Barriers and facilitators to cultural competence in rehabilitation services: a scoping review

Barriers and facilitators to culturally sensitive care in general practice: a reflexive thematic analysis

BACKGROUND

This study investigated the perceived barriers and potential facilitators for culturally sensitive care among general practitioners in Flanders. Understanding these dynamics is crucial for improving healthcare quality and equity.

METHODOLOGY

Twenty-one in-depth interviews were conducted with Flemish GPs. Braun and Clarke's reflexive thematic analysis was employed to develop and interpret themes that elucidate shared underlying meanings and capture the nuanced challenges and strategies related to cultural sensitivity in healthcare.

RESULTS

Two core themes were generated: GPs' uncertainty and opposition. These themes manifest in emotional responses such as frustration, miscomprehension, and feelings of helplessness, influencing relational outcomes marked by patient disconnect and reduced motivation for cultural sensitivity. The barriers identified are exacerbated by resource scarcity and limited intercultural contact. Conversely, facilitators include structural elements like interpreters and individual strategies such as engagement, aimed at enhancing GPs' confidence in culturally diverse encounters. A meta-theme of perceived lack of control underscores the challenges, particularly regarding language barriers and resource constraints, highlighting the critical role of GPs' empowerment through enhanced intercultural communication skills.

CONCLUSION

Addressing GPs' uncertainties and oppositions can mitigate related issues, thereby promoting comprehensive culturally sensitive care. Essential strategies include continuous education and policy reforms to dismantle structural barriers. Moreover, incentivizing culturally sensitive care through quality care financial incentives could bolster GP motivation. These insights are pivotal for stakeholders-practitioners, policymakers, and educators-committed to advancing culturally sensitive healthcare practices and, ultimately, for fostering more equitable care provision.

Geographic Inequity in Physical Medicine and Rehabilitation Services: An Administrative Case Report of Successful Advocacy for Change

OBJECTIVE

Following an injury or disease, physical medicine and rehabilitation (PM&R) services are often necessary to help patients recover function, activity, and community participation. Ten years ago, there was a significant gap between PM&R services in central Israel and those in the rural north of the country in terms of quality, quantity, and layout. The purpose of this administrative case report is to outline the gap in PM&R services between regions in Israel, as portrayed above; to describe a decade of civil action; and to describe civil action administrative approaches and actions that contributed to changes in the PM&R services now available in northern Israel.

METHODS

A decade of civil action to promote PM&R services is reviewed, illustrating the main administrative steps, including initiating and organizing meetings with key partners, lobbying, testifying in front of parliament and government committees, garnering media attention to promote public awareness, and filing a case with the Supreme Court of Israel. The encountered challenges and the subsequent actions are also described.

RESULTS

Awareness of the significance of PM&R services and of the inadequacy of such services in the northern part of Israel rose due to our actions, with practical field results, including a 180-bed government rehabilitation center that plans to open during 2024, and 5 daycare rehabilitation clinics and a private inpatient center that opened between 2020 and 2023. Data-driven research will aid in understanding the current gaps and tracking improvements with the opening of the new rehabilitation facility.

CONCLUSION

When inequality is brought to light and legislation for equality exists, civil action can promote change to reduce these gaps.

IMPACT

Others can follow the steps taken in this administrative case report to achieve success in struggles aiming to correct comparative inequality.

Improving cultural humility in physical therapy students: What is faculty's role?

BACKGROUND

Clinician bias contributes to health disparities; therefore, educational standards and professional expectations incorporate cultural humility. Vague standards and numerous pedagogical methods make implementing an effective and uniform curriculum challenging. Classroom and clinical faculty's attitudes and behaviors are pivotal; however, evidence on roles beyond instruction is lacking.

PURPOSE

This study explored physical therapy (PT) students' perceptions of faculty's role in improving their cultural humility.

