Leadership and cultural competence of healthcare professionals: a social network analysis

An Analysis of Lesbian, Gay, Bisexual, Transgender, and Queer Curricula Inclusion: A National Study of Physician Assistant Programs

INTRODUCTION

The health professions education literature shows an increased focus on inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ) content in curricula; however, it does not address hours of content or methods for content delivery. The purpose of this study was to describe the delivery of LGBTQ content in physician assistant (PA) education through a national survey of PA programs.

METHODS

In 2021, a national program survey was sent to all US-accredited PA Programs (n = 284) and had a completion rate of 71.8% (n = 204). Descriptive statistics were conducted to describe trends and make comparisons in the delivery of LGBTQ content.

RESULTS

Most PA programs are incorporating LGBTQ content into preclinical phases of PA education (81%) and describe that LGBTQ curricula align with institutional values (82%). Most report 1 to 3 hours of preclinical education for all LGBTQ population groups and cite medical interviewing courses as the most frequently used course to address LGTBQ care. Many programs (43%) do not provide instructional hours on LGBTQ content in the clinical phase, and the majority do not offer clinical rotations focused on this care. The results show variability in the level of preparedness that programs report on their students caring for LGBTQ populations.

DISCUSSION

Physician assistant programs are generally integrating the content throughout their didactic curricula; however, few offer clinical experiences focused on caring for patients who are LGBTQ. Offering clinical experiences and assessing student competencies are areas of growth in health professions education as related to LGBTQ health.

Impact of Nurse Manager's Attributes on Multi-Cultural Nursing Teams: A Scoping Review

BACKGROUND

As global migration increases, nurse managers' effectiveness in multi-cultural nursing work environments is crucial due to the rising cultural diversity within healthcare teams. Despite the increasing international recruitment of qualified nurses to address the worldwide nursing shortage, no studies have synthesised the impact of nurse managers' attributes on nurses in multi-cultural nursing teams. Therefore, it was conducted a literature review aimed to synthesise the available literature on how nurse managers' personality traits, competencies, behaviours, and leadership styles influence nurse outcomes in multi-cultural nursing teams.

METHODS

Scoping review conducted according to the Joanna Briggs Institute guidelines to map the relationship or influence of nurse managers' personality traits, competencies, behaviours, and leadership styles on the outcomes of nurses in multi-cultural settings across various clinical environments. Searches were conducted across electronic databases such as CINAHL and MEDLINE, along with grey literature.

RESULTS

This review included 39 studies, highlighting 29 personality traits, 9 competencies, 115 behaviours, and 5 leadership styles that impact nurses' outcomes. Key findings emphasise the importance of nurse managers being supportive, culturally competent, and effective communicators, with transformational leadership style being particularly beneficial.

CONCLUSIONS

These findings provide insights for planning and developing training programmes to equip current and future nurse managers with skills to effectively lead in multi-cultural care settings.

Cultural Competency Challenges Certified Nursing Assistants Experience in Providing Palliative Care

PURPOSE

Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities.

METHOD

A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state.

RESULTS

Four themes emerged from the data: Cultural Needs Expressed by Residents, Cultural Needs Expressed by Family Members, Accommodating Residents' Cultural Needs, and Organizational Responses to Cultural Competency Challenges.

CONCLUSION

Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [Journal of Gerontological Nursing, 50(7), 35-41.].

Renewing the Nursing Culture: Sustaining the Professional Community of Practice Through the Role of the Preceptor

Culture is the driving frame within which all human action takes form. This article explores the elements and characteristics of culture and applies them to the nursing professional community of practice. As it drills down to the work in the cultural context, it argues for the central role of the preceptor in evidencing the influence of culture. For onboarding nurses and the nursing community, the preceptor becomes the carrier of culture, demonstrating the impact of culture in a way that exhibits its influence and impact on nursing practice and patient care.

Patterns and predictors of cultural competence practice among Nigerian hospital-based healthcare professionals

BACKGROUND

Being culturally competent would enhance the quality of care in multicultural healthcare settings like Nigeria, with over 200 million people, 500 languages, and 250 ethnic groups. This study investigated the levels of training and practice of cultural competence among clinical healthcare professionals in two purposively selected Nigerian tertiary hospitals.

