Cultural Sensitivity in Interventions Aiming to Reduce or Prevent Intimate Partner Violence During Pregnancy: A Scoping Review

Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem. Ethnic minorities and immigrant pregnant women experiencing IPV require culturally responsive health services. The aim of this scoping review was to identify aspects of cultural sensitivity in interventions to prevent or reduce IPV among ethnic minorities and immigrant pregnant women in high-income countries. Eight databases were searched in November 2019. Any type of scientific research, quantitative, qualitative, or mixed methods studies regarding interventions against IPV among pregnant women were considered for inclusion. Resnicow et al.'s definition of cultural sensitivity was used to identify aspects of cultural sensitivity. Ten papers relating to nine interventions/studies met our inclusion criteria. These studies, which included randomized controlled trials, a mixed methods study, a program evaluation, and a longitudinal study, were conducted in Australia, Belgium, Norway, and the United States. Aspects of surface cultural sensitivity, including the translation of intervention content into the language of the target group(s) and the involvement of bilingual staff to recruit participants, were identified in eight studies. Deep structure aspects of cultural sensitivity were identified in one study, where the intervention content was pretested among the target group(s). Results that could be related to the culture-sensitive adaptions included successful recruitment of the target population. Three studies were planning to investigate women's experiences of interventions, but no publications were yet available. This scoping review provides evidence that culturally sensitive interventions to reduce or prevent IPV among immigrant pregnant women are limited in number and detail.

Understanding the experiences and needs in autism education: A semi-structured interview among Chinese American parents of autistic children

Background and Aims

The diversity of the autistic population seeking professional services and education in the United States has increased. As the diagnosis of autism increases among the Chinese American immigrant population, there is also an increasing need to learn about this population and provide appropriate intervention and education for this group. However, current education and intervention provided for autistic individuals tend to be culturally blind. Gaps were found in our understanding of the cultural context and its relationship with the education mechanisms among Chinese American autistic families. The current study intends to investigate how Chinese American parents perceive the education materials and intervention strategies received by their autistic children as well as their experiences and needs in the education process.

Method

Semi-structured interviews were conducted among 10 Chinese American parents (one father and nine mothers) online. They all had children who had a formal diagnosis of autism spectrum disorder and received some intervention or education. Thematic analysis was used to analyse the results.

Results

The study suggested that most Chinese American parents were satisfied with the current education materials and intervention strategies provided to their autistic children. Due to cultural-related stigma, parents differ in their perceptions of children's autism diagnosis and characteristics as well as their expectations of children's culturally sensitive education. A theoretical model was created to provide culture-centered interpretation of the interconnected relationship between their pre- and post-immigration contexts and parenting attitudes.

Conclusions

Culture plays a critical role in understanding Chinese American parents' experiences, needs, and expectations of culturally sensitive education for their autistic children. Interconnected relationships were found between contexts and parenting attitudes, which were largely influenced by cultural-related stigma.

Implications

Suggestions and implications were provided for institutions and professionals working with Chinese American families and children. It is critical for them to learn about the experiences, needs, and attitudes of Chinese American parents to provide Chinese American autistic children with more appropriate and culturally sensitive education.

Promoting weight-loss maintenance among Black women primary care patients: A cluster RCT of a culturally sensitive versus standard behavioural approach

