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Davis AM, Burks-Abbott G, Merecias O, Swenor BK. Autism interventions designed or adapted for the Black/African American population: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241259910. [PMID: 38910297 DOI: 10.1177/13623613241259910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
LAY ABSTRACT Black/African American people in the United States who have a diagnosis of autism often experience service-related disparities, including not having the same access to high-quality autism and related care (e.g. behavioral interventions), and are less likely to have sustained treatment engagement across their lifespan. While interventions to support autistic people are typically designed to be universal, there is concern that these interventions not being tailored to the Black/African American population could reduce the overall impact due to a lack of responsiveness to the needs of the Black children or families who receive the intervention. The current systematic review summarized research on interventions developed for the Black autism community, including Black children with autism and their caregivers. After a comprehensive, systematic search, eight peer-reviewed publications were identified that met the study's inclusion criteria. The majority of the interventions were tailored to Black caregivers of children with autism. Autism researchers demonstrate different strategies for engaging Black caregivers in culturally responsive ways; however, more research into these interventions is needed in order to assess their effectiveness. In addition, there are still limited interventions adapted to be culturally responsive to Black/African American autistic people. The Cultural Adaptation Checklist framework is a novel approach with promise to become the standard for adapting interventions to meet the needs of culturally diverse groups. Cultural responsiveness is an important facet in the development of interventions that produce optimal outcomes for the range of diversity in the United States and is an important step to achieving equitable autism research practices.
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Babatunde OA, Ramkumar SP, Nguyen SA, Okereke OI, Clark FA, Nagar A, Osazuwa-Peters N, Adjei Boakye E. Association between number of Adverse Childhood Experiences and depression among older adults is moderated by race. Prev Med 2024; 181:107921. [PMID: 38423302 DOI: 10.1016/j.ypmed.2024.107921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE This study aimed to assess the association between number of Adverse Childhood Experiences (ACE) and history of depression among older adults and to explore the interaction by race. METHODS This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data among 60,122 older respondents (≥ 60 years old). The ACE score (zero, one, two-three, ≥four) included questions assessing exposure to eight types of ACEs before age 18. The outcome was the respondent's self-report depression diagnosed (yes/no). Multivariable logistic regression models examined the association between ACEs and depression stratified by race. Each model adjusted for age, smoking status, income, education, marital status, and body mass index. RESULTS In this sample of older adults, 47%, 23%, 19% and 10% reported having experienced zero, one, two-three, and four or more types of ACEs, respectively. Depression was reported by 16% of survey respondents. There was a significant interaction between ACE score and race and depression (p = 0.038). Respondents who experienced ≥4 ACEs had higher likelihood of reporting depression for all race/ethnicity groups: non-Hispanic Whites (aOR = 3.83; 95% CI: 3.07, 4.79), non-Hispanic Blacks (aOR = 3.39, 95% CI: 1.71, 6.71), or Hispanics (aOR = 12.61; 95% CI: 4.75, 33.43). This translated to a large effect size for non-Hispanic Whites and Hispanics although the magnitude was bigger for Hispanics. CONCLUSION The association between number of ACEs and depression was strongest for older adults who identify as Hispanic, but weaker and less consistent for adults who identify as White and Black.
