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Withall L, Ryder C, Mackean T, Edmondson W, Sjoberg D, McDermott D, Wilson A. Assessing cultural safety in Aboriginal and Torres Strait Islander Health. Aust J Rural Health 2021; 29:201-210. [PMID: 33793013 DOI: 10.1111/ajr.12708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore how nurses and midwives (trained at Flinders University in Adelaide) from rural, remote and urban locations view the impact of cultural safety training on their practice and the extent to which they incorporated cultural safety principles into their practice. DESIGN qualitative research study. SETTING rural, remote and urban locations across Australia. PARTICIPANTS Nurses and midwives who had undertaken cultural safety training at Flinders University as part of their undergraduate degree. METHODS Participants were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Transcripts were coded independently by members of the research team. MAIN OUTCOME MEASURES The use of cultural safety principles in participants' practice, and the extent to which they were applied, was determined. Barriers and enablers to enacting cultural safety in the workplace were also identified. RESULTS 10 individuals participated in an interview (7 nurses and 3 midwives). The Modified Monash Model was used to classify participant location with the following observed: MM1, six; MM2, two; MM5, one; MM6, one. 3 participants were from the Northern Territory and 7 from South Australia. Participants were at varying stages in their journey of cultural safety, ranging from early stages to those able to embody the Cultural Safety Principles and negotiate barriers to provide culturally safe care. Educational strategies for participants to progress their cultural safety journey were also identified. CONCLUSION The extent to which cultural safety principles are applied in practice is diverse amongst the nurses and midwives that participated in this study, demonstrating that cultural safety is a journey and ongoing support is needed.
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Affiliation(s)
- Liz Withall
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Courtney Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tamara Mackean
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Wendy Edmondson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David Sjoberg
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Dennis McDermott
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Annabelle Wilson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062851. [PMID: 33799637 PMCID: PMC7999544 DOI: 10.3390/ijerph18062851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz's approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.
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Prajapati R, Liebling H. Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK. J Racial Ethn Health Disparities 2021; 9:598-619. [PMID: 33686621 PMCID: PMC8897382 DOI: 10.1007/s40615-021-00993-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/13/2022]
Abstract
Background Despite calls to address ethnic inequalities to accessing mental health services in the UK, governmental initiatives have had limited impact. Studies indicate that South Asian communities underutilise mental health services. Previous reviews have identified cultural and institutional factors that may influence service use, but these are mostly narrative and limited in their scope. Method A systematic literature search resulted in fifteen studies exploring the experiences of seeking help and barriers to accessing and using services from the perspective of British South Asian service users. Findings Qualitative data was synthesised through meta-ethnography, and three themes emerged: Distanced from Services, Dilemma of Trust and Threat to Cultural Identity. South Asian service users were positioned at a distance from being able to access services and stuck in a dilemma of mistrusting White and Asian professionals. They constructed their cultural identity through a set of important values which were neglected by mental health services. Service users, therefore, appeared to engage in an ongoing evaluation of the potential benefits of accessing services against the risks of threat to their personal and cultural identities. The findings are discussed in relation to Eurocentric models of care and community engagement approaches. Conclusion The review argues that institutional racism and cultural dissonance marginalise South Asian service users from access to quality and effective mental healthcare. It is recommended that services acknowledge the impact of alienation and powerlessness and advance their practices to establish trust and cultural safety for South Asian service users in the UK.
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Affiliation(s)
- Riddhi Prajapati
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB UK
| | - Helen Liebling
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB UK
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Woods P, Peternelj-Taylor C. Correctional nursing in Canada's Prairie provinces: Roles, responsibilities, and learning needs. Can J Nurs Res 2021; 54:59-71. [PMID: 33657864 PMCID: PMC8899807 DOI: 10.1177/0844562121999282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Nurses represent the largest group of health care professionals working with
incarcerated persons, yet there is limited understanding of their learning
needs, or their roles and responsibilities; and what is known is poorly
disseminated. Purpose The goal of this research was to describe the roles, responsibilities, and
learning needs of correctional nurses practicing in provincial correctional
facilities in Alberta and Manitoba, and to add these data to the existing
data set from Saskatchewan. Methods Three hundred and forty nurses working in provincial correctional facilities
in western Canada were invited to complete a self-administered online survey
consisting of a Learning Needs Assessment questionnaire (demographic
information, knowledge and learning needs, and professional development);
and the Staff Questionnaire (which targeted specific skill sets relevant to
clinical practice in secure environments). Eighty-two nurses completed the
online survey (overall response rate 24%). Results Overall, those who participated were experienced in nursing and correctional
nursing. The learning needs they identified aligned with their correctional
nursing roles and unique practice settings. In particular, issues related to
the care of incarcerated persons with mental health disorders and related
care were paramount (self-harming behaviours, suicide, mental health
assessments in general). In response to the five comprehensive skill sets
assessed in the Staff Questionnaire, respondents rated their involvement and
importance of the individual skills as important to varying degrees. Conclusions The results of this survey shed light on contemporary developments in
correctional nursing within provincial correctional facilities in western
Canada and provide a foundation for continuing professional education and
development, practice, and future research initiatives.
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Affiliation(s)
- Phil Woods
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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355
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Hikaka J, Jones R, Hughes C, Connolly MJ, Martini N. Developing pharmacist-facilitated medicines review services for community-dwelling Māori older adults in New Zealand - A qualitative study exploring stakeholder views. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:564-573. [PMID: 32736415 DOI: 10.1111/hsc.13119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/17/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Māori (Indigenous people of New Zealand [NZ]) experience inequitable health outcomes compared to non-Māori, across the spectrum of clinical care, including those relating to medicines. Internationally, pharmacist-facilitated medicines review services have been shown to benefit older adults. Despite national policies calling for the increased implementation of these services, NZ data relating to them remain limited, and these services may increase disparities between Māori and non-Māori. There are currently no medicines review services developed specifically for Māori older adults. The current study aims to elicit stakeholder views of current and potential pharmacist services to help inform the development of a pharmacist-facilitated medicines review service for community-dwelling Māori older adults. Kaupapa Māori theory was applied within this qualitative research. Purposive sampling was used to recruit participants who were involved in providing, planning, funding developing or culturally supporting health services in Waitematā District Health Board, Auckland, NZ. Data were collected in semi-structured interviews and in a focus group and analysed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research. Eleven participants took part in the research in one focus group (n = 4) and seven semi-structured interviews, conducted between November 2018 and March 2019. Three main themes were generated: (a) moving out of the shadows - claiming pharmacists' unique role within a healthcare whānau (family); (b) 'give them the power to be able to ask' - upholding the mana (self-esteem, pride, standing) and autonomy of kaumātua (Māori older adults) and (c) rights versus realities - reimagining pro-equity Māori health services within the constraints of the colonial health system. The right of Māori to experience equitable health outcomes needs to be included in policy and also operationalised in relation to medicines review services through improved utilisation of pharmacist skills and improving Māori older adults' autonomy and control.
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Affiliation(s)
- Joanna Hikaka
- School of Pharmacy, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | | | - Martin J Connolly
- Waitematā District Health Board, Auckland, New Zealand
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Nataly Martini
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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356
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Lagana` L, Balian OA, Nakhla MZ, Zizumbo J, Greenberg S. A preliminary model of health regarding sexual and ethnic minority older adults. CULTURE, HEALTH & SEXUALITY 2021; 23:333-348. [PMID: 32133922 PMCID: PMC7773154 DOI: 10.1080/13691058.2019.1710566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/27/2019] [Indexed: 05/28/2023]
Abstract
Older individuals with sexual/gender minority and minority racial/ethnic identities typically face unique challenges, along with opportunities to overcome these obstacles. Published studies on the difficulties faced by sexual and gender minorities are available; however, research on older adults with both racial/ethnic minority and sexual and gender minority identities is rarer. These individuals must confront various forms of discrimination related to ageism, homophobia and racism. Resilience likely plays a role in the ability to manage and survive multiple challenges and discriminatory experiences, yet targeted research on these populations is lacking. This paper offers a preliminary model that incorporates prevalent threats to these populations' well-being and their deleterious psychosocial correlates, especially, whenever available, the unique challenges that older individuals must face when age, sexual orientation and race/ethnicity intersect. Recommendations are made to optimise the expansion and empirical testing of this preliminary model.
