1
|
Li S, Miles K, George RE, Ertubey C, Pype P, Liu J. A critical review of cultural competence frameworks and models in medical and health professional education: A meta-ethnographic synthesis: BEME Guide No. 79. MEDICAL TEACHER 2023; 45:1085-1107. [PMID: 36755385 DOI: 10.1080/0142159x.2023.2174419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Cultural competence resides at the core of undergraduate and postgraduate medical and health professional education. The evolution of studies on cultural competence has resulted in the existence of multiple theoretical frameworks and models, each emphasising certain elements of culturally appropriate care, but generally lacking in providing a coherent and systematic approach to teaching this subject. METHODS Following a meta-ethnographic approach, a systematic search of five databases was undertaken to identify relevant articles published between 1990 and 2022. After citation searching and abstract and full article screening, a consensus was reached on 59 articles for final inclusion. Key constructs and concepts of cultural competence were synthesised and presented as themes, using the lens of critical theory. RESULTS Three key themes were identified: competences; roles and identities; structural competency. Actionable concepts and themes were incorporated into a new transformative ACT cultural model that consists of three key domains: activate consciousness, connect relations, and transform to true cultural care. CONCLUSION This critical review provides an up-to-date synthesis of studies that conceptualise cultural competence frameworks and models in international medical and healthcare settings. The ACT cultural model provides a set of guiding principles for culturally appropriate care, to support high-quality educational interventions.
Collapse
Affiliation(s)
- Shuangyu Li
- GKT School of Medical Education, King's College London, London, UK
| | - Katherine Miles
- GKT School of Medical Education, King's College London, London, UK
- Department of Pharmacology, Public Health and Clinical Skills, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Riya E George
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Candan Ertubey
- School of Psychology, University of East London, London, UK
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jia Liu
- GKT School of Medical Education, King's College London, London, UK
| |
Collapse
|
2
|
Zacharia T. An intercultural perspective toward supporting antipsychotic medication adherence in clinical practice. BJPsych Bull 2023; 47:38-43. [PMID: 35388782 PMCID: PMC10028547 DOI: 10.1192/bjb.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In the UK, the incidence of schizophrenia appears highest in Black Caribbean and Black African communities (four- to six-fold that of the White British population). The incidence of psychosis in other minority ethnic groups is also raised, but to a lesser magnitude. Although there are numerous environmental confounding factors, the data stresses the importance of optimising treatment in high-risk (minority) groups. Antipsychotic nonadherence is the most common reason for schizophrenia relapse, and is associated with increased rates of relapse, readmission to hospital and suicide. This article examines available literature to discover how culture can affect antipsychotic nonadherence, and considers culture-based solutions that could enhance antipsychotic adherence. Acknowledging the importance of the therapeutic alliance and sociocultural aspects in antipsychotic adherence, I argue that current cultural competence training provided to clinicians is inadequate. Organisational- and system-level approaches are required to reduce oppressive practise and promote culturally competent, person-centred care.
Collapse
|
3
|
Nagy GA, Cassiello-Robbins C, Anand D, Arnold ML, Coleman JN, Nwosu J, Singh RS, Woodward EN. Building a multicultural peer-consultation team: Planning, implementing, and early sustainment evaluation. Transcult Psychiatry 2022; 59:844-862. [PMID: 35866216 DOI: 10.1177/13634615221105117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article represents an implementation-focused evaluation of a multicultural peer-consultation team situated within a psychiatry department in a large academic medical center in the Southern United States. The evaluation comprised anonymous self-report questionnaires (n = 14) as well as individual (n = 3) or group interviews (n = 10) conducted by outside independent evaluators. Participants were current and former team members (i.e., graduate trainees, mental health care providers, clinical and research staff members) who voluntarily participated in this multimethod implementation evaluation. Results indicated that attendance on the team had several important impacts on members, and most notably an increased ability to provide multiculturally competent care, that is treatment that carefully and routinely considers the influence of culture and context on patients and therefore their clinical presentation. Further, no negative impacts from participating on the team were noted. A primary strength of the team's sustainability is that participation on the team was deemed to be relevant and useful by current and former team members. A major barrier to participation on the team is competing demands, such as high clinical loads. We conclude that this model for multicultural peer-consultation holds promise as an effective and implementable educational method for mental health care professionals. We discuss strengths, limitations, and future directions for research.