METHODS

The research was a cross-sectional study. A multi-stage sampling technique was used to recruit participants who completed the adapted version of Cultural Competence Assessment Instrument (CCAI-UIC). Data were analysed using descriptive statistics, Pearson's correlation, ANOVA, and multivariate linear regression.

RESULTS

The participants were mainly women (66.4%), aged 34.98 ± 10.18 years, with ≤ 5 years of practice (64.6%). Personal competence had a positive weak correlation with age (p < 0.001), practice years (p = 0.01), training (p = 0.001), practice (p < 0.001), and organisational competence (p < 0.001). There were significant professional differences in the level of training (p = 0.005), and differences in training (p = 0.005), and personal competence (p = 0.015) across levels of educational qualifications. Increasing practise years (p = 0.05), medical/dental profession relative to nursing (p = 0.029), higher personal (p = 0.013), and organisational (p < 0.001) cultural competences were significant predictors of the level of training. Male gender (p = 0.005), higher years in practice (p = 0.05), local language ability (p = 0.037), rehabilitation professionals relative to nursing (p = 0.05), high culturally competent practice (p < 0.001), higher training opportunities (p = 0.013), and higher organisational competence (p = 0.001) were significant predictors of higher personal competence.

CONCLUSION

About a third of the participants had no formal training in cultural competence. Incorporating cultural competence in the Nigerian healthcare professionals' education curricula may enhance the quality of care in the multicultural setting.

Mentors' cultural competence at mentoring culturally and linguistically diverse nursing students in clinical practice: An international cross-sectional study

AIMS

This study aimed to identify mentors' cultural competence profiles at mentoring culturally and linguistically diverse nursing students in clinical practice and explore associating factors.

BACKGROUND

Globalization has had a significant impact on healthcare, increasing the diversity of healthcare workforces and the number of culturally and linguistically diverse nursing students in clinical practice. The cultural competence of mentors is important to secure students' safe and successful learning. The mentor role in clinical practice contributes toward enabling and ensuring students' high-quality and goal-oriented development of competence.

DESIGN

This study implemented a cross-sectional design with a final sample of 270 clinical practice mentors from Finland, Lithuania, Spain and Slovenia.

METHODS

The data were collected using an online survey including the Mentors' Cultural Competence Instrument, Mentors' Competence Instrument and background questions during 2020-2021. The data were analyzed using a K-mean cluster algorithm to identify mentors' competency profiles.

RESULTS

Three significantly differing mentor competency profiles (Profile A 42%, Profile B 41%, Profile C 17%) were identified in this study. The cultural competence of the mentors in clinical practice varied between intermediate and high levels. Mentors rated their cultural competence as best in the area of cultural sensitivity and awareness, whereas the lowest scored area was cultural interaction and safety.

CONCLUSIONS

This study showed that the cultural competence of mentors in clinical practice varied and was influenced by mentors' work experience, age, job title and frequency of mentoring. This study provides new knowledge that could help to develop cultural competence operating models and education to enhance the cultural competence of healthcare professionals.

Network approaches and interventions in healthcare settings: A systematic scoping review

INTRODUCTION

The growing interest in networks of interactions is sustained by the conviction that they can be leveraged to improve the quality and efficiency of healthcare delivery systems. Evidence in support of this conviction, however, is mostly based on descriptive studies. Systematic evaluation of the outcomes of network interventions in healthcare settings is still wanting. Despite the proliferation of studies based on Social Network Analysis (SNA) tools and techniques, we still know little about how intervention programs aimed at altering existing patterns of social interaction among healthcare providers affect the quality of service delivery. We update and extend prior reviews by providing a comprehensive assessment of available evidence.

METHODS AND FINDINGS

We searched eight databases to identify papers using SNA in healthcare settings published between 1st January 2010 and 1st May 2022. We followed Chambers et al.'s (2012) approach, using a Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We distinguished between studies relying on SNA as part of an intervention program, and studies using SNA for descriptive purposes only. We further distinguished studies recommending a possible SNA-based intervention. We restricted our focus on SNA performed on networks among healthcare professionals (e.g., doctors, nurses, etc.) in any healthcare setting (e.g., hospitals, primary care, etc.). Our final review included 102 papers. The majority of the papers used SNA for descriptive purposes only. Only four studies adopted SNA as an intervention tool, and measured outcome variables.

