Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model

Testing the Assumptions in the Process of Cultural Competence in the Delivery of Healthcare Services Using Empirical Data, Focusing on Cultural Awareness

INTRODUCTION

Encounters with children of foreign origin call for school nurses' cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses' cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness.

METHODOLOGY

Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence.

RESULTS

The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs (R² = 13.4, p = .06).

DISCUSSION

Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.

Effectiveness of an integrated primary care intervention in improving psychosocial outcomes among Latino adults with diabetes: the LUNA-D study

OBJECTIVE

To compare the effectiveness of usual care (UC) versus a culturally tailored integrated care model in improving mental health symptoms for Latino patients with Type 2 diabetes mellitus (T2DM).

METHODS

We conducted a two-arm randomized controlled trial from 2015 to 2019 at a federally qualified health center. Participants were 456 adults ages 23-80 years who had a previous diagnosis of T2DM and were not currently using insulin. Participants were randomly assigned to Integrated Care Intervention (ICI; including behavioral/mental healthcare, medical visits, health education and care coordination) or UC; standard of care including referrals for health education and behavioral/mental health care where appropriate. Intention-to-treat, multilevel models were used to compare group × time changes in depression and anxiety symptoms (PHQ-8; GAD-7) and perceived stress (PSS-10) across 6 months.

RESULTS

Participant mean age was 55.7 years, 36.3% were male, and 63.7% were primarily Spanish speaking. Baseline sociodemographic factors and mental health symptoms across study arms were balanced. Significant group × time interaction effects were observed for anxiety and depression symptoms (p < .05). Within the ICI and UC groups, mean depression symptom changes were -0.93 and -0.39 (p < .01); anxiety symptom changes were -0.97 (p < .01) and -0.11 (p = .35); and perceived stress changes were -1.56 and -1.27 (p < .01), respectively.

CONCLUSIONS

Although both ICI and UC showed decreases over time, the ICI group evidenced larger, statistically significant changes in both depression and anxiety. Adapted integrated models of behavioral and chronic disease management appear to be effective and could be considered for usual care practices.

CLINICALTRIALS.GOV IDENTIFIER

NCT03983499.

Type 2 Diabetes Mellitus in Latinx Populations in the United States: A Culturally Relevant Literature Review

Type 2 diabetes mellitus (T2DM) affects a large number of the American population. When compared to their representation in the general American population, a disproportionate number of Latinx individuals are affected. Within the Latinx American population, T2DM prevalence rates vary among individuals based on their country of origin. Deaths from T2DM among Latinx American population are also more compared to other ethnicities. This disparity underlines the importance of understanding the cultural considerations of T2DM disease presentation and management in Latinx communities, including risk factors, socioeconomic variables, and other social determinants of health such as access to care. There are various modifiable and non-modifiable risk factors for the development of T2DM, regardless of race. Staple foods in the diet of Latinx American communities, such as tortillas, rice, and beans, can cause spikes in blood sugar levels and can lead to obesity, which predisposes patients to develop T2DM. Latinx American populations suffer from lower access to healthcare than the general population due to many reasons, including language proficiency, immigration status, socioeconomic status, and level of acculturation. This study utilized the format of a commentary, while incorporating elements of a scoping review for data collection, to further explore these disparities and their impact on these populations. Understanding the cultural beliefs of Latinx individuals and how these beliefs contribute to the perceived development of T2DM is essential to properly treat these unique populations. Despite high rates of T2DM affecting Latinx individuals, non-adherence to prescribed diabetes medications is high among these populations. Interventions in the form of culturally tailored preventative education, in addition to active T2DM management, are necessary to combat the toll of this disease on Latinx Americans. Generic interventional techniques and methods should be replaced entirely by those that acknowledge, highlight, and utilize the sociocultural characteristics of Latinx Americans.