METHODS

This study was rooted in a phenomenological approach that incorporated elements of both descriptive and interpretive phenomenology. Thirteen first-year PT students participated in one-on-one interviews which underwent reflexive thematic analysis.

RESULTS

Reflexive thematic analysis generated two hundred-ninety codes, six categories, and one overarching theme. Dissonance emerged between students' perceptions of faculty's role and the explicit and implicit curriculum.

CONCLUSION

Explicit messaging from classroom instruction and implicit messaging from clinical encounters and unspoken attitudes, values, and behaviors were disparate. Faculty role modeling, diversity, cultural awareness, and perceived comfort interacting with a diverse patient population improved students' self-confidence and cultural humility. Professional development including field experience with a cognitive apprenticeship approach, and standardized, discipline-specific cultural humility competencies may provide uniform and clear guidelines.

Raising Awareness About Language- and Culture-Specific Considerations in the Management of Dysarthria Associated With Parkinson's Disease Within the United States

PURPOSE

The purpose of this article is to raise awareness about the importance of diverting from English-centric approaches in the management of dysarthria associated with Parkinson's disease (PD) in the United States, and embracing a language- and culture-specific perspective when working with linguistically and culturally diverse populations within the context of culturally responsive, precision medicine.

METHOD

This tutorial is divided into two primary components: a critical review of language universal and language-specific characteristics of dysarthria associated with PD and their relationship with speech intelligibility, and a practical guide to culturally responsive evidence-based practice for speech-language pathologists.

CONCLUSIONS

We offer a framework for linguistically and culturally appropriate considerations when working with clients with dysarthria associated with PD. While "universal" representations of dysarthria may be part of the big picture, language-specific contributions to speakers' intelligibility should be carefully examined to maximize treatment outcomes. Additionally, an evidence-based model that fully embraces clients' wishes and values within the context of culturally responsive, precision medicine should be prioritized, a practice that may include the use of interpreters.

A qualitative description of primary health care patients' perspectives on factors influencing demand for rehabilitation in Zimbabwe

PURPOSE

Although the need for rehabilitation is increasing in Zimbabwe, rehabilitation remains undervalued. Currently, Zimbabwe struggles to provide rehabilitation services at primary health care. To justify the need for establishing rehabilitation at this level of care, the demand for these services needs to be understood. This study describes the factors influencing the demand for rehabilitation by adults attending primary healthcare in Zimbabwe.

MATERIALS AND METHODS

The study used a qualitative descriptive approach. In-depth interviews were conducted with 18 purposefully selected patients in the Shona language and audio recorded. Transcribed data were translated and back-translated. Thematic analysis was done using Atlas.ti. version 22.2®.

RESULTS

Most patients at primary health care were not actively seeking nor were they able to utilise rehabilitation services because of several factors. The factors identified from the patients' responses were categorised into (i) patient and family-, (ii) healthcare professional-, and (iii) health system-related factors. Key factors included rehabilitation awareness and availability of rehabilitation.

CONCLUSION

The identified factors may inform rehabilitation service and policy planners in improving primary health care patients' access to rehabilitation in similar low-resource settings. Future studies may determine how the identified factors may be addressed to ensure that high need translates to high demand.

"If you do not have Black futures in mind…then what's guiding the steps": anti-racist recommendations for traumatic brain injury rehabilitations' investments in hopeful Black futures

PURPOSE

The need for specialized rehabilitation considerations to address racial health disparities and optimize functional outcomes such as participation in daily life for Black people with traumatic brain injury (TBI) has been acknowledged. This study uses anti-racism as an entry point for addressing institutional racism by examining what the experiences of Black survivors of TBI, rehabilitation providers, and family caregivers tell us about imagined possibilities for rehabilitation to promote Black futures.

MATERIAL AND METHODS

A constructivist-informed narrative inquiry using critical race theory and in-depth narrative interviewing was applied across ten women and four men. Reflexive thematic analysis within and across groups of participants led to conceptualizing two main themes and five sub-themes.

