Online Health Information-Seeking Behaviour among People of African Descent in the United Kingdom: A Qualitative Study

Effective public health interventions rely on understanding how individuals access, interpret, and utilise health information. Studying the health information-seeking behaviour (HISB) of a community can provide valuable insights to inform strategies that address community health needs and challenges. This study explored the online HISBs of People of African Descent (PoAD) in the United Kingdom (UK), a demographic that comprises four percent of the UK population and has a 92.8% active Internet usage rate. Data on the HISB were collected from 21 PoAD across various UK regions through online semi-structured interviews before being analysed using reflexive Thematic Analysis (TA). The participants ranged in age from 20 to 70 years and had a mean age of 42.8 (SD ± 11.4). Our analysis of the interview transcripts revealed five key themes: Internet usage and preferences, attitudes toward social media, barriers to seeking health information online, trust in online health information, and cultural influences on online HISB. Our findings indicate a proactive engagement among PoAD in seeking health information online that is underscored by a preference for professional sources over ethnic congruence. However, concerns about misinformation exist, and there are barriers to accessing health information online, including data privacy, unreliable information, and information relevance and overload. We also found that cultural factors and traditional beliefs impact the adoption of Internet-based interventions among PoAD, highlighting the need for culturally sensitive approaches. Preferences regarding the frequency and delivery of online health information varied among participants, with a majority preferring a weekly update. This study emphasises the critical need for accessible, culturally appropriate, secure, and reliable online health resources tailored to the needs and preferences of the PoAD.

Implementation of pharmacist-led services for sexual and gender minorities: A multisite descriptive report

PURPOSE

This paper compares and contrasts the implementation of pharmacist-led services for 3 different sexual and gender minority populations across California, Mississippi, and Florida.

SUMMARY

Implementation of pharmacist-led services tailored to sexual and gender minorities may be a potential mechanism to address health disparities in these populations. Clinical pharmacists have the potential to provide care with cultural humility and improve health outcomes by optimizing medication regimens, reducing adverse drug events, enhancing medication acquisition, and improving medication adherence.

CONCLUSION

The services provided by clinical pharmacists varied across sites and included management of gender-affirming hormone therapy, HIV antiretroviral medication adherence programming, primary care and chronic disease state management, and involvement in care related to mental health, psychiatry, and substance use as well as sexual health. Various legislative and regulatory barriers and differences in scope of practice for pharmacists were also identified. This paper advocates for the expansion of pharmacy-led services and the adoption of a culturally humble approach to patient care.

The Folkloric Practices of Dominican Women in Managing Bacterial Vaginosis

Bacterial vaginosis (BV) is characterized by changes in the vaginal flora caused by an elevated pH, resulting in symptoms of vaginal discharge, odor, and irritation. BV affects all women, including Dominican women who have specific cultural beliefs regarding vaginal health hygiene. Due to the prevalence of this condition and cultural norms that may influence how women respond to the diagnosis of BV, it is important to understand the factors that may promote the development of BV and that may influence women's choices of treatment options. Amsel's criteria are the most commonly used clinical approach for the diagnosis of BV. Recurrent BV is common and affects women's lives to varying degrees. Discussion about cultural norms and hygienic practices may provide information that may decrease the recurrence of BV. Nurses can provide support and evidence-based information in a culturally sensitive manner to help Dominican women manage BV.

Perceived Acceptability of Child Maltreatment as a Moderator of the Association Between Experiences of Child Maltreatment and Post-Traumatic Symptoms: A Cross-Cultural Study

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator.

The Development and Psychometric Testing of the Scale of Cultural Sensitivity of Health Care Professionals in Japan

INTRODUCTION

The development of cultural sensitivity is essential for health care professionals but there are few tools to measure this quality in Japan. The purpose of this study was to develop a scale of cultural sensitivity for Japanese health care professionals and examine its reliability and validity.

