Involving patients and carers in patient safety in primary care: A qualitative study of a co-designed patient safety guide

BACKGROUND

Involving patients is a key premise of national and international policies on patient safety, which requires understanding how patients or carers want to be involved and developing resources to support this. This paper examines patients' and carers' views of being involved in patient safety in primary care and their views of potentially using a co-designed patient safety guide for primary care (PSG-PC) to foster both involvement and their safety.

METHODS

A qualitative study using semistructured face-to-face interviews with 18 patients and/or carers in primary care. Interviews were transcribed and analysis was conducted using an inductive thematic approach.

RESULTS

Overall participants expressed enthusiasm for the PSG-PC as a tool to support patients and carers to be involved in patient safety in primary care. However, for some participants being involved in patient safety was seen as taking on the role of General Practitioner and had the potential to add an additional workload for patients. Participants' willingness or ability to be involved in patient safety was influenced by a range of factors including an invisible, often underacknowledged role of everyday safety for patients' interactions with primary care; the levels of involvement that patients wanted in their care and safety and the work of embedding the PSG-PC for patients into their routine interactions with primary care. Participants identified components of the PSG-PC that would be useful to them, in particular, if they had a responsibility for caring for a family member if they had more complex care or long-term conditions.

CONCLUSION

Involving patients and carers in patient safety needs a tailored and personalized approach that enables patients and carers to use resources like the PSG-PC routinely and helps challenge assumptions about their willingness and ability to be involved in patient safety. Doing so would raise awareness of opportunities to be involved in safety in line with personal preference.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public involvement were central to the research study. This included working in partnership to develop the PSG-PC with patients and carers and throughout our study including in the design of the study, recruiting participants, interpretation of findings.

Before allyship: A model of integrating awareness of a privileged social identity

Introduction

Although the American Psychological Association encourages clinical psychologists to recognize and understand the experience of social privilege both within themselves and the individuals and communities they serve, there is a dearth of research in the field to guide this pursuit. According to the available literature, an essential barrier to social privilege integration is its implicit and covert nature that prevents consistent consciousness due to hegemonic forces.

Methods

This study explored the process, from initial social privilege awareness to the moment of the study, through individual interviews. A social-constructivist, grounded theory approach was utilized as it was aligned with the understudied phenomena oriented around social justice.

Results

The result is a developmental model of social privilege integration that explicates accumulated exposures to privilege, the resultant threat to and protection of personal identity, and the conducive factors that lead to reconciliation.

Discussion

Implications of this theoretical model include the importance of a developmental perspective to cultivate an understanding of individual prejudice attitudes and discriminatory behaviors, as well as a roadmap toward equitable change. This model may be used by clinical psychologists across multiple settings in response to the most recent APA multicultural guidelines.

Reliability and Validity of the Korean Version of the Social Justice Scale in Nursing Students

The purpose of this study was to translate and adapt a scale to evaluate social justice in nursing students and to examine the validity and reliability within a Korean context. With a survey design, a total of 267 nursing students were recruited, and data were collected using a self-administered study questionnaire to measure their levels of SJS. Using SPSS/WIN 28.0, construct validity, item convergent and discriminant validity, concurrent validity, and internal consistency reliability of the scale was evaluated. Exploratory factor analysis supported the construct validity with a four-factor solution; that explained 55.52% of the total variance. Criterion validity was demonstrated with the Social Issues Advocacy Scale (r = 0.78, p < 0.001). Cronbach's α coefficient for the scale was 0.96. The findings show satisfactory construct and criterion validity and reliability of the Korean version of the SJS for measuring social justice in nursing students.