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Affiliation(s)
| | | | - Sarah A Nguyen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, LA, USA
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Frank A Clark
- Prisma Health, Greer, SC, USA; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Anusuiya Nagar
- Prisma Health, Greer, SC, USA; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
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Joseph JJ, Nolan TS, Brock G, Williams A, Zhao S, McKoy A, Kluwe B, Metlock F, Campanelli K, Odei JB, Khumalo MT, Lavender D, Gregory J, Gray DM. Improving mental health in black men through a 24-week community-based lifestyle change intervention: the black impact program. BMC Psychiatry 2024; 24:34. [PMID: 38195473 PMCID: PMC10775551 DOI: 10.1186/s12888-023-05064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/29/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Poor mental health is a leading cause of morbidity and mortality among Black men in the United States. Efforts to improve mental health among Black men have been hampered by a lack of access and utilization of mental health services. Physical activity and social networks have been shown to improve mental health. Thus, we examined the effect of a community team-based physical activity, health education and social needs intervention among Black men on mental health over 24 weeks. METHODS Black adult males (n = 74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and American Heart Association's (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's Life's Simple 7 (LS7) framework. Measures of mental health including the Center for Epidemiological Studies Depression Scale (CES-D), Patient Health Questionnaire 2-question depression screener (PHQ-2), and Perceived Stress Scale-10 (PSS-10) were completed at baseline, 12 and 24 weeks. The change in mental health scores from baseline to 12 and 24 weeks were evaluated using linear mixed-effects models adjusting for age, education, and income. The change in cardiovascular health scores, defined as objective metrics of LS7 (LS5 [blood pressure, total cholesterol, fasting glucose, body mass index and smoking]), by baseline mental health were evaluated using linear mixed-effects models with an interaction term (time*baseline mental health variable) and a random intercept for each participant. RESULTS Among 71 Black men (mean age 51, 85% employed) at 24 weeks, CES-D scores decreased from 10.54 to 7.90 (-2.64, 95%CI:-4.74, -0.55), PHQ-2 decreased from 1.04 to 0.63 (-0.41, 95%CI: -0.75, -0.07), and PSS-10 decreased from 14.62 to 12.91 (-1.71, 95%CI: -3.53, 0.12). A 1-unit higher CES-D at baseline was associated with less improvement in LS5 scores by -0.04 (95%CI: -0.076, -0.005) and - 0.032 (95%CI:-0.067, 0.003) units at week 12 and 24, respectively, with similar findings for PSS. CONCLUSIONS The Black Impact community-based lifestyle program has the potential to reduce depressive symptoms and stress in Black men. There is a dire need for larger, randomized studies to test the impact of Black Impact on mental health in Black men to advance health equity. TRIAL REGISTRATION Retrospectively Registered, ClinicalTrials.gov Identifier: NCT04787978.
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Affiliation(s)
- Joshua J Joseph
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA.
| | - Timiya S Nolan
- The Ohio State University College of Nursing, Columbus, OH, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| | - Guy Brock
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Amaris Williams
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Alicia McKoy
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| | - Bjorn Kluwe
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Faith Metlock
- The Ohio State University College of Nursing, Columbus, OH, USA
| | | | - James B Odei
- The Ohio State University College of Public Health, Columbus, OH, USA
| | | | - Dana Lavender
- The African American Male Wellness Agency, Columbus, OH, USA
| | - John Gregory
- The African American Male Wellness Agency, Columbus, OH, USA
- National Center for Urban Solutions, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
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Zare H, Ibe CA, Yang M, Porter G, Gaston M, Jones N, Jones W, Rose V, Balamani M, Woods DL, Gaskin DJ. Evaluating the Impact of the Prime Time Sister Circles ® Intervention on Reducing Depressive Symptoms Among African American Women with Uncontrolled Hypertension. J Gen Intern Med 2023; 38:2879-2887. [PMID: 37500950 PMCID: PMC10593703 DOI: 10.1007/s11606-023-08288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The Prime Time Sister Circles®, a randomized controlled trial (PTSC-RCT), assessed the impact of a community-based peer support program on hypertension management among African American women 40-75 years of age. While the PTSC-RCT was designed to evaluate changes in blood pressure control, subsequent sub-analyses revealed a high proportion of self-reported depressive symptoms in our sample. Accordingly, we conducted an ancillary investigation of the PTSC intervention on depression to ascertain its impact on reduced depressive symptoms in the study population. METHOD Depressive symptoms were measured using an adapted version of the Center for Epidemiologic Studies Depression Scale Revised (CES-D-10). We used unadjusted and adjusted fixed effect models. Data for this study came from the PTSC-RCT. We collected data between 2017 and 2018 in Washington, DC. We used a balanced analytical sample of 172 African American, English-speaking women between 40 to 75 years old with uncontrolled hypertension. INTERVENTION The intervention group participated in a 2-h, peer-based support group once a week for 13 weeks. A trained PTSC facilitator facilitated sessions with experts who delivered content on various topics, including psychosocial wellness (e.g., stress, depressive symptoms, anxiety management, and self-esteem), physical health (e.g., hypertension, inflammation, and heart disease), physical activity, and healthy nutrition. RESULTS Results from the fixed-effects models indicated that participants in the PTSC program exhibited a greater reduction in CES-D-10 score at three months (Coeff: -1.99, 95% CI: -3.49, -0.49) and at 15 months (Coeff: -2.38, 95% CI: -3.94, -0.83), as compared to those in the control group. CONCLUSIONS Evidence suggests that the Prime Time Sister Circles® intervention reduced depressive symptoms among African American women with low socioeconomic status and hypertension. TRIAL REGISTRATION NCT04371614.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- University of Maryland Global Campus (UMGC), Adelphi, USA.
