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Apers H, Nöstlinger C, Van Praag L. Explanatory Models of (Mental) Health Among Sub-Saharan African Migrants in Belgium: A Qualitative Study of Healthcare Professionals' Perceptions and Practices. Cult Med Psychiatry 2023; 47:878-897. [PMID: 36939966 PMCID: PMC10026223 DOI: 10.1007/s11013-023-09816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
Culturally differing approaches to the distinction between physical and mental health contribute to cultural differences in explanatory models of what we call "mental" health in a Western context. For this reason, we use "(mental) health" in this study when referring to these models or differences in understanding. This interpretative, interview-based qualitative study focuses on Belgian mental health professionals' perceptions of the (mental) health explanatory models held by their patients of sub-Saharan African (SSA) descent. The study goals were threefold: first, to assess professionals' perceptions of the explanatory models of their patients of SSA descent; second, to examine how these perceptions influence treatment practices; and third, to investigate the role of the professionals' cultural backgrounds, comparing the results between professionals with and without an SSA background. Twenty-two in-depth interviews with mental health professionals were thematically analyzed, with ten of the participants of SSA descent. Results show that all professionals perceived differences between Western and SSA explanatory models of (mental) health. Causal beliefs were mentioned as the most important difference, including their influence on coping strategies and health-seeking behavior among patients of SSA descent. Professionals' perceptions and familiarity with SSA explanatory models of (mental) health affected their treatment practices. Language and conceptual interpretation difficulties were encountered less frequently by professionals of SSA descent. Those with a Western background applied "culturally sensitive" practices, while professionals of SSA descent implemented an integrated approach. These results contribute to ongoing discussions about what is considered "cultural competency."
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Affiliation(s)
- Hanne Apers
- Centre for Migration and Intercultural Studies/Centre for Population, Family and Health, University of Antwerp, Kipdorp 61, 2000 Antwerp, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute for Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Lore Van Praag
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Mandeville Building, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
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2
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Aggarwal NK. The Evolving Culture Concept in Psychiatric Cultural Formulation: Implications for Anthropological Theory and Psychiatric Practice. Cult Med Psychiatry 2023; 47:555-575. [PMID: 36961651 PMCID: PMC10036982 DOI: 10.1007/s11013-023-09821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
For thirty years, psychiatrists and anthropologists have collaborated to improve the validity of psychiatric diagnosis. This collaboration has produced the DSM-IV Outline for Cultural Formulation (OCF) and the DSM-5 Cultural Formulation Interview (CFI). Nonetheless, some anthropologists have critiqued the concept of culture in DSM-5 as too focused on patient meanings and not on clinician practices. This article traces the evolution of the culture concept from DSM-IV through DSM-5-TR by analyzing publications from the American Psychiatric Association on the OCF and CFI alongside scholarship in psychiatry and anthropology. DSM-IV relied on a culture concept of coherent ethnic communities sharing coherent cultures, primarily for minoritized ethnoracial individuals in the United States. Changing demographics and newer immigration patterns around the world deminoritized the culture concept for DSM-5. After George Floyd's death and demands for social justice, the culture concept in DSM-5-TR emphasized social structures. The article proposes an intersubjective model of culture through which patients and clinicians work through similarities and differences. It recommends a revised formulation that attends to clinician practices such as communicating, diagnosing, recommending treatments, and documenting, beyond collecting patient meanings. It also raises the question of whether an intersubjective model of culture prompts reconsiderations of culture-related text in other sections of the DSM. The social sciences can redirect attention to the clinician's culture of biomedicine to close patient health disparities.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University Medical Center, New York, NY, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 11, New York, NY, 10032, USA.
- Committee on Global Thought, Columbia University, New York, USA.
