Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 111
Filtrar
1.
BMC Health Serv Res ; 19(1): 477, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299950

RESUMO

BACKGROUND: Attention to culture and its impact on health care can improve the quality of care given, add to our understanding of health care among culturally diverse populations, and encourage a more holistic approach to health care within general care. Connection to culture is important to Aboriginal peoples, and integrating Aboriginal culture into general care in residential aged care facilities may contribute to improving care delivery and outcomes for residents. The literature to date revealed a lack of understanding of the capacity of residential aged care and the health practices of carers in relation to providing cultural care for Aboriginal people. This study aimed to explore how cultural care needs are maintained for Aboriginal residents from their own and their carers' perspectives. METHODS: Applying an Aboriginal centered research method, an Interpretive Descriptive Approach was used as a theoretical framework to explore data in this study. Semi structured audio-recorded interviews were conducted. An additional file provides a complete description of the interview questions used as a guide for the study [see Additional file 1]. Three Residential Aged Care Centres, in South Australia were used i.e., two rural from centres and one urban metropolitan centre. Seven Aboriginal residents and 19 carers participated in interviews. Data was transcribed and an interpretive analysis was employed to code the transcribed data for themes and sub-themes. The study was guided by an Aboriginal community advisory group with an aim to work under the principle of reciprocity; giving back to the communities, participants and those where the research results may have been relevant. RESULTS: Three themes emerged from the views of the residents and carers: (i) lack of resources and funding; (ii) care practice; and (iii) marginalisation of Aboriginal culture within aged care facilities. CONCLUSION: The findings suggest that carers and residents believe cultural inclusion in general care practices may enrich Aboriginal residents' daily life, health and well-being in residential aged care facilities. This study may provide carers, aged care centre managers and policy makers with information on the need of resources, funding, organised care plan and management, and cultural competency of carers to be considered to improve Aboriginal aged care protocols for integrating cultural care into practice.


Assuntos
Assistência à Saúde Culturalmente Competente/etnologia , Instituição de Longa Permanência para Idosos , Determinação de Necessidades de Cuidados de Saúde , Grupo com Ancestrais Oceânicos , Espiritualidade , Idoso , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Pesquisa Qualitativa , Austrália do Sul
2.
Plast Surg Nurs ; 39(2): 35-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136555

RESUMO

Orofacial clefts are one of the most common global birth defects. Orofacial clefts may be part of a syndrome or an isolated birth defect, and affect approximately 1-1.5 per 1,000 live births worldwide with noted inequalities across geographical areas and cultures. In the United States, Asian American populations have a substantially higher incidence of cleft lip with or without cleft palate (2/1,000 live births). Orofacial clefts are a key health issue with substantial health care costs, and associated medical, psychological, and social ramifications. It has been estimated that the health care costs within the United States are approximately $697 million over a child's lifetime. In disorders like orofacial clefts, because of the complexity of the condition and subsequent medical interventions, as well as the cultural intricacies of the Asian culture, it requires significant knowledge and understanding by the health care providers. In order to provide optimal and safe cleft care, reduce health care costs, and improve the outcomes for the Asian American population, a culturally sensitive, multidisciplinary, and coordinated approach is needed. Increased culturally specific education, early access to prenatal care, and ongoing infant and pediatric health care are essential.


Assuntos
Americanos Asiáticos/psicologia , Fenda Labial/cirurgia , Fenda Labial/epidemiologia , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Humanos , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia
4.
Trials ; 20(1): 158, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832708