| | - Chidinma A Ibe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Gayle Porter
- The Gaston & Porter Health Improvement Center, Inc, Washington, DC, USA
| | - Marilyn Gaston
- The Gaston & Porter Health Improvement Center, Inc, Washington, DC, USA
| | - Nicole Jones
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wehmah Jones
- American Institutes for Research, Washington, DC, USA
| | - Vivienne Rose
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michele Balamani
- The Gaston & Porter Health Improvement Center, Inc, Washington, DC, USA
- Baraka and Associates, Largo, MD, USA
| | - Denise L Woods
- The Gaston & Porter Health Improvement Center, Inc, Washington, DC, USA
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jones G, Herrmann F, Nock MK. A Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety: A Multiple-Baseline Pilot Study. JMIR Form Res 2023; 7:e49284. [PMID: 37585252 PMCID: PMC10468709 DOI: 10.2196/49284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Race-based anxiety is a substantial health issue for the Black community. Although mindfulness interventions have demonstrated efficacy for alleviating anxiety, three central barriers prevent Black Americans from accessing existing mindfulness treatments: high costs, excessive time commitments, and limited cultural relevance. There is a need for novel mindfulness interventions for the Black community that can overcome these barriers. OBJECTIVE The goal of this web-based study was to examine the preliminary efficacy, feasibility, and acceptability of a novel digital music-based mindfulness intervention for middle-to-low-income Black Americans with elevated race-based anxiety. METHODS This study used a nonconcurrent multiple-baseline design (n=5). The intervention featured contributions from Lama Rod Owens (a world-renowned meditation teacher and LA Times best-selling author) and Terry Edmonds (the former chief speechwriter for President Bill Clinton). We examined the effect of the intervention on state anxiety and assessed its feasibility and acceptability using quantitative and qualitative measures. RESULTS Results revealed that administration of the intervention led to significant decreases in state anxiety (Tau-U range -0.75 to -0.38; P values<.001). Virtually all feasibility and acceptability metrics were high (ie, the average likelihood of recommending the intervention was 98 out of 100). CONCLUSIONS This study offers preliminary evidence that a digital music-based mindfulness intervention can decrease race-based anxiety in Black Americans. Future research is needed to replicate these results, test whether the intervention can elicit lasting changes in anxiety, assess mechanisms of change, and explore the efficacy of the intervention in real-world contexts.