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3
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Scott MA, Andazola J, Smith T, Castillo Smith A, de la Rosa I, Michael J. Structural competency in New Mexico: Moving outside of medical education. Glob Public Health 2023; 18:2176003. [PMID: 36803417 DOI: 10.1080/17441692.2023.2176003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
ABSTRACTIn 2019, the Doña Ana Wellness Institute (DAWI), Doña Ana County, New Mexico's health council, sponsored two trainings in structural competency by the Structural Competency Working Group. One focused on health care professionals and learners; the other focused on government, non-profit organisations, and elected officials. DAWI and New Mexico Human Services Department (HSD) representatives attended the trainings and identified the structural competency model as useful for the health equity work both groups were already engaging. These trainings provided the foundation for DAWI and HSD to develop additional trainings, programmes, and curricula founded on structural competency and focused on supporting health equity work.This article describes how DAWI and HSD used the structural competency framework to deepen our work, including how we have expanded the concept beyond its original orientation to support strategic planning, improve communication, and build structurally competent communities. We illustrate how the framework strengthened our existing community and state work and how we adapted the model to better fit our work. Adaptations included changes in language, the use of the lived experiences of organisation members as a foundation for structural competency education, and a recognition that policy work happens at multiple levels and in multiple ways for organisations.
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Affiliation(s)
| | - John Andazola
- Southern New Mexico Family Medicine Residency Program, Las Cruces, NM, USA
| | - Tracy Smith
- New Mexico Human Services Department, Santa Fe, NM, USA
| | | | | | - Jamie Michael
- Doña Ana County Health and Human Services, Las Cruces, NM, USA
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4
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Aggarwal NK. Diversity and Inclusion Training in Health Care: What the Evidence Suggests. Psychiatr Serv 2022; 73:472-475. [PMID: 34235944 DOI: 10.1176/appi.ps.202000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
On September 22, 2020, then-President Donald Trump signed Executive Order 13950, titled "Combating Race and Sex Stereotyping." This order restricted the types of diversity and inclusion (DI) training that federal agencies and contractors could offer with federal funding. In this column, the author denounces that order, uses this critique to examine DI training sessions in their current forms, and suggests evidence-based solutions for organizations that are committed to dismantling racism. Mental health organizations must move beyond single, standalone DI training sessions that target individual providers and initiate institution-wide activities that embrace antiracism and structural competence.
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Affiliation(s)
- Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University Irving Medical Center, New York City. Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
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5
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Smith-Morris C, Rodriguez S, Soto R, Spencer M, Meneghini L. Decolonizing Care at Diagnosis: Culture, History, and Family at an Urban Inter-tribal Clinic. Med Anthropol Q 2021; 35:364-385. [PMID: 33998047 DOI: 10.1111/maq.12645] [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: 06/06/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
The decolonization framework in medical anthropology is slowly reframing tropes of cultural competency toward decolonizing health care. For decolonization of health care to occur, both colonial histories and continuing postcolonial inequities must be recognized from the first diagnostic moment. We report on qualitative research into the role of culture, history, and family experience in person-specific reactions to receipt of a diagnosis. A collaborative approach at an urban inter-tribal clinic was used to interview patients with a recent (within six months) diagnosis of diabetes or related condition. Interviews revealed ways that the Relocation Act eventuated in isolation, poverty, and diabetes among now-urban Native Americans. We discuss how patients may or may not have the ability to (re)connect with their heritage and may simultaneously perceive only recent family contexts as influential in their diabetes. We conclude by acknowledging how postcolonial harms are not captured in diagnoses but should not be left out of diagnostic discussions.
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Affiliation(s)
| | | | - Rose Soto
- Urban Inter-Tribal Center of Texas, Dallas, TX
| | | | - Luigi Meneghini
- University of Texas, Southwestern, Dept. of Internal Medicine
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6
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EPA guidance on cultural competence training. Eur Psychiatry 2020; 30:431-40. [DOI: 10.1016/j.eurpsy.2015.01.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/22/2022] Open
Abstract
AbstractThe stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value.