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Affiliation(s)
- Luciana Lagana`
- Department of Psychology, California State University Northridge, CA, USA
| | - Ovsanna A. Balian
- Doctoral Program in Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Marina Z. Nakhla
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Juan Zizumbo
- Department of Psychology, California State University Northridge, CA, USA
| | - Shayna Greenberg
- Department of Psychology, California State University Northridge, CA, USA
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357
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Leitch S, Smith A, Crengle S, Stokes T. The views of New Zealand general practitioners and patients on a proposed risk assessment and communication tool: a qualitative study using Normalisation Process Theory. Implement Sci Commun 2021; 2:16. [PMID: 33568225 PMCID: PMC7877107 DOI: 10.1186/s43058-021-00120-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Communicating risks of medication harm and obtaining informed consent is difficult due to structural barriers, language and cultural practices, bias and a lack of resources appropriately tailored for the health literacy of most patients. A decision support tool was proposed to alert prescribers of risk and provide tailored information for patients to facilitate informed decision-making with patients and their whānau (family) around medication use. Patient and prescriber co-design was used to ensure the tool was designed to best meet the needs of end-users and avoid increasing health inequity. This paper describes the first stage of the co-design process. METHOD Normalisation Process Theory (NPT) was used to prospectively evaluate the tool. Semi-structured interviews were held with fifteen patients (five Māori, five Pasifika and five NZ European) and nine general practitioners (two Māori and seven European). RESULTS Three themes were identified, which related to the three NPT concepts most relevant to developing the tool. Theme 1 (coherence: meaning and sense making by participants) explored participants' understanding of prescribing safety, medication harm and risk, which is based on experience. Patients want as much information as possible about their medications and risk, but doctors find it difficult to communicate that information. Theme 2 related to the NPT concept of cognitive participation (commitment and engagement by participants) explored what participants thought about a prescribing decision support tool. Participants were cautiously optimistic, but worried about potential harm arising from its use. They also identified requirements for the tool and features to avoid. Theme 3 describes the collective action required for successful implementation of the tool; namely, culturally safe and trustworthy doctor-patient relationships. CONCLUSION Patients and general practitioners provided different perspectives when prospectively evaluating the proposed risk assessment and communication tool. This co-design research identified important pre-requisites for the tool and features to avoid and novel ideas for the proposed tool. Overall participants supported the development of the proposed risk assessment and communication tool, but identified the important role that doctor-patient relationships would play to ensure successful implementation. The use of Māori and Pacific languages in the proposed tool may enhance engagement and understanding.
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Affiliation(s)
- Sharon Leitch
- University of Otago Medical School, Dunedin, New Zealand.
| | - Alesha Smith
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Sue Crengle
- University of Otago Medical School, Dunedin, New Zealand
| | - Tim Stokes
- University of Otago Medical School, Dunedin, New Zealand
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358
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Kidd J, Cassim S, Rolleston A, Chepulis L, Hokowhitu B, Keenan R, Wong J, Firth M, Middleton K, Aitken D, Lawrenson R. Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities. BMC Cancer 2021; 21:121. [PMID: 33541294 PMCID: PMC7863263 DOI: 10.1186/s12885-021-07862-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07862-0.
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Affiliation(s)
- Jacquie Kidd
- School of Clinical Sciences, Faculty of Environmental and Health Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Anna Rolleston
- The Centre for Health, PO Box 13068, Tauranga, 3141, New Zealand
| | - Lynne Chepulis
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Brendan Hokowhitu
- Te Pua Wananga ki te Ao Faculty of Māori and Indigenous Studies, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Janice Wong
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Karen Middleton
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Denise Aitken
- Lakes District Health Board, Rotorua Hospital, Private Bag 3023, Rotorua Mail Centre, Rotorua, 3046, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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359
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Vass A, Adams K. Educator perceptions on teaching Indigenous health: Racism, privilege and self-reflexivity. MEDICAL EDUCATION 2021; 55:213-221. [PMID: 32776344 DOI: 10.1111/medu.14344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION General practitioners (GPs) and family medicine clinicians should respond to Indigenous peoples' health needs. However, medical graduates feel underprepared for this work. The foundational elements of racism, white privilege and cultural self-reflexivity remain conspicuously absent from medical education in general practice programmes, despite inclusion in curriculum frameworks. This study explored the perception and experiences of Australian GP educators in teaching this content. METHODS We undertook a qualitative study that gathered data through semi-structured interviews with GP educators (n = 12) at a medical school in Victoria, Australia. We utilised the Reflection learning domain of the Aboriginal and Torres Strait Islander Health Curriculum Framework to shape interview questions on racism, white privilege and cultural self-reflexivity. Data were analysed from constructivist and Critical Indigenous Theory paradigms to formulate key themes. RESULTS General practitioner educators were challenged by Reflection content, struggled to articulate a refined pedagogy for provision of anti-racist, self-reflexive learning and felt poorly qualified to teach Indigenous health, articulating preference for delegation of teaching to Indigenous peoples. They simultaneously stated the importance of inclusion of Reflection teaching in general practice, alongside expressing beliefs that appeared to devalue its perceived relevance. Students were perceived as being either disinterested or incapable of Reflection learning, or conversely, more engaged than previous generations with these topics. DISCUSSION The results call into question how skilled are GP educators to teach elements of Indigenous health education such as racism, white privilege and cultural self-reflexivity. Unskilled educators can reinforce colonialism in curricula, including through minimisation of content. Stronger anti-racist pedagogy is urgently required in medical education. Vital to this is active research on educator preparedness, evidence-based teaching models and accountable curriculum accreditation.
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Affiliation(s)
- Alyssa Vass
- Department of General Practice, Monash University, Melbourne, Vic., Australia
| | - Karen Adams
- Gukwonderuk Indigenous Health Unit, Monash University, Melbourne, Vic., Australia
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360
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Svalastog AL, Wilson S, Gaski H, Senior K, Chenhall R. Double perspective in the Colonial present. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-020-00156-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AbstractThis paper will explain the concept of double perspective and the impact that this cultural understanding may have on the health of the Indigenous peoples of Scandinavia. In inter-cultural communication, one set of meanings may be discernible to the outsider while a whole extra set of restricted or underlying meanings are only accessible for those people who have the cultural knowledge to discern them. These different sets of meanings embody a double perspective. It is not dual perspectives on the same reality but rather seeing two separate but overlapping realities. We will discuss the layers of meaning which are involved in the interactions between public healthcare institutions, clinicians and staff, and Indigenous people including the Sámi. These interactions are influenced by the impact of colonization and the ongoing epistemicide of Indigenous thought. By realising the improved resilience that a double perspective brings to Indigenous peoples, an awareness of the inclusion and exclusion of Indigenous persons, cultures and histories should become established in public institutions and in everyday life. A double perspective carries Sámi resilience, and should be understood as a key to support individual health, and also the collective wellbeing of a people living on their traditional yet colonized land.
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361
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A qualitative study on health care providers' experiences of providing comprehensive abortion care in Cox's Bazar, Bangladesh. Confl Health 2021; 15:6. [PMID: 33441171 PMCID: PMC7805103 DOI: 10.1186/s13031-021-00338-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers’ perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox’s Bazar, Bangladesh and identifies barriers and facilitators in service provision. Method In-depth interviews (n = 24) were conducted with health care providers (n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants (n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach. Results The national menstrual regulation policy provided a favourable legal environment and facilitated the provision of comprehensive abortion care, while the Mexico City policy created organisational barriers since it made organisations unable or unwilling to provide the full comprehensive abortion care package. Supplies were available, but a lack of space created a barrier to service provision. Although training from organisations had made the health care providers confident and competent and had facilitated the provision of services, their knowledge of the national abortion law and menstrual regulation policy was limited and created a barrier to comprehensive abortion services. Even though the health care providers were willing to provide comprehensive abortion care and had acquired skills and applied strategies to communicate with and provide care to Rohingya women, their personal beliefs and their perceptions of Rohingya women influenced their provision of care. Conclusion The availability and accessibility of comprehensive abortion care was limited by unfavourable abortion policies, a lack of privacy, a lack of knowledge of abortion laws and policies, health care providers’ personal beliefs and a lack of cultural safety. To ensure the accessibility and availability of quality services, a comprehensive approach to sexual and reproductive health and rights is needed. Organisations must ensure that health care providers have knowledge of abortion policies and the ability to provide quality care that is woman-centred and non-judgmental. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00338-9.
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Pimentel J, Kairuz C, Merchán C, Vesga D, Correal C, Zuluaga G, Sarmiento I, Andersson N. The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique. TEACHING AND LEARNING IN MEDICINE 2021; 33:58-66. [PMID: 32812831 DOI: 10.1080/10401334.2020.1805323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.