Trauma and Police Violence: Issues and Implications for Mental Health Professionals

In this piece, the authors present the case of a young Black American man who experienced symptoms of post-traumatic stress disorder after an episode of police violence. Through engagement with this case, the authors consider whether trauma-focused psychotherapies, particularly trauma-focused cognitive behavioral therapies (TF-CBT), are equipped to attend to contextual factors relevant to traumatic experiences of police violence. The authors suggest further research to determine for whom and in what contexts standard forms of psychotherapy as well as alternatives to TF-CBT are effective, and augmenting provider education to include advocacy strategies aimed at reducing police violence-advocacy that is relevant in the context of nationwide protests occurring after the officer-perpetrated killings of George Floyd, Breonna Taylor, and others.

Social Justice Identity Development for International Counseling Psychology Students

Despite the inclusion of social justice and international issues in counseling psychology, there are no conceptual models or research to date that focus on social justice identity development and training issues for international counseling psychology students. The unique cross-cultural experiences and systemic injustices facing many international counseling psychology students may inform their social justice identity development in a distinctive manner. Thus, by incorporating biculturalism and transformative learning theories, this article proposes a theoretical model to illustrate the psychological processes and outcomes of social justice identity development for international counseling psychology students with the following four phases: (a) cultural and social awareness of privilege and oppression, (b) critical analysis of systemic oppression across cultures, (c) synergistic development of social justice competence and bicultural competence, and (d) integration of social justice identity and competence across cultures. We provide recommendations for future practice, advocacy, education, training, and research.

Collective Program Social Justice Identity and Perceived Norms on Promoting Student Advocacy

A growing body of research suggests that graduate psychology training programs with a stronger collective social justice identity are likely to provide more support for students’ advocacy engagements than those with discrepant views among members. We conducted response surface analyses ( N = 178 PhD students; across 16 counseling psychology programs) to examine whether the degree of congruence and discrepancy in social justice attitudes and perceptions of training program norms (perceived social justice norms among students and faculty) between the individual student and other students in their program would be associated with students’ social justice advocacy intentions and behaviors. Higher congruence in attitudes and perceived norms (among students and faculty) were significantly associated with advocacy intentions. For advocacy behaviors, only congruently higher perceptions of faculty were significantly associated. Discrepant attitudes and perceived norms were not significantly related to students’ advocacy intentions and behaviors. Recommendations for training and research are discussed.

"It's Not Only about Clinical Tools but Also Our Role as Agents of Social Change": Implementing a LGBT Competency Training for Future Mental Health Practitioners in Mexico

Recent studies recommend implementing a curriculum that is inclusive of lesbian, gay, bisexual, and transgender (LGBT) identities in health-related higher education programs. Inclusive health services are a means to address stigma-related adverse health outcomes in these populations. In Mexico, research has revealed that sexual and gender minority individuals experience discriminatory conditions that put them at risk for mental health problems. The present study tested the impact of a LGBT training protocol in Mexico; 17 psychology majors living in Mexico City received 12-plus hours of training on LGBT multicultural competencies. A quantitative retrospective assessment of participants' attitudes toward LGBT individuals, knowledge of LGBT issues, and willingness to work with LGBT clients, alongside qualitative data collected from a focus group, provided evidence on the impact of this training strategy. Implications for LGBT multicultural competency training in undergraduate and graduate programs in psychology are discussed herein.

In the same boat? An online group career counseling with a group of young adults in the time of COVID-19

An online group of career counseling for unemployed young adults during the COVID-19 pandemic was developed. Twelve participants were involved in online group career counseling intervention, based on the Life Design for an inclusive and sustainable future. Results indicated at post-test on increased scores on career adaptability, resilience, future orientation, and propensity to identify inclusive and sustainable actions for the future than pre-test. Overall, the online group career counseling intervention effectively promoted particular aspects of young adults' life design for an inclusive e-sustainable future.