RESULTS

Conceptualized themes captured requirements for TBI rehabilitations' investments in Black futures: (1) the need for critical information and specialized educational supports and particular requirements for supporting participation in meaningful life situations, and (2) responsibilities of delivering rehabilitation care for Black service users.

CONCLUSION

TBI rehabilitation must be tailored to the realities of living while being Black, integrate personal values, beliefs, interests, and equitable supports to maximize optimal functioning and participation if the goal of rehabilitation is community integration for all persons living with the impacts of TBI.

"We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine

BACKGROUND

After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging.

AIM

To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine.

METHODS

Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed.

RESULTS

We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units.

CONCLUSIONS

The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.

Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education

Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.

Lessons learned about development and assessment of feasibility of tools for health and rehabilitation services

BACKGROUND

Given the dire need for health and rehabilitation services internationally, exacerbated during the COVID-19 pandemic, there is a critical need to develop tools to support service delivery. This need is palpable in the Global South where tools developed in Eurocentric contexts are not always adaptable, applicable, or relevant. It is for this reason that the researchers present three case studies of tool development using pilot and feasibility studies in South Africa and share the lessons learned from these studies.

OBJECTIVES

To describe three case studies that developed new tools for health and rehabilitation services using pilot and feasibility studies. To synthesize lessons learned from these case studies on the development of tools.

METHOD

The researchers describe three case studies that were developed. The case studies are summarized as follows: aims and objectives, context, problem, study design, findings, and what happened after the study. Thereafter, a qualitative cross-case analysis was conducted by the researchers to generate themes.

FINDINGS

The case studies are described individually and followed by themes identified through cross-case analysis.

DISCUSSION

The lessons learned are discussed. It is essential to develop new tools and protocols, motivated by the need for equitable and contextually relevant practices. Partnerships and collaboration with end-users are critical for success. A critical, scientific process is essential in developing new tools. Pilot and feasibility studies are invaluable in developing tools and assessing the feasibility of tools and implementation. The goal is to develop practical, usable tools and protocols.

CONCLUSION

Through the lessons learned, the researchers are hopeful that the international health and rehabilitation professions will continue to strengthen the scientific development of contextually relevant tools and resources.

Mental Health Care Access Among Arab Immigrants in the United States: Application of Public Arena Model

Arab immigrants constitute a sizable portion of the US population, and their adjustment and relocation challenges might escalate mental health issues. Nevertheless, mental health care accessibility among such populations is not recognized as policy issue. Hence, it is crucial to explore the political tools that might be employed to improve immigrants' access to mental health treatment. The Public Arenas Model (Hilgartner and Bosk, American Journal of Sociology 94:53-78, 1988) provides better understanding of how access to mental health care is defined in the public sphere, why mental health inaccessibility among Arabs has not received attention, and how stakeholders worked to raise the public's attention to such issue (Smith, Policy, Politics & Nursing Practice 10:134-142, 2009). Ultimately, several policy options are proposed to address Arab immigrants' access to mental health care issue, including increasing mental health service providers' language proficiency and cultural competency, integration of behavioral health and primary care services for immigrant populations, and considering novel modes of mental health delivery.

Rehabilitation professions' core competencies for entry-level professionals: a thematic analysis

Rehabilitation services are essential interventions designed to optimize functioning and reduce disability in individuals with health conditions. Eight core professions offer rehabilitation services: audiology, occupational therapy, physical and rehabilitation medicine, physiotherapy, psychology, prosthetics and orthotics, rehabilitation nursing, and speech-language pathology. These professions often work together to provide patient-centered care. Each rehabilitation profession has developed its own international or national document to describe entry-level competencies. However, it is not evident in the literature whether rehabilitation professions share the same core competencies. Therefore, we explored the international standards for rehabilitation professions to identify commonalities and differences in entry-level professionals' required core competencies. A thematic analysis of current, published, international, or national entry-level competencies documents was conducted to determine commonalities and differences in the core competence requirements for the eight rehabilitation professions. The following four themes were evident across all professions: (a) evidence-based clinical practice knowledge and skills; (b) culturally competent communication and collaboration; (c) professional reasoning and behaviors; and (d) interprofessional collaboration. This thematic analysis highlighted the commonalities among rehabilitation professionals and may be used to provide a greater understanding of how rehabilitation professionals can support and work together on interprofessional teams.

Power of narrative: a case study about documenting private insightful experiences while dealing with pain and associated disability

Objective

People adjusting to living with a chronic disability, such as chronic pain, seek support and resources from societal systems, including health systems, to help them cope with this reality. This case study describes the use of a digital health platform designed to help in that quest.

Method

MyHealthMyRecord (MHMR), is being developed to record, register and curate personal private experiences of a chronic condition. MHMR allows users to record and log short (30-90s) personal and private audio-videos of their accommodation-seeking journey in a way that can be encrypted, registered, curated and shared privately. This case study describes the use of a prototype version of the platform by a participant co-designer who experienced a sudden onset of a chronic pain condition, of undetermined origin. System use began three months after the onset of the condition and just after being discharged from several months of hospitalization without any definitive diagnosis.

Result

During a three-month period, 65 short unstructured contributions were authored and logged. This paper presents a qualitative analysis of that content. The clips used various communication styles that documented experiences, concerns, issues, positive and negative interactions and pain episodes. Using thematic analysis with open coding, three domains (person-facing, accessibility and system-facing) and eight themes (pain, joy, therapy, environmental, recommendations, technical, culture and communication) were identified. Comments about pain, stress, etc., were the most common and occurred in 75% of all videos while technical and therapy/physio related comments were the fewest and occurred in 3 and 9% of the videos, respectively.

Conclusion

We conclude that it is possible to create recordings of events, thoughts, reflections and issues on different aspects affecting an individual's health and well-being impact, including effects of the chronic condition as well as tangential outcomes such as accessibility (or lack of it), using MHMR over a longer period of time. The next steps will be to develop functionality to annotate the recordings, automatically analyze and summarize collections of recordings to make them consumable, useful and understandable to the individual and others, and then to share those analyses and summaries with others. In addition, evaluate this functionality longitudinally with more users.

Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review

BACKGROUND

Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families.

METHOD

A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines.

FINDINGS

The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners.

CONCLUSION

These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.

Intellectual Humility: How Recognizing the Fallibility of Our Beliefs and Owning Our Limits May Create a Better Relationship Between the Physical Therapy Profession and Disability

Despite the many advancements over the history of the profession, physical therapy remains in a somewhat paradoxical relationship with disability. The physical therapist profession values disability as diversity but continues to focus on the normalization of body functions as the primary means to promote functionality in people with disability. This focus, consistent with a medicalized view of disability, may prevent physical therapists from empowering individuals with disability to explore alternative, yet effective, perceptual-motor strategies to achieve their functional goals. Additionally, recent research documents implicit, negative biases of physical therapists and physical therapist assistants toward people with disability, again consistent with the medicalized view that disability is the product of an imperfectly functioning body. Dominant underlying beliefs in any profession are often difficult to counter because they are so pervasive, and those beliefs can be reinforced and made stronger when challenged. The purpose of this Perspective article is to introduce physical therapists to a rising construct in psychology-intellectual humility-that may help to facilitate the profession's relationship with disability. Intellectual humility is predicated on recognizing the fallibility of one's beliefs and related practices. Intellectual humility is a promising construct for physical therapy to address the disability paradox and confront implicit attitudes that have served as the basis for many dominant ideas about disability. This Perspective synthesizes views and evidence from the behavioral and social sciences, philosophy, and critical disability studies to contribute to the ongoing evolution of the profession with respect to disability.

IMPACT

The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.

An Examination of Culturally Relevant Health Messages in African-American Churches

This quantitative study examined the presence of culturally relevant health messages for African-Americans based on a preexisting dataset from 21 African-American churches in South Carolina (USA). Content analysis served as the primary methodological approach to code printed media messages based on their cultural relevance among African-Americans (Cohen's kappa = .74). Within the dataset (n = 2166), 477 (22%) items were identified as culturally relevant. A low prevalence of culturally relevant messages was found across the three message topics, two media types, and one media source. Due to the limited presence of culturally relevant messages, researchers should collaborate with African-American churches to design health promotion messages.

Exploring the lived experiences of ethnic minority youth with disabilities: a systematic review and meta synthesis of qualitative data

PURPOSE

Racial and ethnic minority youth with disabilities often encounter more challenges and poorer health, social and vocational outcomes compared to white youth and yet, relatively little is known about their lived experiences. The purpose of this study was to explore the experiences of ethnic minority youth and young adults with disabilities.

METHODS

We conducted a systematic review of qualitative data with eight international databases assessed by four reviewers.

RESULTS

Twenty-one studies met the inclusion criteria, which involved 373 youth and young adults, across four countries over a 20-year period. We identified the following themes: (1) accessing and navigating services (i.e., environmental barriers; lack of supports, resources and information); (2) perceptions of disability (i.e., cultural adjustment and tensions between cultures; differing priorities for independence); (3) systemic factors (i.e., language and communication; stigma, discrimination and racism); (4) coping (i.e., reframing; and family involvement and support); and (5) intersectionality (i.e., disability, race and ethnicity, gender, and socio-economic status).

CONCLUSIONS

Our findings highlight how racial and ethnic minority youth with disabilities encounter many challenges in dealing with their condition and the urgent need for further research to develop a deeper understanding of their needs so that clinicians and service providers can enhance supports.IMPLICATIONS FOR REHABILITATIONRacial and ethnic minority youth with disabilities encounter different challenges than other youth, such as cultural adjustment, racism and culturally inappropriate services.Clinicians and service providers should be cognizant that ethnic minority youth may need different supports and resources as they grapple with tensions between cultures.Clinicians, educators and service providers should consider the complexity of how disability interacts with many other factors, such as race, ethnicity, gender and socio-economic status.

Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research

The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.

Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes

PURPOSE

Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting.

METHODS

A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019-2020 identified as having limited English proficiency. Patterns of interpreter use (professional and "ad hoc") and rehabilitation outcomes were evaluated via medical record review.

RESULTS

Eighty-five participants were included. During inpatient rehabilitation (median 17 [12-28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain.

CONCLUSIONS

Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitationProfessional health care interpreters can be used to overcome language barriers in rehabilitation.In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters.Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation.Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.

Exploring Autism, Culture, and Immigrant Experiences: Lessons from Sri Lankan Tamil Mothers

Background: Canada is home to a mosaic of cultures with immigrant communities from a wide range of countries, but there are significant variations in how autism spectrum disorder (ASD) may be understood across different immigrant groups, including Sri Lankan Tamils. Such gaps in knowledge may present challenges for immigrant families that are trying to access appropriate care for their child, including occupational therapy services. Purpose: This descriptive qualitative study aimed to better understand the experiences of immigrant Sri Lankan Tamil parents of children diagnosed with ASD in Southern Ontario, Canada. Method: Interviews were analyzed using an in-depth content analysis. Findings: Results demonstrated parents' perceived supports and barriers towards ASD intervention planning, and indicated that parents were generally satisfied by the level of cultural competence in current ASD systems. However, families may still experience significant immigrant-related barriers that are not fully addressed. Implications: Recommendations to improve cultural awareness among occupational therapists utilizing ASD interventions are suggested.