The prevalence of obesity is higher among Black women (56.6%) compared to Hispanic women (50%) and non-Hispanic White women (42%). Notably, interventions to reduce obesity typically result in initial weight loss that is not maintained. This study tested (a) the effectiveness of a 6-month Health-Smart Weight Loss (HSWL) Program for Black women patients with obesity implemented by community health workers (CHWs) within primary care clinics and (b) the comparative effectiveness of two 12-month physician-implemented weight loss maintenance programs-a Patient-Centred Culturally Sensitive Weight Loss Maintenance Program (PCCS-WLM Program) and a Standard Behavioural Weight Loss Maintenance Program (SB-WLM Program). Black women patients (N = 683) with obesity from 20 community primary care clinics participated in the HSWL Program and were then randomized to either maintenance program. The HSWL Program led to significant weight loss (i.e., 2.7 pounds, 1.22 kg, p < .01, -1.1%) among the participants. Participants in both the PCCS-WLM Program and the SB-WLM Program maintained their weight loss; however, at month 18, participants in the PCCS-WLM Program had a significantly lower weight than those in the SB-WLM (i.e., 231.9 vs. 239.4 pounds or 105.19 vs. 108.59 kg). This study suggests that (a) the HSWL Program can produce significant weight loss among Black women patients with obesity when implemented in primary care clinics by CHWs, and (b) primary care physicians can be trained to successfully promote weight loss maintenance among their Black women patients.

Norwegian nursing students' experience during clinical placement in an African country: Communication, relationship building and nursing identity. A qualitative study

AIM

The aim of this study was to gain a deeper understanding of the experience of Norwegian bachelor nursing students during clinical placement in an African country, with a focus on communication, relationship building and nurse identity.

DESIGN

Explorative, qualitative methods were used.

METHODS

The data consisted of individual written reflection notes from 8 students' clinical placement in Africa, and transcripts from one semi-structured focus group interview. The materials were analysed with systematic text condensation.

RESULTS

The students described their experience with the community of practice as challenging and enlightening. They found themselves in contexts where communication and language problems occurred. The students described how important relationships were for their practical training, and how this helped shape their nursing identity.

The relationship between sexual myths and intercultural sensitivity in university students

PURPOSE

In the study, it was aimed to investigate the relationship between sexual myths and intercultural sensitivity in university students.

METHOD

The study designed as cross-sectional research was carried out with the participation of 1,061 university students. Data collection tools used were the Personal Information Form, Sexual Myths Scale, and Intercultural Sensitivity Scale.

FINDINGS

It was determined that the students believed in myths at a moderate level. The students who thought that being together with different cultures did not have a positive contribution were found to believe in sexual myths at a higher level (p < 0.001). It was also determined that intercultural sensitivity was a significant predictor of sexual myths in university students (p < 0.001).

IMPLICATIONS FOR PRACTICE

While planning sexual education provided to relay sexual knowledge to societies accurately, cultural differences should be considered.

A Moderation Analysis of Perfectionism, Cultural Sensitivity, and Counselors-In-Training Attitudes Toward Non-Dominant Sexual Identities

The purpose of this study was to explore the moderating effect of maladaptive perfectionism on the relationship between cultural sensitivity and counselors-in-training attitudes toward non-dominant sexual identities. A total of 209 counseling graduate students participated in the study. Results showed that cultural sensitivity predicted attitudes toward individuals who identify with a non-dominant sexual identity after controlling for age. Also, a regression analysis demonstrated that maladaptive perfectionism is a moderator in the relationship between cultural sensitivity and attitudes toward individuals who identify with a non-dominant sexual identity among counselors-in-trainings. Implications in the counseling and education field and suggestions for future research are discussed.

Optimization of eHealth interventions for intimate partner violence and abuse: A qualitative study amongst Arabic-speaking migrant women

AIMS

This interview study focuses on the needs and wishes of Arabic-speaking migrant women in the Netherlands to culturally adapt and optimize the digital support platform SAFE (safewomen.nl) for intimate partner violence and abuse (IPVA) for their use.

DESIGN

This is a qualitative interview-based study.

METHODS

We conducted the study between March 2020 and 2021. The study entailed 16 semi-structured interviews with Arabic-speaking women in the Netherlands with a migration background.

RESULTS

Findings suggest that a cultural gap, a lack of knowledge of the Dutch law, and the prevalence of restrictive gender roles amongst the participants and their spouses affected their acknowledgement of the different forms of IPVA. Furthermore, mental health consequences of IPVA were also strongly stigmatized. Clear information in their native language, summarizing infographics and potential interactive features should be main components of any eHealth intervention for this target group.