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Affiliation(s)
- Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Department of Family Medicine and Public Health, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- Traditional Health Systems Studies Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Camila Kairuz
- Department of Family Medicine and Public Health, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Claudia Merchán
- Department of Family Medicine and Public Health, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Daniel Vesga
- Department of Family Medicine and Public Health, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Camilo Correal
- Department of Family Medicine and Public Health, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- Traditional Health Systems Studies Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Germán Zuluaga
- Traditional Health Systems Studies Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Traditional Health Systems Studies Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Tropical Disease Research (CIET), Autonomous University of Guerrero, Acapulco, Guerrero, Mexico
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363
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Crooks N, Singer R, Tluczek A. Black Female Sexuality: Intersectional Identities and Historical Contexts. ANS Adv Nurs Sci 2021; 44:52-65. [PMID: 33181567 DOI: 10.1097/ans.0000000000000332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Black females experience significant sexual health disparities. Intersectionality theory offers nurses a framework to address health disparities. Intersectionality theory examines how categorical identities of difference confer power or oppression, affect social interactions, and influence individuals' engagement with institutional structures. This secondary analysis of qualitative data details the damaging effects that power, oppression, and disadvantaged identities have on the sexual health of Black women. Twenty participants explained how the intersection of race, gender, age, education, and sexuality influences sexual health risk. Our expanded model of intersectionality theory emphasizes historical context with implications for research, practice, and education to promote health equity.
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Affiliation(s)
- Natasha Crooks
- University of Illinois Chicago College of Nursing, Chicago (Drs Crooks and Singer); and School of Nursing, University of Wisconsin-Madison, Madison (Dr Tluczek)
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364
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“Love and Prayer Sustain Our Work” Building Collective Power, Health, and Healing as the Community Health Board Coalition. GENEALOGY 2020. [DOI: 10.3390/genealogy5010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the course of the last few months, we have seen how structural racism has compounded the impact of COVID-19 on Black, Indigenous, and People of Color (BIPOC) in the United States, resulting in disparate rates of infection and death. The COVID-19 pandemic has revealed how the consequences of deeply entrenched inequities are fatal to BIPOC communities, whether death is a result of the novel coronavirus or the everyday violence of structural racism that manifests as poor health outcomes. We examine the formation of the Community Health Board Coalition (CHBC), a BIPOC-led organization in Washington state, to show how 15 communities have organized for health and healing amidst the collective trauma associated with COVID-19. We note that biopower—literally power over life, the unspeakable—and slow violence have been normalized and escalated in our communities. The use of an antiracist lens and decolonial practices have assisted us in our survivance (survival and resistance). We use autoethnography and testimonio as decolonial theory and method to give voice to individual and collective experiences that brought us to our roles as CHBC founding members and inaugural cochairs.
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365
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Rissel C, Ryder C, Wilson A, Richards B, Bower M. We need to value Aboriginal and Torres Strait Islander cultural education in the Northern Territory health services. Aust J Rural Health 2020; 28:521-522. [PMID: 33191590 DOI: 10.1111/ajr.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chris Rissel
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Courtney Ryder
- Public Health, Indigenous Health, Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Annabelle Wilson
- Indigenous Health, Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Barbara Richards
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Madeleine Bower
- Indigenous Health, Flinders Northern Territory, Flinders University, Katherine, NT, Australia
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366
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Anderson NE, Robinson J, Moeke-Maxwell T, Gott M. Paramedic care of the dying, deceased and bereaved in Aotearoa, New Zealand. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1841877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Natalie Elizabeth Anderson
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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367
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Gubhaju L, Williams R, Jones J, Hamer D, Shepherd C, McAullay D, Eades SJ, McNamara B. "Cultural Security Is an On-Going Journey…" Exploring Views from Staff Members on the Quality and Cultural Security of Services for Aboriginal Families in Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8480. [PMID: 33207696 PMCID: PMC7697803 DOI: 10.3390/ijerph17228480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
Cultural security is a key element of accessible services for Indigenous peoples globally, although few studies have examined this empirically. We explored the scope, reach, quality, and cultural security of health and social services available to Aboriginal and/or Torres Strait Islander families in Western Australia (WA), from the point of view of staff from the services. We recruited staff from health and social services for Aboriginal people in the Perth, Kalgoorlie, Great Southern, and South West regions of WA between December 2015 and September 2017 to complete online surveys. We examined the proportions of participants that responded saying the service was culturally secure, the reasons for the response, and perceived factors related to a high-quality service. Sixty participants from 21 services responded to the survey. Seventy-three percent stated the service was culturally secure; however, only 36% stated that the staff employed at the service had sufficient knowledge on cultural security. Participants suggested having Aboriginal staff and better cultural awareness training as methods to improve cultural security within the service. Participants highlighted that staffing, funding for resources, and patient financial difficulties in accessing care as key areas for quality improvement. Much greater effort is required in improving knowledge through on-going training of staff in the practice of culturally safe care. Organisations must also be required to meet specific standards in cultural safety.
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Affiliation(s)
- Lina Gubhaju
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Robyn Williams
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, 7 Parker Place, Technology Park, Bentley, WA 6102, Australia;
| | - David Hamer
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
| | - Carrington Shepherd
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia;
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, 90 South Street, Murdoch, WA 6150, Australia
| | - Dan McAullay
- Kurongkurl Katitjin, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia;
| | - Sandra J. Eades
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
- Curtin Medical School, Curtin University, 410 Koorliny Way, Bentley, WA 6102, Australia
| | - Bridgette McNamara
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3010, Australia; (R.W.); (D.H.); (S.J.E.); (B.M.)
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368
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Cultural Humility: A Proposed Model for a Continuing Professional Development Program. PHARMACY 2020; 8:pharmacy8040214. [PMID: 33202754 PMCID: PMC7712005 DOI: 10.3390/pharmacy8040214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Continuing professional development (CPD) is an essential component of professional practice for registered health practitioners to maintain and enhance knowledge, skills and abilities. There are many topics that practitioners may pursue relevant to their practice environment, and, in recent years, providing culturally safe and respectful practice is an emerging area of need. Unfortunately, many health professionals, whilst willing to offer cultural safe healthcare, may be uncertain of how to enact that practice. The World Health Organisation recognises attainment of the highest possible standard of health as a basic human right, and cultural safety is increasingly becoming an expectation of health professionals. To address this need and the insufficiency of support in the literature, the authors have presented a discussion paper on various aspects of cultural safety and the underlying constructs, such as cultures, that support it. The discussion takes into account core constructs that signpost the path to cultural safety and recognises the role and accountability of all levels of the healthcare system, not merely the practitioner. Finally, we propose a model program for a cultural humility CPD activity incorporating pre-work, online modules, interactive workshop, reflection on professional practice and a post-workshop evaluation.
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369
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Semlali I, Tamches E, Singy P, Weber O. Introducing cross-cultural education in palliative care: focus groups with experts on practical strategies. BMC Palliat Care 2020; 19:171. [PMID: 33172461 PMCID: PMC7656760 DOI: 10.1186/s12904-020-00678-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The linguistic and cultural diversity found in European societies creates specific challenges to palliative care clinicians. Patients' heterogeneous habits, beliefs and social situations, and in many cases language barriers, add complexity to clinicians' work. Cross-cultural teaching helps palliative care specialists deal with issues that arise from such diversity. This study aimed to provide interested educators and decision makers with ideas for how to implement cross-cultural training in palliative care. METHODS We conducted four focus groups in French- and Italian-speaking Switzerland. All groups consisted of a mix of experts in palliative care and/or cross-cultural teaching. The interdisciplinary research team submitted the data for thematic content analysis. RESULTS Focus-group participants saw a clear need for courses addressing cross-cultural issues in end-of-life care, including in medical disciplines outside of palliative care (e.g. geriatrics, oncology, intensive care). We found that these courses should be embedded in existing training offerings and should appear at all stages of curricula for end-of-life specialists. Two trends emerged related to course content. One focuses on clinicians' acquisition of cultural expertise and tools allowing them to deal with complex situations on their own; the other stresses the importance of clinicians' reflections and learning to collaborate with other professionals in complex situations. These trends evoke recent debates in the literature: the quest for expertise and tools is related to traditional twentieth century work on cross-cultural competence, whereas reflection and collaboration are central to more recent research that promotes cultural sensitivity and humility in clinicians. CONCLUSION This study offers new insights into cross-cultural courses in palliative and end-of-life care. Basic knowledge on culture in medicine, variable practices related to death and dying, communication techniques, self-reflection on cultural references and aptitude for interprofessional collaboration are central to preparing clinicians in end-of-life settings to work with linguistically and culturally diverse patients.