Building a Climate for Advocacy Training in Professional Psychology

Counseling psychologists have been at the forefront of social justice and advocacy efforts in the discipline of psychology. Despite these foci, few graduate training programs in psychology offer formal courses or training in advocacy, social justice, and public policy. To develop and fill a pipeline of professionals involved in social justice and advocacy efforts, graduate training programs in psychology must expose and prepare students to these areas. The purpose of the current paper is to describe how faculty within the professional psychology program at the University of Denver incorporate advocacy, public policy, and social justice education and training into their program. We describe how the program climate and curriculum were created to meet these training needs.

Skin Color Matters in the Latinx Community: A Call for Action in Research, Training, and Practice

While skin color is relevant and important in the Latinx community, as it is associated with colorism, little is known about how often it is measured or the best way to measure it. This article presents results from two studies examining these key concerns in three prominent journals, where Latinx research is typically published (i.e., the Hispanic Journal of Behavioral Sciences, the Journal of Latinx Psychology, and Cultural Diversity and Ethnic Minority Psychology). Study one examined whether skin color was measured as a variable, and if so, what measures and methodologies were used. A review of articles ( n = 1,137) showed few studies measured skin color in these three journals, with studies that did so relying on various approaches. Study two aimed to assess the reliability of a widely used skin color measure, the Massey-Martin scale, also known as the New Immigrant Survey (NIS) Skin Scale. Using a sample of 169 undergraduate students, self-ratings, coder ratings, and in vivo ratings were obtained and compared. One-way random effects model analyses indicated excellent reliability with minimal variability across the various ratings. Our findings suggest a critical need to engage in a more concerted effort to assess and discuss the relevance and importance of skin color within the Latinx community. The authors offer some suggestions on how to facilitate these efforts in clinical, training, and research arenas.

Demarginalizing Stigmatized Identities of Transgender and Gender Nonconforming Individuals Through Affirmative Group Therapy

Drawing from the existing literature on minority stress and stigma, this article highlights challenges - psychological, social, and interpersonal - confronting transgender and gender nonconforming (TGNC) individuals in relation to their gender identity and expression. TGNC individuals are at risk for poor health due to societal stigma and stressors they face as a gender minority group. Further, TGNC individuals may experience stigma in different shapes and forms; specifically, stigma may occur as enacted, felt, internalized, and anticipated stigma. In maintaining an identity that is socially devalued but often invisible to others, TGNC individuals confront additional challenges in negotiating the risks and benefits of disclosing their stigmatized identity. Affirmative group therapy is proposed as a strength-based and social justice-oriented approach for demarginalizing TGNC individuals' stigmatized identity. Group therapists are called on to address how forms of stigma impact TGNC individuals within and outside of the group, provide validation and space for practicing disclosure, highlight their strengths and resilience, and serve as social justice advocates.

International perspectives on social justice: Introduction to the special issue

The concept of social justice has become increasingly prominent in school psychology practice, research, and training. While the literature in this area has burgeoned over the last decade, relatively less scholarship has synthesized global perspectives on social justice. This article provides a brief introduction to the special issue, International Perspectives on Social Justice. In particular, we describe contributions of each of the issue’s four articles to the social justice literature in school and educational psychology as well as identify prominent themes. Finally, we describe potential directions for advancing an international social justice agenda in school psychology.

Counseling Psychology and the Amelioration of Oppression: Translating Our Knowledge Into Action

In the new millennium, counseling psychologists have answered the call to address oppression related to intersectional identities. We have played a major role in the development of practice guidelines and policies, as well as in the application of ethical principles in cultural contexts. The Counseling Psychologist has served to disseminate information addressing needs and interventions for diverse communities. In this article, we review the history and impact of our efforts to ameliorate oppression. The pressing challenges of economic and educational disparities are highlighted along with how counseling psychologists are uniquely situated to meet the needs of the underserved. Our research, training, and practice are anchored in methodological pluralism, global helping paradigms, participatory engagement, and the promotion of liberation and radical healing. We offer recommendations to deconstruct current models and reconstruct a decolonized approach, embrace interdisciplinary collaboration to fight cultural encapsulation, strengthen prevention and advocacy, train a culturally diverse workforce, and prioritize intersectional research.