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Affiliation(s)
- Grant Jones
- Harvard University, Cambridge, MA, United States
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6
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Pham TV, Doorley J, Kenney M, Joo JH, Shallcross AJ, Kincade M, Jackson J, Vranceanu AM. Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants. Pain Manag 2023; 13:473-496. [PMID: 37650756 PMCID: PMC10621777 DOI: 10.2217/pmt-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Doorley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Martha Kenney
- Department of Anesthesiology, Duke University Medical Centre, Durham, NC 27710, USA
| | - Jin Hui Joo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amanda J Shallcross
- Wellness & Preventative Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michael Kincade
- Center for Alzheimer's Research & Treatment, Massachusetts Alzheimer's Disease Research Centre, Boston, MA 02129, USA
| | - Jonathan Jackson
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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Musanje K, Camlin CS, Kamya MR, Vanderplasschen W, Louise Sinclair D, Getahun M, Kirabo H, Nangendo J, Kiweewa J, White RG, Kasujja R. Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001605. [PMID: 36963093 PMCID: PMC10021405 DOI: 10.1371/journal.pgph.0001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The dual burden of living with HIV and negotiating life stage changes has been identified as a contributing factor to lapsed adherence among adolescents with HIV in sub-Saharan Africa. While psychosocial support can promote medication adherence, most interventions in use with adolescents were originally developed for the general population creating a gap in appropriate support. Life-stage-appropriate, evidence-based psychosocial support interventions have been used with young people in high-income contexts, prompting interest in their use in low-income contexts. However, many interventions are less effective when implemented outside of their original settings, hence the need for modifications before implementation. We aimed to culturally adapt an evidence-based psychosocial support intervention designed to improve the mental health of young people for use among adolescents with HIV in a sub-Saharan African context and to explore the acceptability of the adapted intervention among adolescents. We engaged thirty stakeholders (n = 30) in Kampala, Uganda including psychologists, psychiatrists, social workers, HIV counselors, religious leaders and adolescent peers from December 2021 to April 2022 to modify an evidence-based intervention for adolescents. Key adaptations included simplifying the language, adding local practices, integrating locally relevant slang and stories into therapy, introducing racially-congruent visuals and cards representing emotions, and adjusting therapy materials for use in resource-constrained settings. We then tested the acceptability of the intervention in a small sample of service users using a qualitative approach. We recruited nine adolescents with HIV from a participating clinic in Kampala, delivered six 90-minute sessions of the adapted intervention across three weeks and conducted in-depth interviews to assess the acceptability of the intervention. We used thematic analysis to analyze the qualitative data. The adapted intervention was perceived as acceptable among adolescents with HIV, with many stating that it helped them overcome fears, increased their self-acceptance, and gave them the confidence to make careful health-enhancing decisions.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | | | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Hope Kirabo
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - John Kiweewa
- Fairfield University, Fairfield, Connecticut, United States of America
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
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Silas MJ, Seward DX. Black women's help‐seeking and self‐care strategies: A phenomenological exploration. JOURNAL OF COUNSELING AND DEVELOPMENT 2023. [DOI: 10.1002/jcad.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Melany J. Silas
- Department of Health Services State University of New York at Monroe Community College Rochester New York USA
| | - Derek X. Seward
- Department of Counseling and Human Services Syracuse University Syracuse New York USA
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9
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Williams KDA, Adkins A, Kuo SIC, LaRose JG, Utsey SO, Guidry JPD, Dick D, Carlyle KE. Mental health disorder symptom prevalence and rates of help-seeking among University-Enrolled, emerging adults. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:61-68. [PMID: 33735596 PMCID: PMC8448792 DOI: 10.1080/07448481.2021.1873791] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
Objective. Examine mental health symptom prevalence and rates of campus services utilization among Black male, White male and Black female college students. Participants. 2500 students from an ongoing, student survey at a public university; launched in 2011. Methods. Measures included data for anxiety and depressive symptoms and utilization of campus health services (counseling center, health services, etc.). Descriptive analyses determined prevalence and utilization rates. Mann Whitney U tests compared prevalence. Chi-squared tests compared utilization rates. Results. Anxiety prevalence: greater than 60% of students from each ethnic group reported symptoms; reporting rates decreased significantly for Black men (49.6%); p < 0.001. Depression prevalence: greater than 80% reported symptoms; there were significant differences in reporting between Black men and Black women (72.7% vs. 87.1%, p < 0.001). Utilization: Black men utilized counseling services less than White men (20.4% vs. 37.8%, p = 0.024). Conclusion. Black men report depressive and anxiety symptoms but underutilize campus health resources.