Collapse
Affiliation(s)
- Gabriela A Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine & School of Nursing, Durham, NC, USA
| | - Clair Cassiello-Robbins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Deepika Anand
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Macey L Arnold
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jessica N Coleman
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | - Joshua Nwosu
- Psychology Service, Washington DC Veterans Affairs Health Center, Washington, DC, USA
| | - R Sonia Singh
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
4
|
Tanaka-Matsumi J. Counseling Across Cultures: A Half-Century Assessment. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2022. [DOI: 10.1177/00220221221111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the Special Issue of the Journal of Cross-Cultural Psychology celebrates the 50th anniversary of the International Association for Cross-Cultural Psychology (IACCP), this article aims to summarize and track the development of counseling and psychotherapy in cultural contexts over the past half-century. When the edited volume, Counseling Across Cultures (CAC) first appeared nearly half a century ago, it sent an innovative message that culture matters in counseling and psychotherapy. The CAC editors produced six more updated editions in the succeeding years by 2016. The CAC authors examined the cultural context of accurate assessment, meaningful understanding of culture-relevant concepts, and appropriate interventions in each of the seven editions. They have surveyed universal and cultural aspects of counseling and psychotherapy according to such themes as emic and etic approaches to models of mental health, therapeutic relationships and techniques, assessment and interventions, and training needs against the IACCP’s ever-growing academic and professional activities. Research on the cultural adaptation of specific psychotherapies for specific clients should enhance access to culturally sensitive and evidence-based assessments and interventions. The need for training in multicultural awareness is expected to accelerate in the age of rapid globalization. This article affirms the contribution of the foundation-building approaches of CAC and the need for developing the interface between cross-cultural psychology and related clinical and counseling fields.
Collapse
|
5
|
Kaphle S, Hungerford C, Blanchard D, Doyle K, Ryan C, Cleary M. Cultural Safety or Cultural Competence: How Can We Address Inequities in Culturally Diverse Groups? Issues Ment Health Nurs 2022; 43:698-702. [PMID: 34807792 DOI: 10.1080/01612840.2021.1998849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sabitra Kaphle
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | | | - Denise Blanchard
- School of Nursing and Midwifery, University of Newcastle, Central Coast Clinical School, New South Wales, Australia
| | - Kerrie Doyle
- Indigenous Health, School of Medicine, Western Sydney University, Sydney, Australia
| | - Colleen Ryan
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Queensland, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Nagy PhD GA, Arnold Bs ML, Gagliardi Md JP, Convoy Dnp S, Molloy Dnp Rn Cne Chse MA, Wall PhD Rn Pmhnp-Bc Faanp P, Mauro PhD C, Rosenthal PhD MZ. Adaptation of the TEAM Mental Healthcare Delivery Model: A Mixed-Methods Evaluation. Issues Ment Health Nurs 2022; 43:239-250. [PMID: 34543149 DOI: 10.1080/01612840.2021.1975330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report on the adaptation and evaluation of an existing approach to multicultural education into an eight-session online, modular curriculum for psychiatric mental health nurse practitioner students (n = 6) and psychology interns (n = 10). Training participants were invited to complete verbal feedback, self-report questionnaires, and a high-fidelity patient simulation before and after the training. Self-report questionnaire results revealed no changes in knowledge or attitudes, but qualitative analysis of verbal feedback reflected improvements in attitudes and behaviors relevant to cultural competence. Results from the simulation also demonstrated an increase in measurable cultural competence behavioral indicators.
