Patient-centered culturally sensitive health care: model testing and refinement

Real-World Implementation of a COVID-19 Monoclonal Antibody Treatment Program in a Los Angeles County Safety Net Ambulatory Healthcare System - Barriers to Treatment and Lessons Learned

Throughout the COVID-19 pandemic, low-income, minority, and otherwise vulnerable populations have repeatedly been shown to receive unequal access to novel therapies. Addressing this inequity requires specific awareness of the barriers experienced by vulnerable patients, and systemic efforts to address these barriers to provide equitable health care. We designed and implemented an ambulatory COVID-19 treatment program expressly aimed at increasing COVID-19 treatment uptake in a safety-net healthcare system. We describe systemic and human obstacles encountered as well as strategies used to increase use of COVID-19 treatments. Thanks to these strategies, we observed an increase in monoclonal antibody acceptance rate from 29 to 69% over the course of 10 months. We found that interventions such as engaging primary care providers, creating clear-language scripts for outreach calls, assisting with logistic barriers such as transportation, and addressing medical mistrust and hesitancy among both staff and patients were critical to increasing treatment uptake among our safety-net patient population.

Language barriers in head and neck cancer: Matched pair analysis of outcomes between non-English speaking and English-speaking patients

PURPOSE

As society grows in cultural diversity, an increasing proportion of patients are expected to be from non-English speaking backgrounds. This study sought to compare the clinical outcomes between non-English speakers and English speakers treated by radiation therapy for head and neck cancer.

METHODS AND MATERIALS

Seventy-five non-English speaking patients with squamous cell carcinoma of the head and neck were matched to English-speaking controls based on patient and disease variables; clinical outcomes were compared.

RESULTS

Non-English speaking patients had inferior 3-year overall survival (64% vs. 77%, p = 0.02) and progression-free survival (59% vs. 73%, p = 0.01) compared with the English-speaking cohort. On logistical regression, non-English-speaking status was associated with a significantly increased risk of overall death (OR = 1.41; 95% CI, 1.09-1.92).

CONCLUSIONS

Prognosis differed significantly between non-English speaking and English-speaking patients. Culturally tailored programs to address language barriers should be considered to ameliorate disparities in outcome.

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy

BACKGROUND

Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown.

METHODS

our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership.

RESULTS

A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care.

CONCLUSION

Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.

Culturally humble and anti-racist couple and family interventions for African Americans

Anti-Black racism including structural racism and racism-related disparities have come to the foreground in recent years with the increasingly frequent and brutal police killings of innocent African Americans, the disproportionate impacts of the pandemic on the Black community, and the effectiveness of the Black Lives Matter movement. There have been calls to action to ensure cultural effectiveness of couples and family therapy for African Americans. As one response to these calls, this article provides recommendations for culturally humble and anti-racist couple and family interventions. These best practices focus on the necessity of embracing a systemic stance and a strengths-based culturally responsive lens when assessing and intervening with African American couples and families. They focus on the need for therapists to be intentional about and consistent in engaging in self-exploration and taking the necessary steps to be not just competent but also capable. The final set of best practices detailed relate to assessing and intervening using a strengths-based approach in a culturally responsive, anti-racist, and socially attuned fashion. The article concludes with recommendations for couple/family therapists to develop a critical consciousness, engage in anti-racist practices, and address oppression while advancing healing and liberation, all of which are essential to ensuring the resilience and well-being of African American couples and families.

Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions

OBJECTIVE

Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs.

METHOD

217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs.

RESULTS

: In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs.

CONCLUSIONS

: Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.

Building Capacity for Injectable Diacetylmorphine and Hydromorphone for the Treatment of Opioid Use Disorder: Identifying Typical Doses

Identifying typical doses of existing opioid use disorder medications, such as injectable opioid agonist treatment (iOAT), can support client and program needs, and potentially increase iOAT expansion. Longitudinal data from participants in a cohort study (n = 131), along with clinic dispensation records from August 2014 to April 2020, were used to examine physician prescribed as well as used doses of injectable diacetylmorphine and hydromorphone. Dosage groups, by medication and prescribed dose per session, were created for both hydromorphone and diacetylmorphine. A total of 534, 522 injections were registered during the study period among 129 participants. Mean received diacetylmorphine doses ranged from 106 to 989 mg per day, with most clients using 125-262 mg per session (mean 192.99 mg) and attending 2.40 sessions per day. Mean received hydromorphone doses ranged from 51.09 to 696.06 mg per day, with the majority using 88-154 mg per session (mean 121.32 mg; 2.43 sessions). Average daily doses remained stable overtime and, while mid-range doses were most typical, participants used the whole spectrum of allowable dose prescriptions. Evidence supporting typical doses of iOAT can be integrated into program planning to better allow providers and prescribers to anticipate program needs and engage in individualized care.

Policy strategies for capacity building and scale up of the workforce for comprehensive cancer care: a systematic review

BACKGROUND

Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers.

MATERIALS AND METHODS

We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377).

RESULTS

The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited.

CONCLUSIONS

Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.

Influence of the Physical Environment on Maternal Care for Culturally Diverse Women: A Narrative Review

OBJECTIVES

This narrative literature review aims to develop a framework that can be used to understand, study, and design maternal care environments that support the needs of women from diverse racial and ethnic groups.

BACKGROUND

Childbirth and the beginning of life hold particular significance across many cultures. People's cultural orientation and experiences influence their preferences within healthcare settings. Research suggests that culturally sensitive care can help improve the experiences and outcomes and reduce maternal health disparities for women from diverse cultures. At the same time, the physical environment of the birth setting influences the birthing experience and maternal outcomes such as the progression of labor, the use of interventions, and the type of birth.

METHODS

The review synthesizes articles from three categories: (a) physical environment of birthing facilities, (b) physical environment and culturally sensitive care, and (c) physical environment and culturally sensitive birthing facilities.

RESULTS

Fifty-five articles were identified as relevant to this review. The critical environmental design features identified in these articles were categorized into different spatial scales: community, facility, and room levels.