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Affiliation(s)
- Kofoworola D. A. Williams
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Amy Adkins
- Department of Psychology, Virginia Commonwealth University College of Humanities & Sciences, Richmond, VA, USA
| | - Sally I-Chun Kuo
- Department of Psychology, Virginia Commonwealth University College of Humanities & Sciences, Richmond, VA, USA
| | - Jessica G. LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Shawn O. Utsey
- Department of African American Studies, Virginia Commonwealth University College of Humanities & Sciences, Richmond, VA, USA
| | - Jeanine P. D. Guidry
- Robertson School of Media and Culture, Virginia Commonwealth University College of Humanities & Sciences, Richmond, VA, USA
| | | | - Danielle Dick
- Department of Psychology, Virginia Commonwealth University College of Humanities & Sciences, Richmond, VA, USA
| | - Kellie E. Carlyle
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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10
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Ward EC, Brown RL, Sullivan-Wade L, Sainvilma S. A Culturally Adapted Depression Intervention for African American Adults: An Efficacy Trial. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2021; 120:273-280. [PMID: 35025174 PMCID: PMC9815899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the most common, costly, and debilitating psychiatric disorders in the United States, and the World Health Organization has identified MDD as a leading cause of disability. Although the rates of MDD among African American and White populations in the US are comparable, African Americans in the US tend to experience higher rates of disability associated with MDD compared to White people. Despite the high burden of MDD among African Americans, their use of mental health services is low, in part due to suboptimal care. OBJECTIVES This study evaluated the efficacy of a culturally adapted depression intervention (Oh Happy Day Class [OHDC]) compared to an active control, the Coping with Depression (CWD) course. METHODS A clustered randomized controlled trial was conducted with a sample of 132 patients with mild to moderate depressive symptoms. They were randomly assigned in a 2-armed randomized controlled trial. They received 1 of 2 (OHDC or CWD) 12-week interventions in weekly in-person group sessions. The primary outcome was a change in depressive symptoms during and post-intervention, measured with the Center for Epidemiologic Studies Depression Scale (CES-D) and the Quick Inventory of Depression Symptoms (QIDS). Analyses included log-rank test and mixed effects linear regression models. RESULTS Both interventions were efficacious in reducing symptoms of depression. However, a greater dose of the culturally adapted intervention, Oh Happy Day Class, showed a greater reduction in depression symptoms. CONCLUSION This study represents the first randomized controlled trial evaluating the culturally adapted treatment depression intervention, Oh Happy Day Class. These findings provide evidence for and the need for culturally adapted treatments. Future research with larger samples of African Americans from different regions across the US could examine effectiveness and generalizability of the Oh Happy Day Class depression treatment.
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Affiliation(s)
- Earlise C Ward
- University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin,
| | - Roger L Brown
- University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | | | - Suzie Sainvilma
- University of Wisconsin-Madison, School of Education, Madison, Wisconsin
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11
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Arundell LL, Barnett P, Buckman JEJ, Saunders R, Pilling S. The effectiveness of adapted psychological interventions for people from ethnic minority groups: A systematic review and conceptual typology. Clin Psychol Rev 2021; 88:102063. [PMID: 34265501 PMCID: PMC8591374 DOI: 10.1016/j.cpr.2021.102063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
This review assessed the efficacy of adapted psychological interventions for Black and minority ethnic (BME) groups. A conceptual typology was developed based on adaptations reported in the literature, drawing on the common factors model, competence frameworks and distinctions between types of cultural adaptations. These distinctions were used to explore the efficacy of different adaptations in improving symptoms of a range of mental health problems for minority groups. Bibliographic searches of MEDLINE, Embase, PsycINFO, HMIC, ASSIA, CENTRAL, CDSR and CINAHL spanned the period from 1965 to December 2020. Adaptations to interventions were categorised: i) treatment specific: therapist-related, ii) treatment-specific: content-related and iii) organisation-specific. Meta-analyses of RCTs found a significant effect on symptom reduction when adapted interventions were compared to non-adapted active treatments (K = 30, Hedge's g = -0.43 [95% CI: -0.61, -0.25], p < .001). Studies often incorporated multiple adaptations, limiting the exploration of the comparative effectiveness of different adaptation types, although inclusion of organisation-specific adaptations may be associated with greater benefits. Future research, practitioner training and treatment and service development pertaining to adapted care for minority groups may benefit from adopting the conceptual typology described.