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Affiliation(s)
- Imane Semlali
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Av. de Beaumont 23, 1011, Lausanne, Switzerland.
| | - Emmanuel Tamches
- Palliative & Supportive Care Service, Lausanne University Hospital, Av. Pierre-Decker 5, 1011, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Av. de Beaumont 23, 1011, Lausanne, Switzerland
| | - Orest Weber
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Av. de Beaumont 23, 1011, Lausanne, Switzerland
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370
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McEwen A, Jacobs C. Preparing the genetic counseling workforce for the future in Australasia. J Genet Couns 2020; 30:55-60. [PMID: 33169896 DOI: 10.1002/jgc4.1358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 11/10/2022]
Abstract
Current genetic counseling students will graduate into a workforce involving more opportunities, diversity, and uncertainty than any previous generation. Preparing the future genetic counseling workforce is a dynamic challenge, both for the profession and for educators. The dominance of the medical model in the state funded Australian healthcare system creates a power imbalance between doctors and other health professionals. As a result, professional regulation to protect the public from harm in line with the United States, the UK, and Canada only became mandatory in 2019. Professional regulation has the additional benefit of enhancing professional standing and autonomy, enabling genetic counselors to help shape the future of genetic health care in Australia and New Zealand. Within this rapidly evolving environment, we are establishing a new Masters' program and building a discipline of genetic counseling, working alongside other allied health professionals. Our program involves synchronous and asynchronous learning, greater accessibility, flexibility and, as we have learned in 2020, reduction in disruption during a global pandemic. In this program, we foreground the inherent knowledge, skills, and values of genetic counseling, shifting the focus from provision of genetic and genomic tests, to educating competent, person-centered, research enabled and culturally safe genetic counselors. As educators, we have a responsibility to prepare students to embrace the uncertainties, challenges, and potential of the genomic era, to seize the many possibilities that lie ahead, and to expand their thinking and vision. We ask our students to be courageous, to step into a deep exploration of their own identity, beliefs, understanding, and experiences of oppression, power, and privilege. We are pushing boundaries, and challenging ourselves and our students to remain always open to possibilities. Equipping students with open eyes and listening ears may be the single most important thing we can do to prepare the genetic counseling workforce of the future to provide the best possible care.
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Affiliation(s)
- Alison McEwen
- Genetic Counseling, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Genetic Counseling, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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371
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Kumlien C, Bish M, Chan EA, Rew L, Chan PS, Leung D, Carlson E. Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields. BMC MEDICAL EDUCATION 2020; 20:406. [PMID: 33158446 PMCID: PMC7648285 DOI: 10.1186/s12909-020-02326-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields. METHODS A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument. RESULTS The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. CONCLUSION The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.
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Affiliation(s)
- Christine Kumlien
- Department of Care Science, Malmö University, Jan Waldenströms gata 25, 20506, Malmö, Sweden.
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
| | - Melanie Bish
- Department of Rural Nursing & Midwifery, La Trobe Rural Health School, Melbourne, Australia
| | - Engle A Chan
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Lynn Rew
- School of Nursing, University of Texas at Austin, Austin, USA
| | - P S Chan
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Doris Leung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Elisabeth Carlson
- Department of Care Science, Malmö University, Jan Waldenströms gata 25, 20506, Malmö, Sweden
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372
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Wu J, Ebrahim AK. Ethnic disparities for thyroid surgery. ANZ J Surg 2020; 90:2527-2531. [PMID: 33135832 DOI: 10.1111/ans.16410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/27/2020] [Accepted: 10/03/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Significant health disparities exist between Māori and non-Māori patients in New Zealand. Māori patients treated medically for their thyroid disease are less likely to be euthyroid. The prevalence of thyroid disease and characteristics of Māori presenting for thyroid surgery has not been well studied. We aim to assess the differences in ethnic representation for thyroid surgery. METHODS A retrospective analysis of cases performed between 2009 and 2019 at the Otolaryngology/Head and Neck Department in Waikato District Health Board (DHB) was completed. All patients who received a thyroid operation were included and divided into Māori and non-Māori groups. Clinical and operation notes were reviewed and the duration of presenting symptoms, weight, volume and diagnosis of the thyroid gland were assessed. RESULTS A total of 93 patients were included in our study, of whom 71 patients were female and 22 male with 37 being Māori and 56 non-Māori. Māori patients had significantly higher rates of retrosternal extension, compressive symptoms, post-operative complications, delayed presentation and larger thyroid goitres when compared to non-Māori (P < 0.05). CONCLUSION Our study confirms that there is a significant ethnic disparity for Māori patients requiring thyroid surgery. This highlights an additional poor health outcome for Māori compared to non-Māori patients.
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Affiliation(s)
- Johnny Wu
- Department of Otolaryngology, Waikato Hospital, Hamilton, New Zealand
| | - A K Ebrahim
- Department of Otolaryngology, Waikato Hospital, Hamilton, New Zealand
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373
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School-based Streptococcal A Sore-throat Treatment Programs and Acute Rheumatic Fever Amongst Indigenous Māori: A Retrospective Cohort Study. Pediatr Infect Dis J 2020; 39:995-1001. [PMID: 32502125 PMCID: PMC7556236 DOI: 10.1097/inf.0000000000002770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute rheumatic fever (ARF) predominantly affects indigenous Māori schoolchildren in Bay of Plenty region, and more so male Māori students, especially when socioeconomically deprived. We evaluated the effectiveness of strategies for reducing ARF with group A streptococcal pharyngitis treatment in 2011-18. METHODS We retrospectively assessed outcomes of 3 open cohorts of Māori schoolchildren receiving different interventions: Eastern Bay rural Cohort 1, mean deprivation decile 9.80, received school-based sore-throat programs with nurse and general practice (GP) support; Eastern Whakatane township/surrounds Cohort 2, mean deprivation 7.25, GP management; Western Bay Cohort 3, mean deprivation 5.98, received predominantly GP care, but 3 highest-risk schools received school-based programs. Cases were identified from ICD10 ARF-coded hospital discharges, notifications to Ministry of Health, and a secondary-prevention penicillin database. Primary outcomes were first-presentation ARF cohorts' incidence preintervention (2000-10) and postintervention (2011-18) with cases over annual school rolls' Māori students-year denominators. RESULTS Overall, ARF in Maori schoolchildren declined in the cohorts with school-based programs. Cohort 1 saw a postintervention (2011-18) decline of 60%, 148 to 59/100,000/year, rate ratio (RR) = 0.40(CI 0.22-0.73) P = 0.002. Males' incidence declined 190 to 78 × 100,000/year RR = 0.41(CI 0.19-0.85) P = 0.013 and females too, narrowing gender disparities. Cohort 3 ARF incidence decreased 48%, 50 to 26/100,000/year RR = 0.52(CI 0.27-0.99) P = 0.044. In contrast, ARF doubled in Cohort 2 students with GP-only care without school-based programs increasing 30 to 69/100,000/year RR = 2.28(CI 0.99-5.27) P = 0.047, especially for males 39/100,000/year to 107/100,000/year RR = 2.71(CI 1.00-7.33) P = 0.0405. CONCLUSIONS School-based programs with indigenous Māori health workers' sore-throat swabbing and GP/Nurse support reduced first-presentation ARF incidence in Māori students in highest-risk settings.