CONCLUSIONS

Most studies focus on maternal or culturally sensitive care settings outside the United States. Since the maternal care environment is an important aspect of their culturally sensitive care experience, further studies exploring the needs and perspectives of racially and ethnically diverse women within maternal care settings in the United States are necessary. Such research can help future healthcare designers contribute toward addressing the ongoing maternal health crisis within the country.

Client perspectives on primary care integration in a rural-serving behavioral health center

Purpose

Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona.

Design/methodology/approach

Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview.

Findings

The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes.

Originality/value

This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.

When the Process Is the Problem: Racial/Ethnic and Language Disparities in Care Management

OBJECTIVES

Achieving health equity requires addressing disparities at every level of care delivery. Yet, little literature exists examining racial/ethnic disparities in processes of high-risk care management, a foundational tool for population health. This study sought to determine whether race, ethnicity, and language are associated with patient entry into and service intensity within a large care management program.

DESIGN

Retrospective cohort study.

METHODS

Subjects were 23,836 adult patients eligible for the program between 2015 and 2018. Adjusting for demographics, utilization, and medical risk, we analyzed the association between race/ethnicity and language and outcomes of patient selection, enrollment, care plan completion, and care management encounters.

RESULTS

Among all identified as eligible by an algorithm, Asian and Spanish-speaking patients had significantly lower odds of being selected by physicians for care management [OR 0.74 (0.58-0.93), OR 0.79 (0.64-0.97)] compared with White and English-speaking patients, respectively. Once selected, Hispanic/Latino and Asian patients had significantly lower odds compared to White counterparts of having care plans completed by care managers [OR 0.69 (0.50-0.97), 0.50 (0.32-0.79), respectively]. Patients speaking languages other than English or Spanish had a lower odds of care plan completion and had fewer staff encounters than English-speaking counterparts [OR 0.62 (0.44-0.87), RR 0.87 (0.75-1.00), respectively].

CONCLUSIONS

Race/ethnicity and language-based disparities exist at every process level within a large health system's care management program, from selection to outreach. These results underscore the importance of assessing for disparities not just in outcomes but also in program processes, to prevent population health innovations from inadvertently creating new inequities.

Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care

BACKGROUND

United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations.

METHODS

A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables.

RESULTS

Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees.

CONCLUSIONS

Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.

National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020

Importance

Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention.

Objective

To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD.

Design, Setting, and Participants

This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023.

Exposure

Self-reported race and ethnicity.

Main Outcome and Measures

Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications.

Results

The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively.

Conclusions and Relevance

In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.

Gaps in medical education curricula on skin of color in medical school, residency, and beyond: Part 1

Various studies have revealed a disproportionately low representation of skin of color (SOC) dermatology in the medical education system of the United States. This disparity contributes to adverse experiences, missed and/or delayed diagnoses, and overall health inequities for individuals of color. The lack of sufficient SOC education begins at the medical school level and continues throughout residency, fellowship, and beyond formal training. This lack of education can be seen in the dearth of images of common and uncommon skin conditions in darker skin in widely used textbooks and educational resources as well as in the lack of formal training in SOC in many residency programs. Thus far, there have been valuable strides to make dermatologic education more inclusive of all skin colors, but there remains significant work to be done. With the population of the United States expected to continue to diversify and with the expectation that SOC will be a trait of over half of the population of the United States by 2050, it is important to strive for health equity by ensuring that comprehensive and inclusive medical training incorporates SOC. This paper will explore the issue of gaps in medical education in SOC dermatology at all levels and offer a strategic call to action to aid in rectifying this situation.

Diversity in Urology, Are We Moving in the Right Direction?: Analysis of American Urologic Association Urology Residency Match Statistics 2019-2023

Analysis of the urology match statistics provides a window into the future of the urology workforce. Match statistics from 2019 to 2023 were analyzed to determine whether the efforts to promote diversity in 2020 have been impactful. The popularity in the field of urology among all racial/ethnic groups peaked interest in application in 2022. However despite an increase in URIM applicants over the last 5 years, 2023 URM applicants have 1/3 the odds of matching into urology as white applicants.

Importance of sensitivity to patients' individual background in venous care

In the current era of increasing emphasis on diversity, inclusion, and equity, it is of utmost importance for vascular surgeons to be cognizant of the increasingly diverse population in the United States. We should try our best to ensure the same quality of vascular care to all our patients, regardless of their backgrounds. It is humanly impossible to expect any of us to have a deep understanding of all the cultures, and that is not the point of this essay. The key lesson from this essay is that we should be able to recognize that patients from different backgrounds may have different expectations from us and we should try to meet those expectations to the best of our abilities.

PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study: protocol for a hybrid type I, mixed method, randomised controlled trial

INTRODUCTION

Kidney transplant candidates (KTCs) need to be in optimal physical and psychological condition prior to surgery. However, KTCs often experience compromised functional capacity which can be characterised as frailty. Prehabilitation, the enhancement of a person's functional capacity, may be an effective intervention to improve the health status of KTCs. The PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study aims to examine the effectiveness of a multimodal prehabilitation programme on the health status of KTCs, and to explore the potential of implementation of prehabilitation in daily clinical practice.

METHODS AND ANALYSIS

This study uses a single centre, effectiveness-implementation hybrid type I study design, comprised of a randomised controlled trial and a mixed-methods study. Adult patients who are currently on the transplant waiting list or are waitlisted during the study period, at a university medical centre in The Netherlands, will be randomly assigned to either prehabilitation (n=64) or care as usual (n=64) groups. The prehabilitation group will undergo a 12-week home-based, tailored prehabilitation programme consisting of physical and/or nutritional and/or psychosocial interventions depending on the participant's deficits. This programme will be followed by a 12-week maintenance programme in order to enhance the incorporation of the interventions into daily life. The primary endpoint of this study is a change in frailty status as a proxy for health status. Secondary endpoints include changes in physical fitness, nutritional status, psychological well-being, quality of life and clinical outcomes. Tertiary endpoints include the safety, feasibility and acceptability of the prehabilitation programme, and the barriers and facilitators for further implementation.