METHOD

A draft scale was created through conceptual analysis and a questionnaire was completed by 515 health care professionals and 1,322 college students. Exploratory and confirmatory factor analyses were used to determine suitable scale items and examine model fitness.

RESULTS

The four-factor 18-item scale showed acceptable model fitness. Cronbach's α coefficient exceeded .90 and correlation coefficients for criterion-related validity were over .29. Construct validity was confirmed by the significantly higher score of the cross-culturally experienced groups. The intraclass correlation coefficient was .642 (professionals) and .722 (students).

DISCUSSION

This reliable and valid scale for Japanese health professionals and college students may be used to evaluate training programs to increase their cultural sensitivity.

Cultural Advocacy for Indigenous Individuals With Serious Illness

Indigenous American (I.A.) individuals with serious illness and their families have unmet needs. Often, this group is viewed as a minority within a minority. Numerous health challenges exist within the I.A. populations resulting in dire health care situations. Historical trauma and mistrust of the healthcare system impacts access to quality palliative care by this marginalized population. Given the range of social, spiritual, and cultural issues, the interprofessional team needs increased knowledge specific to the I.A. population to ensure holistic, culturally sensitive care. Utilizing a case study, this article reviews of the needs of I.A. individuals with serious illness and essential skills. The aim is empower palliative care clinicians the knowledge to provide culturally sensitive and congruent care to I.A. individuals with serious illness and their community.

Ramadhan fasting for people living with chronic illness: A narrative literature review

Muslims constitute approximately 20% of the world's population. In South Africa, Muslims constitute just under 2% of the total population. Fasting is one of the mandatory activities of adherents of the Islamic faith, where all healthy adult Muslims abstain from food, drink, and sexual activities between dawn and dusk during the month of Ramadhan. Medical doctors are frequently required to provide advice to their Muslim patients about the safety or other health impacts of this type of fasting. This narrative review provides an overview of research conducted on Muslim populations during the fasting period, with special reference to non-communicable diseases (NCDs) that are prevalent in the Muslim community. In the absence of evidence-based clinical guidelines, this article summarises the latest published research on this topic, providing a resource for clinicians and researchers. This paper provides an evidence summary to clinicians when engaging with their patients who may be engaging in Ramadhan fasting, while also identifying gaps in the body of evidence that could inform future research.

"Expectation is Always that the Practitioner Might Not Be Okay with Queerness": Experiences of LGBTQ+ With the Healthcare System in Saskatchewan, Canada

This project aimed to explore the experiences of perceived mistrust and stigma by the LGBTQ+ members while accessing healthcare services in Saskatchewan, Canada. In partnership with local organization, a community-based participatory research (CBPR) approach was employed and, semi structured descriptive interviews were conducted. Sixteen participants ranging from age 20-60 were recruited and interviewed. Inductive coding method with thematic data analysis was performed, and descriptive comprehensive results were produced. The LGBTQ+ community reported negative experiences within the context of four emerging themes: (a) perceived stigma and discrimination in healthcare settings, (b) practitioners' LGBTQ+-specific healthcare knowledge, (c) the need for LGBTQ+-specific cultural sensitivity and inclusion, and (d) a call for changes in healthcare policy. Each theme and its corresponding experiences serve as a baseline of information to demonstrate the need for improved access to safe healthcare and increased sustainable health for the LGBTQ+ community members. This calls for training and education, establishing cultural sensitivity, and mandating policy changes could improve the experiences of the LGBTQ+ community members.

Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden

BACKGROUND

Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants' sexual and reproductive health (SRH) is rarely studied in Sweden.

OBJECTIVES

To explore young migrants' understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services.

METHODS

This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality.

RESULTS

Young migrants understood SRH as both 'essential' and 'a right.' Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the 'open environment,' however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services' quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality.

CONCLUSION

The access of young migrants to SRH services is facilitated by an 'open environment' and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

Individual characteristics on multicultural team performance: does the role played by leaders and team members matter?