RESUMO

BACKGROUND: Difficulties with delaying gratification, coping with frustration, and regulating emotions are significant predictors of aggression and behavioural and interpersonal problems early in life and mental health disorders during childhood, adolescence, and adulthood. Mental health problems generate a high burden of disease in society in general, and there is a significant treatment gap, especially among economically vulnerable populations. Prevention strategies appear to be the more recommendable options, mainly if these interventions can be implemented early in life and at low cost. Few preventive interventions aiming to increase resilience in the face of adversity have been rigorously evaluated among Chilean preschoolers. Substantial international evidence indicates that strengthening basic psychological skills, such as emotion regulation and social problem-solving, can reduce the incidence of mental pathology and improve various academic indicators. The curriculum of the Interpersonal Cognitive Problem-Solving Programme, also known as I Can Problem Solve (ICPS), is focussed on the development of the cognitive process and children's social problem-solving skills. ICPS is effective at increasing prosocial behaviours and reducing aggressive behaviour among preschoolers. ICPS provides children with the skills to think about how to solve problems using sequenced games, discussion, and group-interaction techniques focussed on listening to, and observing, others, promoting empathy and alternative and consequential thinking. The aims of this study are (1) to develop a culturally appropriate version of the ICPS programme and (2) to evaluate the acceptability and feasibility of the adapted version of ICPS among vulnerable schools in Santiago, Chile, conducting a pilot randomised controlled trial with three arms: (1) the ICPS programme delivered by an internal early teacher, (2) the ICPS programme delivered by an external early teacher, and (3) a control group. METHODS AND DESIGN: This is a pilot, three-armed randomised controlled trial of the adapted version of ICPS with an enrolment target of 80 preschoolers attending four schools per arm. Children in both intervention groups will receive the ICPS programme: 59 sessions of 20 min each delivered three times a week by trained internal or external early teachers over 5-6 months. Internal teachers are part of the school staff, and external teachers are facilitators hired by the research team to go to schools and deliver the intervention during a normal school day, working together with the early teacher present in the classroom. The intervention consists of games using pictures, puppets, and simple role-playing techniques to facilitate the learning process. Cognitive regulation, emotion recognition, social-problem-solving skills, and psychological functioning will be measured at baseline and after the intervention. DISCUSSION: No previous studies in Spanish-speaking Latin American countries have been conducted to explore the acceptability and feasibility of ICPS to provide information to evaluate the effectiveness of this intervention on a larger scale. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03383172 . Registered on 26 December 2017.


Assuntos
Comportamento Infantil , Terapia Cognitivo-Comportamental , Assistência à Saúde Culturalmente Competente , Transtornos do Neurodesenvolvimento/prevenção & controle , Adaptação Psicológica , Fatores Etários , Comportamento Infantil/etnologia , Pré-Escolar , Chile/epidemiologia , Cognição , Características Culturais , Assistência à Saúde Culturalmente Competente/etnologia , Emoções , Estudos de Viabilidade , Feminino , Humanos , Masculino , Saúde Mental , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/etnologia , Transtornos do Neurodesenvolvimento/psicologia , Projetos Piloto , Resolução de Problemas , Ensaios Clínicos Controlados Aleatórios como Assunto , Resiliência Psicológica , Método Simples-Cego , Comportamento Social , Fatores de Tempo , Resultado do Tratamento
5.
Acad Psychiatry ; 43(3): 300-305, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30617998

RESUMO

OBJECTIVE: Promoting awareness in residency training about the influence of religion on the doctor's and patient's ability to negotiate a patient-centered treatment plan is challenging and yet important for improving the quality of mental health care for religious individuals. This paper aims to explore the use of community partners and non-psychiatry faculty to provide this education within psychiatry residency programs. METHODS: Fifty-one psychiatry residents at an academic psychiatric hospital took part in a 4-h interdisciplinary workshop aimed at improving doctors' overall approach to treating African-American Christian patients. Community-based African-American clergy and mental health professionals, hospital-based psychiatrists, and primary care physicians facilitated educational sessions. A majority of the facilitators were African-American. A pre- and post-workshop survey was administered to measure change in participant attitudes and comfort levels associated with exposure to the workshop. Paired t tests on three subscales were used to calculate change in attitudes on pre- to post-workshop surveys. RESULTS: Resident scores on each of the three factor subscales increased significantly between pre- and post-workshop assessments: comfort in discussions with patients about spirituality [t [17] = 2.758; p = 0.013]; willingness to collaborate with clergy [t [16] = 3.776; p = 0.002]; and importance of religion to mental health [t [17] = 3.645; p = 0.002]. CONCLUSION: Findings suggest that collaboration between academic and community-based clergy, physicians, and other mental health providers may be a feasible method of improving psychiatry trainees' comfort in addressing religion in psychiatric care to ultimately provide more culturally competent care.