ETHICS AND DISSEMINATION

Medical ethical approval was granted by the Medical Ethics Committee Groningen, Netherlands (M22.421). Written informed consent will be obtained from all participants. The results will be disseminated at international conferences and in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT05489432.

Identifying the barriers and facilitators to culturally responsive HIV and PrEP screening for racial, ethnic, sexual, and gender minoritized patients: A scoping review protocol

INTRODUCTION

While mainstream messaging about human immunodeficiency virus (HIV) disparities continues to highlight individual risk-taking behavior among historically marginalized groups, including racial, ethnic, sexual, and gender minoritized patients, the effect of structural factors and social determinants of health (SDOH) on morbidity and mortality remain underestimated. Systemic barriers, including a failure of adequate and acceptable screening, play a significant role in the disparate rates of disease. Primary care practitioner (PCP) competency in culturally responsive screening practices is key to reducing the impact of structural factors on HIV rates and outcomes. To address this issue, a scoping review will be performed to inform the development of a training series and social marketing campaign to improve the competency of PCPs in this area.

OBJECTIVES

This scoping review aims to analyze what recent literature identify as facilitators and barriers of culturally responsive HIV and pre-exposure prophylaxis (PrEP) screening practices for historically marginalized populations, specifically racial, ethnic, sexual, and gender minoritized groups. A secondary aim is to identify themes and gaps in the literature to help guide future opportunities for research.

METHODS

This scoping review will be performed following the framework set forth by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Relevant studies between the years 2019-2022 will be identified using a rigorous search strategy across four databases: MEDLINE (via PubMed), Scopus, Cochrane (CENTRAL; via Wiley), and CINAHL (via EBSCO), using Boolean and Medical Subject Headings (MeSH) search terms. Studies will be uploaded to the data extraction tool Covidence to remove duplicates and perform a title/abstract screening, followed by a full-text screening and data extraction.

RESULTS

Data will be extracted and analyzed for themes related to culturally responsive HIV and PrEP screening practices in clinical encounters with the identified target populations. Results will be reported according to PRISMA-ScR guidelines.

DISCUSSION

To our knowledge, this is the first study to use scoping methods to investigate barriers and facilitators to culturally responsive HIV and PrEP screening practices for racial, ethnic, sexual, and gender minoritized populations. The limitations of this study include the analysis restrictions of a scoping review and the timeframe of this review. We anticipate that this study's findings will interest PCPs, public health professionals, community activists, patient populations, and researchers interested in culturally responsive care. The results of this scoping review will inform a practitioner-level intervention that will support culturally sensitive quality improvement of HIV-related prevention and care for patients from minoritized groups. Additionally, the themes and gaps found during analysis will guide future avenues of research related to this topic.

Perceptions of Patient-Centered Care and Their Association With Patient Satisfaction in Abortions for Medical Reasons

OBJECTIVE

Abortions for medical reasons, which happen in the event of fetal abnormalities or maternal life endangerment, are highly politicized and understudied given their prevalence. Our objective was to understand the health care experiences of U.S. individuals who had an abortion of a wanted pregnancy for medical reasons in the second or third trimester.

METHODS

Participants were recruited on Facebook and completed surveys with their demographic information, their perception of their health provider's cultural sensitivity, their patient satisfaction, and their satisfaction with their decision to proceed with an abortion for medical reasons.

RESULTS

Participants were 132 women who were mostly between the ages of 31 and 40 (72.7%), highly educated (84.1% had at least a 4-year college degree), and non-Hispanic White (85.6%). There was no statistically significant difference in patients' rated highest average item score on their providers' Competence or Sensitivity; however, average item scores of providers' Competence and Sensitivity were both higher than Respect scores. Linear regression results show that experiencing patient-centered care significantly predicted patient satisfaction (β = .73, t(131) = 12.03, p < .001) and decision satisfaction (β = .37, t(131) = 4.63, p < .001).

CONCLUSION

Our findings underscore the importance of training providers to deliver patient-centered care that empowers patients to adapt to challenging situations, such as the diagnosis of medical concerns during pregnancy. Providers understanding and supporting the complex process of an abortion for medical reasons can ameliorate the emotional impact of this procedure.

Oral Health Disparities and Inequities in Older Adults

The number of individuals 65 and older living in the United States is increasing substantially and becoming more racially and ethnically diverse. This shift will affect the demographics of the patient population seeking dental care. It will also impact the future treatment needs of older adults. In older adults, similar to the general adult population, oral health disparities continue to exist related to race, ethnicity, gender, and socioeconomic level. Dental practitioners must understand these changes in order to meet the challenges of providing oral health care to the increasing numbers of diverse, medically compromised, and cognitively impaired older adults.

"Health without Borders": Early Findings and Lessons Learned from a Health Promotion Program for Ethnic Minorities Living in Italy

In multicultural contexts, health promotion can be challenging due to people's differences in beliefs, values, and practices regarding health and healthcare. Using the prototypical case scenario offered by the "Health without Borders" program, this study was generally aimed at summarizing the lessons learned and suggesting implications that are hopefully relevant to future culturally competent health promotion programs. This exploratory study used in-depth interviews, focus groups, and document analyses as primary methodological tools to gather data. A qualitative approach was chosen because it has the potential to explore, in depth, the main characteristics (values, operational domains, and action strategies) behind this prototypical case. The study findings suggest that the multicultural health promotion program under study is characterized by four main intertwined core values (i.e., empowerment; peer education; social embeddedness; tailor-made). In turn, these values are expressed in the ten main operational domains (i.e., proactive approach to health promotion; fostering interculturality in health promotion; fostering multidisciplinarity in health promotion; measuring the impact of initiatives; identifying, training, and activating key community members in the role of peer educators; promoting community engagement; fostering a "domino effect"; building institutional links with the organization of the territory; continuous training of the professionals involved in the initiatives; flexibility and a constant focus on projects' continuous redesign) that orient specific strategies of action. This program is based on a tailor-made principle for intervention design and delivery. This feature allows intervention providers to flexibly incorporate the target population's values in delivering health promotion activities. Therefore, the value of this prototypical case lies in the design of "adjustable" initiatives that fit the "program-as-designed" with the cultural characteristics of target populations involved in the intervention.