CONCLUSIONS

We found little evidence for SNA-based intervention programs in healthcare settings. We discuss the reasons and challenges, and identify the main component elements of a network intervention plan. Future research should seek to evaluate the long-term role of SNA in changing practices, policies and behaviors, and provide evidence of how these changes affect patients and the quality of service delivery.

Health Center Leadership Perspectives Regarding Barriers to and Facilitators of Providing Culturally Responsive Care for Sexual and Gender Minority Patients

Purpose: This study identified barriers and facilitators associated with providing culturally responsive care for sexual and gender minority (SGM) patients at federally qualified health centers (FQHCs) in the United States, from the perspective of clinical leadership. Methods: Between July and December 2018, 23 semistructured, in-depth qualitative interviews were held with clinical leaders representing six FQHCs residing in rural and urban settings. Stakeholders included Chief Executive Officer, Executive Director, Chief Medical Officer, Medical Director, Clinic Site Director, and Nurse Manager positions. Interview transcripts were analyzed using inductive thematic analysis. Results: Barriers included personnel factors related to lack of training and fear, competing priorities, and environments that focused on treating all patients similarly. Facilitators included established partnerships with external organizations, staff with prior SGM training and knowledge, and active initiatives in clinic settings targeting SGM care. Conclusions: Clinical leadership expressed strong support for evolving their FQHCs into organizations that provide culturally responsive care for their SGM patients. FQHC staff across all levels of clinical care would benefit from regularly occurring training sessions on culturally responsive care for SGM patients. To ensure sustainability, improve staff buy-in, and mitigate the impact of staff turnover, improving culturally competent care for SGM patients should be a shared goal and responsibility for leadership, medical providers, and administrative staff. CTN Registration: NCT03554785.

Social support and professional networks of nurses and nursing technicians in coping with Covid-19: A sectional study in two Brazilian cities

Among healthcare workers, nurses are at exceptionally considerable risk for contracting COVID-19. Regardless of professionals' level of education, Brazilian nursing is one of the healthcare occupations shouldering the highest levels of responsibility and workload. Social support networks to health and nursing can be a strategy to reduce workload and stress and may contribute to implementing the activities and protecting workers' health. This study aimed to map and analyze social support networks at workplaces as informed by frontline nursing professionals working in healthcare units in the Brazilian cities of Rio de Janeiro and Fortaleza, capitals of the States of Rio de Janeiro and Ceará, respectively. This observational and cross-sectional study used an online data collection instrument based on social network analysis methodology. We recruited 163 participants in two reference services for health professionals suspected or with COVID-19 symptoms. The research question was: "Which category or categories of health professionals have supported you or other colleagues the most in the event of diagnosis or suspicion of COVID-19 among nursing categories? Data were organized by nursing category and city and analyzed through social network analysis using Ucinet©, generating graphs and centrality metrics. Results point to the central relevance of nursing categories in the workplace social support in the pandemic, followed by other health professional categories.

Cultural competence and decision-making of nurse leaders in a university hospital in Saudi Arabia: A descriptive-correlation study

AIMS

To determine the quality of decision-making and cultural competence in terms of cultural competence behavior and cultural awareness and sensitivity of nurse leaders. Furthermore, this study explores the relationships between selected demographic profiles, cultural awareness and sensitivity, cultural competence behavior, and quality of decision-making.

BACKGROUND

Diversity contributes to varying beliefs and practices in the workplace. Leaders with cultural competence, awareness, and sensitivity can evaluate alternatives for the decision-making process and develop effective strategies to implement decisions.

METHODS

A descriptive correlational design was utilized. The respondents (n=122) completed the Cultural Competence Assessment instrument and Decision Making Quality Scale questionnaire.

RESULTS

Cultural awareness and sensitivity are significantly related to the Middle Eastern race. Furthermore, cultural competence behavior is significantly related to years of experience in Saudi Arabia and leadership positions. Quality of decision-making is significantly related to years of experience in Saudi Arabia. Cultural awareness, sensitivity, and cultural competence behavior are significantly related to the quality of decision-making.

CONCLUSIONS

Culturally aware, sensitive, and competent nurse leaders are more likely to adhere to the quality decision-making criteria.

IMPLICATIONS FOR NURSING MANAGEMENT

Promoting training and continuing education for nurse leaders are crucial to ensure they possess the right cultural knowledge and skills.