Collapse
Affiliation(s)
- Gabriela A Nagy PhD
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke University School of Nursing, Durham, North Carolina, USA
| | - Macey L Arnold Bs
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Jane P Gagliardi Md
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sean Convoy Dnp
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | | | - Christian Mauro PhD
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - M Zachary Rosenthal PhD
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| |
Collapse
|
7
|
Singla DR, Meltzer-Brody S, Savel K, Silver RK. Scaling Up Patient-Centered Psychological Treatments for Perinatal Depression in the Wake of a Global Pandemic. Front Psychiatry 2022; 12:826019. [PMID: 35197873 PMCID: PMC8859455 DOI: 10.3389/fpsyt.2021.826019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
There is a call to action to reduce the public health burden of perinatal depression worldwide. The COVID-19 pandemic has further highlighted significant gaps in perinatal mental health care, especially among women who identify as Black, Indigenous, People of Color (BIPOC). While psychotherapeutic (cognitive, behavioral and interpersonal) interventions are endorsed for perinatal mood disorders, barriers to access and uptake contribute to inequitable access to treatment at the population level. To effectively address these barriers and increase the scalability of psychotherapy among perinatal women, we suggest four pragmatic questions to be answered from a patient-centered lens; namely, "who," "what," "how," and "when." Promising avenues include task-sharing among mental health non-specialists, an emphasis on culturally sensitive care, web-based delivery of psychotherapy with some caveats, and a lifespan approach to perinatal mental health. Innovative research efforts are seeking to validate these approaches in diverse contexts across North America and the UK, lending optimism toward scalable and long-term solutions for equitable perinatal mental health care.
Collapse
Affiliation(s)
- Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katarina Savel
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Richard K. Silver
- Department of Obstetrics and Gynecology, North Shore University Health System, University of Chicago, Chicago, IL, United States
| |
Collapse
|
8
|
Santos MM, Nagy GA, Kanter JW, López SR. Applying a Process-Oriented Model of Cultural Competence to Behavioral Activation for Depression. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:127-146. [PMID: 38371740 PMCID: PMC10871711 DOI: 10.1016/j.cbpra.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Efforts to integrate cultural competence and evidence-based treatments (EBTs) typically take the form of cultural adaptations of EBTs, characterized by modifications to the existing treatment based on presumed cultural notions of a given race or ethnic group. Much less attention has been given to ways EBTs can integrate a process model of cultural competence, which focuses on what clinicians do in-session to identify and integrate key cultural factors for a given individual in the treatment. Our objective is to consider how a process model of cultural competence (Shifting Cultural Lenses) can be integrated with an EBT (Behavioral Activation). We present a theoretical rationale for integrating the SCL model with BA and illustrate this integration, which clinician provides an additional approach to bringing culture to treatments and shows promise for identifying clinicians' in-session behaviors that reflect cultural competence.
Collapse
|
9
|
Lewis-Fernández R, Aggarwal NK, Kirmayer LJ. The Cultural Formulation Interview: Progress to date and future directions. Transcult Psychiatry 2020; 57:487-496. [PMID: 32838656 DOI: 10.1177/1363461520938273] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Cultural Formulation Interview (CFI) developed for DSM-5 provides a way to collect information on patients' illness experience, social and cultural context, help-seeking, and treatment expectations relevant to psychiatric diagnosis and assessment. This thematic issue of Transcultural Psychiatry brings together articles examining the implementation and impact of the CFI in diverse settings. In this editorial introduction we discuss key areas raised by these and other studies, including: (1) the potential of the CFI for transforming current psychiatric assessment models; (2) training and implementation strategies for wider application and scale-up; and (3) refining the CFI by developing new modules and alternative protocols based on further research and clinical experience.
Collapse
Affiliation(s)
- Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University & Culture and Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| |
Collapse
|