclusive breastfeeding for the recommended first 6 months of an infant's life and underscore a need for all antenatal healthcare providers to collaboratively ensure that breastfeeding information is comprehensively provided throughout the span of antenatal care.

Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed.

Background: Breastfeeding has become the recognized standard for good parenting, with social costs for not breastfeeding, but not every mother wants to or is able to breastfeed. Objectives: This study investigated social and personal costs with no breastfeeding. Materials and Methods: An in-depth survey was conducted with 250 mothers with infants who were not breastfeeding. Situated in the Framework Integrating Normative Influences on Stigma model for stigma, the study analyzed internalized stigma and perception of stigma from others, maternal feelings of warmth for the infant, and hiding formula use. Results: Mothers who chose not to breastfeed reported little personal or public stigma. In comparison, mothers who were unable to breastfeed experienced relatively more internalized stigma and perceived that other people saw them as failures. Mothers who experienced more internalized and perceived social network stigma were likely to hide use of infant formula from others and had lower feelings of warmth for their infants. Knowledge about formula use and availability of support resulted in less stigma and more warmth for the infant. Conclusions: These results suggest that public responses causing a mother to feel guilty for using infant formula result in negative feelings of self-worth and dysfunctional maternal behaviors.

The Impact of Generativity Awareness on Mid- to Old-Age Smokers in China.

Smoking remains a serious health threat to many mid- to old-age Chinese people. Many smoking interventions have been implemented in public areas, but smoking occurring in a private setting, such as at home, has largely been neglected. Generativity is based on evaluating the worth of one's life experience that can be passed on to others. This study evaluated whether generativity awareness can have an impact on smoking reduction. Five hundred and eight Chinese smokers were recruited and demonstrated their strong awareness of generativity, specifically general generativity (e.g., moral ethics), health-related generativity (e.g., living a healthy life), and smoke-free family generativity. The study showed support for a three-dimensional model for generativity, namely general, health, and smoke-free generativity. The three types of generativity varied in their effects on behavioral intention to reduce smoking and to encourage younger family members not to smoke. Family communication patterns also influenced behavioral intention to reduce smoking and to encourage younger family members not to smoke. Theoretical and practical implications are discussed.

Keep Doing the Good Work: Impact of Coworker and Community Support on Continuation of Breastfeeding.

Returning to work poses a challenge to new mothers' breastfeeding success during the first 6 months postpartum. While previous research has shown that breastfeeding-related workplace policy plays a significant role in women's decision to continue breastfeeding, the extent to which interpersonal factors such as coworkers' (lack of) support and stigma affect women's breastfeeding behavior is less understood. Through a cross-sectional survey with 500 working mothers, this research found that female coworker support of other women played an important role in affecting mothers' decision to continue breastfeeding after returning to work and contributed to breastfeeding self-efficacy. The findings suggest that mothers' perception of supportive coworker communication has an impact on sustained breastfeeding. Workplaces need to enhance the mother-friendly climate by encouraging and rewarding coworkers and providing support necessary for breastfeeding colleagues.

The "pumpgate" incident: Stigma against lactating mothers in the U.S. workplace.

Studies conclude that breastfeeding for six months is associated with better lifelong health for the mother and the child. Mothers in the U.S. returning to work after maternity leave report difficulty with the need to take frequent breaks to pump breastmilk so many stop breastfeeding. Factors discouraging pumping breastmilk in the workplace motivated a content analysis of public comments posted in response to a legal deposition that occurred in January of 2011 in which an attorney who was a new mother was challenged about taking a break to pump breastmilk. A total of 899 public comments posted on Yahoo in 2015-2016 in response to this earlier incident were analyzed for content. Of these, only 336 mentioned breastfeeding. Overall, 148 comments showed support for breastfeeding or pumping breastmilk at work, while 182 comments showed moderate to strong disapproval (six unclassified). The majority of disapproving comments were critical of pumping breastmilk in the workplace. Implications of these findings for the duration of breastfeeding after returning to work are discussed.

Effects of normative antismoking messages in China--a brief report.

The negative health effects of smoking are especially problematic in China, where 30% of the world's smokers reside and where male smoking continues to be the accepted norm. Smoking resistance is an important issue for both smokers and nonsmokers in China, where there is widespread acceptance of smoking. While smoking norms have been studied extensively in China, the effects of smoking prevention messages based on descriptive and injunctive norms have not yet been tested with Chinese respondents. Based on a 2 × 2 between-subjects factorial design, data were obtained from 143 working adults in China. The message describing high prevalence and disapproval of smoking resulted in stronger smoking resistance. Smoking status, group identity, and outcome expectancy influenced the impact of normative messages on smoking resistance. The results suggest the usefulness of adopting normative messages in smoking prevention and cessation campaigns.