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374
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Whitney C, Greene MZ, Dudek A. Getting it right after getting it wrong: Using the AQUERY tool in conversation with transgender nursing students. NURSE EDUCATION TODAY 2020; 94:104560. [PMID: 32932057 DOI: 10.1016/j.nedt.2020.104560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Clare Whitney
- Stony Brook University, School of Nursing, United States of America.
| | - Madelyne Z Greene
- University of Wisconsin-Madison, School of Nursing, United States of America
| | - Alex Dudek
- University of Wisconsin-Madison, School of Nursing, United States of America
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375
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Wendt DC, Marsan S, Parker D, Lizzy KE, Roper J, Mushquash C, Venner KL, Lam A, Swansburg J, Worth N, Sorlagas N, Quach T, Manoukian K, Bernett P, Radin SM. Commentary on the impact of the COVID-19 pandemic on opioid use disorder treatment among Indigenous communities in the United States and Canada. J Subst Abuse Treat 2020; 121:108165. [PMID: 33097315 PMCID: PMC7546255 DOI: 10.1016/j.jsat.2020.108165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
This commentary focuses on how some Indigenous communities in the United States (U.S.) and Canada are addressing the opioid epidemic within the context of the COVID-19 pandemic, from the perspective of the co-authors as researchers, clinicians, and pharmacists working within or among Indigenous communities in three eastern Canadian provinces and two western U.S. states. The pandemic has likely exacerbated opioid use problems among Indigenous communities, especially for individuals with acute distress or comorbid mental illness, or who are in need of withdrawal management or residential services. In response to the pandemic, we discuss first how greater prescription flexibility has facilitated and even increased access to medications for opioid use disorder. Second, we describe how Indigenous-serving clinics have expanded telemedicine services, albeit not without some challenges. Third, we note challenges with restricted participation in traditional Indigenous healing practices that can be helpful for addiction recovery. Fourth, we mention providers' worries about the pandemic's impact on their patients' mental health and safety. We argue that certain treatment transformations may be helpful even after the pandemic is over, through enhancing access to community-grounded treatment, decreasing stigma, and promoting patient self-efficacy. COVID-19 pandemic has challenged opioid use treatment for Indigenous peoples. Treatment has been aided through expanded telemedicine and prescription flexibility. These adjustments may expand future treatment access to Indigenous communities.
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Affiliation(s)
- Dennis C Wendt
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St., Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - Stéphanie Marsan
- Department of Family and Emergency Medicine, Université de Montréal, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet St., Montreal, Quebec H2X 0C1, Canada.
| | - Daniel Parker
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St., Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - Karen E Lizzy
- Cowlitz Tribal Health, 15455 65th Ave S, Tukwila, WA 98188, USA.
| | - Jessica Roper
- Eskasoni Mental Health Services, 4555 Shore Rd., Eskasoni, Nova Scotia B1W 1K3, Canada.
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, 955 Oliver Rd., Thunder Bay, Ontario P7B 5E1, Canada.
| | - Kamilla L Venner
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addiction, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA.
| | - Alice Lam
- Canadian Research Initiative in Substance Misuse (CRISM) Quebec-Atlantic Node, Centre hospitalier de l'Université de Montréal, CRCHUM - Pavillon R, 900 St-Denis St., Montreal, Quebec H2X 0A9, Canada.
| | - Jennifer Swansburg
- Canadian Research Initiative in Substance Misuse (CRISM) Quebec-Atlantic Node, Department of Psychology, Dalhousie University, 1355 Oxford St., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Nancy Worth
- Kahnawake Shakotiia'takehnhas Community Services (KSCS), P.O. Box 1440, Kahnawake, Quebec J0L 1B0, Canada.
| | - Nicholas Sorlagas
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Seattle, WA 98105, USA.
| | - Tania Quach
- Kateri Memorial Hospital Centre (KMHC), 10 River Rd., Kahnawake, Quebec J0L 1B0, Canada.
| | - Kristapore Manoukian
- Proxim Pharmacie Kristapore Manoukian, Inc., P.O. Box 2231, Kahnawake, Quebec J0L 1B0, Canada.
| | - Payton Bernett
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St., Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - Sandra M Radin
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Seattle, WA 98105, USA.
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376
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Ronald MM, Aramoana JKA, Hill AG. Surgeons and cultural safety and cultural competency: the road to transformation. ANZ J Surg 2020; 90:2563-2566. [PMID: 33090638 DOI: 10.1111/ans.16379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Maxine M Ronald
- Department of Surgery, Whangarei Hospital, Whangarei, New Zealand
| | | | - Andrew G Hill
- Department of Surgery, The University of Auckland Faculty of Medical and Health Sciences, Middlemore Hospital, Auckland, New Zealand
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377
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Pearce LA, Homayra F, Dale LM, Moallef S, Barker B, Norton A, Hayashi K, Nosyk B. Non-disclosure of drug use in outpatient health care settings: Findings from a prospective cohort study in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102873. [PMID: 32731111 PMCID: PMC7832509 DOI: 10.1016/j.drugpo.2020.102873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Illicit drug use is associated with severe health-related harms, yet people who use drugs (PWUD) face substantial barriers to healthcare. We sought to identify factors associated with disclosure of drug use to a healthcare provider and describe differences in self-reported quality of care received based on disclosure status. METHODS A client-reported experience questionnaire on healthcare access and quality, adapted from the World Health Organization Survey on Health and Health System Responsiveness, was administered within two ongoing prospective cohort studies of PWUD in Vancouver, Canada. Respondents not currently receiving addiction treatment were asked about experience of care and drug use disclosure to their most commonly accessed outpatient healthcare provider in the past 6 months. We used an adjusted logistic regression model to identify client characteristics associated with disclosure. RESULTS From a total of 261 respondents (34.1% female), less than half (n = 125, 47.8%) reported disclosing drug use to their healthcare provider. Indigenous participants were less likely to disclose compared to non-Indigenous participants (adjusted OR: 0.55, 95% confidence interval: 0.30, 0.97). Disclosure was associated with lower self-reported quality of care (overall rating: disclosed 8.2 vs. did not disclose 8.8, p = 0.04). CONCLUSIONS In a sample of PWUD accessing outpatient healthcare services, we observed low rates of drug use disclosure, particularly for Indigenous respondents, and reduced quality of care for those who disclosed. These findings highlight the need for culturally safe and non-stigmatizing care to address pervasive stereotyping in the healthcare system and improved screening for substance use disorder in outpatient healthcare services.
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Affiliation(s)
- Lindsay A Pearce
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton VIC 3053, Melbourne, Australia
| | - Fahmida Homayra
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Laura M Dale
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Soroush Moallef
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; First Nations Research and Knowledge Exchange, First Nations Health Authority, 100 Park Royal South, West Vancouver V7T 1A2, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Alexa Norton
- First Nations Research and Knowledge Exchange, First Nations Health Authority, 100 Park Royal South, West Vancouver V7T 1A2, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bohdan Nosyk
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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378
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Redvers N, Schultz C, Vera Prince M, Cunningham M, Jones R, Blondin B. Indigenous perspectives on education for sustainable healthcare. MEDICAL TEACHER 2020; 42:1085-1090. [PMID: 32657230 DOI: 10.1080/0142159x.2020.1791320] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A range of global environmental changes are contributing to an increasing global burden of disease. Since human health and well-being are intimately associated with the health of our planet, healthcare providers will not only be charged with caring for this expanding disease burden but will also need to become more environmentally sustainable in their professional practice. There is thus an urgent need in the health professions education community to prioritize environmentally sustainable healthcare practice, which must include and prioritize Indigenous voices and Indigenous knowledge systems. Critical global dialogue on the significance of Indigenous knowledge systems in educating health professionals for a sustainable future will be required if we are ready to ensure the generations that follow us are able to live healthy lives. Indigenous ways of 'being' in the world, which emphasize the importance of interconnection and reciprocal stewardship with everything in the natural world, are essential for advancing education for sustainable healthcare and overall well-being. Given the colonial legacy however, Indigenous people, despite their essential knowledge systems and abilities, still face many barriers accessing safe decolonizing spaces and presence in health professions education, which needs to be addressed.
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Affiliation(s)
- Nicole Redvers
- Family and Community Medicine-INMED Program, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
- Arctic Indigenous Wellness Foundation, Yellowknife, Canada
| | - Clinton Schultz
- Faculty of Medicine and Health Sciences, Bond University, Gold Coast, Australia
| | | | - Myrna Cunningham
- Fondo para el Desarrollo de los Pueblos Indígenas de América Latina y El Caribe (FILAC), La Paz, Bolivia
| | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Be'sha Blondin
- Arctic Indigenous Wellness Foundation, Yellowknife, Canada
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379
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Churchill ME, Smylie JK, Wolfe SH, Bourgeois C, Moeller H, Firestone M. Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients. BMJ Open 2020; 10:e038168. [PMID: 32994245 PMCID: PMC7526316 DOI: 10.1136/bmjopen-2020-038168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Cultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care. DESIGN AND SETTING Interviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens. PARTICIPANTS Saturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants). RESULTS Three domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent. CONCLUSION The Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where 'cultural safety' becomes a standard of care.