Social Justice in Counseling Psychology: Then, Now, and Looking Forward

In this article, a diverse group of early, mid, and advanced career scholars call for counseling psychology to continue to evolve in our integration of social justice action in our field. In doing so, we first consider our history as proponents and enactors of social justice, highlighting the ways in which counseling psychologists have served as social justice leaders in psychology. We then discuss our field’s contemporary challenges to, and opportunities for, social justice progress as we work toward equity and justice. Finally, we offer recommendations for counseling psychologists individually and as a field to move forward in our social justice action. Given our longstanding social justice values and our unique training as counseling psychologists, if we aim with intentionality to use our skills toward systems change, counseling psychologists are poised to have a strong and proactive role as social change agents within psychology and society at large.

Social Justice and International Competencies: Positioning Counseling Psychologists for the Global Era

In this article, we attempt to draw a connection between social justice and international competencies within counseling psychology. Built on Constantine et al.’s general social justice competencies as well as the cross-national cultural competences model and dynamic-systemic-process model of international competencies, nine international social justice competencies are outlined and their relevance in international contexts is highlighted. In addition, three specific mindsets for the enhancement of international social justice work by U.S.-based counseling psychologists are discussed. We believe that by promoting the integration of social justice and international competencies, future counseling psychologists will be better prepared for the global era.

Invisible Bruises: Theoretical and Practical Considerations for Black/Afro-Latina Survivors of Childhood Sexual Abuse

This article focuses on the intersectionality of race, gender, and violence in the lives of Black/Afro-Latinas who have experienced childhood sexual abuse. First, we discuss the trauma of slavery, racism, and colonization in Latin America and the Caribbean, which objectifies Black bodies and renders Blackness invisible. Second, we identify institutional and interpersonal barriers to seeking trauma support. Third, we present preliminary findings from a Listening Circle among survivors who participated in the Black Latinidad: Building Siblinghood to End Child Sexual Abuse Project. Finally, we propose a racially and culturally specific, trauma-informed approach that draws on the strengths of survivors and centralizes their voices and how to intervene.

Fostering Critical Feminist Multicultural Qualitative Research Mentoring

Qualitative research mentorship is essential to the development of counseling psychology as a field that supports socially just and multicultural inquiry. This type of research aligns with the core values proposed by the American Psychological Association. However, the governing beliefs and practices of neoliberal structures in higher education challenge critical qualitative research mentorship in counseling psychology. Namely, the values of economic gain promote practices that may constrain the potential for effective mentoring and socially just qualitative research practices. In opposition to these forces, we propose a critical multicultural feminist praxis for qualitative research mentoring. Critical feminist multicultural mentoring attends to systemic and relational power dynamics through transparency, collaboration, reflexivity, and attention to context. We describe the assumptions of critical feminist multicultural mentoring and apply them to case vignettes to illustrate ways to mentor students engaging in socially just qualitative research. In our discussion, we articulate implementation, policy, and research implications.

Exploring Social Justice Advocacy in Dietetic Education: A Content Analysis

PURPOSE

To explore the extent to which knowledge- and skill-based learning regarding social justice and/or social justice advocacy is included in the course descriptions of required courses of accredited, English-speaking dietitian training programs in Canada.

METHODS

This study is a mixed-methods content analysis of required course descriptions sampled from university academic calendars for accredited, English-speaking dietitian training programs across Canada.

RESULTS

Quantitative analysis showed that required course descriptions (n = 403) included few instances of social justice-related terminology (n = 63). Two themes emerged from the qualitative analysis: competing conceptualizations of social issues and dietitians' roles; prioritization of science-based knowledge and ways of knowing.

CONCLUSIONS

Accredited, English-speaking dietitian training programs in Canada appear to include little knowledge- or skill-based learning regarding social justice issues and advocacy. Supporting future dietitians to pursue leadership roles in redressing social injustices and socially just dietetic practice may require more explicit education and training about social justice issues and advocacy skills.