Development and validation of the Communicating with Family about Brain Death Scale.

This study reports development of a scale assessing communication with family about brain-dead organ donation. Two cross-sectional studies demonstrated scale validity. Tests of internal, external, and predictive validity were conducted using confirmatory factor analysis. In both studies, the same 6 items were shown to be unidimensional with acceptable reliability. Parallelism was shown between the Brain Death Scale and a measure of communication with family. Predictive validity was exhibited between participants' donor status and the Brain Death Scale. The scale was associated with knowledge about brain death confirming misconceptions about brain-dead organ donation.

Combating weight-based cyberbullying on Facebook with the dissenter effect.

Weight-based cyberbullying is prevalent among youth and adolescents and can have lasting negative psychological effects on the victims. One way to combat these negative effects is through modeling dissenting behavior. When a bystander challenges the bully or supports the victim, this models dissenting behavior. In this study, 181 participants were exposed to message manipulations posted on a Facebook page aimed at testing the conformity effect, the dissenter effect, and the bystander effect in response to enactment of weight-based bullying. Facebook is a common social media site where cyberbullying is reported. Results indicate that in the dissenting condition, participants' comments were significantly more positive or supporting for the victim, as compared to other conditions. This effect was more pronounced for men than for women. In addition, in the dissenting condition, men were less likely to consider the victim unhealthy than women and men in other conditions. These results support the effectiveness of efforts to model dissenting behavior in the face of bullies and extend them to online contexts. Implications are discussed.

The Impact of Personal Metaphors and Memorable Interpersonal Communication on Body Satisfaction.

Memorable messages about body size can have profound negative psychological and emotional effects on body image and personal health. We found that both men and women recalled more negative than positive memorable messages about their body appearance and size. Participants who reported receiving negative memorable messages also revealed stronger current body dissatisfaction and poorer self-image than participants who reported positive memorable messages. Participants who received negative body comments also described their own body using negative metaphors. Negative memorable messages often occurred in front of third parties who expressed approval for the message, sometimes in the form of laughter. We discuss the mental health consequences of negative messages about body size and the implications for public health campaigns.

Influence of smoking norms and gain/loss antismoking messages on young Chinese adults.

INTRODUCTION: This study tested efficacy of 4 types of smoking prevention messages directed toward young Chinese adults based on message framing and the target of the message. The claim that social smoking is an entrenched behavior was also tested. METHODS: This study was based on a 2 (friends vs. self) × 2 (gain vs. loss) factorial design. Respondents were directed to a Web site, where they answered questions about demographics and smoking status and then read 1 of 4 experimental messages or continued with the no-message control condition. Descriptive and injunctive norms about the extent and acceptability of smoking were also measured. Dependent variables included measures of smoking resistance efficacy, susceptibility to the harms of smoking, smoking enjoyment, severity of smoking harms, and behavioral intention to smoke. RESULTS: Totally, 315 participants enrolled in a large Chinese university participated in this study. Overall, gain messages were more effective for smoking prevention. Participants were more persuaded to refrain from smoking by the friend-gain-framed message rather than self-targeted messages. Loss messages were largely ineffective both for smokers and nonsmokers. Participants who read messages about effects on friends indicated more susceptibility to the harms of smoking compared with participants who read messages about effects on self. Significant effects were associated with descriptive and injunctive norms for the intention to smoke. CONCLUSIONS: Future studies need to more fully investigate whether loss antismoking messages are effective in other contexts and with other moderators beyond those investigated in this study.

Communicating stigma about body size.

Body-size stigma is a well-documented phenomenon, particularly for large bodies (Puhl & Brownell, 2003), but few studies have investigated the features of body-related stigma communication. This article uses Smith's (2007a) stigma communication framework to analyze descriptions of male and female bodies of various sizes for their stigma content. Analyses reveal that elements of stigma communication appeared in 46.5% of comments across all bodies. The most common elements of stigma communication were severe labeling and negative comparison to body ideals. The most stigmatized body was the large male body; the second most stigmatized body was the very small female body. This article shows that stigmatizing communication occurs across the spectrum of body sizes for both genders. The implications of weight-based stigma communication on emotional and physical health are discussed. Implications for future health communication interventions aimed at decreasing body size stigma are presented.