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Affiliation(s)
- Laura-Louise Arundell
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; iCope, Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
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12
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Ezawa ID, Strunk DR. Differences in the Delivery of Cognitive Behavioral Therapy for Depression When Therapists Work with Black and White Patients. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Anik E, West RM, Cardno AG, Mir G. Culturally adapted psychotherapies for depressed adults: A systematic review and meta-analysis. J Affect Disord 2021; 278:296-310. [PMID: 32979561 DOI: 10.1016/j.jad.2020.09.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is current debate about the effectiveness and generalizability of evidence-based psychological therapies in treatment of depression for diverse ethno-cultural groups. This has led to increasing interest in culturally adapted psychotherapies (CAPs). METHODS Studies on CAPs for face-to-face treatment of depressed adults were identified using nine electronic database searches. Data on the process of adaptation was analysed using thematic analysis and treatment efficacy was assessed through meta-analysis of Randomized Controlled Trials. RESULTS Fifteen studies were included in the review, of which eight were included in a meta-analysis. Cognitive Behavioural Therapy and Behavioural Activation were commonly selected approaches for CAPs, mainly based on their strong evidence base for effectiveness. Twelve studies reported the adaptation process that follows all or some phases recommended by the Medical Research Council Framework for developing complex interventions. A meta-analysis of 16 RCTs, which included eight studies from the current review and eight studies from an earlier review (Chowdhary et al. (2014), demonstrated a statistically significant benefit in favour of CAPs, reducing symptom burden [standardized mean difference -0.63, 95% confidence interval -0.87 to -0.39]. Subgroup analysis showed a larger effect when the intervention was for the majority ethnic group in a population, rather than a minority group. LIMITATIONS Some studies did not report all relevant information, and in the subgroup analysis only three studies were of minority groups. CONCLUSIONS CAPs were confirmed to be more efficacious than control treatments. This supports the continued development and evaluation of culturally adapted psychotherapies for depression.
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Affiliation(s)
- Evrim Anik
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Robert M West
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Alastair G Cardno
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Ghazala Mir
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK
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14
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Salami TK, Carter SE, Cordova B, Flowers KC, Walker RL. The Influence of Race-Related Stress on Eating Pathology: The Mediating Role of Depression and Moderating Role of Cultural Worldview Among Black American Women. JOURNAL OF BLACK PSYCHOLOGY 2019. [DOI: 10.1177/0095798419887632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The current study aimed to advance the eating pathology literature through investigating the association between a salient stressor for Black American women (race-related stress) and eating pathology, while also examining the potential mediating role of depressive symptoms on this association. In addition, the study aimed to examine the potential protective role of cultural worldview in this model. A community sample of 119 Black women between the ages of 18 and 60 years ( M = 36.34, SD = 12.51) were recruited for the study. Results supported a significant indirect effect of race-related stress on eating pathology through depressive symptoms. Moderated mediation analyses revealed a conditional effect of depression at various levels of worldview. Contrary to our hypotheses, participants with a more collectivistic and spiritual worldview often engaged in more eating pathology as a result of self-reported depressive symptoms stemming from experiences of race-related stress. Implications and future directions are discussed.
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15
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Hawkins JM, Schwenzer C, Hecht HK, Jones L, Velez-Ortiz D, Lee J, Ahmedani B, Piatt G. Mental health care use in men with comorbid diabetes and depression: The role of age and race. ACTA ACUST UNITED AC 2019; 4. [PMID: 33869794 PMCID: PMC8049769 DOI: 10.15761/hec.1000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Older adults with diabetes have double the normal average risk for depression. While women also report higher rates of depression, men are less likely than women to recognize symptoms and seek assistance for mental health treatment. Racial disparities in mental health care use among men have also been identified. While age and gender differences in mental health care use have been accounted for in adults with comorbid diabetes and depression little is known about within group differences among men. The purpose of this study was to examine the influence of age and race on mental health service use in a sample of men with comorbid diabetes and depression. Methods: This study utilized secondary data from a large health care delivery system serving in a Midwestern urban city and included 335 Black, and non-Latino White men with comorbid type 2 diabetes and depression. Results and Discussion: Findings indicate that men under the age of 55 were less likely to experience a 6-month or more delay in receiving a psychiatric medication prescription after their initial depression diagnosis. Black men over 55 years of age were significantly more likely to experience a delay of over six months to receiving psychiatric medication. More research is needed to explore preferred depression treatment methods for older Black men with type 2 diabetes, in addition to any issues with access to pharmacological medications to treat depression.