Promoting Health Equity: Identifying Parent and Child Reactions to a Culturally-Grounded Obesity Prevention Program Specifically Designed for Black Girls Using Community-Engaged Research

The Butterfly Girls (BFG) Study is a culturally and developmentally appropriate online obesity prevention program for 8–10-year-old Black girls designed with key stakeholders in the Black community. This multi-methods investigation, conducted with parent–child dyads who participated in an outcome evaluation of the intervention, aimed to understand parent and child reactions to the program. We were particularly interested in understanding perceptions regarding its cultural and developmental appropriateness, relevance and acceptability. Program participation and survey data (demographics, parent and child write-in comments on process evaluation surveys) were analyzed. Participation data demonstrated high adherence in treatment and comparison groups. Descriptive statistics were calculated for survey data and highlighted the socioeconomic diversity of the sample. Post intervention surveys included two fill-in-the-blank questions for parents (n = 184 for question 1, n = 65 for question 2) and one for children (n = 32). Comments were analyzed using structured thematic analysis. The majority of the feedback from child participants was complimentary and many found the program relatable. Among the parent responses, the majority found the program to be beneficial in its educational nature and in promoting behavior change. This multi-methods analysis suggests that the BFG program was perceived as beneficial by parents while being culturally and developmentally appropriate and engaging for young Black girls, highlighting the importance of co-collaboration in program development.

Fostering globally competent dental students through virtual team-working, problem-solving and person-centred multi-disciplinary care planning

Background/purpose

: Development and acquisition of communication, logical thinking, team-building, critical appraisal, critical thinking and person-centred multi-disciplinary care planning must be considered as skill sets and global core competencies for a dental professional. Therefore, an international online study course to foster undergraduate dental students' skill sets in these areas was established and this study aimed to report the perceptions of participants.

Materials and methods

An international online course consisting of three levels pertaining to the school year was delivered to dental undergraduates of Japan and Thailand from September to December in 2021. An online questionnaire survey was conducted to obtain feedback from the participants and assess the implementation of the course.

Results

In total, 64 responses were obtained from students who participated in all the assigned online sessions and completed the questionnaire (a response rate of 88%). More than 95% of students from each level felt that the programme increased their motivation to study clinical dentistry, and was beneficial for their future and made them appreciate the importance of participating in international exchange. The ratio of favourable respondents was more than 90% with a 95% confidence interval.

Conclusion

Fostering globally competent dental students is important and the acquisition of necessary skill sets could be enhanced through international virtual team-working, problem-solving and person-centred multi-disciplinary care planning activities. These are beneficial for undergraduate dental student training so that they graduate with a broader global perspective and an appreciation of the importance of delivering person-centred culturally sensitive dental care.

Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary

Historical osteopathic principles and practices (OPP)-considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body's self-healing ability into care-are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a 'traditional-minded' group following historical OPP despite evidence against those models and an 'evidence-minded' group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients' values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes.

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

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

Community mental health interventions for people with major depressive disorder: A scoping review

People with major depressive disorder continue to be marred by chronically pernicious yet preventable outcomes in the biopsychosocial aspects. With the reallocation of healthcare resources towards the fight against the coronavirus 2019 pandemic, much emphasis has been placed on existing community mental health interventions to ameliorate the disruption of mental health services. Moreover, the recent propulsion of community mental health services by the World Health Organization Mental Health Action Plan 2013-2030 ignited the need to bolster existing community interventions by providing comprehensive, responsive and integrated mental healthcare. The enhanced emphasis on mental healthcare in the community and the heightened demands of people with major depressive disorder underscores the need to explore the current state of community mental health interventions. This scoping review examined 51 primary studies published from year 2010 to 2020 using Arskey & O'Malley's five-stage framework and provided an overview of the impact of existing community mental health interventions for people with major depressive disorder. Findings using thematic analysis have recommended the adoption of person-centred community mental healthcare via the biopsychosocial approach for people with major depressive disorder. Enablers of community mental health interventions were driven by culturally appropriate care and augmented by technology-driven modalities. Challenges and gaps of community mental health interventions include the perpetuation of stigma and misconception, complex demands of persons with major depressive disorder and lack of holistic and long-term outcomes. Given the impact of major depressive disorder on the various biopsychosocial aspects, it is envisioned that our insights into the enablers and barriers of community mental health interventions will guide prospective interdisciplinary and nurse-led interventions in holistically improving the care of persons with major depressive disorder in the community settings.

Can Nutritional Status in Adults Be Influenced by Health Locus of Control?

The external health locus of control (HLC) is based on an assumption that obtained health results depend on the influences of external factors. As for the internal HLC-that is the effect of our own actions and capabilities. Little is known regarding how the HLC can influence body weight or the occurrence of visceral obesity. The study aimed to assess the relationship between the health locus of control and nutritional status in adults. The study included 744 adults (452 women, 292 men; 2.8% underweight, 43.8% normal weight, 29.7% overweight, and 23.7% obese). In addition to anthropometric measurement and socio-demographic data, the health locus of control, using the Multidimensional Health Locus of Control Scale (MHLC) by Wallston K, Wallston B, and DeVellis R, was assessed. The percentage of subjects with an internal HLC did not differ significantly between obese, overweight, and normal-weight groups. However, the percentage of subjects with an external HLC-dependent on the impact of others-was significantly higher in both men and women with obesity than in corresponding overweight and normal-weight groups (p < 0.01). Yet, the percentage of subjects with an external HLC subject to the impact of chance was significantly higher among overweight and obese women than in those of normal weight (p < 0.05) only. Women with overweight or obesity, with external health locus of control, experienced both the impact of others and of chance more often than women with normal weight. However, men with overweight and with obesity more often had external health locus of control influenced only by others.