Exploring Outcomes of an Asynchronous Learning Module on Increasing Cultural Competence for Speech-Language Pathology Graduate Students

Purpose Cultural competence is an essential tool for speech-language pathologists and other allied health care professionals in providing ethical and clinically competent care. Determining pedagogical approaches to teaching cultural competence skills to students training in preprofessional programs is imperative to effectively convey the importance of cultural awareness prior to students embarking on their professional careers. Method Forty-five (45) speech-language pathology graduate students were administered a multicultural knowledge quiz before and after a targeted, asynchronous learning module on cultural competence and again 2 months later. Results Quiz scores indicated significant findings immediately following a cultural competence learning module with an additional increase in scores at follow-up. Scores were not significant for minority background but were significant for clinical experience. Conclusions Evidence indicates a brief, targeted video module can positively impact cultural competence skills for speech-language pathology graduate students regardless of clinical experience. Results suggest a combination of targeted instruction along with repeated clinical experience produces the most significant improvement over time. As the current pilot study was employed to test methodology and results are not generalizable, implications for future pedagogical approaches and research studies with comprehensive methodological approaches are provided. Supplemental Material https://doi.org/10.23641/asha.14569482.

Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes

We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.

"I Had Nobody to Represent Me": How Perceptions of Diabetes Health-Care Providers' Age, Gender and Ethnicity Impact Shared Decision-Making in Adults With Type 1 and Type 2 Diabetes

OBJECTIVES

Our aim in this study was to investigate how patients' perceptions of their diabetes health-care providers' (HCP) age, gender and ethnicity impact shared decision-making using the Theory of Planned Behaviour.

METHODS

Adult participants receiving diabetes care at community sites, primary care or specialty clinics participated in semistructured, one-on-one interviews conducted from November 2018 to January 2019. Responses were transcribed and qualitatively analyzed for emergent themes using statistical software (NVivo version 9).

RESULTS

We conducted 28 interviews with participants 34 to 81 years of age. The following themes were identified: 1) participants' gestalt of their diabetes HCP was strongly gender dependent 2) there was a hidden preference for Caucasian HCPs, 3) age evoked a less defensive response with regard to shared decision-making and 4) degree of trust in self and in their diabetes HCP directed participants' readiness to be part of the shared decision-making.

CONCLUSIONS

Participants' narrative experiences strongly suggest that they view their diabetes HCPs through a gendered and racialized lens.

Behavioral Medicine Review: Strategic Management of Diabetes Risk

There is widespread public health concern about the upsurge in diabetes and its cardiometabolic comorbidities. Unfortunately, too many patients still do not receive best practices care. This review discusses some key contributing dynamics as well as considerations for progress toward the more comprehensive, strategic management of diabetes and its associated risks.

Beyond the Melting Pot and Salad Bowl Views of Cultural Diversity: Advancing Cultural Diversity Education of Nutrition Educators

This article outlines how the melting pot and salad bowl views of cultural diversity have influenced the cultural training of nutrition educators and other health professionals. It explores how these views are changing in reaction to the changing demographics and health disparities seen in the US today and how the cultural training of nutrition educators has not kept up with these changing views. Suggestions for how this cultural education could be modified include placing a greater emphasis on both the cultural self-awareness of nutrition educators and the sociopolitical historical factors that influence the cultural orientation of nutrition educators and their clients.

Impact of nurses' cross-cultural competence on nursing intellectual capital from a social cognitive theory perspective

AIMS

To understand the relationships among certain key factors such as organizational climate, self-efficacy and outcome expectation on registered nurses, with regard to the development of registered nurses' cross-cultural competence. The focus is specifically on the use of a social cognitive framework for nurses for providing intercultural nursing care to international patients. This study also aims to examine the relationship between nurses' cross-cultural competence and nursing intellectual capital.

BACKGROUND

Given the influence of globalization on healthcare services, healthcare providers need to have enough cross-cultural competence to effectively care for patients from different cultures. Thus, the development of cross-cultural competence in nursing care has become an important issue.

DESIGN

A quantitative method and a cross-sectional design were employed in this study.