Assuntos
Afro-Americanos , Assistência à Saúde Culturalmente Competente , Assistência Centrada no Paciente , Psiquiatria/educação , Adulto , Atitude do Pessoal de Saúde , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/normas , Feminino , Humanos , Internato e Residência , Masculino , Saúde Mental/etnologia , Pessoa de Meia-Idade , Assistência Centrada no Paciente/normas , Religião e Psicologia , Adulto Jovem
6.
Australas J Ageing ; 38(1): 39-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30632245

RESUMO

OBJECTIVE: To examine the prevalence and context of racism self-reported by older Aboriginal and Torres Strait Islander people. METHODS: The 2015 National Aboriginal and Torres Strait Islander Survey was used to measure the prevalence, contexts and demographic differences in reports of racism. Multivariable logistic regression was used to examine the association of age with racism in later life. RESULTS: A sizeable minority of older Aboriginal people reported experiences of unfair treatment (31%) and avoidance (15%), oftentimes occurring in contexts critical to human capital investments. Specific demographic groups, including those with higher levels of education, were more likely to report experiences of unfair treatment. The prevalence of unfair treatment and avoidance remains relatively high in later life (albeit lower than younger ages), with a significant reduction from age 65. CONCLUSION: Addressing racism, particularly in contexts crucial to human capital, is important for the health and well-being of older Aboriginal people.


Assuntos
Envelhecimento/psicologia , Aprendizagem da Esquiva , Grupo com Ancestrais Oceânicos/psicologia , Racismo/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Envelhecimento/etnologia , Atitude do Pessoal de Saúde/etnologia , Austrália , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde/etnologia , Escolaridade , Feminino , Empregados do Governo/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Opinião Pública , Racismo/etnologia , Fatores de Risco , Autorrelato , Fatores de Tempo , Adulto Jovem
7.
Asian J Psychiatr ; 39: 53-57, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30572272

RESUMO

Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder characterized by social, communication, and behavioral deficits. Fortunately, early intervention has proved to be of significant benefit in the lives of children with ASD. However, timely access to health services and support requires equitable access, which is often a challenge for immigrant families. Barriers to equal access and support for immigrant families of children with ASD include cultural beliefs about child development and ASD, delayed diagnosis, access to services, and negative perceptions of services. There is a shortage of studies that explore how to increase understanding and collaboration among the immigrant population and health care practitioners to address these barriers. The barriers can indeed be appropriately addressed with structured programs and cultural models. The objectives of this article are to shed light on how barriers impact outcomes of immigrant children with ASD and to describe a culturally sensitive program model to address the barriers and provide awareness, education, and interventions for these immigrant families. The South Asian Autism Awareness Center in Toronto, Canada is presented as an example of such a model.


Assuntos
Transtorno Autístico/diagnóstico , Transtorno Autístico/terapia , Assistência à Saúde Culturalmente Competente/métodos , Emigrantes e Imigrantes , Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtorno Autístico/etnologia , Criança , Assistência à Saúde Culturalmente Competente/etnologia , Humanos
8.
J Palliat Care ; 34(1): 12-15, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29947278

RESUMO

BACKGROUND:: This case report addresses a client from a minority cultural background in Australia and her complex cultural needs at the end of life. CASE HISTORY:: A 66-year-old Japanese female client diagnosed with renal cancer, and lung and spine metastasis shared her story. Since a left nephrectomy in 2007, she has had hemodialysis 3 days a week. She left Japan more than 30 years ago and moved to Australia 20 years ago. With the 6-month prognosis, she expressed her desire to "go home." The meaning of "going home" was explored with the author who shares the same cultural background and language and is a palliative care nurse. The meanings for wanting to go home were her nostalgia for the traditional food, language, land, and death rituals. DISCUSSION:: The client identified her preferred place to die and discussed her death wishes. Open, honest communication with health professionals about her condition and prognosis facilitated meaningful discussions. CONCLUSION:: The narrative demonstrates the complex issues and needs of clients from minority cultural backgrounds and the importance of understanding the real cultural meaning behind their stories. Exploring the meaning with compassionate curiosity as well as interpretation support was the key.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Atitude Frente a Morte/etnologia , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Cuidados Paliativos/psicologia , Assistência Terminal/psicologia , Idoso , Austrália , Feminino , Humanos , Cuidados Paliativos/métodos , Assistência Terminal/métodos
10.
Isr J Psychiatry Relat Sci ; 55(2): 22-30, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30351277

