Cultural responsiveness for mental health professionals working with Aboriginal and Torres Strait Islander clients: a concept analysis

Factors influencing general practice nurse's implementation of culturally responsive care, using normalization process theory: A cross-sectional study

AIMS

To explore levers and barriers to providing culturally responsive care for general practice nurses (GPNs) using normalization process theory.

DESIGN

A self-administered online cross-sectional survey.

METHODS

A participatory co-designed adapted version of the normalization of complex interventions measure (NoMAD) validated tool was distributed to a convenience sample of GPNs between December 2022 and February 2023. The sample comprised of GPNs working in general practice services in Ireland (n = 122). Data were analysed using descriptive and analytical statistics (Pearson correlations) and principles of content analysis. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

RESULTS

GPNs in this study indicated their familiarity with, acknowledged the importance of and were committed to, providing culturally responsive care. However, implementing culturally responsive care in daily practice was problematic due to insufficient education and training, scarcity of resources and supports and a lack of organizational leadership. Subsequently, GPNs experience difficulties adapting everyday practices to respond appropriately to the care needs of culturally and linguistically diverse (CaLD) patients.

CONCLUSION

This analysis highlights the necessity of exploring the intricacies of factors that influence capabilities and capacity for providing culturally responsive care. Despite demonstrating awareness of the importance of providing nursing care that responds to the needs of CaLD patients, GPNs do not have full confidence or capacity to integrate culturally responsive care into their daily work practices.

IMPACT

Using normalization process theory, this study elucidates for the first time how GPNs in Ireland make sense of, legitimize, enact and sustain culturally responsive care as a routine way of working. It illuminates the multitude of micro-level (individual), meso-level (organizational) and macro-level (structural) factors that require attention for normalizing culturally responsive care in general practice services.

PATIENT OR PUBLIC CONTRIBUTION

The study question was identified in a participatory research prioritization for Irish research about migrant health that involved migrants in the process.

Development and validation of the Cultural Responsiveness Assessment Measure (CRAM): A self-reflection tool for mental health practitioners when working with First Nations people

BACKGROUND

The purpose of this study was to develop and to validate a measure of cultural responsiveness that would assist mental health practitioners across a range of disciplines, in Australia, to work with Indigenous clients.

AIM

The Cultural Responsiveness Assessment Measure (CRAM) was developed to provide a tool for practitioners and students to evaluate their own culturally responsive practice and professional development.

METHOD

Following expert review for face validity the psychometric properties of the measure were assessed quantitatively, from the responses of 400 mental health practitioners.

RESULTS

Confirmatory Factor Analysis yielded a nine factor, 36 item instrument that demonstrated strong convergent and discriminant validity as well as test-retest reliability.

CONCLUSIONS

It is anticipated that the CRAM will have utility as both a learning tool and an assessment measure, for mental health practitioners to ensure that services are culturally responsive for Aboriginal and Torres Strait Islander people.

Vaccine Mandates and Cultural Safety

The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety-not state compulsion-must remain the first principles of any engagement-including vaccination-with First Nations Peoples, families, and communities.

Reliability and validity of the Self-Reflection and Insight Scale for psychologists and the development and validation of the revised short version

Self-reflection is broadly considered a core competency for psychologists; however, there is an absence of measures of self-reflection, limiting the extent to which self-reflection can be assessed in both research and practice contexts. Whilst the Self-Reflection and Insight Scale (Grant et al., 2002) has been validated in a range of formats with different populations, it has not yet been validated with psychologists. Further, the psychometric properties of a short version of the scale (Silvia, 2021) have not been examined for use with psychologists. This study tested the factor structure, internal consistency and convergent and divergent validity of the Self-Reflection and Insight Scale with registered psychologists (N = 123), finding both the full scale and short version to have sound psychometrics. However, as there were low loading items across both versions of the measure, and the short version also excluded high-loading items, the SRIS-Revised (SRIS-R) was formed through model improvement, retaining a total of 14 items. This revised version of the scale captures high loading items without redundancy of low-loading items, resulting in a measure that parsimoniously captures the construct of self-reflection as relevant to psychologists. The SRIS-R demonstrated good internal consistency (α = .882), convergent, divergent and construct validity. Scores on the SRIS-R were used to test whether there was a correlation between self-reflection and years of professional registration, with this not being significant.

Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia

BACKGROUND

Refugee and migrant women are at higher risk of childbirth complications and generally poorer pregnancy outcomes. They also report lower satisfaction with pregnancy care because of language barriers, perceived negative attitudes among service providers, and a lack of understanding of refugee and migrant women's needs. This study juxtaposes health policy expectations in New South Wales (NSW), Australia on pregnancy and maternity care and cultural responsiveness and the experiences of maternal healthcare providers in their day-to-day work with refugee and migrant women from non-English speaking backgrounds.

METHODS

This study used a qualitative framework method to allow for a comparison of providers' experiences with the policy expectations. Sixteen maternal health service providers who work with refugee and migrant women were recruited from two local health districts in New South Wales, Australia and interviewed (November 2019 to August 2020) about their experiences and the challenges they faced. In addition, a systematic search was conducted for policy documents related to the provision of maternal health care to refugee and migrant women on a state and federal level and five policies were included in the analysis.

RESULTS

Framework analysis revealed structural barriers to culturally responsive service provision and the differential impacts of implementation gaps that impede appropriate care resulting in moral distress. Rather than being the programmatic outcome of well-resourced policies, the enactment of cultural responsiveness in the settings studied relied primarily on the intuitions and personal responses of individual service providers such as nurses and social workers.

CONCLUSION

Authentic culturally responsive care requires healthcare organisations to do more than provide staff training. To better promote service user and staff satisfaction and wellbeing, organisations need to embed structures to respond to the needs of refugee and migrant communities in the maternal health sector and beyond.