METHODS

Data were collected from 309 RN working in 16 healthcare institutions in Taiwan from May to August 2013. Structural equation modelling, in combination with the smart partial least squares method, was used to measure the relationships in the research model.

RESULTS

The results show that outcome expectation has a stronger impact on nurses' cross-cultural competence than self-efficacy. In addition, it was found that the cross-cultural competence of nurses has a positive impact on nursing intellectual capital.

CONCLUSION

Nursing supervisors should promote a higher level of outcome expectation on nurses to enhance the improvement of their cross-cultural competence. Raising the cross-cultural competence of nurses will aid in the accumulation of nursing intellectual capital.

Cultural Competence Training for Law Enforcement Responding to Domestic Violence Emergencies With the Deaf and Hard of Hearing

Objective. To evaluate a training workshop for law enforcement as first responders for the purpose of increasing officers’ cultural competency in working with Deaf and hard-of-hearing people (Deaf/HH) during domestic violence (DV) emergencies. Method. This evaluation assesses the efficacy of a 2-hour training workshop for law enforcement. Thirty-four participants completed questionnaires at pre- and postintervention to assess participants’ (1) satisfaction with training; (2) skills in responding to Deaf/HH individual(s) in a DV emergency; (3) attitudes toward the Deaf/HH, including bias recognition, self-assessment of cultural competency, and perceived self-efficacy; and (4) knowledge of communication. Focus groups (FGs) were also conducted ( n = 6 for FG1, n = 13 for FG2). SPSS software was used to analyze survey data; principal components analysis was conducted on the survey instruments. Results. There were significant differences between pre- and posttests for several targeted outcomes, including knowledge and perceived self-efficacy. Both survey and FG results demonstrated that participants gained cultural competency skills as indicated by changes in attitudes toward the Deaf/HH, both in DV emergencies and in large-scale emergencies. Conclusion. Significant differences were evident between pre and posttest results in terms of knowledge and perceived self-efficacy. Nonetheless, survey participants demonstrated a lack of knowledge about policy and the law. Survey findings also suggest that while a onetime training can improve the perceived self-efficacy of participants, shifting attitudes about the capabilities of the Deaf/HH may require different training strategies. FG participants demonstrated a greater awareness of the complexity of working with this population in a DV emergency.

Diabetes Causation Beliefs Among Spanish-Speaking Patients

PURPOSE

The purpose of this study was to explore how the inquiry of cultural diabetes causation beliefs can improve Hispanic/Latino patient self-management.

METHODS

Two semistructured focus groups were conducted with 13 Hispanic/Latinos adults diagnosed with type 2 diabetes mellitus. Prior to taking part in the group discussion, participants completed a demographic survey and the Illness Perception Questionnaire-Revised.

RESULTS

The top 5 diabetes causation items endorsed by participants per the questionnaire included stress or worry, behavior, hereditary, diet/eating habits, and family problems/worries. The qualitative analysis revealed stress as a recurring theme for a cause of diabetes. Work stress was specifically identified as a contributor to unhealthy eating and diabetes. Most participants were aware of and believed in susto and referred to it as coraje (anger). Participants believed that asking patients about their diabetes causation beliefs and emotional status can help health professionals (1) better understand the patient and (2) identify and prioritize diabetes treatments. Participants also indicated that the role of doctors is important and the encouragement that they give to patients is clinically and spiritually valued.

CONCLUSIONS

Stress was identified as a cause of diabetes in addition to unhealthy diets and heredity. Asking patients about diabetes causation beliefs and emotional status may help prioritize treatment and management goals.