RESUMO

In recent decades there has been a significant increase in the prevalence of eating disorders among non-Western populations. This article aims to address unique sociocultural issues regarding the procedure and dilemmas of the diagnosis process of eating disorders among Ethiopian adolescents in Israel. We will discuss cultural aspects relating to the perception of the disease and the circumstantial contexts relating to this population, such as the process of immigration, integration into Israeli society and issues related to identity and trauma. Diagnostic dilemmas relating to the differences between traditional vs Western perceptions of the illness will be discussed. For illustration, two case studies will be presented. In the discussion, a culturally-sensitive diagnostic model is proposed. Based on Cultural Formulation Interview, this model assumes that the observation of clinical cases from different cultural backgrounds cannot be achieved solely through a western diagnostic prism. Rather, we suggest that the diagnostic process should continue throughout the entire therapeutic process.


Assuntos
Assistência à Saúde Culturalmente Competente/etnologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etnologia , Adolescente , Etiópia/etnologia , Feminino , Humanos , Israel/etnologia , Masculino
11.
Trials ; 19(1): 519, 2018 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-30249293

RESUMO

BACKGROUND: Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN: In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION: The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION: NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.


Assuntos
Afro-Americanos/psicologia , Pressão Positiva Contínua nas Vias Aéreas , Assistência à Saúde Culturalmente Competente/etnologia , Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Infuência dos Pares , Apneia Obstrutiva do Sono/terapia , Sono , Apoio Social , Humanos , Cidade de Nova Iorque/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Apneia Obstrutiva do Sono/etnologia , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/psicologia , Fatores de Tempo , Resultado do Tratamento
12.
J Gen Intern Med ; 33(11): 1885-1891, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30143979

RESUMO

BACKGROUND: While the need to address language barriers to provide quality care for all is generally accepted, little is known about the complexities of decision-making around patients' limited language proficiency in everyday clinical encounters. OBJECTIVE: To understand how linguistic complexities shape cross-cultural encounters by incorporating the perspective of both, patients and physicians. DESIGN: A qualitative hospital study with semi-structured interviews and participant-observation in a Swiss University Hospital. Thirty-two encounters were observed and 94 interviews conducted. PARTICIPANTS: Sixteen patients of Turkish and 16 of Albanian origin and all actors (administration, nurses, physicians, if required, interpreters) involved in the patients' entire process. MAIN APPROACH: Interviews were audio-recorded and transcribed verbatim. A thematic content analysis was conducted using MAXQDA. For reporting, the COREQ guidelines were used. KEY RESULTS: Three themes were relevant to patients and physicians alike: Assessment of the language situation, the use of interpreters, and dealing with conversational limits. Physicians tend to assess patients' language proficiency by their body language, individual demeanor, or adequacy of responses to questions. Physicians use professional interpreters for "high-stakes" conversations, and "get by" through "low-stakes" topics by resorting to bilingual family members, for example. Patients are driven by factors like fearing costs or the wish to manage on their own. High acceptance of conversational limits by patients and physicians alike stands in stark contrast to the availability of interpreters. CONCLUSIONS: The decision for or against interpreter use in the "real world" of clinical care is complex and shaped by small, frequently inconspicuous decisions with potential for suboptimal health care. Physicians occupy a key position in the decision-making to initiate the process of medical interpreting. The development and testing of a conceptual framework close to practice is crucial for guiding physicians' assessment of patients' language proficiency and their decision-making on the use of interpreting services.