The Phenomenology of Military Sexual Trauma Among Women Veterans

Although researchers have examined health outcomes among survivors of military sexual trauma, knowledge regarding the phenomenology of military sexual trauma among women veterans remains limited. We used a qualitative, phenomenological approach to describe the experience, context, and perceived effects of military sexual trauma among women veterans. Thirty-two cisgender female military sexual trauma survivors participated in interviews, which we analyzed through thematic analysis. The following themes emerged: (1) sexual harassment: “expected,” “constant,” and “normal”; (2) silencing and disempowerment: “If you want a career, then shut up”; (3) changed attitudes toward the military: “I lost faith”; (4) loss of relational trust: “I can protect me if I’m not involved with someone”; (5) survivor internalization of messages conveyed by military sexual trauma: “If I looked different, none of this would have happened”; (6) coping by escape and avoidance: “I put my head in the sand and hoped it would go away”; and (7) a path to healing through validation and justice: “You’ll get through it.” Results suggest the importance of increasing stakeholders’ knowledge regarding military sexual trauma complexities and contexts. Military sexual trauma survivors should be heard, believed, and supported in pursuing justice. We also suggest cultural shifts and continued efforts to prevent military sexual trauma. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Psychological Interventions Promoting Resilience Among Transgender Individuals: Transgender Resilience Intervention Model (TRIM)

Transgender people experience disproportionately high mental and physical health risks. Minority stress theory identifies distal and proximal stressors that contribute to negative mental health outcomes for transgender people, and suggests that resilience factors can buffer the negative influence of these stressors. In this article, we aim to synthesize the psychological literature on resilience strategies among transgender people and position it within the minority stress framework and introduce an adapted model called the transgender resilience intervention model (TRIM). The TRIM suggests that social support, community belonging, family acceptance, participating in activism, having positive role models, and being a positive role model are group-level resilience factors. Self-worth, self-acceptance and/or pride, self-definition, hope, and transition are individual-level factors that promote resilience. Community, group, and individual interventions and their potential influence on resilience are discussed. The model calls for the development of additional interventions aimed at increasing resilience for transgender people.

Survivors’ Perspectives on Recovery From Commercial Sexual Exploitation Beginning in Childhood

This study explored the process of exiting and recovery from commercial sexual exploitation beginning in childhood, utilizing semistructured interviews with 11 adult female survivors who had been out of the commercial sex industry for at least six months. The narratives were analyzed using consensual qualitative research. Participants described a complex interface of internal motivation and external resources in the exiting process. They identified a need for comprehensive, nonjudgmental services across all stages of change, in order to support a profound reconstruction of identity and community. Subgroup comparisons revealed that women who were exploited at younger ages were more vulnerable to coercive and dehumanizing exploitation and required especially intensive services. These results support the methods of many survivor-led programs for sexually exploited youth. Implications of survivors’ perspectives for counseling, research, and advocacy are discussed.

Breaking Institutional Habits: A Critical Paradigm for Social Change Agents in Psychology

There is a growing concern in counseling psychology that the field is not matching its commitment to social justice with adequate preparation of social change agents. Compiling and building off of a uniquely interdisciplinary framework, this article offers an alternative way forward for psychologists and trainees. Recommendations include a reorientation to institutions in which psychologists are immediately embedded and a legitimization of direct-action methods.