Medications Without Borders: Themes in Caregiver Administration of Imported Medications in Pediatrics

OBJECTIVE

This study aimed to identify motivating factors in why parents administer imported medications to their children.

METHODS

In this qualitative study, we enrolled caregivers of patients younger than 18 years who presented for care at a pediatric emergency department. The study team conducted face-to-face interviews with caregivers in the emergency department and used a semistructured question guide to probe for themes regarding the use of imported medications in children. Interviews were recorded, transcribed, translated if necessary, and coded. We applied grounded theory methodology to assess for themes and adapted the Andersen model of health care utilization to provide a framework for the identified themes.

RESULTS

We completed 30 interviews, 9 of which were conducted in Spanish. Themes surrounding imported medication usage were categorized into predisposing, enabling, and need factors. Predisposing factors included perception that an ill child needs medication to get better, perception of medication quality, and past experiences with medications. Enabling factors included proximity to foreign countries, cost, limited access to primary care, and convenience of obtaining medications. Need factors included utilization of foreign medications for a "simple illness" and utilization of foreign care for a "second opinion."

CONCLUSIONS

Our study used qualitative methodology to gain important insights into the caregiver experience of a diverse patient population. We identify themes not previously published in the medication importation literature. These concepts can provide insights in educational strategies aimed at mitigating the potential dangers of imported medication use in pediatrics.

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

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

Perspectives on cultural competency and race concordance from perinatal patients and community-based doulas

BACKGROUND

As awareness of perinatal health disparities grows, many birthing people of color are seeking racially and/or culturally concordant providers. We described preferences for, and perceptions of, racial and/or cultural concordance and cultural competence in the context of the doula-client relationship.

METHODS

Seven focus group discussions (FGDs) with a total of 27 participants were conducted to investigate the perspectives of patients and doulas across Massachusetts, United States. An interdisciplinary stakeholder group informed the data collection instrument content and design. Two coders achieved 0.89 Kappa for inter-rater reliability prior to coding the remaining transcripts. We used a modified grounded theory approach and Dedoose software for coding.

RESULTS

Two major themes emerged. First, cultural competency in doula care is a learning process, with definitions consistent with terms such as "cultural humility" and "structural competency." Doulas discussed listening to clients' needs rather than making assumptions, the importance of understanding privilege and power dynamics, and self-initiating relevant education beyond formal doula training. Second, trust was most frequently cited as an indicator of successful doula-patient relationships.

CONCLUSIONS

Most study participants specified the importance of cultural humility in doula-client relationships. Doulas approaching the relationship humbly with a willingness to learn and challenge their own assumptions-regardless of the level of concordance-can make a meaningful impact on the perinatal experience.

Effect of Adding a Wheelchair Immersion Program to a Physical Medicine and Rehabilitation Clerkship on Emotions, Behavior, and Attitude: A Prospective Pilot Study

ABSTRACT

People with disabilities encounter significant barriers in health care and report that healthcare providers often lack an understanding in caring for them. Currently, there is limited disability awareness training in medical school curricula. This mixed-methods pilot study examined the effects of integrating a short wheelchair immersion program in a physical medicine and rehabilitation clerkship, versus the clerkship alone, on attitudes toward people with disabilities, comfort in treating people with disabilities, knowledge of wheelchair etiquette, and understanding of wheelchair-associated challenges. The standard training group underwent the physical medicine and rehabilitation clerkship, consisting of a 2-wk clinical rotation and didactic program. The intervention group additionally underwent a newly developed 1-hr wheelchair program where they simulated mobility and some activities of daily living as a "wheelchair user" and "caregiver." Quantitative analysis demonstrated that all students who completed the clerkship had significantly improved attitudes toward and comfort in treating people with disabilities, knowledge of wheelchair etiquette, and understanding of wheelchair-associated challenges, whereas students in the wheelchair immersion program had a greater change in understanding wheelchair-associated challenges. Qualitative analysis revealed that the intervention resulted in positive attitudinal changes. These findings suggest that integrating a brief wheelchair immersion program with a physical medicine and rehabilitation clerkship may enhance disability awareness training in medical school curricula.

Perceptions of the impact of COVID-19 on healthcare communication in a nationally representative cross-sectional survey of family caregivers

OBJECTIVE

To understand the perceptions of the impact of the COVID-19 pandemic on healthcare communication with family caregivers.

DESIGN

Nationally representative survey.

SETTING

USA (national).

PARTICIPANTS

340 family caregivers, demographically representative of the US population by race/ethnicity.

PRIMARY OUTCOME MEASURES

Communication outcomes (feeling involved by the provider, feeling involved by the care recipient, feeling more encouraged to be involved in care, feeling contributory to discussions, feeling questions are being answered), behavioural/wellness outcomes (feeling anxious, feeling isolated, feeling it is easier to attend the clinic visit), and desire to continue using telemedicine.

RESULTS

Having less than a college degree was associated with decreased odds of feeling involved by the provider (OR 0.46; 95% CI 0.26 to 0.83; p=0.01), feeling involved by the care recipient (OR 0.44; 95% CI 0.24 to 0.79; p=0.01), feeling more encouraged to be involved in care (OR 0.49; 95% CI 0.27 to 0.86; p=0.01), feeling like they contribute to discussions (OR 0.45; 95% CI 0.25 to 0.82; p=0.01) and feeling like their questions are being answered (OR 0.33; 95% CI 0.18 to 0.60; p<0.001).

CONCLUSION

In our sample, the shift to telemedicine during COVID-19 was well received but caregivers of low educational attainment reported poorer health communication, and a greater proportion of black/African American and Hispanic caregivers reported a desire to return to in-person visits. There is an opportunity to improve health systems and increase equity as telemedicine becomes more widespread.

Program evaluation of a pilot mobile developmental outreach clinic for autism spectrum disorder in Ontario

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing prevalence worldwide. Early identification of ASD through developmental screening is critical for early intervention and improved behavioural outcomes in children. However due to long wait times, delays in diagnosis continue to occur, particularly among minority populations who are faced with existing barriers in access to care. A novel Mobile Developmental Outreach Clinic (M-DOC) was implemented to deliver culturally sensitive screening and assessment practices to increase access to developmental health services, reduce wait times in diagnoses, and aid in equitable access to intervention programs among vulnerable populations in Ontario.