Leadership style and culturally competent care: Nurse leaders' views of their practice in the multicultural care settings of the United Arab Emirates

Abstract It is well recognised that nurse leader managers play an important role in facilitating the quality and nature of hospital care, the improvement of work performance and work satisfaction. In the United Arab Emirates (UAE) they face the additional challenge of working within a context of significant linguistic and cultural diversity where leadership in the provision of culturally competent care is a major requirement. With this goal at the fore, a sample of 153 nurse-leader-managers, including matrons, nursing directors, supervisors, nurses-in-charge and in-service education staff from four private and six government hospitals completed the Multifactor Leadership Questionnaire (Bass & Avolio, 2004). The survey also explored participants' perceptions of the characteristics of good leaders and what they needed to do in their particular work place to enhance culturally competent care. The results showed nurseleader-managers used both transformational and transactional leadership attributes but in different combinations across the two hospital types.

Community health center provider and staff's Spanish language ability and cultural awareness

Many community health center providers and staff care for Latinos with diabetes, but their Spanish language ability and awareness of Latino culture are unknown. We surveyed 512 Midwestern health center providers and staff who managed Latino patients with diabetes. Few respondents had high Spanish language (13%) or cultural awareness scores (22%). Of respondents who self-reported 76-100% of their patients were Latino, 48% had moderate/low Spanish language and 49% had moderate/low cultural competency scores. Among these respondents, 3% lacked access to interpreters and 27% had neither received cultural competency training nor had access to training. Among all respondents, Spanish skills and Latino cultural awareness were low. Respondents who saw a significant number of Latinos had good access to interpretation services but not cultural competency training. Improved Spanish-language skills and increased access to cultural competency training and Latino cultural knowledge are needed to provide linguistically and culturally tailored care to Latino patients.

Content, placement, and acquisition of cancer education for Latino patient care: a qualitative study of medical and nursing students

A focus group study was conducted with five medical and nursing education programs in Southeastern USA. Twenty-five third and fourth year students were queried about their experiences, beliefs, and attitudes regarding Latino patients and cancer care. A general inductive process using open coding and content comparison to identify emerging themes was used to analyze the qualitative data. Investigators used a process of constant comparison to identify emerging themes. Themes included: (1) importance of cultural specificity and relevance in cancer training, (2) timing and placement of cancer education in the curriculum, including classes and/or clinical rotations, (3) anatomical system specificity of cancer training-studying cancer in the context of a specific body system, and (4) the prevention-focused nature of cancer training. Results of the focus groups have been used to inform a web-based survey of medical and nursing students to identify gaps in cancer education specific to Latino populations.

Explanatory models of diabetes in the U.S. and Mexico: the patient-provider gap and cultural competence

Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994-2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient-provider understanding.

“Because being fat means being sick”: children at risk of type 2 diabetes

This study addresses the social and cultural underpinnings that shape children’s risk of type 2 diabetes, as identified by a racially and economically diverse group of parents and their children living in Anaheim, California. Based on in-depth interviews with 28 adults and 17 children, we explored how they understood what constitutes “good health” in children and the aspects of their neighborhoods and communities that acted as resources or impediments to their children’s well-being. We found that parents and children employed a language of food that reflected a fear-based, medicalized orientation to food consumption. Although nearly all agreed that children should stay active, densely populated neighborhoods, apartment complexes with rigid outdoor rules, high crime rates, police surveillance, and diminished access to public parks and recreational facilities posed challenges. Similarly problematic were deficits in school lunch programs and the limited sometimes demeaning, conversations with healthcare professionals about diabetes risk and prevention. Together, these narratives identify key structural processes attendant to type 2 diabetes risk in children and call for a more politicized conversation regarding prevention strategies and public healthcare practices.

Health care provider perceptions of pain treatment in Hispanic patients

Despite increasing numbers of Hispanic patients in the United States, this group continues to face disparities in access and quality of pain treatment. Although previous surveys have examined treatment disparities experienced by minority patients, none have provided a provider-centric perspective on issues and concerns surrounding pain relief among pain patients of Hispanic/Latino origin. The goal of this study was to assess the relationship between provider characteristics (ie, Spanish fluency, Hispanic caseload size, and experience with Hispanic pain patients) and their perceptions of pain treatment in these patients. One hundred eighty-seven health professionals completed an online survey. The major findings indicated that: (1) less than 20% of health professionals treating Hispanic pain patients reported Spanish proficiency at an advanced level; (2) surveyed health professionals were involved treating a significant proportion of Hispanic patients in their caseloads, but reported a lack of cultural competence training; (3) Spanish fluency and experience with Hispanic pain patients exerts a strong effect on the use of established pain treatment practices; (4) providers with greater Spanish fluency report a significantly greater effect of patients' cultural beliefs and attitudes on treatment; and (5) providers did not regard cultural or language barriers as significantly impacting opioid prescribing or patient compliance.