CONCLUSION

The participants in our study deemed e-help a potentially valuable support option for women experiencing IPVA in their community. The impact of IPVA on mental health is currently overlooked within this target group and should be emphasized in future interventions.

IMPACT

Cultural sensitivity proved crucial in understanding the concepts of IPVA amongst women with migrant backgrounds. To ensure effective eHealth interventions for migrant women, they should be involved in the design and delivery of these interventions.

Cultural Sensitivity and Ethical Considerations

Global surgery is a burgeoning area of global health. Surgeons can engage in one-or many-of the facets of global healthcare delivery: clinical care, capacity building, education, research, etc. Working in an increasingly global community, surgeons must be aware of the richness of cultural diversity at home and around the world such that they can provide culturally sensitive care. This chapter focuses on the most common way in which surgeons engage in global surgery: surgical short-term experiences in global health (STEGHs). Surgical STEGHs pose an intricate set of ethical dilemmas. As team leaders, surgeons must understand the community they intend to serve on these trips. Further, they should confirm that everyone who joins them is prepared to deliver care in a culturally sensitive and competent manner. Finally, surgeons must consider potential ethical dilemmas that may arise before, during, and after surgical STEGHs and have strategies to navigate them.

Applying an authentic partnership approach to facilitate optimal health of Aboriginal children

The aim of this development paper is to inform the ongoing implementation of the partnership approach with Aboriginal families in Australia. As almost all Community Health Nurses employed by the Health Department of Western Australia, Country Health Service are non-Aboriginal, there are a number of factors that may, potentially, limit their capacity to work effectively with the primary caregivers of Aboriginal children.

Historically, much that has been written about the health and development of Aboriginal people in Australia has been negative and derogatory with wide criticism for their non-participation with health services and healthy lifestyle activities. Not only has this “deficit discourse” approach proved to be unhelpful in terms of improving the health and well-being of Aboriginal people but also there is mounting evidence that it has been detrimental to mental and physical health and capacity to achieve autonomy in all aspects of life.

In response to the voices of Aboriginal people, the partnership approach to care has been promoted for use by Community Health Nurses in Western Australia. However, the implementation of the approach is not always genuinely strength based, and it does not always focus on mutual goal setting within authentic partnership relationships. The partnership approach has the potential to improve the lives of Aboriginal people if it is implemented with appropriate cultural sensitivity, shared responsibility, dignity and respect.

Community Conversations About COVID-19

"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.

Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review

BACKGROUND

Moral distress is a phenomenon that all nurses experience at different levels and contexts. The level of moral distress can be affected by individual values and the local culture. The sources of the values shape the level of moral distress experienced and the nurses' decisions.

AIM

The present scoping review was conducted to examine the situations that cause moral distress in ICU nurses in different countries.

RESULTS

A scoping review methodology was adopted for the study, in line with the approach of Arksey, and O'Malley Literature was searched within PubMed/Medline, Scopus, Web of Science, and PsycINFO indexed keywords such as "moral distress", "Critical Care Nurse", and "Moral Distress Scale-Revised". Of the 617 identified citations, 12 articles matched the inclusion criteria.

CONCLUSION

The moral distress experienced in countries and regions with similar cultures and geographies was parallel. The situations that cause the most moral distress are futile-care to prolong death, unnecessary tests and treatments, and working with incompetent healthcare personnel.

Cultural Sensitivity in Preventive Infant Mental Health Care: An Example From the Developmental Guidance Project FIRST STEPS in Belgium

