Military Culture and Cultural Competence in Public Health: U.S. Veterans and SARS-CoV-2 Vaccine Uptake

As part of the U.S. effort to encourage vaccination for SARS-CoV-2, scholars have emphasized the importance of culture and identity in vaccine uptake decisions. The culture and identity of military service are poorly understood in the context of understanding Veterans’ acceptance of COVID-19 vaccines. In analyzing data from semi-structured interviews with Veterans in homeless transitional housing, this article examines their willingness to get vaccinated for COVID-19. Themes invoking military culture included (a) mandatory vaccinations in the military; (b) cynicism and mistrust toward the government; and (c) trust of and reliance on Veteran peers with shared military culture in decision-making. To further understand how military culture influences vaccine uptake and explore avenues for building culturally competent, trust-based health care interventions with Veterans, a previously published case study of Veterans volunteering in Team Rubicon (TR) disaster relief is examined. Veteran participants in TR described the experience of being in a Veteran-centric organization as an empathetic context wherein they were able to: (a) address their reintegration struggles; (b) gain a new appreciation of their Veteran status; and (c) connect with trusted peers. Given TR’s credibility, Veteran-serving health care organizations could collaborate with Veteran-led organizations to expand shared efforts to address Veterans’ distrust of government-promoted vaccines.

The Soul of Therapy: The Therapist’s Use of Self in the Therapeutic Relationship

This paper is based on the premises that the conscious, active and purposeful use of self by the therapist in the therapeutic process is an essential aptitude in establishing an effective therapeutic relationship, and that this therapeutically purposeful use of self can and should be incorporated in the training of all therapists in a explicitly systematic manner. The paper will attempt to identify the contributions of the “what and how” the use of self by therapists contributes to the therapeutic process. First of all, therapists’ use of self is meant to be viewed as a Common Factor as defined by Sprenkle, Davis & Lebow (2009), which is a perspective about the effectiveness of therapy that “asserts that the qualities and capabilities of the person offering the treatment are more important than the treatment itself” (p. 4). Secondly, the use of self by therapists emphasizes developing the skill set of the therapist in the conscious, active and purposeful use of self as is in the moment of the therapeutic engagement with clients, and does so without denying the importance of therapists working to resolve personal issues of theirs that may interfere with the therapist's professional effectiveness. Therapists’ use of self gives particular emphasis to the purposeful use of self as is in therapy’s relationship, assessment and interventions whatever the therapy model (Aponte & Kissil, 2016). Thirdly, the use of self represents an aptitude that can be developed and refined through well elaborated structures for schooling therapists in the therapeutic use of all they bring of their personal selves to the therapy relationship including through the use of their human vulnerabilities as they exist at the moment of empathic engagement with clients.

Making the Decision to Stay at Home: Developing a Community-Based Care Process Model for Aging in Place

The care of older adults who wish to spend their old age at home should be regulated in every country. The purpose of this article is to illustrate the steps for developing a community-based care process model (CBCPM), applied to a real-world phenomenon, using an inductive, theory-generative research approach to enable aging at home. The contribution to practice is that the collaboration team experts facilitate the application of the process in their own work as non-professional human resources. This means that each older adult is his or her own case study. Different experts and non-experts can engage in the process of meeting needs as required. The empirical work examined the number of levels and steps required and the types of human resources needed. The proposed typology of the CBCPM for older adults can provide insight, offer a useful framework for future policy development, and evaluate pilots at a time when this area of legislation is being implemented.

Validation of a counseling guide for adherence to antiretroviral therapy using implementation science

Objective:

to determine the contents that must be included in the usual counseling to improve the adherence to antiretroviral therapy (ART) of HIV patients, according to their different levels of alcohol consumption, and to determine the validity of the Counseling Guide in improving the adherence to ART in patients who consume alcohol using Implementation Science.

Method:

this is an observational study with formative and validation phases. The formative phase defined the content, approach and structure of the counseling. Validation included focus groups with patients and nurses, trial process by an expert and a pilot test. The criteria evaluated based on Implementation Science were: intervention source, evidence strength and quality, relative advantage, and complexity. The following criteria were also evaluated: usefulness, practicality, acceptability, sustainability, effectiveness; content consistency and congruence; procedural compliance and difficulties, and time spent in counseling.

Results:

the strength of evidence of the counseling is High-IIA, with strong level of recommendation and presenting usefulness, practicality, acceptability, sustainability and effectiveness. Eight in 11 experts argued that the Guide is clear, consistent and congruent. Initial counseling takes around 24 minutes; and follow-up counseling, 21. The instruments of the Guide present reliability levels between good and high (0.65 ≥ alpha ≤ 0.92).

Conclusion:

the Counseling Guide is valid to improve the adherence to antiretroviral therapy in patients who consume alcohol.

Lessons and Challenges of Disaster Relief Work in Rural China

Due to the disastrous Wenchuan earthquake that hit Sichuan, China, on May 12, 2008, approximately 70,000 people died, around 400,000 were injured, 18,467 were missing, and millions were left homeless due to the collapse of their homes. The substantial trauma and loss in the disaster area posed a challenge for disaster relief work focused on survivors’ psychological health. Many of the psychological interventions were based on Western or urban outpatient populations and were thus inappropriate for the uneducated, agriculturally based population of rural China, potentially limiting patient care and sensitivity during this postdisaster relief. This article discusses the therapeutic issues involved and finds that the collectivist nature of the rural Chinese culture and indigenized ways of working with the earthquake survivors are of paramount importance. It adds to the research literature by discussing the importance of relationships through the Chinese concept of Guanxi in the context of disaster relief work in rural China. Consistent with the concept of Guanxi, disaster relief volunteers must fully respect the world of the survivors while remaining flexible and creative in their work to build deeper connections and relationships.