Assuntos
Tomada de Decisão Clínica/métodos , Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Relações Médico-Paciente , Centros de Atenção Terciária , Feminino , Humanos , Masculino , Suíça/epidemiologia
13.
Prim Care Diabetes ; 12(6): 501-509, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30145188

RESUMO

AIMS: To explore General Practice teams cultural-competence, in particular, ethnicity, linguistic skillset and cultural awareness. The practice teams' access to diabetes-training, and overall perception of cultural-competence were also assessed. METHODS: A cross-sectional single-city-survey with one in three people with diabetes from an ethnic minority group, using 35 semi-structured questions was completed. Self-reported data analysed using descriptive statistics, interpreted with reference to the Culturally-Competent-Assessment-Tool. RESULTS: Thirty-four (52%) of all 66 practices in Coventry responded between November 2011 and January 2012. KEY FINDINGS: (1) One in five practice staff was from a minority group in contrast with one in ten of Coventry's population, (2) 164 practice staff (32%) spoke a second language relevant to the practice's minority population, (3) 56% of practices were highly culturally-competent at providing diabetes services for minority populations, (4) 94% of practices reported the ethnicity of their populations, and (5) the most frequently stated barriers to culturally-competent service delivery were language and knowledge of nutritional habits. CONCLUSIONS: Culturally-competent diabetes care is widespread across the city. Language barriers are being addressed, cultural knowledge of diabetes-related-nutrition requires further improvement. Further studies should investigate if structured cultural-competence training for diabetes service providers produces positive effects in diabetes-related outcome-measures in minority populations.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde Culturalmente Competente/etnologia , Diabetes Mellitus/terapia , Medicina Geral , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Saúde das Minorias/etnologia , Barreiras de Comunicação , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Inglaterra/epidemiologia , Comportamento Alimentar/etnologia , Pesquisas sobre Serviços de Saúde , Humanos , Multilinguismo , Equipe de Assistência ao Paciente , Relações Profissional-Paciente
14.
J Pain Symptom Manage ; 56(4): 530-540.e6, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30025937

RESUMO

CONTEXT: Better understanding of clinicians' skill communicating with their patients and of patients' trust in clinicians is necessary to develop culturally sensitive palliative care interventions. Race/ethnicity, socioeconomic status, and religiosity have been documented as factors influencing quality of communication and trust. OBJECTIVES: The objective of this study was to explore associations of seriously ill patients' race/ethnicity, socioeconomic status, and religiosity with patients' ratings of the quality of clinicians' communication and trust in clinicians. METHODS: An observational analysis was performed using baseline data from a multicenter cluster-randomized trial of a communication intervention. We enrolled consecutive patients with chronic, life-limiting illnesses (n = 537) cared for by primary and specialty care clinicians (n = 128) between 2014 and 2016 in outpatient clinics in Seattle, Washington. We assessed patient demographics (age, gender, race/ethnicity, education, income, and self-rated health status), Duke University Religion Index, Quality of Communication Scale, and Wake Forest Physician Trust Scale. We used probit and linear regression and path analyses to examine associations. RESULTS: Patients providing higher ratings of clinician communication included those belonging to racial/ethnic minority groups (P = 0.001), those with lower income (P = 0.008), and those with high religiosity/spirituality (P = 0.004). Higher trust in clinicians was associated with minority status (P = 0.018), lower education (P = 0.019), and clinician skill in communication (P < 0.001). CONCLUSION: Contrary to prior studies, racial/ethnic minorities and patients with lower income rated communication higher and reported higher trust in their clinicians than white and higher income patients. More research is needed to identify and understand factors associated with quality communication and trust between seriously ill patients and clinicians to guide development of patient-centered palliative care communication interventions.


Assuntos
Estado Terminal/psicologia , Assistência à Saúde Culturalmente Competente , Comunicação em Saúde , Relações Profissional-Paciente , Confiança , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Estado Terminal/epidemiologia , Estudos Transversais , Assistência à Saúde Culturalmente Competente/etnologia , Grupos Étnicos , Feminino , Humanos , Masculino , Grupos Minoritários , Profissionais de Enfermagem , Médicos , Religião e Medicina , Classe Social
15.
BMJ Open ; 8(7): e021999, 2018 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-29980547

RESUMO

OBJECTIVE: To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. DESIGN: A participant-blinded and assessor-blinded pilot randomised controlled trial. SETTING: Outpatient physiotherapy departments at two public hospitals and one district pain clinic. PARTICIPANTS: Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. INTERVENTIONS: 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. OUTCOME MEASURES: Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. RESULTS: 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. CONCLUSIONS: Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes. TRIAL REGISTRATION NUMBER: ACTRN12616000857404; Pre-results.