Preventive developmental guidance programmes have been applied on a large scale for several decades now in many western countries. But how do we adapt these programs to families with very different ethnic backgrounds? How can we concretise the concept of cultural sensitivity into that context? The plea of von Klitzing, the former President of the World Association for Infant Mental Health, for further reflection on the concretization of cultural sensitivity in the context of infant mental health care is the main source of inspiration to this article. von Klitzing speaks out against the point of view in which universal children’s rights or conditions that are seen as promoting a child’s development all around the globe, are criticized as being only western conceptions and thereby culturally biassed. Following this kind of reasoning, a culturally relativistic stance on what a facilitating environment is, should be adopted. Such a discussion in terms of universalism versus relativism, though, as argues von Klitzing, is an old antagonism that cannot inspire us for the adaptation of early health care practices or developmental guidance programs that are fitting in to the needs of families and their babies that are living in multicultural contexts. Although it could be interesting to think about how certain universal principles of good-enough child care can be formulated or embodied in an intercultural variety of ways, these variable expressions of the worldwide agreed upon principles of good early mental health care will only be culture-specific translations of these universal principles. They can’t in any way be seen as an argument against the universality of these principles, as argues von Klitzing, who is describing another way of solving the problem of the cultural relativist criticism on the universality of principles of good infant mental health: culture sensitive infant mental health services. But, to make the principle of cultural sensitivity work in practice, we need to fill it with content. This article is mainly on what it concretely means to work in a culture sensitive way in our preventive practice within the FIRST STEPS program, a Belgian project for immigrant and exiled mothers and their children from zero to three.

The effects of nursing students' conscientious intelligence on their cultural sensitivity levels

PURPOSE

This study was carried out to determine the relationship between the level of conscientious intelligence and cultural sensitivity among nursing students.

METHODS

This is a cross-sectional descriptive design. The sample of this study consisted of 172 nursing students. The study data were collected using a sociodemographic data form, the intercultural sensitivity scale, and the conscientious intelligence scale.

RESULTS

The mean intercultural sensitivity scale score was 80.07 ± 10.68, and the mean conscientious intelligence scale score was 120.89 ± 12.32. Also, a positive relationship was determined between both scales that the nursing students obtained.

PRACTICE IMPLICATIONS

The scale scores of nursing students were found to be a moderate level. As students' conscientious intelligence levels increased, their intercultural sensitivity was determined to increase, as well.

A Systematic Review of Assessment Tools Measuring Cultural Competence Outcomes Relevant to Pharmacy Education

Objective. To identify and describe validated assessment tools that measure cultural competence and are relevant to pharmacy education.Methods. A systematic approach was used to identify quantitative cultural competence assessment tools relevant to pharmacy education. A systematic search of the literature was conducted using the OVID and EBSCO databases and a manual search of journals deemed likely to include tools relevant to pharmacy education. To be eligible for the review, the tools had to be developed using a study sample from the United States, have at least one peer-reviewed validated publication, be applicable to the pharmacy profession, and be published since 2010.Results. The systematic literature and manual search identified 27 tools. Twelve assessment tools met the criteria to be included in the summary and their relevancy to pharmacy education is discussed.Conclusion. A review of literature demonstrates that assessment tools vary widely and there is no one tool that can effectively assess all aspects of cultural competence in pharmacy students or the Doctor of Pharmacy curriculum. As cultural competence is a priority within the accreditation standards for pharmacy education, PharmD programs are encouraged to develop additional tools that measure observed performance.

Survey of Japanese Medical Schools on Involvement of English-speaking Simulated Patients to Improve Students' Patient Communication Skills

PHENOMENON

With increasing mobility of people across borders and medical tourism, more countries are called to make their healthcare environment ready to accept foreign patients. Patient communication skills in English are indispensable for healthcare professionals in non-English-speaking countries. This is not only in caring for foreign patients within the country but also contributing to the global health by practicing outside of the country. Although Japanese-speaking simulated patients have been involved in medical education in Japan since the 1970s and with Objective Structured Clinical Examinations formally implemented in 2005, very few medical schools have been working with English-speaking simulated patients (ESSPs).

APPROACH

A nationwide survey was conducted to investigate the involvement of ESSPs at medical schools in Japan. A questionnaire with closed and open-ended questions was mailed to the deans of 80 medical schools to determine the current ESSP involvement and the problems educators were facing in regard to working with or not working with ESSPs. The survey was conducted from November 2015 through March 2016. Data were analyzed to find problems regarding ESSPs so that their involvement could be enhanced toward developing medical students' patient communication skills.