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Abstract
Drawing on participant-observation and semi-structured interviews, this paper examines the local forms of clinical practice in a 26-bed acute psychiatric inpatient unit located within a private psychiatric hospital in the Northeastern United States. It focuses on how clinicians, staff, and management understand and utilize the concepts of culture, race, and ethnicity in their daily work, finding that a humanistic approach to care that that treats patients as "individuals" was dominant. Clinicians and staff categorized patients using descriptive, behavior based categories including language, propensity for violence, and whether patients are "from the streets." They also used additional forms of difference such as the patient's pathway to care, their illness category or severity, and whether they use drugs. These forms of difference were shaped by the urgent needs of daily work. These local practices of categorization directly affected the quality of care when staff members assigned cultural characteristics to group members and treated them differently as a result. These findings suggest that anthropologists and clinicians should focus on the way new forms of cultural difference are constructed in small social settings in order to provide equitable treatment to all patients.
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Affiliation(s)
- Seth Donal Hannah
- Social Sciences Department, California Polytechnic State University, Building 47, Room 13, San Luis Obispo, CA, 93407, USA.
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Orienting to Medicine: Scripting Professionalism, Hierarchy, and Social Difference at the Start of Medical School. Cult Med Psychiatry 2018; 42:654-683. [PMID: 29687188 DOI: 10.1007/s11013-018-9580-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Nascent medical students' first view into medical school orients them toward what is considered important in medicine. Based on ethnography conducted over 18 months at a New England medical school, this article explores themes which emerged during a first-year student orientation and examines how these scripts resurface across a four-year curriculum, revealing dynamics of enculturation into an institution and the broader profession. We analyze orientation activities as discursive and embodied fields which serve "practical" purposes of making new social geographies familiar, but which also frame institutional values surrounding "soft" aspects of medicine: professionalism; dynamics of hierarchy and vulnerability; and social difference. By examining orientation and connecting these insights to later, discerning educational moments, we argue that orientation reveals tensions between the overt and hidden curricula within medical education, including what being a good doctor means. Our findings are based on data from semi-structured interviews, focus groups, and participant-observation in didactic and clinical settings. This article answers calls within medical anthropology and medical education literature to recognize implicit values at play in producing physicians, unearthing ethnographically how these values are learned longitudinally via persisting gaps between formal and hidden curricula. Assumptions hidden in plain sight call for ongoing medical education reform.
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Mews C, Schuster S, Vajda C, Lindtner-Rudolph H, Schmidt LE, Bösner S, Güzelsoy L, Kressing F, Hallal H, Peters T, Gestmann M, Hempel L, Grützmann T, Sievers E, Knipper M. Cultural Competence and Global Health: Perspectives for Medical Education - Position paper of the GMA Committee on Cultural Competence and Global Health. GMS JOURNAL FOR MEDICAL EDUCATION 2018; 35:Doc28. [PMID: 30186938 PMCID: PMC6120152 DOI: 10.3205/zma001174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 05/11/2023]
Abstract
Introduction: Routine medical care in Germany, Austria and Switzerland is being increasingly impacted by the cultural and linguistic diversity of an ever more complex world. Both at home and as part of international student exchanges, medical students are confronted with different ways of thinking and acting in relation to health and disease. Despite an increasing number of courses on cultural competence and global health at German-speaking medical schools, systematic approaches are lacking on how to integrate this topic into medical curricula. Methodological approach: This paper is based on a structured consensus-building process by a multidisciplinary committee composed of faculty and students. In a first step, a qualitative online survey was carried out in order to establish an inventory of definitions and concepts. After the second step, in which a literature search was conducted and definitions of global health and transcultural and intercultural competence were clarified, recommendations were formulated regarding content, teaching and institutional infrastructure. Based on small-group work and large-group discussions, different perspectives and critical issues were compiled using multiple feedback loops that served to ensure quality. Results: An inventory on the national and international level showed that great heterogeneity exists in regard to definitions, teaching strategies, teaching formats and faculty qualification. Definitions and central aspects considered essential to medical education were thus established for the use of the terms "cultural competence" and "global health". Recommendations are given for implementation, ranging from practical realization to qualification of teaching staff and education research. Outlook: High-quality healthcare as a goal calls for the systematic internationalization of undergraduate medical education. In addition to offering specific courses on cultural competence and global health, synergies would be created through the integration of cultural competence and global health content into the curricula of already existing subject areas. The NKLM (the national competence-based catalogue of learning objectives for undergraduate medical education) would serve as a basis for this.