The main purpose of this study was to analyze the impact of individual characteristics of cultural sensitivity, adaptability, cohesion, and cultural diversity on the multicultural team performance. Also, we analyzed the moderating effect of being a team member or a team leader on the relationships mentioned above. To test out hipotheses, data were collected from 415 members of multicultural teams specifically, from 304 team members and 111 leaders. The findings provided evidence to support a positive relationship between cultural sensitivity, adaptability, cohesion, and team performance. Cultural diversity did not show a significant impact on team performance. The study also showed that the leaders and members had different perceptions about the factors that influence team performance. For instance, team members consider that cohesion influences team performance, while leaders consider adaptability as the key factor to achieve performance. Main implications from findings are discussed.

Promoting Inclusive Cancer Care: Beyond Medical Interpreters

Opportunities exist to promote inclusive cancer care and clinical research to reduce disparity and achieve health equity. Through raising awareness of the nuances of the clinical encounter to promote inclusivity as well as reducing barriers to access and enrollment in clinical trials, a more complete understanding regarding the spectrum of disease and opportunity for inclusive cancer care can be achieved.

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis

BACKGROUND

Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks.

AIM

This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme.

METHODS

Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks.

RESULTS

The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad.

CONCLUSION

Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.

Exploration of Cyberethics in Health Professions Education: A Scoping Review

As digital technologies rapidly integrate into Health Professions Education (HPE), understanding cyberethics is increasingly crucial. This scoping review explores the pedagogy of cyberethics in HPE, highlighting a significant gap in explicit definitions and conceptualizations. Additionally, the absence of specific theoretical frameworks in most documents raises concerns about research progression. Only four articles introduce educational interventions in cyberethics, indicating a promising avenue for future research. While comprehensive search methods are employed, limitations, including language biases, exist. Future investigations should broaden the discourse to encompass ethical implications of emerging technologies within HPE. Cultivating comprehensive, culturally sensitive, and inclusive guidelines is vital for ethical digital practices in the health care community.

Culturally sensitive active ageing seen through the lens of the welfare theory of health: assistant nurses' views

Assistant nurses caring for older adults with immigrant backgrounds are on the front lines of a practical, theoretical, and policy battlefield. They need to implement culturally sensitive care provision while not overstating the importance of culture, thereby, contributing to a negative picture of older immigrants as especially problematic. One proposed way to strike such a balance is the welfare theory of health (WTH). In this article, we let assistant nurses apply the WTH to a series of questions in four different vignettes representing the life stories of older persons who characterize typical dilemmas described by the theory. The results show that, through the lens of the WTH, assistant nurses looked for individual care preferences rather than stereotypical ideas about cultural characteristics. Further, the assistant nurses expressed a desire to get to know the persons more deeply to better interpret and understand their individual preferences. Thus, the theoretical framework is useful not only for exposing vulnerabilities to which some older adults with immigrant backgrounds may be exposed, but also for finding ways to mitigate the vulnerability by illuminating vital life goals and using them as a framework to organize care. This approach allows for mitigating the gap between the vital life goals and available resources to achieve a holistic state of health.

Experiences of and recommendations for LGBTQ+-affirming substance use services: A qualitative study with LGBTQ+ people who use opioids and other drugs

Background

Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., non-binary individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this qualitative study was to characterize LGBTQ + people's experiences in SU services and recommendations for LGBTQ+-affirming care.

Methods

We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ + people. We employed a flexible coding approach to describe participants' experiences with stigma, discrimination, and support within SU services; and participant recommendations for how to make such services LGBTQ+-affirming at the patient-, staff-, and organizational-level. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis.

Results

Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ + peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ + patients, holistic treatment models, and openly LGBTQ + staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, routine pronoun sharing, LGBTQ+-specific programming, hiring LGBTQ + staff, routine staff sensitivity training, and gender-inclusive program structures.

Conclusions

LGBTQ + people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Double stigma in mental health service use: Experience from ethnic minorities in Hong Kong

BACKGROUND

Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could help reduce their mental health disparities.