Assuntos
Dor Crônica/reabilitação , Assistência à Saúde Culturalmente Competente/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Grupos Étnicos , Dor Musculoesquelética/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Modalidades de Fisioterapia , Adulto , Austrália/epidemiologia , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Protocolos Clínicos , Assistência à Saúde Culturalmente Competente/etnologia , Emigração e Imigração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/psicologia , Medição da Dor , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
16.
Acad Med ; 93(9): 1276-1280, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29877912

RESUMO

Patient-physician language discordance within the growing Spanish-speaking patient population in the United States presents a significant challenge for health systems. The Civil Rights Act, an Executive Order, and federal standards establish legal requirements regarding patients' legal right to access medical care in their language of origin and to culturally and linguistically appropriate services, and national competency standards for undergraduate and graduate medical education and licensing examinations support the importance of patient-physician communication. However, no requirements or guidelines currently exist for medical Spanish educational resources, and there is no standardized process to assess the competency of medical students and physicians who use Spanish in patient care. Relatedly, existing data regarding current medical Spanish educational resources are limited, and Spanish proficiency evaluations are often based on self-assessments. Future efforts should use a multifaceted approach to address this complex challenge. A standardized process for Spanish-language-concordant medical care education and quality assurance should incorporate the validation of medical Spanish educational resources, competency requirements for medical usage of Spanish, an incentivized certification process for physicians who achieve medical Spanish competency, and health system updates that include routine collection of language concordance data and designation of Hispanic-serving health centers.


Assuntos
Competência Cultural/ética , Assistência à Saúde Culturalmente Competente/normas , Satisfação do Paciente/etnologia , Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Hispano-Americanos , Humanos , Linguagem , Relações Médico-Paciente , Estados Unidos/etnologia
17.
J Hum Lact ; 34(3): 478-484, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29763363

RESUMO

BACKGROUND: Increasing breastfeeding rates among low-income African American women may work toward the achievement of health equity. The dynamic breastfeeding assessment process (D-BAP) is a community-grounded, equity-focused intervention designed to increase prenatal breastfeeding self-efficacy. Research aim: The aims of the pilot study were (a) to determine the effect of the D-BAP on breastfeeding self-efficacy among pregnant, low-income African American women, (b) to examine the findings among women with no previous breastfeeding experience, and (c) to compare the findings between women with prior breastfeeding experience and those without it. METHODS: A pre/post, paired-samples design was utilized. Convenience sampling was used to recruit pregnant, low-income African American women ( N = 25). Participants completed the Breastfeeding Self-Efficacy Scale-Short Form prior to and following the D-BAP. RESULTS: The Wilcoxon signed rank test indicated that participation in the D-BAP had a statistically significant influence on breastfeeding self-efficacy ( z = -2.01, p = .04). Among a subsample of participants with no previous breastfeeding experience ( n = 12), completion of the D-BAP resulted in a statistically significant increase in breastfeeding self-efficacy ( z = -2.36, p = .02). There was no statistically significant difference between those with prior breastfeeding experience and those without it. CONCLUSION: Breastfeeding among low-income African American women is a health equity issue for which culturally responsive, effective breastfeeding interventions are needed. This research demonstrates an association between completion of the D-BAP and an increase in prenatal breastfeeding self-efficacy.


Assuntos
Afro-Americanos/psicologia , Aleitamento Materno/métodos , Assistência à Saúde Culturalmente Competente/métodos , Adulto , Afro-Americanos/etnologia , Afro-Americanos/estatística & dados numéricos , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Assistência à Saúde Culturalmente Competente/etnologia , Feminino , Grupos Focais/métodos , Humanos , Projetos Piloto , Pobreza/etnologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa
18.
J Natl Med Assoc ; 110(3): 212-218, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29778122

RESUMO

OBJECTIVE: To examine associations between self-assessed language ability and provision of clinical care without professional interpretation. METHODS: We conducted an anonymous web-based survey of pediatric residents at a large pediatric training program. Respondents self-rated their language ability, and then reported on their willingness to deliver clinical care without professional interpretation in standardized clinical scenarios. RESULTS: All pediatric residents completed the survey (n=81; 100%). Many residents (58 of the total sample) indicated at least rudimentary skills in a second language, and seven (9%) indicated they were proficient in Spanish. Eight-five percent had sometimes relied upon friends or family to communicate with parents. Most (69%) reported occasional use of Spanish-language skills to take a history or provide medical advice without the use of a professional interpreter. In contrast, in clinical scenarios where a child was believed to have a complex medical history, few residents (2.5%) felt comfortable using their language skills in the clinical encounter. Residents were willing to have their language ability assessed. CONCLUSIONS: Residents still face circumstances in which care proceeds without an interpreter. Discomfort with providing care in a second language grows with the perceived complexity of care, and yet a complex condition may not be apparent when communication barriers exist. Overcoming barriers to the use of professional interpretation may improve care for LEP children.


