Improving Cultural Knowledge to Facilitate Cultural Adaptation of Pain Management in a Culturally and Linguistically Diverse Community.

Purpose: Health care disparities exist for people from culturally and linguistically diverse (CALD) communities. Addressing the cultural competence of health care providers could limit these disparities. The aim of this study was to improve cultural knowledge of and humility regarding pain in a CALD community. Method: This interpretive description qualitative study used focus group discussions (FGDs) to generate ideas about how South Asian culture could influence how health care providers manage pain. A total of 14 people with pain and of South Asian background (6 women and 8 men, aged 28-70 y) participated. Two investigators independently analyzed the data. This process involved repeatedly reading the transcripts, then manually sorting the key messages into categories. The investigators compared their categorizations and resolved differences through discussion. Next, similar categories and concepts were grouped into ideas (potential themes). These ideas, along with supporting categories and verbatim quotes, were presented to the full research team for feedback. After compiling the feedback, the ideas formed the thematic representation of the data. Results: The data from the FGDs revealed how pain management could be culturally adapted. The FGDs generated four themes about South Asian cultural perspectives that could influence the pain management experience for people living with pain: (1) cultural and linguistic impediments to communication, (2) understanding of pain in terms of the extent to which it interferes with function and work, (3) nurturing or personal attention as a marker of good care, and (4) value attributed to traditional ideas of illness and treatment. Conclusion: This study demonstrates how engaging with CALD people living with pain can lead to improved cultural knowledge and humility that can form the basis for adapting pain management. Through this process, it is more likely that a meaningful and client-centred pain management plan can be developed.

Objectif : les membres de communautés linguistiques et culturelles diversifiées (CLCD) font face à des disparités en matière de soins. Si les dispensateurs de soins acquéraient des compétences culturelles, il serait possible d'atténuer ces disparités. La présente étude visait à améliorer les connaissances et l'humilité culturelle au sujet de la douleur dans les CLCD. Méthodologie : étude qualitative descriptive et interprétative faisant appel à des entrevues de groupe pour générer des idées sur la manière dont la culture sud-asiatique peut influencer les modes de gestion de la douleur par les dispensateurs de soins. Au total, 14 personnes d'origine sud-asiatique qui souffrent de douleur y ont participé (six femmes et huit hommes de 28 à 70 ans). Deux chercheurs ont analysé les données de manière indépendante. Ce processus incluait la lecture répétée des comptes rendus, puis la catégorisation manuelle des principaux messages. Les chercheurs ont comparé les catégories et résolu leurs différends par des discussions. Ils ont ensuite regroupé les catégories et les concepts semblables en idées (thèmes potentiels). Les idées, de même que les catégories et les citations textuelles qui les appuyaient, ont ensuite été présentées à l'ensemble de l'équipe de recherche pour qu'elle y réagisse. Une fois les réactions compilées, les idées ont formé la représentation thématique des données. Résultats : les données tirées des entrevues de groupe ont révélé des manières d'adapter la gestion de la douleur à la culture. Les entrevues ont produit quatre thèmes sur les points de vue de la culture sud-asiatique qui pourraient influer sur l'expérience de gestion de la douleur des personnes qui vivent avec la douleur : 1) les obstacles culturels et linguistiques à la communication, 2) la compréhension de l'importance de l'entrave que représente la douleur pour le fonctionnement et le travail, 3) l'accompagnement ou l'attention personnelle comme marqueur de bons soins et 4) la valeur attribuée aux idées traditionnelles de la maladie et du traitement. Conclusion : la présente étude démontre que le fait d'engager un dialogue avec des personnes de CLCD qui vivent avec la douleur peut améliorer les connaissances et l'humilité culturelles sur lesquelles reposeront les mesures d'adaptation. Grâce à ce processus, il est plus probable d'établir un plan concret de gestion de la douleur, axé sur le client.

Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study.

INTRODUCTION: Physical activity is a cost-effective and non-pharmaceutical strategy that can help mitigate the physical and psychological health challenges associated with breast cancer survivorship. However, up to 70% of women breast cancer survivors are not meeting minimum recommended physical activity guidelines. Project MOVE is an innovative approach to increase physical activity among breast cancer survivors through the use of Action Grants, a combination of microgrants (small amounts of money awarded to groups of individuals to support a physical activity initiative) and financial incentives. The purpose of this paper is to describe the rationale and protocol of Project MOVE. METHOD AND ANALYSIS: A quasi-experimental pre-post design will be used. Twelve groups of 8-12 adult women who are breast cancer survivors (N=132) were recruited for the study via face-to-face meetings with breast cancer-related stakeholders, local print and radio media, social media, and pamphlets and posters at community organisations and medical clinics. Each group submitted a microgrant application outlining their proposed physical activity initiative. Successful applicants were determined by a grant review panel and informed of a financial incentive on meeting their physical activity goals. An evaluation of feasibility will be guided by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and assessed through focus groups, interviews and project-related reports. Physical activity will be assessed through accelerometry and by self-report. Quality of life, motivation to exercise and social connection will also be assessed through self-report. Assessments will occur at baseline, 6 months and 1 year. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board (#H14-02502) and has been funded by the Canadian Cancer Society Research Institute (project number #702913). Study findings will be disseminated widely through peer-reviewed publications, academic conferences, local community-based presentations, as well as partner organisations, including the Canadian Cancer Society.