Primary language and cultural background as factors in resident burnout in medical specialties: a study in a bilingual US city

OBJECTIVE

The aim of this study was to identify the degree of burnout among resident physicians enrolled in seven postgraduate training programs at Texas Tech University Health Sciences Center (TTUHSC), Paul L. Foster School of Medicine, El Paso, Texas, as it related to residents' age, gender, marital status, number of hours worked per week, primary language, race/ethnicity, and cultural background.

METHOD

: The Maslach Burnout Inventory Human Service Survey (MBI) was administered to measure the level of burnout according to the prevalence of emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA).

RESULTS

: Eighty-one percent of the residents at TTUHSC participated in the study. Residents raised in the United States or Canada comprised 28% and 35% of the study, and all reported English as their primary language. The EE scale was significant for obstetrics/gynecology (OB/GYN) residents (prevalence odds ratio [POR] = 13.55, P = 0.02) and psychiatry (PSY) residents (POR = 6.50, P = 0.03). Emergency medicine (EM) residents (POR = 23.35, P = 0.002), OB/GYN (POR = 10.89, P = 0.02), and general surgery (GS) (POR = 6.24, P = 0.03) residents had high DP. Internal medicine (IM) residents (primarily Spanish-speaking) reported significantly low EE (POR = 0.22, P = 0.03) and PA (POR = 0.09, P = 0.001) scores. Residents from the United States or Canada who reported English as their primary language and noted their race as white, had high EE (POR = 3.06, P = 0.03; POR = 5.61, P = 0.0001; POR = 2.91, P = 0.004), DP (POR = 3.19, P = 0.02; POR = 8.34, P < or = 0.0001; POR = 4.70, P < or = 0.0001) and PA (POR = 2.61, P = 0.02; POR = 2.35, P = 0.05, POR 0.29, P = 0.3) scores.

CONCLUSION

Using valid measures, this pilot study identified a statistically significant relationship between burnout and residents' race/ethnicity, primary language, and cultural background. Larger studies with similar focus would be necessary to generalize these findings. At-risk residents in bilingual locations should be provided with cultural awareness workshops, language assistance programs, as well as senior resident and faculty mentors.

Mexican Americans With Type 2 Diabetes in an Emerging Latino Community: Evaluation of Health Disparity Factors and Interventions

Mexican Americans suffer from disproportionately higher rates of type 2 diabetes and its associated complications than the general population. They also confront significant obstacles to health care access and may not receive the same quality of health care as non-Hispanic Whites. Understanding the factors contributing to their health disparities is critical for nurses and other health care providers working with Latino immigrants, especially those in emerging Latino communities such as North Carolina who may lack the established infrastructure of more traditional Latino communities. The purpose of this article is to explicate these factors and examine culturally competent diabetes interventions being used to assist Mexican Americans increase their knowledge of diabetes and health promoting behaviors in order to achieve better glycemic control and prevent complications.

Disability, culture and the U.N. convention

Is the universality of human rights, such as those set out in the United Nations Convention on the Rights of Persons with Disabilities, incompatible with therapeutic strategies of respecting cultural differences? I show that universalism is essential to the notion of human rights, as well as the rarely explained, political slogan of 'the rights approach to disability'. Similarly, culture responsiveness is commonly defended by therapists. I argue that the conflict between universalism of rights and cultural sensitivity exist only if these positions are expressed in extreme form: rights absolutism and cultural relativity. If more sensibly spelled out--in the form of progressive realisation of rights and situational sensitivity of difference--there is no conflict at all. Indeed, these more reasonable positions are mutually supportive. I conclude that, given resource and other constraints, the realisation of human rights will always be a matter of political negotiation, and that a social commitment to equality demands that we ensure that only transparent, fully-informed and fully-participatory procedures, respectful of difference [are employed]. These principles should guide us when we have to make hard choices in the implementation of human rights.