FINDINGS

Responses from 60 medical schools (75% response rate) were received and analyzed. Among them, 22 schools were working with ESSPs, and 23 schools were willing to introduce them into their programs. The background of ESSPs varied with international students or faculty often filling the role. Many ESSPs received less than two hours of training. ESSP programs were required in the preclinical years, and more often elective in the clinical years. Medical schools mentioned the difficulty of recruiting and training ESSPs and finding the funding to pay for their remuneration and travel expenses.

INSIGHTS

ESSPs were increasingly used in Japanese medical schools but they were haphazardly recruited from within the school or from the local community, not trained fully, and inconsistent performers. Nevertheless, an encounter with a non-Japanese English-speaking simulated patient was regarded effective in developing medical students' patient communication skills in English (language skills and cultural sensitivity). Ways must be found to assure the availability, quality, and sustainability of trained ESSPs so that more authentic practices and high-stakes skills exams can be introduced to ensure patient safety in the globalized world. As countries become more multicultural and international migration of healthcare professionals expands, ESSPs can be a valuable source for training and assessing international medical students and trainees' English-language patient interviewing skills. Regional hubs of ESSPs and the use of telehealth in collaboration with educators around the world could enhance the use of ESSPs worldwide.

Strategies for Providing Culturally Sensitive Care to Diverse Populations

ABSTRACT

Nurses are called to care for patients and families from many backgrounds and cultural groups. This article discusses the key strategies of cultural humility, conscientious practice, and establishing trust that promotes cultural sensitivity as well as congruence with Christian values. When implemented, these strategies can facilitate the provision of quality, culturally sensitive patient care that conforms to a biblical worldview.

Development of a culturally adaptable internet-based cognitive behavioral therapy for Japanese women with bulimia nervosa

BACKGROUND

The process of cultural adaptation of internet-based cognitive behavioral therapy (ICBT) programs for bulimia nervosa (BN) have rarely been reported despite the potential influence of cultural adaptation of psychosocial interventions on therapeutic response.

AIM

This study aimed to illustrate development process of an ICBT program for Japanese women with bulimia nervosa (BN).

METHODS

A mixed methods approach was used to assess cultural adaptation of the prototype of an original ICBT program by using the Cultural Relevance Questionnaire (CRQ). Five women with BN and seven clinicians were interviewed using the CRQ.

RESULTS

Quantitative analyses were conducted to assess cultural adaptation of the prototype of the program and participants rated cultural adaptation as high. A qualitative analysis of the mixed method supported the culturally sensitive changes implemented.

CONCLUSIONS

The results of this study show that a series of processes can make ICBT programs more culturally adapted.

Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.

Objective

To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.

Design

The Campinha-Bacote model of cultural competence was used as the primary reference.

Method

A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.

Results

Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.

Conclusions

Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

Southeast and East Asian immigrant women's transnational postpartum experiences: A meta-ethnography

The increase in births to Southeast and East Asian (SEEA) immigrants in their adopted countries is of international importance. SEEA women experience the postpartum period differently than that of the general population. Despite the documented difference, there is limited representation of SEEA women in the literature. The purpose of this meta-ethnography is to synthesise the qualitative findings from different research studies examining the experiences of SEEA immigrant women during the first 4-6 weeks of the postpartum period and has been written in adherence with enhancing transparency in reporting the synthesis of qualitative research (PRISMA). Noblit and Hare's meta-ethnographic approach was used. Seven articles (four qualitative and three mixed-methods studies) were reviewed, analysed and synthesised. Four themes emerged: two were facilitators of birth culture (availability and quality of social support and maternity care provider cultural knowledge and response) and two were barriers to birth culture (lack of structural and social support and cultural alienation after childbirth). Due to lack of structural and social support in SEEA immigrant women's adopted countries, they also experienced social and economic hardships after childbirth and made conscious decisions to modify their postpartum cultural practices out of convenience and practicality. SEEA immigrant women also experienced discrimination from maternity care providers, which prevented them from fully engaging in postpartum cultural practices. Maternity care providers can advocate and intervene for SEEA immigrant women by eliciting any postpartum cultural beliefs, assess their social and economic needs early on in prenatal care and make culturally congruent referrals based on those assessments.

