The care needs of Pakistani families caring for disabled children: how relevant is cultural competence?

Patient safety vulnerabilities for children with intellectual disability in hospital: a systematic review and narrative synthesis

PURPOSE

Adults and children with intellectual disability (ID) are vulnerable to preventable morbidity and mortality due to poor quality healthcare. While poor quality care has been commonly identified among children with ID, evidence of the patient safety outcomes for this group is lacking and therefore explored in this review.

DATA SOURCES

Systematic searches of six electronic bibliographic research databases were undertaken from January 2000 to October 2017, in addition to hand searching.

STUDY SELECTION

Keywords, subject headings and MeSH terms relating to the experience of iatrogenic harm during hospitalisation for children with ID were used. Potentially relevant articles were screened against the eligibility criteria. Non-English language papers were excluded.

DATA EXTRACTION

Data regarding: author(s), publication year, country, sample, health service setting, study design, primary focus and main findings related to measures of quality and safety performance were extracted.

RESULTS OF DATA SYNTHESIS

Sixteen studies met the inclusion criteria, with three themes emerging: the impact of the assumptions of healthcare workers (HCWs) about the child with ID on care quality and associated safety outcomes; reliance on parental presence during hospitalisation as a protective factor; and the need for HCWs to possess comprehensive understanding of the IDs experienced by children in their care, to scientifically deduce how hospitalisation may compromise their safety, care quality and treatment outcomes.

CONCLUSION

When HCWs understand and are responsive to children's individual needs and their ID, they are better placed to adjust care delivery processes to improve care quality and safety during hospitalisation for children with ID.

A collaborative exploration of the reasons for lower satisfaction with services among Bangladeshi and Pakistani social care users

This study explored underlying reasons for the expression of dissatisfaction with services among Bangladeshi and Pakistani social care users in England and investigated, using a collaborative approach, how these could be addressed. In-depth interviews were conducted in Birmingham, Leeds and London during 2012-2013 with 63 Bangladeshi, Pakistani and white British service users and 24 social care managers, social workers and care workers. A further 34 cognitive interviews were conducted within the same study. Following data analysis, three collaborative workshops involving service users and providers were held to validate the findings and to draw out policy and practice recommendations. Analysis of the cognitive interviews showed that higher dissatisfaction among Bangladeshi and Pakistani service users reported in social care surveys was not due to questionnaire design. Instead in-depth interviews showed that dissatisfaction across all three groups was expressed along the social care journey, including accessing care, communication with social workers and the nature of care received. While many issues were common to all three groups, cultural differences also emerged as affecting experiences of social care. These included misunderstandings about family roles in care; gender issues, especially relating to women; language and communication barriers, alongside the need for a more nuanced approach to ethnic 'matching'; and continuing limited cultural understanding among care workers. The collaborative workshops identified practical actions that could address some of the issues identified. These covered raising awareness of services within communities; improving support for informal carers; service user input to assessments; consistent and ongoing sharing of information; improving access; and more efforts to diversify and appropriately train the social care workforce. In conclusion, the paper presents the reality of dissatisfaction among these groups and argues for more action involving communities and service providers to address these persistent issues collaboratively.

Establishing components of cultural competence healthcare models to better cater for the needs of migrants with disability: a systematic review

This study examined the challenges of providing services to migrants with disability (MWD), including healthcare providers’ (HCP) level of cultural competence, and documented components of the cultural competence framework required to reduce disability-related health inequalities. This systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Six databases were searched from January 2000 to August 2013: Ovid Medline, Ovid PsychINFO, EMBASE, CINHAL plus, Informit health databases and Scopus. The search focused on MWD, carers of MWD and HCP working with MWD in industrialised countries. The search yielded 271 articles of which 11 met the inclusion criteria (10 qualitative and 1 quantitative). While HCP perceived themselves as being culturally competent, carers of MWD felt that HCP needed to be more culturally competent as MWD’s needs were not being adequately addressed due to cultural misunderstandings and disrespect of cultural values, beliefs and traditions. The review found one existing healthcare model intended for use with MWD; however, the lack of specific attention to cultural competency limits its clinical utility. The findings of this review led to the development of suggested components to be included in a cultural competence model for HCP working with MWD.