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Affiliation(s)
- Mackenzie E Churchill
- Well Living House, MAP Centre for Urban Health Solutions (C-UHS), St Michael's Hospital, Toronto, Ontario, Canada
| | - Janet K Smylie
- Well Living House, MAP Centre for Urban Health Solutions (C-UHS), St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara H Wolfe
- Seventh Generation Midwives Toronto (SGMT), Toronto, Ontario, Canada
| | | | - Helle Moeller
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, Toronto, Ontario, Canada
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380
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Guillén AG, Te Karu L, Singh JA, Dalbeth N. Gender and Ethnic Inequities in Gout Burden and Management. Rheum Dis Clin North Am 2020; 46:693-703. [PMID: 32981646 DOI: 10.1016/j.rdc.2020.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although effective and low-cost urate-lowering therapy has been available for decades, inequities in gout management exist. Despite high impact of disease, rates of urate-lowering therapy prescription are low in women, in African-Americans in the United States, in Māori (Indigenous New Zealanders), and in Pacific peoples living in Aotearoa/New Zealand. Social determinants of health, barriers to accessing the health care system, health literacy demands, stigmatization, and bias contribute to inequities in gout burden and management. Approaches that focus on building health literacy and delivering culturally safe care lead to improved outcomes in gout, and offer important solutions to achieve health equity.
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Affiliation(s)
| | - Leanne Te Karu
- Ngā Kaitiaki o te Puna Rongoā o Aotearoa, Taupō, New Zealand; School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center; Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street South, Birmingham, AL 35294, USA
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand; Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand.
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381
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Pimentel J, Cockcroft A, Andersson N. Impact of Co-Designed Game Learning on Cultural Safety in Colombian Medical Education: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17297. [PMID: 32442146 PMCID: PMC7490681 DOI: 10.2196/17297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 01/27/2023] Open
Abstract
Background Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients’ worldviews. Lack of cultural safety in health care is linked to stigma and discrimination toward culturally diverse patients. Training in cultural safety poses considerable challenges. It is an unappealing subject for medical students and requires behavioral changes in their clinical practice. Game jams—collaborative workshops to create and play games—have recently shown effectiveness and engaging potential in university-level education. Objective The trial aims to determine if medical students’ participation in a game jam to design an educational game on cultural safety is more effective than a standard lesson on cultural safety in terms of change in the students’ self-reported intended patient-oriented behavior. Methods A parallel-group, 2-arm randomized controlled trial with a 1:1 allocation ratio will randomize 340 medical students and 60 medical interns (n=400) at the Faculty of Medicine at La Sabana University, Colombia (170 students and 30 medical interns to each arm). The intervention group will participate in an 8-hour game jam comprising (1) a preliminary lecture on cultural safety and game design, (2) a game building session where groups of students will create educational games about cultural safety, and (3) a play-test session in which students will play and learn from each other’s games. The control group will receive a standard lesson, including a 2-hour lecture on cultural safety, followed by a 6-hour workshop to create posters about cultural safety. Web-based self-administered 30-item Likert-type questionnaires will assess cultural safety self-reported intended behavior before, immediately after, and 6 months after the intervention. An intention-to-treat approach will use a t-test with 95% CIs to determine the significance of the effect of the intervention, including within- and between-group comparisons. The qualitative most significant change technique will explore the impact of the intervention on the clinical experience of the students. Results Study enrollment began in July 2019. A total of 531 students completed the baseline survey and were randomized. Data collection is expected to be complete by July 2020, and results are expected in October 2020. The study was approved by the institutional review board of the Faculty of Medicine at McGill University (May 31, 2017) and by the Subcommittee for Research of the Faculty of Medicine at La Sabana University (approval number 445). Conclusions The research will develop participatory methods in game-based learning co-design that might be relevant to other subjects. Ultimately, it should foster improved cultural safety skills for medical students, improve the quality of health services for diverse cultural groups, and contribute to enhanced population health. Game learning may provide an innovative solution to a long-standing and neglected problem in medical education, helping to meet the educational expectations and needs of millennial medical students. Trial Registration ISRCTN Registry ISRCTN14261595; http://www.controlled-trials.com/ISRCTN14261595
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Affiliation(s)
- Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Facultad de Medicina, Universidad de La Sabana, Chia, Colombia.,Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Colombia
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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382
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Merry L, Villadsen SF, Sicard V, Lewis-Hibbert N. Transnationalism and care of migrant families during pregnancy, postpartum and early-childhood: an integrative review. BMC Health Serv Res 2020; 20:778. [PMID: 32838781 PMCID: PMC7446052 DOI: 10.1186/s12913-020-05632-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/06/2020] [Indexed: 12/05/2022] Open
Abstract
Background Migrant families’ transnational ties (i.e., connections to their countries of origin) may contribute to their hardships and/or may be a source of resiliency. A care approach that addresses these transnational ties may foster a positive identity and give coherence to experiences. We conducted an integrative review to determine what is known about transnational ties and the care of migrant families during pregnancy, postpartum and early childhood. Methods We searched 15 databases to identify literature reporting on a health or social program, service, or care experience of migrant families during pregnancy up to age five in a Western country (i.e., Canada, US, Australia, New Zealand or a European country). Information regarding if and how the service/program/care considered transnational ties, and care-providers’ perceptions of transnational ties, was extracted, analyzed and synthesized according to transnational ‘ways of belonging’ and ‘ways of being’. Results Over 34,000 records were screened; 69 articles were included. Care, programs and services examined included prenatal interventions (a mhealth app, courses, videos, and specialized antenatal care), doula support, maternity care, support groups, primary healthcare and psycho-social early intervention and early childhood programs. The results show that transnational ties in terms of ‘ways of belonging’ (cultural, religious and linguistic identity) are acknowledged and addressed in care, although important gaps remain. Regarding ‘ways of being’, including emotional, social, and economic ties with children and other family members, receipt of advice and support from family, and use of health services abroad, there is very little evidence that these are acknowledged and addressed by care-providers. Perceptions of ‘ways of belonging’ appear to be mixed, with some care-providers being open to and willing to adapt care to accommodate religious, cultural and linguistic differences, while others are not. How care-providers perceive the social, emotional and economic ties and/or the use of services back home, remains relatively unknown. Conclusion Significant knowledge gaps remain regarding care-providers’ perceptions of transnational ‘ways of being’ and whether and how they take them into account, which may affect their relationships with migrant families and/or the effectiveness of their interventions. Continued efforts are needed to ensure care is culturally safe for migrants.
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Affiliation(s)
- Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Canada.
| | | | - Veronik Sicard
- School of Kinesiology and Exercise Science, University of Montreal, Montreal, Canada
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383
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Lee S, Collins FL, Simon-Kumar R. Blurred in translation: The influence of subjectivities and positionalities on the translation of health equity and inclusion policy initiatives in Aotearoa New Zealand. Soc Sci Med 2020; 288:113248. [PMID: 32753115 DOI: 10.1016/j.socscimed.2020.113248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/10/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Growing health inequities among the increasingly diverse population in Aotearoa New Zealand have prompted responses in the healthcare system. Diversity-related policies and programmes have been developed in some District Health Boards (DHB) to address the issues. The translation of such policy into practice is, however, convoluted by subjective interests and power differentials and thus the outcomes of policies may deviate from their original objectives. In this paper we examine how staff in one DHB translate and implement health equity and diversity initiatives in their everyday practices in hospital settings. In high-level institutional thinking, Māori health equity policy is dictated by the Treaty of Waitangi which sets it apart from the cultural competence focus of programmes for other ethnic groups. Drawing on interviews with clinical staff in the DHB, we reveal how intersecting subject positions, including personal histories and institutional roles, influence the interpretation and enactment of these policies and programmes in ways that blur their distinct agendas. As a result, the paper demonstrates how the politics that underpin agendas that distinctly address equity and diversity, as well as the potential for change in these areas, can be compromised in everyday practice on the hospital floor.
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Affiliation(s)
- Sandy Lee
- School of Environment, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Francis L Collins
- National Institute of Demographic and Economic Analysis, University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Rachel Simon-Kumar
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, 1142, New Zealand.