Tonsil Riots and Vaccine Hesitancy: A 100-Year Legacy of Medical Mistrust

The "tonsil riots" of 1906 were panics that developed at several public schools in historically immigrant-dominated neighborhoods of New York City (NYC). Per archived newspaper articles, several NYC public schools asked for parental consent to have Board of Health physicians come and perform tonsillectomy and adenoidectomy on their students. When children subsequently returned home from school "drooling mouthfuls of blood and barely able to speak," mothers reacted with panic and flocked to the schools demanding the safe return of their children. Police, ultimately, had to be called in to manage the crowds, and the events of 1906 largely faded from the public eye. However, these events can offer important lessons in communication and cultural humility as the United States continues its mass vaccination against coronavirus disease 2019.

An Opportunity to Integrate Cultural Sensitivity Training Into the Doctor of Pharmacy Curriculum

Instructors of pharmacy skills-based laboratory courses are positioned to prepare students to be practice-ready practitioners through use of hands-on instructional activities essential for pharmacists. This commentary explores an approach to developing cultural sensitivity in pharmacy students, a skill which is reflected in Accreditation Council for Pharmacy Education (ACPE) Standard 3.5 and viewed by the authors as a critical skill for all healthcare practitioners. This commentary challenges the Academy to develop best practices for promoting cultural sensitivity in student-learners with the goal of producing students aware of how their own experiences may influence health inequities. The authors propose, using the model of self-efficacy theory as a framework, that skills-based pharmacy education is an ideal platform for cultural sensitivity skill development and engagement because of its ability to go beyond knowledge attainment and influence student abilities, behaviors, and attitudes. The authors' recommendations include that members of the Academy self-assess personal and institutional cultural sensitivity, ensure integration of cultural sensitivity in curriculum, use self-efficacy theory as a guide to integrate best practices for providing culturally sensitive care in laboratory activities, and develop best practices.

Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study

OBJECTIVE

The increasing ethnic diversity in the European Union (EU) calls for adaptations to neuropsychological assessment practices. The aims of this study were to examine the current state of cross-cultural neuropsychological assessment in EU-15 countries and to provide recommendations for researchers and policy makers.

METHOD

Twelve experts from nine EU-15 countries participated in a Delphi consensus study involving two sequential rounds of web-based questionnaires and an in-person consensus meeting. The experts individually rated Delphi topics on the basis of importance (scale 1-10). The degree of consensus was determined by assessing first and third quartiles (Q1 and Q3) and medians.

RESULTS

Consensus outcomes showed the following priorities: (a) the development of tests (median importance rating 10, Q1-Q3: 9-10), (b) the collection of normative data (median importance rating 9, Q1-Q3: 8-10), and (c) more training, awareness, and knowledge regarding cross-cultural assessment among neuropsychologists in the EU (median importance rating 9, Q1-Q3: 8-10). Whereas memory tests were often available, tests measuring social cognition (median 9, Q1-Q3: 8-10) and language (median 9, Q1-Q3: 7-10) are particularly lacking. Recommendations were made regarding essential skills and knowledge necessary for cross-cultural neuropsychological assessment.

CONCLUSIONS

This study in a small group of experts suggests that the development and availability of cross-cultural tests and normative data should be prioritized, as well as the development and implementation of training initiatives. Furthermore, EU guidelines could be established for working with interpreters during neuropsychological assessment. Before implementing these recommendations, follow-up studies are recommended that include more minority neuropsychologists and community stakeholders.

Cultivating Student Belonging and School Connectedness

The effect on students from the COVID-19 pandemic, violence related to racism, and loss of customary school routines may cause loss of both school connection and a sense of belonging. School nurses can positively influence student belonging and school connection as they encounter students throughout in-person school and virtual school environments. School nurses build connections with students whom they know and outreach to students whom they identify as vulnerable in the areas of belonging and school connectedness. With a mind-set of the Framework for 21st Century School Nursing Practice and in collaboration with a school team implementing a multitiered system of support, school nurses intentionally outreach and cultural sensitivity to grow positive school climate that benefits students.

The Stroman Effect: Participants in MEN Count, an HIV/STI Reduction Intervention for Unemployed and Unstably Housed Black Heterosexual Men, Define Its Most Successful Elements

Interventionists often prioritize quantitative evaluation criteria such as design (e.g., randomized controlled trials), delivery fidelity, and outcome effects to assess the success of an intervention. Albeit important, criteria such as these obscure other key metrics of success such as the role of the interactions between participants and intervention deliverers, or contextual factors that shape an intervention’s activities and outcomes. In line with advocacy to expand evaluation criteria for health interventions, we designed this qualitative study to examine how a subsample of Black men in MEN Count, an HIV/STI risk reduction and healthy relationship intervention with employment and housing stability case management for Black men in Washington, DC, defined the intervention’s success. We also examined the contextual factors that shaped participation in the study’s peer counseling sessions. We conducted structured interviews with 38 Black men, ages 18 to 60 years (M = 31.1, SD = 9.33) who completed at least one of three peer counseling sessions. Analyses highlighted three key themes: (a) the favorable impact of Mr. Stroman, the lead peer counselor, on participants’ willingness to participate in MEN Count and disclose their challenges—we dubbed this the “Stroman Effect”; (b) the importance of Black men intervention deliverers with relatable life experiences; and (c) how contextual factors such as the HIV/AIDS epidemic, needs for housing and employment services and safe spaces to talk about challenges, and absentee fathers shaped participation. We discuss the study’s implications for sustainable programs after funding ends and future multilevel health interventions to promote health equity for poor urban Black men.

Cross-Cultural Bayesian Network Analysis of Factors Affecting Residents' Concerns About the Spread of an Infectious Disease Caused by Tourism

COVID-19 has had a severe impact globally, and the recovery can be characterized as a tug of war between fast economic recovery and firm control of further virus-spread. To be prepared for future pandemics, public health policy makers should put effort into fully understanding any complex psychological tensions that inherently arise between opposing human factors such as free enjoyment versus self-restriction. As the COVID-19 crisis is an unusual and complex problem, combinations of diverse factors such as health risk perception, knowledge, norms and beliefs, attitudes and behaviors are closely associated with individuals' intention to enjoy the experience economy but also their concerns that the experience economy will trigger further spread of the infectious diseases. Our aim is to try identifying what factors are associated with their concerns about the spread of the infectious disease caused by the local experience economy. Hence, we have chosen a "data-driven" explanatory approach, "Probabilistic Structural Equational Modeling," based on the principle of Bayesian networks to analyze data collected from the following four countries with indicated sample sizes: Denmark (1,005), Italy (1,005), China (1,013), and Japan (1,091). Our findings highlight the importance of understanding the contextual differences in relations between the target variable and factors such as personal value priority and knowledge. These factors affect the target variable differently depending on the local severity-level of the infections. Relations between pleasure-seeking via the experience economy and individuals' anxiety-level about an infectious hotspot seem to differ between East Asians and Europeans who are known to prioritize so-called interpersonal- and independent self-schemes, respectively. Our study also indicates the heterogeneity in the populations, i.e., these relations differ within the respective populations. Another finding shows that the Japanese population is particularly concerned about their local community potentially becoming an infectious hotspot and hence expecting others to comply with their particular social norms. Summarizing, the obtained insights imply the importance of considering both cultural- and individual contexts when policy makers are going to develop measures to address pandemic dilemmas such as maintaining public health awareness and accelerating the recovery of the local experience economy.