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Affiliation(s)
- Claudia Mews
- University Medical Center Hamburg-Eppendor,f Department of General Practice/Primary Care , Hamburg, Germany
- *To whom correspondence should be addressed: Claudia Mews, University Medical Center Hamburg-Eppendor,f Department of General Practice/Primary Care , Martinistr. 52, D-20246 Hamburg, Germany, Phone: +49 (0)40/7410-56854, Fax: +49 (0)40/7410-53681, E-mail:
| | - Sylvie Schuster
- University Hospital Basel, Head of Program on Diversity Management, Basel, Switzerland
| | - Christian Vajda
- Medical University of Graz, Department of Medical Psychology and Psychotherapy, Graz, Austria
| | - Heide Lindtner-Rudolph
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Institute and Outpatients Clinic Medical Psychology, Research Group on Migration and Psychosocial Health (MiPH), Hamburg, Germany
| | - Luise E. Schmidt
- University of Greifswald, Department of Psychiatry and Psychotherapy, Greifswald, Germany
- Helios Hanseklinikum Stralsund, Department of Psychiatry and Psychotherapy, Stralsund, Germany
| | - Stefan Bösner
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - Leyla Güzelsoy
- Paracelsus Medical Private University, Nuremberg Hospital, Department of Psychosomatic Medicine and Psychotherapy, Psychosomatic Consultation and Liaison Service, Nuremberg, Germany
| | - Frank Kressing
- Ulm University, Institute of the History, Philosophy and Ethics of Medicine, Ulm, Germany
| | - Houda Hallal
- University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Tim Peters
- Ruhr-University Bochum, Medical Faculty, Center for Medical Education, Bochum, Germany
| | - Margarita Gestmann
- University of Duisburg-Essen, Medical Faculty, Dean's office for student affairs, Essen, Germany
| | - Linn Hempel
- University of Dusseldorf, Medical Faculty, Psychosomatic and Psychotherapy, Dusseldorf, Germany
| | - Tatjana Grützmann
- RWTH Aachen University, Dean's office for student affairs, Aachen, Germany
| | - Erika Sievers
- Academy of Public Health Services, Düsseldorf, Germany
| | - Michael Knipper
- Justus Liebig University Giessen, Institute for the History of Medicine, Giessen, Germany
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10
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['How strange is the patient to me?']. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:280-296. [PMID: 28974172 DOI: 10.13109/zptm.2017.63.3.280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
'How strange is the patient to me?' Physicians' attitudes and expectations toward treating patients with a migration background Objectives: Undergraduate and postgraduate training in cultural competence remains a challenging issue. It might be useful to integrate culturally sensitive learning objectives in existing curricula. As part of a needs assessment, this qualitative study examined the prototypical experiences in clinical routines with patients with a migration background. METHODS Twenty physicians took part in half-structured narrative interviews, which were then analyzed by linguistic-ethnographic conversation analysis. RESULTS The main reasons for difficulties in patient-physician relation proved to be language barriers. Assignments of professional interpreters were rated critically. Physicians attributed the responsibility for successful communication mainly to the patient. The physicians saw little need for training in cultural competence. CONCLUSIONS The integration of learning objectives related to cultural sensibility in existing curricula would seem to be useful, especially because the physicians interviewed reported little need for additional training on their own. The importance of implied negative attitudes and stereotypes in creating a culturally sensitive approach should be taken into account.