Methods

This study applied two evaluation frameworks (process and outcome evaluation) to determine whether the delivery model was implemented as intended, and if the program achieved its targeted goals. A mixed-methods design was undertaken to address the study objectives.

Results

Between September 2018–February 2020, M-DOC reached 227 families with developmental health concerns for their child, while successfully targeting the intended population and achieving its goals. The mean age of the child-in-need at intake was 31.6 months (SD 9.9), and 70% of the sample were male. The program’s success was attributed to the use of cultural liaisons to break cultural and linguistic barriers, the creation of multiple points of access into the diagnosis pathway, and delivery of educational workshops in local communities to raise awareness and knowledge of autism spectrum disorder.

Conclusions

The findings underscore the need for community-based intervention programs that focus on cultural barriers to accessing health services. The model of delivery of the M-DOC programs highlights the opportunity for other programs to adopt a similar mobile outreach clinic approach as a means to increase access to services, particularly in targeting hard-to-reach and vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07789-7.

Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua

BACKGROUND

The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery.

METHODS

We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country.

RESULTS

Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (β = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (β = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group.

CONCLUSIONS

Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

Objectives:

Within the United States (US), significant racial and ethnic disparities exist in the rates of latent TB infection (LTBI) and active TB disease. A disproportionate number of TB disease cases result from untreated LTBI among individuals born outside the US. This study evaluates LTBI treatment outcomes among an underserved, at-risk population in Rhode Island.

Methods:

A quantitative retrospective chart review of adult patients with a positive screening test assessed LTBI care cascade outcomes including referral, treatment initiation, and completion.

Results:

Seventy-four percent of patients found to have positive screening TB tests were born outside of the US; 80% identified as Hispanic or Black and 45% spoke a preferred language other than English. Twenty-one percent of potential candidates for LTBI treatment initiated treatment.

Conclusions:

Major gaps were identified in referral success and treatment initiation. Expanding LTBI treatment access into primary care settings could be a solution to improve outcomes and decrease health inequities among at-risk communities.

Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters

INTRODUCTION

Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study's purpose is to understand Hmong medical interpreters' perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters.

METHOD

A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis.

RESULTS

13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters' ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients.

DISCUSSION

Clinical encounters that match patient-interpreter ages, gender, and/or local culture may reduce communication barriers.

Social determinants of the disproportionately higher rates of COVID-19 infection among African Caribbean and Black (ACB) population: A systematic review protocol

The challenges of identifying and eliminating racial disparities regarding the exposure, transmission, prevention, and treatment of communicable diseases within the healthcare system have been a mounting concern since the COVID-19 pandemic began. The African, Caribbean, and Black (ACB) populations in Canada represent a fast-expanding and underprivileged community, which have been previously found to have higher susceptibility to communicable diseases and lower sensitivity to intervention measures. Currently, there is insufficient evidence to adequately identify racial patterns in the prevalence and healthcare utilization among the ACB population within the context of the ongoing pandemic. Our proposed study will explore the association between the social determinants of health (SDH) and COVID-19 health outcomes in ACB populations in high-income countries (UK, US, Australia, Canada). We will explore the current evidence through a systematic review of COVID-19 pandemic literature covering the period between December 2019 and October 2020. The objectives include investigating the effect of SDH on the ACB populations’ risk to COVID-19 health outcomes, including COVID-19 infection incidence, severity of disease, hospitalization, mortality and barriers to the treatment and management of COVID-19 for Black people in Canada. In addition, this project aims to investigate the effect of COVID-19 on ACB communities in Ontario by examining the challenges that front-line healthcare workers and administrators have during this pandemic as it pertains to service provisions to ACB communities. A systematic review of original and review studies will be conducted based on the publications on eleven databases (MEDLINE, Web of Science, Cochrane Library, CINAHL, NHS EDD, Global Health, PsychInfo, PubMed, Scopus, Proquest, and Taylor and Francis Online Journals) Primary outcomes will include the rate of COVID-19 infection. The systematic review will include a meta-analysis of available quantitative data, as well as a narrative synthesis of qualitative studies. This systematic review will be among the first to report racial disparities in COVID-19 infection among the ACB population in Canada. Through synthesizing population data regarding the risk factors on various levels, the findings from this systematic review will provide recommendations for future research and evidence for clinical practitioners and social workers. Overall, a better understanding of the nature and consequences of racial disparities during the pandemic will provide policy directions for effective interventions and resilience-building in the post-pandemic era.

Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers

Background

There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill.

Objective

This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia.

Methods

A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis.

Results

A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program.

Conclusions

We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers.

Views of Black women patients with obesity on desired and undesired weight-focused clinical encounters

Non-Hispanic Black women have the highest rates of overweight/obesity of any group in the United States. To date, few interventions have worked to reduce overweight/obesity in this population. This study investigated the views of Black women with overweight and obesity treated in a primary care setting regarding desired and undesired verbal and non-verbal behaviours by providers in provider-patient clinical encounters focused on losing weight, maintaining weight loss, and/or obesity. Two focus groups and an individual interview (n = 15) were conducted. Qualitative data analysis yielded five distinct themes, with 11 codes (listed in parenthesis): (a) desired weight-focused discussions (codes: Discussing weight loss with patients and discussing weight-loss maintenance with patients), (b) desired weight-focused support (codes: Supporting patients experiencing weight loss and supporting patients experiencing weight gain), (c) undesired weight-focused discussions (codes: Things to avoid during weight loss discussions and things to avoid during weight gain discussions), (d) desired attitudes and behaviours during weight-focused discussions (codes: Show caring and understanding and encourage behaviour change for weight loss), and (e) building physician-patient rapport (codes: Enable patients to feel respected by doctors, enable patients to feel comfortable with doctors and enable patients to trust their doctors). The qualitative approach employed in this study generates a deep understanding not only of the experiences of Black women patients but also of potential strategies that physicians could employ to succeed in their discussions with patients regarding healthy weight achievement and maintenance.