Assuntos
Competência Cultural/educação , Assistência à Saúde Culturalmente Competente , Pais , Pediatria/métodos , Criança , Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Tomada de Decisões , Pesquisas sobre Serviços de Saúde , Humanos , Internato e Residência/métodos , Determinação de Necessidades de Cuidados de Saúde , Relações Médico-Paciente , Estados Unidos/etnologia
19.
Prim Health Care Res Dev ; 19(5): 448-463, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29729677

RESUMO

AimThe aim of this study was to determine the feasibility and efficacy of a culturally tailored lifestyle intervention, ¡Vivir Mi Vida! (Live My Life!). This intervention was designed to improve the health and well-being of high risk late middle-aged Latino adults and to be implemented in a rural primary care system. BACKGROUND: Rural-dwelling Latino adults experience higher rates of chronic disease compared with their urban counterparts, a disparity exacerbated by limited access to healthcare services. Very few lifestyle interventions exist that are both culturally sensitive and compatible for delivery within a non-metropolitan primary care context. METHODS: Participants were 37 Latino, Spanish-speaking adults aged 50-64-years-old, recruited from a rural health clinic in the Antelope Valley of California. ¡Vivir Mi Vida! was delivered by a community health worker-occupational therapy team over a 16-week period. Subjective health, lifestyle factors, and cardiometabolic measures were collected pre- and post-intervention. Follow-up interviews and focus groups were held to collect information related to the subjective experiences of key stakeholders and participants.FindingsParticipants demonstrated improvements in systolic blood pressure, sodium and saturated fat intake, and numerous patient-centered outcomes ranging from increased well-being to reduced stress. Although participants were extremely satisfied with the program, stakeholders identified a number of implementation challenges. The findings suggest that a tailored lifestyle intervention led by community health workers and occupational therapists is feasible to implement in a primary care setting and can improve health outcomes in rural-dwelling, late middle-aged Latinos.


Assuntos
Promoção da Saúde/métodos , Hispano-Americanos/estatística & dados numéricos , Estilo de Vida/etnologia , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , População Rural/estatística & dados numéricos , California/etnologia , Agentes Comunitários de Saúde , Assistência à Saúde Culturalmente Competente/etnologia , Assistência à Saúde Culturalmente Competente/métodos , Estudos de Viabilidade , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
20.
Australas J Ageing ; 37(3): E85-E90, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29655278

RESUMO

OBJECTIVE: To describe the activity of daily living and behavioural and complex care needs of residents born in non-English-speaking countries in Australian aged care facilities. METHODS: De-identified cross-sectional data were provided by the Australian Institute of Health and Welfare for all residents in government-funded facilities on 30 June 2015. Analyses included t-tests, chi-squared tests and logistic regressions. RESULTS: A total of 33 168 (19%) residents were born in one of 188 non-English-speaking countries. Compared to residents born in English-speaking countries, they were significantly younger, lived in larger facilities, were more likely to be male and live in an urban area. Their care requirements were greater for activities of daily living and behavioural and complex care. Residents from non-English-speaking countries living in ethno-specific facilities had higher levels of these needs. CONCLUSION: The needs of residents born in non-English-speaking countries should be considered when planning aged care services.


Assuntos
Atividades Cotidianas , Assistência à Saúde Culturalmente Competente , Emigrantes e Imigrantes/psicologia , Emigração e Imigração , Necessidades e Demandas de Serviços de Saúde , Instituição de Longa Permanência para Idosos , Determinação de Necessidades de Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Estudos Transversais , Características Culturais , Assistência à Saúde Culturalmente Competente/etnologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA