Healthworlds, Cultural Health Toolkits, and Choice: How Acculturation Affects Patients' Views of Prescription Drugs and Prescription Drug Advertising

How do minorities differ from Whites in their interactions with the broader consumeristic health culture in the United States? We explore this question by investigating the role that acculturation plays in minority and White patients' views of prescription drugs and the direct-to-consumer advertising (DTCA) of prescription drugs. Drawing on data from six race-based focus groups, we find that patients' views of prescription drugs affect their responses to DTCA. While both minorities and Whites value the information they receive from DTCA, level of acculturation predicts how minorities use the information they receive from DTCA. Less acculturated minorities have healthworlds and cultural health toolkits that are not narrowly focused on prescription drugs. This results in skepticism on the part of less acculturated minorities toward pharmaceuticals as treatment options. In this article, we argue that researchers must consider the role acculturation plays in explaining patients' health dispositions and their consumeristic health orientations.

Visibility and Voice: Aboriginal People Experience Culturally Safe and Unsafe Health Care

In Canada, cultural safety (CS) is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples' encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how CS for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted, and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, although less frequently reported, were described as interpersonal interactions with feelings visibility and therefore, treatment as a "human being."

Negotiating biomedical and traditional Chinese medicine treatments among elderly Chinese Singaporean women

In this article we examine how elderly Chinese Singaporean women navigated between biomedicine and traditional Chinese medicine in their practices of maintaining well-being. We interviewed 36 elderly women to understand their negotiation of medical choices in the interplay of structure, culture, and personal agency. Our findings show that participants made situational decisions under structural and cultural influences, such as family members' changing expectations and interpretations of medical practices, institutional preferences for biomedicine, and the patients' negotiating position between biomedicine and traditional Chinese medicine. Participants demonstrated their capacity to enact agency through their examination of the effects and side effects of each medical system and through their integrative use of different medical treatments, depending on the purpose. Through our findings, we unveil contextual meanings of health among elderly women and the unique coexistence of traditional and modern medical practices within the context of Singapore.

Former child soldiers' problems and needs: Congolese experiences

With this article, we explore how staff working at transit centers and vocational training centers in the eastern Democratic Republic of the Congo experienced the problems and needs of former child soldiers. We argued that the staff's experience of the children's daily lives and their understanding of the sociocultural context of the conflict make their perspective a valuable source of information when trying to understand the phenomenon of child soldiering. Additionally, we reasoned that how the staff frame these children's problems influences how they attempt to aid the children. We conducted 11 semistructured interviews and analyzed these using a hermeneutical-phenomenological approach. We clustered our findings around six themes: unfavorable contextual factors, acting as if still in the army, addiction, symptoms of psychopathology, social rejection, and reintegration needs. The overarching message we observed was that the informants experienced that former child soldiers require help to be transformed into civilians who participate proactively in their society.

"It is a challenge to do it the right way": an interpretive description of caregivers' experiences in caring for migrant patients in Northern Sweden

BACKGROUND

Experiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice.

METHODS

We used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis.

RESULTS

We found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas with varied social, cultural and religious affiliations, migration histories and statuses, all of which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system.

CONCLUSIONS

The study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers' contextual understanding of migrant groups and their needs, (d) and improve migrants' health literacy through strategies such as community based educational outreach.

Divergent views of hope influencing communications between parents and hospital providers

This study evaluated parents' and health care providers' (HCPs) descriptions of hope following counseling of parents at risk of delivering an extremely premature infant. Data came from a longitudinal multiple case study investigation that examined the decision making and support needs of 40 families and their providers. Semistructured interviews were conducted before and after delivery. Divergent viewpoints of hope were found between parents and many HCPs and were subsequently coded using content analysis. Parents relied on hope as an emotional motivator, whereas most HCPs described parents' notions of hope as out of touch with reality. Parents perceived that such divergent beliefs about the role of hope negatively shaped communicative interactions and reduced trust with some of their providers. A deeper understanding of how varying views of hope might shape communications will uncover future research questions and lead to theory-based interventions aimed at improving the process of discussing difficult news with parents.