Implementing Social Change: A Qualitative Analysis of Counseling Psychologists’ Engagement in Advocacy

In recent years, many counseling psychology training programs in the United States have adopted social justice principles into training. Although previous studies have provided thought-provoking discussions on social justice advocacy, they mostly reflected the voices of psychologists in academia; therefore, the advocacy work of practitioners has been neglected. In order to explore the advocacy experiences of counseling psychologists in practice, we utilized qualitative content analysis to analyze semistructured interviews with 11 practitioners who were trained in social justice-oriented counseling psychology doctoral programs. The findings were clustered under three domains: (a) participants’ development of a social justice orientation, (b) different ways of implementing advocacy in practice, and (c) positioning advocacy in psychology. The interviews depicted resources and challenges with regard to integrating advocacy into practice indicating that counseling psychologists continue to struggle with systemic barriers that limit their advocacy actions. We discuss implications for research, practice, and training in counseling psychology.

Allies for Life? Lessons From White Scholars of Multicultural Psychology

This article reports on a qualitative investigation conducted to assess how White multicultural scholars have responded to critical questions raised in the 1990s about their roles and responsibilities in multicultural psychology. We used the consensual qualitative research method to analyze semistructured interview data from 12 leading White scholars of multicultural psychology. Findings revealed 10 domains with nuanced categories within each. Key themes addressed: (a) antecedents of participants’ interest and commitments to multicultural theory and research, (b) how participants understood Whiteness broadly, and how it influenced their multicultural scholarship specifically, (c) rewards and challenges of conducting multicultural research, and (d) recommendations for future White counseling psychologists. Implications for training and future research are provided.

White Professors Teaching About Racism: Challenges and Rewards

One of the complexities of multicultural teaching is that course content inevitably relates to personal experiences of privilege and oppression among both students and professors. Even when professors have benefitted from their own multicultural training, teaching about race and racism presents particular challenges to different professors based upon their own social locations. In this article, we answer the following question: What personal and professional challenges can White professors expect when they work as social justice educators? The authors present relevant considerations and illustrate them with examples from their own teaching experiences.

Black Lives Matter: A Call to Action for Counseling Psychology Leaders

Police brutality and widespread systemic racism represent historical and current sources of trauma in Black communities. Both the Black Lives Matter movement and counseling psychology propose to confront these realities at multiple levels. Black Lives Matter seeks to increase awareness about systemic racism and promote resilience among Black people. Counseling psychology states values of multiculturalism, social justice, and advocacy. Executive leadership in counseling psychology may seek to promote racial justice, yet struggle with how to participate in Black Lives Matter movements and address racial discrimination within larger systems spontaneously and consistently. However, counseling psychology trainees and professionals are actively involved in the Black Lives Matter movement, leading the way forward. Through the framework of spontaneity in social movements, this manuscript highlights what counseling psychologists are currently contributing to Black Lives Matter and makes recommendations that build on the opportunity counseling psychologists have for further involvement in the movement.

Immigrant Women’s Experiences of Acculturative Stress

We examined the relation of two acculturation stressors, exclusion from ordinary privileges and overt discrimination, to two indicators of psychological well-being (i.e., psychiatric symptoms and satisfaction with life) among a diverse sample of immigrant women living in Ireland ( N = 174). We grouped our sample into “visible” immigrant women of color and “nonvisible” White immigrant women. As expected, visible immigrant women reported more experiences of overt discrimination and fewer experiences of ordinary privileges than did nonvisible immigrant women. The associations of belonging to a visible immigrant group with both psychiatric symptoms and satisfaction with life were each mediated through ordinary privileges and overt discrimination. The magnitude of the two indirect effects was equal for psychiatric symptoms, but for satisfaction with life, the indirect effect through ordinary privileges was stronger. After accounting for ordinary privileges and overt discrimination, the average score for satisfaction with life was higher for visible immigrant women than for nonvisible immigrant women. These findings suggest that visible immigrant women experience exclusion from ordinary privileges to a greater extent than nonvisible immigrant women and that this type of exclusion is at least as detrimental to psychological health as more overt forms of discrimination. Our findings demonstrate the importance of attending to discrimination of both visible and nonvisible immigrants and highlight the importance of ordinary privileges to immigrants’ well-being in their countries of destination. We discuss implications for future research and social policy.