"Worried all the time'': distress and the circumstances of everyday life among immigrant Australians with type 2 diabetes

People with diabetes commonly experience emotional distress and are often diagnosed with depression. To explore lay accounts of the conditions and social aspects of their co-occurrence, we draw on qualitative research conducted in metropolitan Melbourne, Australia. Data derive from in-depth interviews with men and women from Greek, Chinese, Indian and Pacific Island communities, all of which have a higher than average incidence of type 2 diabetes mellitus. Participants generally saw stress as a precursor to diabetes, influencing their ability to control symptoms. Yet they also emphasized that life adversities, trauma, disruption, and multiple losses caused distress and depression. Participants regarded diabetes as an illness that interrupted their ability to carry out everyday living tasks. This contributed to their social isolation and unsettled self-identity, resulting in feelings of personal inadequacy, loss and further distress. These themes were common across immigrant groups.

The challenge of providing infertility services to a low-income immigrant Latino population

OBJECTIVE

To provide insight into the experience of low-income immigrant Latino couples seeking infertility treatment.

DESIGN

Qualitative interview study.

SETTING

Infertility clinic at a university-affiliated urban public teaching hospital.

PATIENT(S)

Infertile low-income immigrant Latino couples (105 women and 40 men).

INTERVENTION(S)

In-depth, tape-recorded interviews.

MAIN OUTCOME MEASURE(S)

After transcription and translation, the interviews were coded and analyzed for thematic content.

RESULT(S)

Four major challenges to providing infertility services to this population were identified: [1] communication: language and cultural barriers resulted in patients having difficulty both in understanding diagnoses and treatments and in communicating their questions, concerns, and experiences to physicians; [2] continuity: because medical students and residents rotated frequently, patients usually saw a different physician at each visit; [3] bureaucracy: patients reported having difficulty with appointment scheduling, follow-up visits, and timed laboratory procedures; and [4] accessibility: patients faced issues of limited availability and affordability of treatment.

CONCLUSION(S)

At a large, urban, university-affiliated infertility clinic, challenges related to communication, comprehension, continuity, bureaucracy, accessibility, availability, and affordability impeded the delivery of optimal infertility care to many low-income immigrant Latino patients. A greater availability of translators and both patient and physician cultural orientations to address these health care barriers is recommended.

African American Adolescent Perceptions of Vulnerability and Resilience to HIV

HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.

Transformational leadership, transnational culture and political competence in globalizing health care services: a case study of Jordan's King Hussein Cancer Center

Background

Following the demise of Jordan's King Hussein bin Talal to cancer in 1999, the country's Al-Amal Center was transformed from a poorly perceived and ineffectual cancer care institution into a Western-style comprehensive cancer center. Renamed King Hussein Cancer Center (KHCC), it achieved improved levels of quality, expanded cancer care services and achieved Joint Commission International accreditation under new leadership over a three-year period (2002–2005).

Methods

An exploratory case research method was used to explain the rapid change to international standards. Sources including personal interviews, document review and on-site observations were combined to conduct a robust examination of KHCC's rapid changes.

Results

The changes which occurred at the KHCC during its formation and leading up to its Joint Commission International (JCI) accreditation can be understood within the conceptual frame of the transformational leadership model. Interviewees and other sources for the case study suggest the use of inspirational motivation, idealized influence, individualized consideration and intellectual stimulation, four factors in the transformational leadership model, had significant impact upon the attitudes and motivation of staff within KHCC. Changes in the institution were achieved through increased motivation and positive attitudes toward the use of JCI continuous improvement processes as well as increased professional training. The case study suggests the role of culture and political sensitivity needs re-definition and expansion within the transformational leadership model to adequately explain leadership in the context of globalizing health care services, specifically when governments are involved in the change initiative.