Long-Term Outcomes of a Community of Practice for Dietitians Working in Aboriginal and Torres Strait Islander Health: A Multimethod, Follow-up Study

INTRODUCTION

Dietitians are in an important position to work alongside Aboriginal and Torres Strait Islander peoples to improve their health and may play a role in reducing the burden of disease experienced by Aboriginal and Torres Strait Islander peoples. Many dietitians do not feel confident to practice effectively in these settings and require improved workforce development opportunities. Communities of Practice can improve dietitians' confidence and practice in Aboriginal and Torres Strait Islander health; however, evidence for long-term impacts is limited. This study aims to determine if a Community of Practice can have long-term impacts on dietitians working in Aboriginal and Torres Strait Islander health.

METHODS

Data were collected through semistructured interviews and a cultural awareness self-assessment tool. Analysis was through a multimethod approach and combined qualitative inductive thematic analysis, social network analysis, and descriptive statistics.

RESULTS

Three main areas of long-term impact were identified including development of a social and professional network, career progression and retention, and a fundamental change in thinking and practice. All participants experienced feelings of support and increased confidence.

DISCUSSION

Communities of practice may be a feasible, low-cost workforce development strategy that can reduce dietitians' feelings of professional isolation when working in Aboriginal and Torres Strait Islander health. Further research is required to identify the mechanisms underlying sustained impacts. Social network analysis, combined with realist evaluation may be an appropriate research design, to answer future and more in-depth questions about the effectiveness of communities of practice.

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care

BACKGROUND

Cultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand.

AIM

The aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers.

DESIGN

A pre- and post-evaluation design and a sub-group analysis.

SETTINGS AND PARTICIPANTS

This study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study.

METHODS

The intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups.

RESULTS

One hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group.

CONCLUSION

A nurse-led cross-cultural care program can improve aged care workers' cultural competence.

Providers' perspectives on factors complicating the culturally sensitive care of individuals with intellectual disabilities

BACKGROUND

Culturally sensitive care is essential for improving healthcare for ethnic minorities with intellectual disabilities (ID), who require intensive, sometimes lifelong, care and support.

AIMS

The present study aimed to uncover factors that may complicate the delivery of culturally sensitive care for ethnic minorities with ID, which have not previously been studied for this group.

METHODS AND PROCEDURES

By means of in-depth interviews with care professionals we identified these factors at the care receiver, professional, and institutional levels.

OUTCOMES AND RESULTS

Eight factors were found to complicate the delivery of culturally sensitive care: abilities of the individuals with ID, communication with the family of the care receiver, cultural competency of the professional, personal attitude and experience of the professional, job position and responsibilities of the professional, resources, legislation and protocols, and the team of colleagues. The factors at the care receiver level were specific for the delivery of culturally sensitive care to individuals with ID.

CONCLUSIONS AND IMPLICATIONS

In addition to the complicating factors previously identified for other forms of culturally sensitive healthcare, we identified novel complicating factors for the care of individuals with ID. Future research should investigate how these complicating factors could be overcome.

A multilevel investigation of cultural competence among South Korean clinical nurses

BACKGROUND

There is lack of empirical evidence on whether organisational variables affect the cultural competence of nurses.

AIM

This study aimed to investigate individual and organisational characteristics associated with South Korean clinical nurses' cultural competence.

METHODS

A descriptive cross-sectional research design was used. A convenient sample of 401 clinical nurses from 21 hospitals in South Korea was recruited between November 2015 and February 2016. Multilevel modelling was used to estimate the effects of individual- and organisation-level predictors. Data were analysed using the nlme package in R.

RESULTS

Multilevel modelling indicated that professionalism (β = 0.02, p < 0.001) and foreign language fluency (β = 0.25, p = 0.012) were significant individual-level predictors. Education on foreign patient care was marginally significant at p = 0.069. At the organisational level, nurse-to-patient ratio (β = 0.37, p = 0.038) and organisational cultural competence (β = 0.02, p < 0.001) were significant predictors. In addition, hospital ownership and work environment were marginally significant at p = 0.054 and p = 0.050, respectively. Furthermore, there was a significant cross-level interaction between professionalism and hospital ownership (β = 0.03, p = 0.003).