Development of rehabilitation services in an Inuit sociocultural context: challenges, strategies and considerations for the future

In recent years, a new rehabilitation programme has been developed on the Hudson Bay coast of Nunavik. The purpose of this article is to reflect on the experience of an occupational and physical therapy programme development in an Inuit sociocultural context. To do so, the challenges encountered during the first years following the implementation of rehabilitation services and the strategies implemented by the professionals to overcome them were identified, examined in the light of the literature, and discussed with members of the rehabilitation team. The challenges encountered and strategies implemented were divided into 10 major themes: (1) diverse clinical needs; (2) communication issues; (3) acquisition of cross-cultural interaction and population-specific knowledge; (4) adaptation of clinical practice to Nunavimmiut; (5) client engagement in rehabilitation; (6) professional isolation; (7) lack of awareness around the objectives and scope of rehabilitation practice; (8) use of culturally safe assessment tools; (9) staff turnover; (10) large geographic area to be served. This exercise highlighted the need to adapt clinical rehabilitation practices to Nunavimmiut’s worldviews and culture, as well as to adopt a reflective practice in order to improve the quality, relevance and effectiveness of rehabilitation services.

A systematic scoping review of early interventions for parents of deaf infants

Background

Over 90% of the 50,000 deaf children in the UK have hearing parents, many of whom were not expecting a deaf child and may require specialist support. Deaf children can experience poorer long-term outcomes than hearing children across a range of domains. After early detection by the Universal Newborn Hearing Screening Programme, parents in the UK receive support from Qualified Teachers of the Deaf and audiologists but resources are tight and intervention support can vary by locality. There are challenges faced due to a lack of clarity around what specific parenting support interventions are most helpful.

Methods

The aim of this research was to complete a systematic scoping review of the evidence to identify early support interventions for parents of deaf infants. From 5577 identified records, 54 met inclusion criteria. Two reviewers screened papers through three rounds before completing data extraction and quality assessment.

Results

Identified parent support interventions included both group and individual sessions in various settings (including online). They were led by a range of professionals and targeted various outcomes. Internationally there were only five randomised controlled trials. Other designs included non-randomised comparison groups, pre / post and other designs e.g. longitudinal, qualitative and case studies. Quality assessment showed few high quality studies with most having some concerns over risk of bias.

Conclusion

Interventions commonly focused on infant language and communication followed by parental knowledge and skills; parent wellbeing and empowerment; and parent/child relationship. There were no interventions that focused specifically on parent support to understand or nurture child socio-emotional development despite this being a well-established area of poor outcome for deaf children. There were few UK studies and research generally was not of high quality. Many studies were not recent and so not in the context of recent healthcare advances. Further research in this area is urgently needed to help develop evidence based early interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02893-9.

Treatment for Anomia in Bilingual Speakers with Progressive Aphasia

Anomia is an early and prominent feature of primary progressive aphasia (PPA) and other neurodegenerative disorders. Research investigating treatment for lexical retrieval impairment in individuals with progressive anomia has focused primarily on monolingual speakers, and treatment in bilingual speakers is relatively unexplored. In this series of single-case experiments, 10 bilingual speakers with progressive anomia received lexical retrieval treatment designed to engage relatively spared cognitive-linguistic abilities and promote word retrieval. Treatment was administered in two phases, with one language targeted per phase. Cross-linguistic cognates (e.g., rose and rosa) were included as treatment targets to investigate their potential to facilitate cross-linguistic transfer. Performance on trained and untrained stimuli was evaluated before, during, and after each phase of treatment, and at 3, 6, and 12 months post-treatment. Participants demonstrated a significant treatment effect in each of their treated languages, with maintenance up to one year post-treatment for the majority of participants. Most participants showed a significant cross-linguistic transfer effect for trained cognates in both the dominant and nondominant language, with fewer than half of participants showing a significant translation effect for noncognates. A gradual diminution of translation and generalization effects was observed during the follow-up period. Findings support the implementation of dual-language intervention approaches for bilingual speakers with progressive anomia, irrespective of language dominance.

Access to Prenatal Testing and Ethically Informed Counselling in Germany, Poland and Russia

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic analysis. Visible in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level.

Changing Perspectives of Local Therapists Eight Years after the Implementation of an Occupational Therapy Service in a Unique Himalayan Cross-Cultural Setting

Background. Whether concepts and principles of Occupational Therapy (OT) can successfully be applied to non-Western and cross-cultural settings is being intensively discussed. Aims/Objectives. We explored the changing perspectives of local occupational therapists (OTs) eight years after the implementation of an OT service in a Himalayan cross-cultural setting in terms of (1) treatment applied, (2) professional identity, and (3) cross-cultural interactions. Material and Methods. A qualitative study design was chosen, and semistructured interviews were conducted in all employed practitioners (a) during implementation and (b) eight years later (n = 7). Questions were carefully formulated in order to narrow down the intended issues but respecting crosscultural differences. The framework method was implemented for data analysis. Findings. Long-term empowering local OTs resulted in the successful development of a sustainable OT department in a unique Himalayan cross-cultural setting. Practitioners became aware of their therapeutic potentials, a clear sense of professional identity was developed, and it was recognised that sensitive cross-cultural practice is only achieved by an ongoing and intentional cultural learning process. Conclusions and Significance. Our findings suggest that OT can be applied to non-Western cross-cultural settings.

Students' perceptions of training and experiences with interpreters in a pro bono physical therapy setting

Professional interpreters are an essential part of the healthcare team in providing high-quality care to all patients. However, interprofessional skills for working with professional interpreters are often not developed until after entering the workforce. Little is known about the educational impact of working with interpreters in a pro bono setting during graduate education. Therefore, the purpose of this study was to investigate students' perceptions of their training and experiences working with a professional interpreter in a pro bono physical therapy setting. Eighteen physical therapy students participated in one of five focus groups. Students who took part in the study had volunteered in a pro bono physical therapy clinic and worked with a professional interpreter. Four primary themes emerged from the data: Value, Patient-Centered Care, Challenges, and Professional Development. Based on student feedback, key findings were: 1) an increase in student confidence in working with a professional interpreter, 2) the safe learning environment of a supervised hands-on experience promoted learning through challenges, and 3) the value of professional interpreters as part of the healthcare team and their assistance in developing interprofessional communication skills. When considering Doctor of Physical Therapy education, offering a low-stakes hands-on experience with professional interpreters may offer distinct growth opportunities for students as they develop their professional skills.

Developing a community rehabilitation and lifestyle service for a remote indigenous community

PURPOSE

Community rehabilitation is an essential health service that is often not available to remote Australians. This paper describes the first cycle of a collaborative project, between local community members, allied health professionals and a university, to co-design a community rehabilitation and lifestyle service to support adults and older people to stay strong and age well in place.

METHODS

An action research framework was used to develop the service for adults in two remote communities, one being a discrete Aboriginal community. The first cycle involved planning for, and trialling of a service, with observations, reflections and feedback from clients, community members, university students and health service providers, to inform the subsequent service.

RESULTS

Over two years, stakeholders worked collaboratively to plan, trial, reflect and replan an allied health student-assisted community rehabilitation service. The trial identified the need for dedicated clinical and cultural supervision. During replanning, three key elements for culturally responsive care were embedded into the service: reciprocity and yarning; holistic community-wide service; and Aboriginal and Torres Strait Islander mentorship.

CONCLUSIONS

An action-research approach to co-design has led to the establishment of a unique community rehabilitation service to address disability and rehabilitation needs in two remote Australian communities.Implications for rehabilitationCo-design of community rehabilitation services between Aboriginal and Torres Strait Islander community members and the local allied health professionals can lead to development of an innovative service model for remote Aboriginal communities.Culturally responsive community rehabilitation services in Aboriginal and Torres Strait Islander communities requires holistic and community-wide perspectives of wellbeing.Incorporating Aboriginal and Torres Strait Islander ways of engaging and communicating, and leadership and mentorship for non-Indigenous allied health professionals and students are essential components for students-assisted culturally responsive services.

Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients

OBJECTIVES/HYPOTHESIS

To evaluate whether language of choice affects compliance with speech therapy for voice disorders.

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance.

RESULTS

Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P = .0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance.

CONCLUSION

This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance.

LEVEL OF EVIDENCE

IV Laryngoscope, 131:E2298-E2302, 2021.

[Barriers and Resources in Inpatient Psychosomatic Rehabilitative Care of Migrant Patients]

Patients from migrant descent access inpatient psychosomatic rehabilitative care less and achieve less treatment success than patients from the host populations. They are confronted with different process barriers in the healthcare system which combined with individual barriers can inhibit successful treatment. Studies have shown that working with migrant patients may also be challenging for healthcare providers.This study aims to assess and compare barriers and resources faced by migrant and non-migrant patients during their treatment in inpatient psychosomatic rehabilitative care. Also, the aim is to assess and compare barriers and resources faced by healthcare providers in treating migrant and non-migrant patients in order to identify barriers and resources specific to working with migrant patients.A total of 77 semi-structured interviews were conducted (20 migrant and 19 non-migrant patients as well as 14 migrant and 24 non-migrant healthcare providers). Data were transcribed and analyzed applying the method of qualitative content analysis (Mayring) with inductive categories.Migrant and non-migrant patients stated that they profit from the treatment in inpatient psychosomatic rehabilitative care. The greatest barriers for both migrant patients and healthcare providers are language barriers, cultural differences, differences in expectations regarding the treatment and limited organizational cultural competences. As far as organizational cultural competences are implemented, they are profitable for migrant patients and non-migrant healthcare providers. However, migrant healthcare workers seem responsible for implementing culturally competent care and suffer from increased workload.

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review

The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

BACKGROUND

Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities.

OBJECTIVE

To describe the state of CC training across hospices.

DESIGN

National survey of hospices' practices to promote CC.

RESULTS

A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality's role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)-the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT.

CONCLUSIONS

CCT has been shown to improve healthcare providers' knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.

Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

Do you let me symptomatize? The potential role of cultural values in cross-national variability of mental disorders' prevalence

BACKGROUND

Mental disorders may show inherent cross-national variability in their prevalence. A considerable number of meta-analyses attribute this heterogeneity to the methodological diversity in published epidemiological studies. Cultural values are characteristically not assessed in meta-regression models as potential covariates.

AIM

Our aim was to conduct a meta-regression analysis to explore to what extent certain cultural values and immigration rates (as indicator of cultural diversity) might be associated with the cross-national heterogeneity of prevalence rates.

METHOD

To minimize methodological differences that may exert a confounding effect, prevalence rates were obtained from the World Health Organization's (WHO) World Mental Health Survey Initiative. Cultural indices (overall emancipative values; overall secular values) were collected from the World Value Survey, while immigration rates were registered by utilizing the data of the United Nations' World Population Policies 2005 report.

RESULTS

Meta-regression analysis indicated that overall emancipative values (i.e. promoting self-expression, non-violent protest) showed significant connection with lifetime and last year prevalence of any mood disorders (Z = 4.71, p = .001; Z = 2.35, p = .02) and any internalizing disorders (a merged category that combined mood and anxiety disorders; Z = 2.82, p = .004; Z = 2.34, p = .02). Overall secular values (i.e. rejecting authority and obedience) were negatively associated with last year prevalence of depression (Z = -2.75, p = .06). Multistep regression analysis indicated that immigration rate moderated the connection between cultural values and mental disorders. Countries with higher immigration rates showed higher emancipative and secular values.

CONCLUSION

Our findings might function as potential foundation for formulating hypotheses regarding the cultural context's influence on the population's mental health.