Conclusion

The KHCC case underscores the utility of the transformational leadership model in an international health care context. To understand leadership in globalizing health care services, KHCC suggests culture is broader than organizational or societal culture to include an informal global network of medical professionals and Western technologies which facilitate global interaction. Additionally, political competencies among leaders may be particularly relevant in globalizing health care services where the goal is achieving international standards of care. Western communication technologies facilitate cross-border interaction, but social and political capital possessed by the leaders may be necessary for transactions across national borders to occur thus gaining access to specialized information and global thought leaders in a medical sub-specialty such as oncology.

Behavioral Medicine Review: Strategic Management of Diabetes Risk

There is widespread public health concern about the upsurge in diabetes and its cardiometabolic comorbidities. Unfortunately, too many patients still do not receive best practices care. This review discusses some key contributing dynamics as well as considerations for progress toward the more comprehensive, strategic management of diabetes and its associated risks.

Synergy and peripheral percutaneous transluminal angioplasty

Peripheral percutaneous transluminal angioplasty with endovascular stent is a procedure to improve the symptoms of claudication caused by peripheral vascular disease. There is evidence to show that upward of 30% of patients seek further intervention for recurring symptoms in 1 year. This high rate of recidivism necessitates nursing intervention postprocedure in the hospital to promote a lifestyle change. The Synergy Model is useful to develop a relationship between the patient and the nurse that promotes a lifestyle change. The outlined patient who underwent peripheral percutaneous transluminal angioplasty and the nurse characteristics within the Synergy Model lend themselves to frame a short, intense hospital stay inclusive of thorough, patient-centered teaching.

Type 2 diabetes in the Hispanic or Latino population: challenges and opportunities

PURPOSE OF REVIEW

To describe how type 2 diabetes affects the Latino or Hispanic population in the United States, and identify the multiple challenges and opportunities to improve diabetes care in this rapidly growing group.

RECENT FINDINGS

Three compelling reasons justify the work in this area. First, this group has become the largest minority in the country, representing 13.7% of the total population. Based on current growth rates, one in four individuals will be of Hispanic origin by the year 2050. Second, this population suffers from very high rates of type 2 diabetes, obesity, the metabolic syndrome and their multiple vascular complications. A genetic tendency to develop insulin resistance and abdominal obesity, along with multiple nutritional, lifestyle, socio-economic and cultural factors, influence the development and course of type 2 diabetes among Latinos. Third, Hispanics have lagged behind in their diabetes care when compared with the predominant non-Hispanic White population.

SUMMARY

Understanding the challenges and opportunities in Latinos with diabetes is necessary to develop and implement comprehensive culturally oriented diabetes care, education, outreach and research programs. Some of these strategies may also be beneficial for other groups and can contribute to better integrate our societies.

Evaluation of residency training in the delivery of culturally effective care

OBJECTIVE

To augment resident training in the delivery of culturally effective care in order to improve clinician capacity to effectively care for patients from diverse backgrounds.

METHODS

Residents from the Naval Medical Center San Diego and the University of California San Diego participated in experiential learning and service activities. Programme evaluation assessed aspects of the delivery of culturally effective care in community settings. A community-based participatory approach to engaging residents in the delivery of culturally effective care and evaluation of the effectiveness of this approach are described.

RESULTS

A significant pre-post rotation increase was noted in residents' self-perceived ability to identify culture-related issues that may impact on the patient's view of illness (P<0.001) and ability to address a culture-related issue (P<0.001). Community evaluations rated residents positively on behaviours that reflected communication skills and professionalism, but less positively on knowledge about communities.

CONCLUSIONS

The authors conclude that resident exposure to the block rotation curriculum contributes to improved knowledge of the skills necessary to provide culturally effective care in diverse community settings.