CONCLUSION

To provide culturally competent care, nurse leaders should recognise the importance of organisational-level factors, such as nurse staffing and organisational cultural competence, and create an environment that is inclusive of diverse patients, as well as promote professionalism among individual nurses.

The Shillam-Clipper Leadership Minimum Demographic Data Set: A Tool for Advancing Healthcare Research

OBJECTIVE

The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies.

BACKGROUND

Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes.

METHODS

This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership.

RESULTS

The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection.

CONCLUSION

This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.

Developing and validating the Nursing Cultural Competence Scale in Taiwan

Background

Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses.

Methods

Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses’ cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale.

Results

The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach’s α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70.

Conclusions

The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Effectiveness of case based cultural competency among nurses working in private hospitals of Bangkok, Thailand: A Quasi-experimental study

OBJECTIVES

To evaluate the effect of case based cultural competency level and its factors affecting on nurse job in two private hospitals of Bangkok, Thailand.

METHODS

This was a quasi-experimental study implemented the cased-based cultural competent intervention in two private hospitals of Thailand in 2015. One hundred sixty six nurses from two control and intervention private hospitals through simple random selection method were selected for this study. Data was collected at the beginning of study (pre-test), immediately after the intervention and after two months of intervention (post-test). Tool was pretested, validated and piloted before to conduct study.

RESULTS

Total 166 nurses were included in this study. The characteristics among the study participants were similar between both hospitals at the baseline and found statistically non-significant (p= > 0.05). However, after the intervention the cultural knowledge, attitude and practice competency score levels have significantly increased among the nurses in the intervention group as compared to control group (p= < 0.05).

CONCLUSION

Study has concluded that an intervention has positively affected on cultural knowledge, practice and attitude competency among nurses working in private hospital of Bangkok Thailand.

Evaluating Cultural Competence of Pediatric Oncology Nurses at a Teaching Hospital: A Pilot Study

This cross-sectional descriptive study evaluated registered nurses’ self-ratings of cultural competence on the hematology/oncology unit at a large Northeastern urban children’s hospital. The Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals was used to measure 5 constructs of cultural competence. The study findings show that there were significant correlations between the knowledge and skill subscales (ρ = .57, P < .001) and the knowledge and desire subscales (ρ = .42, P < .05). The highest mean among the 5 subscales was cultural desire (mean = 15.5), indicating that nurses were motivated to engage in the process of becoming culturally competent. The lowest mean among the 5 subscales was cultural knowledge (mean = 11.2), followed by cultural skill (mean = 11.8), indicating that nurses did not perceive themselves to be well informed in these areas. The findings from this pilot study suggest that nurses on this pediatric oncology unit are most likely to possess cultural desire and cultural awareness, but there is certainly opportunity to engage and educate the staff. Targeted interventions to improve cultural competence on this inpatient unit are being explored and a larger scale study is being planned to assess the cultural competence of nurses across the hospital.

Cultural competence and social relationships: a social network analysis

AIM

This study investigated the role of social relationships in the sharing of cultural competence by testing two hypotheses: cultural competence is a socially shared behaviour; and central healthcare professionals are more culturally competent than non-central healthcare professionals.

BACKGROUND

Sustaining cultural competence in healthcare services relies on the assumption that being culturally competent is a socially shared behaviour among health professionals. This assumption has never been tested.

INTRODUCTION

Organizational aspects surrounding cultural competence are poorly considered. This therefore leads to a heterogeneous implementation of cultural competence - especially in continental Europe.

METHODS

We carried out a social network analysis in 24 Belgian inpatient and outpatient health services. All healthcare professionals (ego) were requested to fill in a questionnaire (Survey on social relationships of health care professionals) on their level of cultural competence and to identify their professional relationships (alter). We fitted regression models to assess whether (1) at the dyadic level, ego cultural competence was associated with alter cultural competence, and (2) health professionals of greater centrality had greater cultural competence.

RESULTS

At the dyadic level, no significant associations were found between ego cultural competence and alter cultural competence, with the exception of subjective exposure to intercultural situations. No significant associations were found between centrality and cultural competence, except for subjective exposure to intercultural situations.

DISCUSSION

Being culturally competent is not a shared behaviour among health professionals. The most central healthcare professionals are not more culturally competent than less central health professionals.