Prevalence and Socioeconomic Factors of Diabetes and High Blood Pressure Among Women in Kenya: A Cross-Sectional Study

Background

The emerging burden of high blood pressure (HBP) and diabetes in sub-Saharan Africa will create new challenges to health systems in African countries. There is a scarcity of studies that have reported associations of diabetes and HBP with socioeconomic factors on women within the population. We assessed the prevalence and socioeconomic factors of diabetes and high blood pressure among women in Kenya.

Methods

We analysed cross-sectional data from the 2014 Kenya Demographic and Health Survey. Subjects were women aged 15–49 years. Self-reported status of HBP and diabetes was used to measure the prevalences. The association between educational and wealth index with HBP and diabetes was assessed by multivariable binary logistic regression.

Results

The prevalences of self-reported HBP and diabetes were 9.4% and 1.3%, respectively. Women with secondary [aOR = 1.53; 95% CI = 1.15–2.02] and primary [aOR = 1.48; 95% CI = 1.15–1.92] levels of education were more likely to report having HBP, compared to those with no formal education. However, there was no significant association between educational level and self-reported diabetes. In terms of wealth quintile, we found that women with higher wealth quintile were more likely to report having HBP and diabetes compared to those with poorest wealth quintile. Specifically, the highest odds of self-reported HBP was found among women with richest wealth quintile compared to those with poorest wealth quintile [aOR = 2.22; 95% CI = 1.71–2.88]. Also, women with poorer wealth quintile were more likely to have self-reported diabetes compared to those with poorest wealth quintile [aOR = 1.89; 95% CI = 1.08–2.38].

Conclusion

The prevalence of HBP and diabetes was low among women in Kenya. Household wealth status was associated with HBP and diabetes. No causation can be inferred from the data; hence, longitudinal studies focusing on health-related behaviour associated with NCDs are recommended. Proper dissemination of health information regarding the risk factors for HBP and diabetes may prove to be beneficial for NCD prevention programmes.

Addressing Obstetric Health Disparities among Refugee Populations: Training the Next Generation of Culturally Humble OB/GYN Medical Providers

Issue: The burden of increasing obstetric morbidity and mortality in the United States disproportionately affects marginalized and vulnerable populations, including refugees. Many factors have been attributed to this disparity in birth outcomes, such as linguistic, cultural, and health system limitations. However, refugee health disparities have received little attention in the U.S., especially as it relates to the training of healthcare providers. Evidence: Poor obstetric outcomes among refugee communities have been historically attributed to delayed initiation of prenatal care, failure to detect co-morbidities, as well as higher rates of Cesarean sections in comparison to host-country mothers. These inequities are often linked to poor communication due to cultural misunderstandings, which ultimately leads to mistrust and reduced utilization of healthcare services. In 2017, a Midwest academic hospital, refugee community, and health system came together to form the Congolese Health Partnership (CHP). The CHP was formed to improve access to quality healthcare for expecting Congolese mothers and their families experiencing poor quality of obstetric care. Discussions that arose from this partnership identified issues of mistrust in healthcare providers within the community, worry about misjudgment and overuse of C-sections, and a lack of understanding about health insurance during pregnancy and childbirth. Therefore, it is apparent that understanding the contextual nuances that play a role in these poor outcomes among refugee communities in the U.S. is critical in order to narrow the healthcare gap. Implications: Since pregnancy and its surrounding events are intricately tied to the ways in which different societies define culture, we argue for a focus on culture when training future healthcare providers to work with refugees in the U.S. Specifically, we focus on the necessity of cultural humility, rather than cultural competence, when caring for obstetric patients from diverse backgrounds. Cultural humility forces providers to think about power imbalances that exist between a patient and provider when cultural differences exist. We describe specific barriers to care among Congolese refugees living in eastern Iowa and explore ways to utilize community-provider partnership and cultural humility training to address obstetric morbidity. Finally, we propose ways to incorporate cultural humility training among OB/GYN residents to address community-identified barriers to improve overall health outcomes locally with implications for refugee communities across the U.S.

Questioning Capacity in an Elderly Jamaican Man with Terminal Cancer Exhibiting Near-Death Awareness: A Case Report and Review of Literature

Background: Near-death awareness (NDA) refers to visions and dreams commonly experienced by terminally ill individuals within months to hours before death. Methods: A case report of a 68-year-old Jamaican male diagnosed with advanced cholangiocarcinoma, who experienced visions of his deceased mother during hospitalization. Results: This article discusses how to differentiate NDA from delirium, core components for determining decisional capacity, and how clinicians can use a cultural guide to optimize patient-centered care. Conclusion: Improved recognition of NDA may promote cultural humility/competency and help to differentiate NDA from an underlying medical/psychiatric condition. It may assist the clinician in understanding the significance of NDA and the comfort and meaning these experiences may hold for both the individual and their family.

Fundamental causes of barriers to participation in Alzheimer's clinical research among African Americans

Objectives: African Americans have a significantly higher risk than Whites for developing Alzheimer's disease (AD), but show lower participation in AD clinical trials. Studies of African Americans' involvement in clinical research have identified fear and mistrust of research as barriers to participation. Historical occurrences of unethical research practices are often cited as the source of these attitudes, but underlying factors such as African Americans' experiences of racism and discrimination remain unexplored. The goal of this study was to examine the roles of race and culture in the attitudes and beliefs of African Americans about participating in clinical research.Design: Five focus groups were conducted with 44 African American men and women (aged 50 and over) in a western U.S. state. Participants were asked scripted questions regarding their knowledge and beliefs about AD and their feelings about participating in clinical research. A taxonomy was created to organize results based on participant responses.Results: Four major thematic clusters emerged that influence African Americans beliefs about and participation in clinical research: (a) experiences of unequal treatment and racism, (b) cultural trauma due to historical events and contemporary experiences, (c) racial identity and cultural norms, and (d) the importance of cultural competency and racial congruence in recruitment and research studies.Conclusions: Understanding, acknowledging, and addressing the factors that underlie mistrust and fear of research is important to build trust and to develop culturally appropriate outreach, education, and recruitment strategies that will increase African Americans' participation in clinical research.