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Santhanam-Martin R, Fraser N, Jenkins A, Tuncer C. Evaluation of cultural responsiveness using a transcultural secondary consultation model. Transcult Psychiatry 2017; 54:488-501. [PMID: 28776452 DOI: 10.1177/1363461517724984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the expansion of a transcultural secondary consultation model run by a state-wide transcultural unit. The model aims to enhance cultural responsiveness in partnership with mental health services. We discuss a series of 12 consultations that occurred between 2011 and 2012. We outline the processes of setting up the structure of secondary consultation, the actual consultation-facilitation format, and methods of evaluation. Evaluations were done in two phases: the first immediately after the consult and the second after a period of 3-6 months. The discussion highlights the usefulness of a transcultural model of consultation and, based on the evaluations, identifies the benefits the model brings to understanding and intervening with clients, culture, and systems. The results emphasise the need for multidisciplinary collaboration and a facilitated space for clinical teams to explore culturally responsive therapeutic practices.
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Affiliation(s)
| | - Natalie Fraser
- The Melbourne Clinic.,St Vincent's Mental Health, Australia
| | - Anna Jenkins
- Metro North Mental Health Service, Australia.,University of Queensland Brisbane
| | - Can Tuncer
- St Vincent's Hospital, Australia.,University of Melbourne Victoria.,Istanbul Medeniyet University
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12
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Aggarwal NK, Like R, Kopelowicz A, Oryema N, Lu F, Farias P, Lewis-Fernández R. Has the Time Come for a Cultural Psychiatry Fellowship in the USA? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:928-931. [PMID: 27472932 PMCID: PMC5106297 DOI: 10.1007/s40596-016-0585-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
| | - Robert Like
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alex Kopelowicz
- David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Nadia Oryema
- New York University Langone Medical Center, New York, NY, USA
| | - Francis Lu
- University of California, Davis, CA, USA
| | | | - Roberto Lewis-Fernández
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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13
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Weiß A. Understanding physicians' professional knowledge and practice in research on skilled migration. ETHNICITY & HEALTH 2016; 21:397-409. [PMID: 26158400 DOI: 10.1080/13557858.2015.1061100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Research on the integration of migrant professionals into high-skilled labor markets either focuses on differences between nation states which may be exacerbated by national closure or it celebrates the global versatility of professional knowledge, especially in the natural and health sciences. Building on a pragmatist approach to professional knowledge, the article argues that professional knowledge should not be seen as either universal or local, but both the institutionalized and the incorporated aspects of cultural capital are characterized by 'local universality'. Professionals recreate professional knowledge in specific 'local' situations by relating to universal standards and to internalized 'libraries' of situated expert experience. While the more common notion of knowledge as a socially contested resource continues to be relevant for research on skilled migration, professional knowledge should also be seen as emerging in situations in response to socio-material problems. These problems can be structured by the nation-state, but they can also be transnational in nature.
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Affiliation(s)
- Anja Weiß
- a Institute for Sociology, University of Duisburg-Essen , Lotharstraße 63, 47057 Duisburg , Germany
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14
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Aggarwal NK, Cedeño K, Guarnaccia P, Kleinman A, Lewis-Fernández R. The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators. SPRINGERPLUS 2016; 5:384. [PMID: 27065092 PMCID: PMC4814393 DOI: 10.1186/s40064-016-2037-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches. Administrators and clinicians named clinician techniques for psycho-education whereas patients named these techniques for enlistment in treatment planning as equals. All groups named patient cultural views and institutional challenges as barriers to care, but only patients and administrators additionally named clinician biases as possible barriers. We discuss these discrepant perceptions and possible solutions to improve research, practice, and policy on cultural competence in mental health.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, 1051 Riverside Drive, Unit 11, New York, NY 10032 USA ; New York State Psychiatric Institute, New York, NY USA
| | - Kryst Cedeño
- New York State Psychiatric Institute, New York, NY USA
| | - Peter Guarnaccia
- Department of Human Ecology, Rutgers, The State University of New Jersey, Newark, NJ USA
| | - Arthur Kleinman
- Department of Social Medicine, Harvard University, Cambridge, MA USA
| | - Roberto Lewis-Fernández
- Columbia University Medical Center, New York, NY USA ; NYS Center of Excellence for Cultural Competence, and Hispanic Treatment Program, New York State Psychiatric Institute, New York, NY USA