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Affiliation(s)
| | | | | | | | | | - Jaewon Lee
- School of Social Work Michigan State University, USA
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16
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Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractCognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of theCognitive Behaviour Therapisthave tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.
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17
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Naab F, Brown R, Ward EC. Culturally adapted depression intervention to manage depression among women with infertility in Ghana. J Health Psychol 2019; 26:949-961. [PMID: 31216898 DOI: 10.1177/1359105319857175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This study tested the feasibility of a culturally adapted depression intervention among women with infertility. Women who were seeking medical treatment for infertility were randomized into treatment and control groups. Data were collected at baseline, 6 weeks, 12 weeks, and 3 months post intervention. General linear mixed model using empirical Bayesian estimates for repeated measures was used. The findings indicate an improvement in the women's psychosocial health in the treatment group as compared with the controls. These findings strongly suggest that the management of these psychosocial problems should be an integral part of the management of infertility.
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Affiliation(s)
- Florence Naab
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Ghana
| | - Roger Brown
- School of Medicine, Nursing and Public Health, University of Wisconsin-Madison, USA
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McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers. Ethn Dis 2019; 29:359-364. [PMID: 31308606 DOI: 10.18865/ed.29.s2.359] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of implementation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations.
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Abrams JA, Hill A, Maxwell M. Underneath the Mask of the Strong Black Woman Schema: Disentangling Influences of Strength and Self-Silencing on Depressive Symptoms among U.S. Black Women. SEX ROLES 2019; 80:517-526. [PMID: 31086431 PMCID: PMC6510490 DOI: 10.1007/s11199-018-0956-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent investigations have elucidated the influence of the Strong Black Woman (SBW) Schema on the mental health and treatment seeking behaviors of Black women in the United States. However, the SBW schematic characteristics that produce depression have yet to be identified. The current study fills this void in the literature through a quantitative examination of how characteristics of the SBW Schema relate to depressive symptomology. Analyses were based on 194 participants, including college students (n = 98) and community members (n = 96), ranging in age from 18 to 82 years-old (M = 37.53, SD = 19.88). As hypothesized, various manifestations of self-silencing were found to significantly mediate the relationship between the perceived obligation to manifest strength (a SBW characteristic) and depressive symptomatology. The present study advances the idea that depressive symptoms are related to endorsement of the SBW Schema and highlights self-silencing as a mechanism by which this relationship occurs. These results offer evidence and clarification of the impact of the SBW Schema on Black women's mental health and identify specific points of intervention for mental health practitioners conducting therapeutic work with Black women. We provide recommendations for future research to avoid pathologizing strength and we discuss the implications and potential benefits of integrating a Womanist theoretical perspective into counseling for Black women, a population that has historically underutilized mental health resources.
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Doornbos MM, Zandee GL, Timmermans B, Moes J, DeGroot J, DeMaagd-Rodriguez M, Smit-Scholman J, Zietse M, Heitsch E, Quist M. Women supporting women: Supportive/educative groups for ethnically diverse, urban, impoverished women dealing with depression and anxiety. Arch Psychiatr Nurs 2018; 32:524-529. [PMID: 30029743 DOI: 10.1016/j.apnu.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/08/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
Abstract
Depression and anxiety are mental health issues that disproportionately affect urban, ethnically diverse, impoverished women. Using community based participatory research and in the context of long-term partnerships between a nursing department and underserved neighborhoods that are predominately Black, Hispanic, and White respectively, supportive/educative groups were offered. The study employed a quasi-experimental, nonequivalent comparison group pretest-posttest design. Seventy-two women aged 17-88 years participated. Repeated measures ANOVA indicated a significant increase in knowledge for self-care for depression and anxiety and a significant decrease in anxiety and depression symptomatology from before to after the group sessions.