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384
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Billan J, Starblanket D, Anderson S, Legare M, Hagel MC, Oakes N, Jardine M, Boehme G, Dubois E, Spencer O, Hotomani M, McKenna B, Bourassa C. Ethical research engagement with Indigenous communities. J Rehabil Assist Technol Eng 2020; 7:2055668320922706. [PMID: 32612848 PMCID: PMC7309372 DOI: 10.1177/2055668320922706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/06/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Canada’s colonial policies and practices have led to barriers for Indigenous older adults’ access to healthcare and research. As a result, there is a need for Indigenous-led research and culturally safe practices. Morning Star Lodge is developing a training module to assist AgingTech researchers on ethical, culturally safe ways to engage Indigenous communities. This includes exploring Indigenous health research, community-based partnerships, reciprocal learning, and cultural safety; this is presented through a case study on ethically engaged research. Methods Morning Star Lodge developed a research partnership agreement with File Hills Qu’Appelle Tribal Council and established a Community Research Advisory Committee representing the eleven First Nations within the Tribal Council. The work designing the culturally safe training module is in collaboration with the Community Research Advisory Committee. Results Building research partnerships and capacities has changed the way the eleven First Nation communities within File Hills Qu’Appelle Tribal Council view research. As a result, they now disseminate the knowledge within their own networks. Conclusions Indigenous Peoples are resilient in ensuring their sustainability and have far more community engagement and direction. Developing culturally safe approaches to care for Indigenous communities leads to self-determined research. Culturally safe training modules can be applied to marginalized demographics.
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Affiliation(s)
- Jennifer Billan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
- Jennifer Billan, University of Saskatchewan College of Medicine, 401-2631 28th Ave, Regina, Saskatchewan S4S 6X3, Canada.
| | - Danette Starblanket
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Sadie Anderson
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Marlin Legare
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Mikayla Caroline Hagel
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Nathan Oakes
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Mackenzie Jardine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Gail Boehme
- File Hills Qu’Appelle Tribal Council, Fort Qu’Appelle, Canada
| | - Ethel Dubois
- File Hills Qu’Appelle Tribal Council, Fort Qu’Appelle, Canada
| | - Orval Spencer
- File Hills Qu’Appelle Tribal Council, Fort Qu’Appelle, Canada
| | - Millie Hotomani
- File Hills Qu’Appelle Tribal Council, Fort Qu’Appelle, Canada
| | - Betty McKenna
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
| | - Carrie Bourassa
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Regina, Canada
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385
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Sinclair K, Carty C, Gonzales K, Nikolaus C, Gillespie L, Buchwald D. Strong Men, Strong Communities: Design of a Randomized Controlled Trial of a Diabetes Prevention Intervention for American Indian and Alaska Native Men. Am J Mens Health 2020; 14:1557988320945457. [PMID: 32757825 PMCID: PMC7412907 DOI: 10.1177/1557988320945457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023] Open
Abstract
Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, very few were men. To date, there have been no concerted efforts to recruit and retain AI/AN men in interventions that promote weight loss and healthy lifestyles to prevent diabetes, and they remain underrepresented in these types of studies. This article describes the design and methods of the first randomized controlled trial of a diabetes prevention program with a study sample comprised entirely of AI/AN men. Research to date has demonstrated suboptimal patterns of recruitment and retention of AI/AN men, resulting in their virtual absence in health and intervention research. Effective methods to recruit and retain AI/AN men, and potential benefit gained from participation in diabetes prevention research, are unknown for this population who experience a high prevalence of type 2 diabetes. The study design presented in this article offers promising insights to help remedy these important shortcomings in the science of recruitment and retention of AI/AN men in research.
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Affiliation(s)
- Ka‘imi Sinclair
- College of Nursing, Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Cara Carty
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Kelly Gonzales
- Portland State University-Oregon Health Sciences University Joint School of Public Health, Portland, OR, USA
| | - Cassandra Nikolaus
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Lucas Gillespie
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
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386
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George MS, Davey R, Mohanty I, Upton P. "Everything is provided free, but they are still hesitant to access healthcare services": why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare? Int J Equity Health 2020; 19:105. [PMID: 32590981 PMCID: PMC7320563 DOI: 10.1186/s12939-020-01216-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequity in access to healthcare services is a constant concern. While advances in healthcare have progressed in the last several decades, thereby significantly improving the prevention and treatment of disease, these benefits have not been shared equally. Excluded communities such as Indigenous communities typically face a lack of access to healthcare services that others do not. This study seeks to understand why the indigenous communities in Attapadi continue to experience poor access to healthcare in spite of both financial protection and adequate coverage of health services. METHODS Ethnographic fieldwork was carried out among the various stakeholders living in Attapadi. A total of 47 in-depth interviews and 6 focus group discussions were conducted amongst the indigenous community, the healthcare providers and key informants. The data was coded utilising a reflexive and inductive approach leading to the development of the key categories and themes. RESULTS The health system provided a comprehensive financial protection package in addition to a host of healthcare facilities for the indigenous communities to avail services. In spite of this, they resisted attempts by the health system to improve their access. The failure to provide culturally respectful care, the discrimination of the community at healthcare facilities, the centralisation of the delivery of services as well as the lack of power on the part of the indigenous community to negotiate with the health system for services that were less disruptive for their lives were identified as the barriers to improving healthcare access. The existing power differentials between the community and the health system stakeholders also ensured that meaningful involvement of the community in the local health system did not occur. CONCLUSION Improving access to health care for indigenous communities would require UHC interventions to be culturally safe, locally relevant and promote active involvement of the community at all stages of the intervention. Continuing structural power imbalances that affect access to resources and prevent meaningful involvement of indigenous communities also need to be addressed.
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Affiliation(s)
- Mathew Sunil George
- Health Research Institute, University of Canberra, ACT, Canberra, 2617, Australia.
| | - Rachel Davey
- Health Research Institute, University of Canberra, ACT, Canberra, 2617, Australia
| | - Itismita Mohanty
- Health Research Institute, University of Canberra, ACT, Canberra, 2617, Australia
| | - Penney Upton
- Health Research Institute, University of Canberra, ACT, Canberra, 2617, Australia
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387
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Pimentel J, Sarmiento I, Zuluaga G, Andersson N. What motivates medical students to learn about traditional medicine? A qualitative study of cultural safety in Colombia. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:120-126. [PMID: 32570216 PMCID: PMC7870450 DOI: 10.5116/ijme.5eb4.620f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/07/2020] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia. METHODS We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine. RESULTS Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge. CONCLUSIONS We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.
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Affiliation(s)
- Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Quebec, Canada
| | - Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Quebec, Canada
| | - Germán Zuluaga
- School of Medicine and Health Sciences, Del Rosario University, Bogotá, Colombia
| | - Neil Andersson
- Centre for Tropical Disease Research (CIET), Autonomous University of Guerrero, Mexico
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388
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Tratt E, Sarmiento I, Gamelin R, Nayoumealuk J, Andersson N, Brassard P. Fuzzy cognitive mapping with Inuit women: what needs to change to improve cervical cancer screening in Nunavik, northern Quebec? BMC Health Serv Res 2020; 20:529. [PMID: 32527254 PMCID: PMC7291667 DOI: 10.1186/s12913-020-05399-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Among Canadian Inuit, cervical cancer incidence and mortality rates are up to three times higher than the Canadian average. Cervical cancer is preventable through regular screening which, in Quebec, is opportunistic and requires physical examination and Papanicolaou (“Pap”) smears. Since Human Papillomavirus (HPV) is the necessary cause of cervical cancer, HPV testing is a plausible screening alternative. HPV testing by self-sampling also addresses several barriers associated with physical examination and access to healthcare. In a participatory research paradigm, we worked with two communities of Nunavik to explore the possible implementation of HPV self-sampling. Method Key community stakeholders formed an Advisory Committee to guide direct discussions with Inuit women. We presented available facts around cervical cancer, HPV and the female anatomy, and used Fuzzy Cognitive Mapping to collate women’s views. A thematic analysis summarized data, adding links and weights to represent the relationship of each factor on the outcome: screening for cervical cancer. Results According to the 27 Inuit women who participated, the most influential factor in using health services was the cultural awareness of the healthcare provider. A significant barrier to screening was patient lack of information. The principal vector of change – the factor most likely to influence other factors – was the means of communication between the healthcare provider and the patient: visual communication was told to be the most effective. Conclusion Fuzzy Cognitive Mapping is a practical tool for discussing possible health actions with stakeholders and to inform future research. The tool offers a visual aid for discussion across cultural and educational differences. It can help to build the partnerships that incorporate community voices into co-design of interventions that are relevant to and aligned with the needs of those who use them.
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Affiliation(s)
- Elyse Tratt
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ivan Sarmiento
- Department of Family Medicine, CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rachel Gamelin
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Neil Andersson
- Department of Family Medicine, CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Paul Brassard
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada. .,Department of Medicine, McGill University, Montreal, Quebec, Canada.