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15
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Huhn D, Junne F, Zipfel S, Duelli R, Resch F, Herzog W, Nikendei C. International medical students--a survey of perceived challenges and established support services at medical faculties. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2015; 32:Doc9. [PMID: 25699112 PMCID: PMC4330639 DOI: 10.3205/zma000951] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 09/04/2014] [Accepted: 10/30/2014] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Medical students with a non-German background face several challenges during their studies. Besides support given by foreign student offices further specific projects for international students have been developed and are offered by medical faculties. However, so far, neither a systematic survey of the faculties' perceived problems nor of the offered support exists. METHOD All study deaneries of medical faculties in Germany were contacted between April and October 2013 and asked for their participation in a telephone interview. Interview partners were asked about 1.) The percentage of non-German students at the medical faculty; 2.) The perceived difficulties and problems of foreign students; 3.) The offers for non-German students; and 4.) The specification of further possibilities of support. Given information was noted, frequencies counted and results interpreted via frequency analysis. RESULTS Only 39% of the medical faculties could give detailed information about the percentage of non-German students. They reported an average share of 3.9% of students with an EU migration background and 4.9% with a non-EU background. Most frequently cited offers are student conducted tutorials, language courses and tandem-programs. The most frequently reported problem by far is the perceived lack of language skills of foreign students at the beginning of their studies. Suggested solutions are mainly the development of tutorials and the improvement of German medical terminology. DISCUSSION Offers of support provided by medical faculties for foreign students vary greatly in type and extent. Support offered is seen to be insufficient in coping with the needs of the international students in many cases. Hence, a better coverage of international students as well as further research efforts to the specific needs and the effectiveness of applied interventions seem to be essential.
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Affiliation(s)
- D. Huhn
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - F. Junne
- Eberhard-Karls-University Tubingen, Medical Clinic, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - S. Zipfel
- Eberhard-Karls-University Tubingen, Medical Clinic, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - R. Duelli
- Ruprecht-Karls-University of Heidelberg, Dean's Office of the Medical Faculty of Heidelberg, Heidelberg, Germany
| | - F. Resch
- Ruprecht-Karls-University of Heidelberg, Dean's Office of the Medical Faculty of Heidelberg, Heidelberg, Germany
| | - W. Herzog
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - C. Nikendei
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany,*To whom correspondence should be addressed: C. Nikendei, University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Thibautstraße 2, D-69115 Heidelberg, Germany, Phone: +49 (0)6221/56-38663, Fax: +49 (0)6221/56-5330, E-mail:
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16
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Baker K, Beagan B. Making Assumptions, Making Space: An Anthropological Critique of Cultural Competency and Its Relevance to Queer Patients. Med Anthropol Q 2014; 28:578-98. [DOI: 10.1111/maq.12129] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Baker
- Department of Anthropology; Western University
| | - Brenda Beagan
- School of Occupational Therapy; Dalhousie University
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Abstract
The concept of historical trauma (HT) is compelling: Colonialism has set forth cumulative cycles of adversity that promote morbidity and mortality at personal and collective levels, with especially strong mental health impacts. Yet as ongoing community-based as well as scholarly discussions attest, lingering questions continue to surround HT as a framework for understanding the relationships between colonialism and indigenous mental health. Through an overview of 30 recent peer-reviewed publications that aim to clarify, define, measure, and interpret how HT impacts American Indian and Alaska Native (AIAN) mental health, this paper examines how the conceptual framework of HT has circulated in ways shaped by interactions among three prominent research approaches: evidence-based, culturally relevant, and decolonizing. All define current approaches to AIAN mental health research, but each sets forth different conceptualizations of the connections between colonialism and psychological distress. The unfolding trajectory of research about HT reflects persistent tensions in how these frameworks interact, but also possibilities for better integrating them. These considerations aim to advance conversations about the politics of producing knowledge about AIAN mental health, and support ongoing calls for greater political pluralism in mental health research.
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18
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Affiliation(s)
- Michael Knipper
- Institute of the History of Medicine, Justus Liebig University, Giessen, Germany.
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