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van Apeldoorn JAN, Roozekrans AK, Harskamp RE, Richard E, Agyemang C, Moll van Charante EP. General practitioners' views on cardiovascular prevention for ethnic minorities-a qualitative study in the Netherlands. Fam Pract 2024; 41:340-348. [PMID: 36994852 PMCID: PMC11167987 DOI: 10.1093/fampra/cmad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES While ethnic minorities in Europe are disproportionally affected by cardiovascular disease (CVD), little is known about how general practitioners (GPs) perceive differences in risk or care needs across ethnic minority groups. Therefore, we explored GPs' views on whether ethnicity influences cardiovascular risk, whether a culturally sensitive approach is warranted, on potential barriers in the provision of such care, and to find potential opportunities to improve cardiovascular prevention for these groups. METHODS We conducted a qualitative study by interviewing GPs practising in The Netherlands. The interviews were semistructured, audio-recorded, and analysed by 2 researchers using thematic analysis. RESULTS We interviewed 24 Dutch GPs (50% male). GPs' views on the impact of ethnicity on CVD risk varied widely, yet it was generally recognized as a relevant factor in cardiovascular prevention for most minority groups, prompting earlier case-finding of high-risk patients. While GPs were aware of sociocultural differences, they emphasized an individualized approach. Perceived limitations were language barriers and unfamiliarity with sociocultural customs, leading to a need for continuing medical education on culturally sensitive care and reimbursement of telephone interpreting services. CONCLUSION Dutch GPs have differing views on the role of ethnicity in evaluating and treating cardiovascular risk. Despite these differences, they emphasized the importance of a personalized and culturally sensitive approach during patient consultations and expressed a need for continuing medical education. Additional research on how ethnicity influences CVD risk may strengthen cardiovascular prevention in increasingly diverse primary care populations.
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Affiliation(s)
- Joshua A N van Apeldoorn
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alet K Roozekrans
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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De-María B, Topa G, López-González MA. Cultural Competence Interventions in European Healthcare: A Scoping Review. Healthcare (Basel) 2024; 12:1040. [PMID: 38786450 PMCID: PMC11120989 DOI: 10.3390/healthcare12101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation.
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Affiliation(s)
- Berta De-María
- Department of Social and Organizational Psychology, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain; (B.D.-M.); (G.T.)
| | - Gabriela Topa
- Department of Social and Organizational Psychology, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain; (B.D.-M.); (G.T.)
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Karnjuš I, Ličen S, Prosen M. UNDERSTANDING DEMOGRAPHIC AND EPIDEMIOLOGIC CHARACTERISTICS OF HOSPITALIZED IMMIGRANT FEMALE PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY. Acta Clin Croat 2023; 62:323-329. [PMID: 38549604 PMCID: PMC10969641 DOI: 10.20471/acc.2023.62.02.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/25/2021] [Indexed: 04/02/2024] Open
Abstract
Precise epidemiologic and demographic characteristics of immigrant women admitted to gynecology or obstetrics departments are rarely explored. The aim of this retrospective observational study was to analyze the epidemiologic and demographic characteristics of immigrant female patients hospitalized between 2012 and 2017 in one maternity hospital in south-west Slovenia. Clinical data retrieved from hospital electronic information system were used to analyze these characteristics. In the mentioned period, 605 immigrant women were hospitalized, most of them originating from countries of the former Yugoslavia (60.50%) or former Eastern Bloc (14.05%). The results show that in recent years there has been a constantly growing trend of immigrant women being admitted compared to the total number of hospitalizations. No statistical differences were established in the incidence of abortion, preterm delivery or vacuum extraction between Slovenian and immigrant women, although the analysis revealed a higher rate of cesarean section among immigrant women (χ2=26.960, p<0.01). Education level seems to be a significant predictor of the likelihood of an abortion in the group of immigrant women (B=-0.492, p=0.015), where less educated women are at a greater risk. To improve what is known about the sexual and reproductive health-related problems of immigrant women, a large-scale epidemiologic study is needed in the near future.
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Affiliation(s)
- Igor Karnjuš
- University of Primorska, Faculty of Health Sciences, Izola, Slovenia
| | - Sabina Ličen
- University of Primorska, Faculty of Health Sciences, Izola, Slovenia
| | - Mirko Prosen
- University of Primorska, Faculty of Health Sciences, Izola, Slovenia
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Springer P, Franzen-Castle L, Gratopp E, Schmader B. What is a healthy community? Refugee youth’s perspective on freedom, safety, and trust: a photovoice project. INTERNATIONAL JOURNAL OF SYSTEMIC THERAPY 2022. [DOI: 10.1080/2692398x.2022.2135344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paul Springer
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Lisa Franzen-Castle
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Emily Gratopp
- Lancaster County Extension, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Brenna Schmader
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change. BMC Public Health 2021; 21:1524. [PMID: 34372808 PMCID: PMC8351340 DOI: 10.1186/s12889-021-11548-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal. Methods We conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach. Results Major uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment. Conclusions This formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11548-4.
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Meinema JG, Haafkens JA, Jaarsma DADC, van Weert HCPM, van Dijk N. Development and evaluation of a culturally appropriate hypertension education (CAHE) training program for health care providers. PLoS One 2017; 12:e0178468. [PMID: 28594878 PMCID: PMC5464541 DOI: 10.1371/journal.pone.0178468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/13/2017] [Indexed: 01/13/2023] Open
Abstract
Background In Western countries, hypertension and hypertension-related complication are more common in ethnic minority groups of African descent than in indigenous populations. Addressing ethnic minority patients’ perceptions of hypertension and its treatment through the use of cultural appropriate hypertension education (CAHE) increases adherence to medication and lifestyle recommendations. Given these effects, it seems warranted to develop a training program on how to deliver this type of patient education for Primary Care Nurse Practitioners (PCNPs). Objective Development and evaluation of a training program for PCNPs aimed at providing culturally appropriate hypertension patient education. Design Prospective cohort study evaluating attitude and intended behavioral changes. Participants Both experienced PCNPs and PCNPs in training participated in this study. Main measures The effects of the CAHE-training were measured by 3 different questionnaires on 1) the satisfaction with the training program, 2) the attitude towards culturally appropriate care, and 3) the commitment to change. Results The CAHE-training program consists of 10 different components divided over two 4-hour sessions and was taught to 87 participating PCNPs. The program utilizes constructivist-learning principles and educational evidence on adult learning. The content of the program is based on the knowledge obtained from our previous studies on culturally appropriate care. The mean satisfaction-score was 7.5 (1–10 scale), with the role-play exercise with patient-actors scoring highest (8.2). We observed non-significant but positive changes in attitude. PCNPs who reported on the implementation of their intended behavior change showed significant attitude changes after three months. Conclusion We demonstrated that our evidence based training program for PCNPs resulted in a positive learning experience with adequate intended behavioral changes in practice. Unfortunately, response rates were too low to demonstrate persistent changes in attitude.
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Affiliation(s)
- Jennita G. Meinema
- Department of General Practice/ Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Joke A. Haafkens
- Amsterdam Institute for Advanced labour Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - Debbie A. D. C. Jaarsma
- Center for Education Development and Research in Health Professions, University Medical Center of Groningen, University of Groningen, Groningen, the Netherlands
| | - Henk C. P. M. van Weert
- Department of General Practice/ Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Nynke van Dijk
- Department of General Practice/ Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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Su JG. An online tool for obesity intervention and public health. BMC Public Health 2016; 16:136. [PMID: 26864125 PMCID: PMC4748626 DOI: 10.1186/s12889-016-2797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though the United States of America (U.S.A.) obesity rate shows signs of leveling off, rates remain high. Poor nutrition contributes to the development of obesity, and physical inactivity is an important cause of numerous diseases and directly linked to obesity. Efforts to improve diet, increase physical activity and pursue other behavioral changes seem imperative. However, the effective management of intervention strategies for large number of participants are challenging because services in primary, secondary, and tertiary cares are often under-resourced, relatively uncoordinated with other parts of the health system. It is thus necessary to have accompanying intervention strategies that can be carried out at population level. In this paper, we describe an online intervention tool designed for the Obesity Prevention Tailored for Health II project to help achieve such goals. RESULTS The first part of the online tool locates healthy food stores and recreational programs within a specified distance of a participant's home or a place of interest. The food environments include fruit & vegetable stores, farmers' markets and grocery stores, and the companying popup window shows the street address and contact information of each store. The parks and recreational programs are displayed on names of park or recreational program, types of program available, and city each amenity belongs to. The tool also provides spatial coverage of vegetation greenness, air pollution and of historical traffic accidents involving active travel. The second part of the tool provides optimized travel options for reaching various amenities. By incorporating bicycling, walking and public transit into the trip planner, this online tool helps increase active transport and reduce dependence on automobiles. It promotes transportation that encourages safety awareness, physical activity, health, recreation, and resource conservation. CONCLUSIONS We developed the first Google-based online intervention tool that assists obese and overweight participants in finding food and recreational amenities around locations of interest and identifying optimized routes that fit their personal preferences. This tool can also serve general public and policy makers for education, disease prevention and health promotion.
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Affiliation(s)
- Jason G Su
- Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, 94720-7360, USA.
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Fransen MP, Beune EJAJ, Baim-Lance AM, Bruessing RC, Essink-Bot ML. Diabetes self-management support for patients with low health literacy: Perceptions of patients and providers. J Diabetes 2015; 7:418-25. [PMID: 25042519 DOI: 10.1111/1753-0407.12191] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/22/2014] [Accepted: 06/29/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of the present study was to explore perceptions and strategies of health care providers regarding diabetes self-management support for patients with low health literacy (LHL), and to compare their self-management support with the needs of patients with LHL and type 2 diabetes. This study serves as a problem analysis for systematic intervention development to improve diabetes self-management among patients with LHL. METHODS This qualitative study used in-depth interviews with general practitioners (n = 4), nurse practitioners (n = 5), and patients with LHL (n = 31). The results of the interviews with health care providers guided the patient interviews. In addition, we observed 10 general practice consultations. RESULTS Providers described patients with LHL as uninvolved and less motivated patients who do not understand self-management. Their main strategy to improve self-management was to provide standard information on a repeated basis. Patients with LHL seemed to have a different view of diabetes self-management than their providers. Most demonstrated a low awareness of what self-management involves, but did not express needing more information. They reported several practical barriers to self-management, although they seemed reluctant to use the information provided to overcome them. CONCLUSIONS Providing and repeating information does not fit the needs of patients with LHL regarding diabetes self-management support. Health care providers do not seem to have the insight or the tools to systematically support diabetes self-management in this group. Systematic intervention development with a focus on skills-based approaches rather than cognition development may improve diabetes self-management support of patients with LHL.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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