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389
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Purdy SC. Communication research in the context of te whare tapa whā model of health. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:281-289. [PMID: 32686594 DOI: 10.1080/17549507.2020.1768288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: Te whare tapa whā represents a Māori view of health and wellness in four dimensions: taha wairua (spiritual health), taha hinengaro (mental health), taha tinana (physical health) and taha whānau (family health). This model of health focuses on indigenous Māori in Aotearoa/New Zealand but has relevance for all people. Speech-language pathologists, including those not familiar with this model, recognise that all four dimensions are needed to support health and wellbeing. Taha wairua includes the importance of culture and heritage to personal identity, an area that speech-language pathology (SLP) recognises as key to clinical competency. Taha hinengaro includes the need to express thoughts and feelings, another area particularly salient to SLP. The other two dimensions taha tinana (physical health) and taha whānau (family health) are arguably more familiar in the day-to-day work of speech-language pathologists.Method: Two broad strands of research are examined within this model of health exploring the challenges faced by vulnerable populations namely: (1) two community based groups (a Choir and a Gavel Club) for people with acquired neurological conditions such as stroke and Parkinson's disease, and (2) diagnosis and management of hearing loss and auditory processing disorder.Result: Community based groups, explored through the CeleBRation Choir and the Gavel Club, highlighted the application of all aspects of te whare tapa whā to the experiences of people with neurological conditions participating in these community therapies. In the area of hearing loss and auditory processing disorder, gaps across all four dimensions of taha wairua, taha hinengaro, taha tinana and taha whānau were identified in the available literature and in examination of clinical provision for participants.Conclusion: Te whare tapa whā provides a framework to consider all the elements that contribute to people living well while experiencing communication challenges within their whānau (extended family). This approach relies on strong partnerships between clinicians, extended family, researchers, communities, organisations and other professionals. Clinicians and researchers are encouraged to consider how their beliefs, practices and impact could improve through consideration of Indigenous health models such as te whare tapa whā.
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Affiliation(s)
- Suzanne C Purdy
- School of Psychology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, The University of Auckland, Auckland, New Zealand; and
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
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390
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Kerrigan V, Lewis N, Cass A, Hefler M, Ralph AP. "How can I do more?" Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload. BMC MEDICAL EDUCATION 2020; 20:173. [PMID: 32471490 PMCID: PMC7260793 DOI: 10.1186/s12909-020-02086-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/21/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Aboriginal cultural awareness training aims to build a culturally responsive workforce, however research has found the training has limited impact on the health professional's ability to provide culturally safe care. This study examined cultural awareness training feedback from healthcare professionals working with high Aboriginal patient caseloads in the Top End of the Northern Territory of Australia. The aim of the research was to assess the perception of training and the potential for expansion to better meet workforce needs. METHODS Audit and qualitative thematic analysis of cultural awareness training evaluation forms completed by course participants between March and October 2018. Course participants ranked seven teaching domains using five-point Likert scales (maximum summary score 35 points) and provided free-text feedback. Data were analysed using the Framework Method and assessed against Kirkpatrick's training evaluation model. Cultural safety and decolonising philosophies shaped the approach. RESULTS 621 participants attended 27 ACAP sessions during the study period. Evaluation forms were completed by 596 (96%). The mean overall assessment score provided was 34/35 points (standard deviation 1.0, range 31-35) indicating high levels of participant satisfaction. Analysis of 683 free text comments found participants wanted more cultural education, designed and delivered by local people, which provides an opportunity to consciously explore both Aboriginal and non-Aboriginal cultures (including self-reflection). Regarding the expansion of cultural education, four major areas requiring specific attention were identified: communication, kinship, history and professional relevance. A strength of this training was the authentic personal stories shared by local Aboriginal cultural educators, reflecting community experiences and attitudes. Criticism of the current model included that too much information was delivered in one day. CONCLUSIONS Healthcare providers found cultural awareness training to be an invaluable entry point. Cultural education which elevates the Aboriginal health user's experience and provides health professionals with an opportunity for critical self-reflection and practical solutions for common cross-cultural clinical encounters may improve the delivery of culturally safe care. We conclude that revised models of cultural education should be developed, tested and evaluated. This requires institutional support, and recognition that cultural education can contribute to addressing systemic racism.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Nicole Lewis
- Department of Health, Northern Territory Government, GPO Box 2391, Darwin, NT 0801 Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
- Royal Darwin Hospital, Darwin, Northern Territory 0811 Australia
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391
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Wilson C, Heinrich L, Heidari P, Adams K. Action research to implement an Indigenous health curriculum framework. NURSE EDUCATION TODAY 2020; 91:104464. [PMID: 32526618 DOI: 10.1016/j.nedt.2020.104464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/12/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
In recent decades Indigenous health curriculum frameworks have been developed, however, few studies about their implementation exist. This study aimed to employ critical theory and action research to understand how an Indigenous health curriculum framework could be applied and associated learning and teaching iteratively improved. Three action research cycles where conducted from 2017 to 2019. Student reaction (satisfaction and engagement) was collected via survey 2017-2019. Student learning was collated 2018-2019 via self-perception survey (knowledge, attitude, confidence, commitment); multi-choice questions (knowledge) and; content analysis of apply and analyse activities (skill). The teaching team met annually to reflect on findings and plan enhancements to learning and teaching. Over 2017-2019 there was a pattern of improved student reaction and learning. Connecting this research to Faculty level committees led to widening success and improved sustainability of the practice. The online unit and workshop delivery were scalable, overcame a barrier of educator skill and confidence to teach this area, allowed for quality content control and provided data for analysis. Interestingly, learning gained from this unit matched that described as occurring from student placements in health settings with high numbers of Indigenous people. Student learning occurred across the Framework three levels (novice, intermediate and entry to practice) suggesting that the taxonomy of the Framework does not necessarily align with the reality of learning and teaching. Vertical implementation of the five learning domains would benefit from alignment with training evaluation models and validated assessment to understand learning that has occurred rather than the teaching that has been taught. In this study health profession accreditation bodies had driven the imperative for an Indigenous health program and curriculum. Research on Indigenous health learning and teaching relating to behaviour and results in workplaces is needed.
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Affiliation(s)
- Cath Wilson
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Science, Clayton Campus, Victoria 3800, Australia
| | - Liesl Heinrich
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Science, Clayton Campus, Victoria 3800, Australia
| | - Parvaneh Heidari
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Science, Clayton Campus, Victoria 3800, Australia
| | - Karen Adams
- Gukwonderuk Indigenous Health Unit, Faculty of Medicine, Nursing and Health Science, Clayton Campus, Victoria 3800, Australia.
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392
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Maar M, Bessette N, McGregor L, Lovelace A, Reade M. Co-creating Simulated Cultural Communication Scenarios with Indigenous Animators: An Evaluation of Innovative Clinical Cultural Safety Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520980488. [PMID: 33403243 PMCID: PMC7745560 DOI: 10.1177/2382120520980488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Building on partnerships with Indigenous communities and with the support of the Northern Ontario School of Medicine, faculty created groundbreaking, authentic cultural immersion curriculum designed to foster culturally safe interpersonal skills and cultural understanding. However, structural barriers to the teaching of clinical communication skills for culturally safe care to Indigenous patients persisted. To address this challenge, faculty collaborated with Indigenous animators on the co-creation of a new teaching modality of Simulated Cultural Communication Scenarios. We evaluated student learning experience, the faculty teaching experience, the attainment of teaching goals, benefits, and areas for improvement for this approach. METHODS We piloted 9 Simulated Cultural Communication Scenarios with 64 medical students and 17 tutors. We collected quantitative and qualitative data regarding their experiences and perceptions of the new curriculum. The quantitative data was statistically summarized, and the qualitative data was coded and thematically analyzed. RESULTS The emergent themes indicate that co-created Simulated Cultural Communication Scenarios support the acquisition of culturally safe clinical skills because the modality fosters authentic, safe, context rich, and anti-oppressive patient dialogue with Indigenous animators. Recommendations for optimizing the sessions included ensuring tutors have a deep understanding of the significance of cultural safety in patient care. As the pedagogy is different from the familiar standardized clinical skills sessions, tutors and students benefit from education on the pedagogical approach. CONCLUSION Simulated Cultural Communication Scenarios, co-created with cultural insiders and academic educators, represent an authentic education approach to teaching culturally safe clinical encounters. The findings contribute to our understanding of translating social accountability into the clinical setting.
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Affiliation(s)
- Marion Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Nicole Bessette
- Undergraduate Medical Education, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Lorrilee McGregor
- Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Amy Lovelace
- Department of Medicine, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Maurianne Reade
- Clinical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON, Canada
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