Patient-provider communication patterns among Asian American immigrant subgroups in New York City

OBJECTIVES

Patient-provider communication is essential for patient-centered care, yet Asian American immigrant populations face barriers. We aim to describe: 1) patient-reported communication-related characteristics for 16 disaggregated Asian American subgroups; and 2) the association of patient comprehension of provider communication with socio-demographics, language proficiency and concordance, and perceived cultural sensitivity in this population.

METHODS

Descriptive statistics are presented for 1269 Asian American immigrants responding to cross-sectional, venue-sampled surveys conducted in New York City. Logistic regression models examine predictors of low comprehension of provider communication.

RESULTS

Approximately 11% of respondents reported low comprehension of provider communication: lowest among South Asians and highest among Southeast Asians. Eighty-four percent were language-concordant with their provider, 90.1% agreed that their provider understood their background and values, and 16.5% felt their provider looked down on them. Low comprehension of provider communication was significantly associated with Southeast Asian subgroup, less education, limited English proficiency, public health insurance, patient-provider language discordance, and perceived low cultural understanding.

CONCLUSION

Among our sample, language and cultural sensitivity are associated with comprehension of provider communication.

PRACTICE IMPLICATIONS

Strategies improving language access and cultural sensitivity may be important for Asian immigrant patients. These could include interpretation services, bilingual community-based providers, and cultural sensitivity training.

Application of the Spanish-Language Consultation and Relational Empathy (CARE) Measure to Assess Patient-Centered Care Among Latino Populations

INTRODUCTION

Reliable and valid measures are needed to assess the patient-centeredness of clinical care among Latino populations.

METHODS

We translated the Consultation and Relational Empathy (CARE) measure from English to Spanish and assessed its psychometric properties using data from 349 Latino parents/guardians visiting a pediatric clinic. Using confirmatory factor analysis, we examined the psychometric properties of the Spanish CARE measure.

RESULTS

Internal reliability of the Spanish CARE measure was high (Omega coefficient = 0.95). Similar to the English-language CARE measure, factor analysis of the Spanish CARE measure yielded a single domain of patient-centeredness with high item loadings (factor loadings range from 0.79 to 0.96).

CONCLUSION

This preliminary analysis supports the reliability and validity of the Spanish version of the CARE measure among Latinos in pediatric care settings. With further testing, the Spanish CARE measure may be a useful tool for tracking and improving the health care delivered to Latino populations.

Latinx Patients' Perceptions of Culturally Sensitive Health Care and their Association with Patient Satisfaction, Patient-Provider Communication, and Therapeutic Alliance

Latinx in the USA experience disparities in morbidity and mortality when compared to their non-Hispanic White counterparts. Patient-centered culturally sensitive health care (PC-CSHC) has been deemed a best practice approach to alleviate and eliminate these disparities. However, literature on how Latinx patients perceive their care and what indicators of PC-CSHC may be most related to treatment outcomes is limited. This study collected data from 81 adult Latinx participants who had been admitted to an inpatient care unit to understand the following: (a) their perception of their providers' PC-CSHC in three different areas: Competence/Confidence, Sensitivity/Interpersonal, and Respect/Communication; (b) whether there are differences between English- and Spanish-speaking Latinx patients in their perception of their providers' PC-CSHC; and (c) whether these PC-CSHC indicators were associated to patient satisfaction, patient-provider communication, and therapeutic alliance. Participants were mostly male, older than 55 years of age, and working or lower class, with English as their primary language. Results showed that patients rated their providers' Competence (M = 3.57, SD = .46) higher than both Sensitivity, t(68) = .04, p = .04, (M = 3.49, SD =.54), and Respect, t(53) = 2.765, p = .008, (M = 3.38, SD = .57). English-speaking Latinx were overall less satisfied with their providers than Spanish-speaking Latinx, in particular in their communication. Finally, higher provider cultural sensitivity appears to be a predictor of patient satisfaction, patient-provider communication, and working alliance. Implications for refining provider trainings to treat this vulnerable and understudied (i.e., Latinx) population are discussed.

Oral Health Disparities and Inequities in Older Adults

The number of individuals 65 and older living in the United States is increasing substantially and becoming more racially and ethnically diverse. This shift will affect the demographics of the patient population seeking dental care. It will also impact the future treatment needs of older adults. In older adults, similar to the general adult population, oral health disparities continue to exist related to race, ethnicity, gender, and socioeconomic level. Dental practitioners must understand these changes in order to meet the challenges of providing oral health care to the increasing numbers of diverse, medically compromised, and cognitively impaired older adults.

Global Research on Quality of Life of Patients with HIV/AIDS: Is It Socio-Culturally Addressed? (GAPRESEARCH)

Quality of life (QOL) has been considered as an important outcome indicator in holistic care for HIV-infected people, especially as HIV/AIDS transforms from a fatal illness to a chronic condition. This study aimed to identify trends and emerging topics among research concerning the QOL of people living with HIV/AIDS (PLWHA). The analyzed data were English papers published from 1996 to 2017, searched and extracted from the Web of Science Core Collection. Collaborations between countries and the correlation between the keywords were visualized by VOSviewer while the abstracts’ content was analyzed using exploratory factor analysis and Jaccard’s’ similarity index. There has been an increase in both the number of publications and citations. The United Nations of America leads in terms of paper volume. The cross-nation collaborations are mainly regional. Despite a rather comprehensive coverage of topics relating to QOL in PLWHA, there has evidently been a lack of studies focusing on socio-cultural factors and their impacts on the QOL of those who are HIV-infected. Further studies should consider investigating the role of socio-cultural factors, especially where long-term treatment is involved. Policy-level decisions are recommended to be made based on the consideration of cultural factors, while collaborations between developed and developing nations, in particular in HIV/AIDS-ridden countries, are strongly recommended.