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Jongen C, McCalman J, Bainbridge R, Clifford A. Cultural Competence Strengths, Weaknesses and Future Directions. SPRINGERBRIEFS IN PUBLIC HEALTH 2018. [DOI: 10.1007/978-981-10-5293-4_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jongen CS, McCalman J, Bainbridge RG. The Implementation and Evaluation of Health Promotion Services and Programs to Improve Cultural Competency: A Systematic Scoping Review. Front Public Health 2017; 5:24. [PMID: 28289677 PMCID: PMC5327788 DOI: 10.3389/fpubh.2017.00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/08/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. METHODS This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. RESULTS The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. DISCUSSION Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.
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Affiliation(s)
- Crystal Sky Jongen
- School of Human Health and Social Sciences, Central Queensland University, Cairns, QLD, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, QLD, Australia
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Curran TM, Monahan JL, Samp JA, Coles VB, DiClemente RJ, Sales J. Sexual Risk Among African American Women: Psychological Factors and the Mediating Role of Social Skills. COMMUNICATION QUARTERLY 2016; 64:536-552. [PMID: 28490827 PMCID: PMC5421988 DOI: 10.1080/01463373.2015.1132241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Prior research demonstrates a positive association between mental health problems and sexual risk for African American women. Using the social skills deficit hypothesis, we proposed that social skills mediate this relationship. African American women (n = 557, M age = 20.58) completed measures of depression, stress, emotional dysregulation, sexual risk behaviors, and perceptions of their social skills with their primary sexual partner. Social skills mediated the link between the mental health assessments and a composite sexual risk index. Theoretical implications of extending the social skill deficit hypothesis are discussed as well as implications for interventions.
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Affiliation(s)
- Timothy M Curran
- (M.A., University of Montana, 2014) is a graduate student in the Department of Communication at the University of Georgia
| | - Jennifer L Monahan
- (Ph.D., University of Southern California, 1993) is a professor in the Department of Communication at the University of Georgia
| | - Jennifer A Samp
- (Ph.D., University of Wisconsin-Madison, 1999) is a professor in the Department of Communication at the University of Georgia
| | - Valerie B Coles
- (M.A., University of Georgia, 2013) is a graduate student in the Department of Communication at the University of Georgia
| | - Ralph J DiClemente
- (Ph.D., University of California San Francisco, 1984) is a professor in the Rollins School of Public Health at Emory University
| | - Jessica Sales
- (Ph.D., University of Emory University, 2004) is a research associate professor in the Rollins School of Public Health at Emory University
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Woods-Giscombe C, Robinson MN, Carthon D, Devane-Johnson S, Corbie-Smith G. Superwoman Schema, Stigma, Spirituality, and Culturally Sensitive Providers: Factors Influencing African American Women's Use of Mental Health Services. JOURNAL OF BEST PRACTICES IN HEALTH PROFESSIONS DIVERSITY : RESEARCH, EDUCATION AND POLICY 2016; 9:1124-1144. [PMID: 33043323 PMCID: PMC7544187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many African American women are heavily burdened by unmet mental health needs yet underuse mental health services. The superwoman schema (SWS) conceptual framework provides a new culturally sensitive framework to enhance researchers', providers', and educators' understanding of the barriers to mental health service use among this group. The "superwoman" role involves perceived obligations to (1) project strength, (2) suppress emotions, (3) resist feelings of vulnerability and dependence, (4) succeed despite limited resources, and (5) prioritize caregiving over self-care. In this study, the SWS framework guided a secondary qualitative analysis of data from eight focus groups comprised of 48 African American women from the southeastern United States and a broad range of age and educational backgrounds. Results suggest that the major components of SWS, as well as perceived stigma, religious and spiritual concerns, and the desire for culturally sensitive providers influenced participants' perceptions and use of mental healthcare. Understanding how SWS operates in African American women may (1) enable researchers to better understand and develop interventions to mitigate disparities in mental health service use; (2) help healthcare professionals to engage and treat this population more effectively; and (3) equip health professions educators to improve the cultural sensitivity of the next generation of providers.
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Affiliation(s)
- Cheryl Woods-Giscombe
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Dana Carthon
- School of Nursing, Michigan State University, East Lansing, Michigan
| | | | - Giselle Corbie-Smith
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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