CONCLUSIONS AND IMPLICATIONS FOR HEALTH POLICIES

Culturally competent health care is not yet a norm in health services. Health care and training authorities should either make cultural competent health care a licensing criteria or reward culturally competent health care.

What is the Profile of Individuals Joining the KNEEguru Online Health Community? A Cross-Sectional Mixed-Methods Study

Background

The use of the Internet for seekers of health-related information provides convenience and accessibility to diverse sources (of variable quality) for many medical conditions. There is a suggestion that patients may find empowerment by engaging with Internet health care strategies and communities. The profile of consumers of online health information on knee pain has not been explored.

Objective

Our objective was to identify the characteristics and motivations of online health information-seekers accessing the online health community, KNEEguru (KG). The study was designed to obtain the respondents’ sociodemographic profile, together with their main reasons and motivations for joining such a community, their health information-seeking behavior, the extent of their knee problems, and their general Internet usage.

Methods

We undertook an online questionnaire survey, offered to users of the KG website from June to July 2012. A mix of open and closed questions was used to facilitate inductive enquiry. Quantitative responses were analyzed using univariate analysis; qualitative thematic analysis of the open responses was completed and a conceptual model was developed.

Results

One-hundred and fifty-two respondents took part (11.56% response rate, 152/1315), with a mean age of 40.1 years. Of this cohort, 61.2% were female, 68.4% were in domestic partnerships, 57.2% were employed, 75.0% had higher education qualifications, and 80.3% were of white/Caucasian ethnicity. Females were associated with joining KG in order to get emotional support from other users (OR 2.11, 95% CI 1.04 - 4.27, P=.04). Respondents’ self-perception of health was associated with reported quality of life (OR 10.86, 95% CI 3.85 - 30.43, P<.001). Facebook users were associated with joining KG to share experiences (OR 2.34, 95% CI 1.04 - 5.56, P=.03). Post-surgery respondents were associated with joining KG to compare symptoms with other users (OR 7.31, 95% CI 2.06 - 39.82, P<.001). Three key themes were induced: condition, emotion and support. Respondents expressed distress and frustration at uncertainty of prognosis around various knee conditions, with some users preferring to initially observe rather than engage. Conversely, a strong desire to inform and support other community members was stated with reciprocation of ideas and experiences. KG was conceptualized as a filter that takes an individual’s condition and emotional response to that condition as basis for support; this filter facilitated validation as the outcome of engagement.

Conclusions

This study, in line with wider literature, suggests that users of an online knee-specific community are typically female, middle-aged, white/Caucasian, married, employed, and have attained a level of higher education. These users demonstrate a pragmatic approach to health care information with altruistic motivations and a desire to share experiences as a means of validation. This finding emphasizes a means of promoting efficient and appropriate online health care, and demonstrates the benefits of the Internet as a viable complement to clinical engagement.

Development and psychometric testing of the satisfaction with Cultural Simulation Experience Scale

Decreasing the numbers of adverse health events experienced by people from culturally diverse backgrounds rests, in part, on the ability of education providers to provide quality learning experiences that support nursing students in developing cultural competence, an essential professional attribute. This paper reports on the implementation and evaluation of an immersive 3D cultural empathy simulation. The Satisfaction with Cultural Simulation Experience Scale used in this study was adapted and validated as the first stage of this study. Exploratory factor analysis and confirmatory factor analysis were undertaken to investigate the psychometric properties of the scale using two randomly-split sub-samples. Cronbach's Alpha was used to examine internal consistency reliability. Descriptive statistics were used for analysis of mean satisfaction scores and qualitative comments to open-ended questions were analysed and coded. A purposive sample (n = 497) of second of nursing students participated in the study. The overall Cronbach's alpha for the scale was 0.95 and each subscale demonstrated high internal consistency: 0.92; 0.92; 0.72 respectively. The mean satisfaction score was 4.64 (SD 0.51) out of a maximum of 5 indicating a high level of participant satisfaction with the simulation. Three factors emerged from qualitative analysis: "Becoming culturally competent", "Learning from the debrief" and "Reflecting on practice". The cultural simulation was highly regarded by students. Psychometric testing of the Satisfaction with Cultural Simulation Experience Scale demonstrated that it is a reliable instrument. However, there is room for improvement and further testing in other contexts is therefore recommended.