AIMS

This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong.

METHODS

Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use.

RESULTS

Among 31 adults (20 [64.5%] women, 11 [35.5%] men; 17 [54.8%] aged 25-39 years) who participated, most participants self-identified as Indian (13 [41.95]) or Pakistani (10 [32.3]). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools.

CONCLUSION

This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.

Exploring the option of student-run free health clinics to support people living with type 2 diabetes mellitus: a scoping review

Diabetes is a major cause of morbidity and premature mortality worldwide and now identified as a 'public health emergency' and a 'modern and preventable pandemic'. Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. Student run free clinics (SRFCs) may play an important role in the prevention and management of T2DM. The primary objective of this scoping review was to investigate the opportunity for curriculum enhancement through the role and effectiveness of SRFCs in managing T2DM. Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to October 2022. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. The research team collectively created a data charting table/form to standardize data collection. A narrative synthesis was used to summarize the evidence. Six studies (total of 319 participants) that met our eligibility criteria were included in this scoping review. SRFCs can provide high-quality diabetic care, especially for uninsured and economically weaker population. Preliminary evidence further indicate that shared medical appointments and telehealth may facilitate diabetic care especially during times where access to care may be difficult (e.g., COVID lockdown). However, no study included in the review explored or discussed family centred/culturally sensitive interventions. Hence, such interventions should be made part of the curriculum in the future with students in SRFCs exposed to such an approach.

The effect of the communication skills training on the sensitivity and cultural competence of the nurses in the pediatric wards: A quasi-experimental study

BACKGROUND

This study aimed to investigate the effect of the communicative training skills on the sensitivity and cultural competence of the nurses in the pediatric wards.

MATERIALS AND METHODS

The participants included 54 nurses from the pediatric ward of Namazi Hospital affiliated with REDACTED. The sample members entered the study through voluntary registration in the in-service training system.

RESULTS

The results showed that cultural sensitivity score was 44.22±11.78 before the intervention, 48.51±13.34 immediately after the intervention, and 55.55±20.20 one month after the intervention. Cultural sensitivity score significantly increased immediately and one month after communication skills training for nurses compared to before the intervention (P < 0.001). The results also showed that cultural competency score was 51.68±9.43 before the intervention and increased significantly immediately after the communication skills training and one month after the intervention (57.64±10.43 and 62.56±11.53, respectively), showing significant improvement (P < 0.001).

CONCLUSION

The communication skills training promoted the nurses' cultural sensitivity and competence in childcare wards. Therefore, the implementation of the theoretical and practical methods of teaching communication skills is suggested to improve nurses' cultural competence and consequently, improve childcare quality in different cultures.

The relationship between personal and interpersonal mental health experiences and stigma-related outcomes in Hong Kong

BACKGROUND

Previous research indicates that personal mental health experiences (e.g. one's current mental health status) and interpersonal mental health experiences (e.g. one's familiarity with someone with mental illness) are associated with stigma-related outcomes. These outcomes include knowledge, attitudes and desire for social distance from people with mental illness.

AIMS

To explore the extent to which current personal mental health status and familiarity with mental illness predict stigma-related outcomes in Hong Kong.

METHOD

Data were drawn from a larger research project examining mental well-being in Hong Kong citizens. Citizens (N = 1010) aged ≥18 years were surveyed between August and September 2021.

RESULTS

Multiple regression analyses revealed that immediate family and friends showed better attitudinal outcomes and lower desire for social distance compared with people who did not know anyone with mental illness (all β > 1.00, all P < 0.05), whereas people with personal experience of mental illness showed higher prejudicial attitudes compared with people who did not know anyone with mental illness (β = -0.744, P = 0.016). Better current personal mental health predicted lower prejudicial attitudes (β = 0.488, P < 0.001) and mixed outcomes on different realms of mental health knowledge.

CONCLUSIONS

Cultural concerns surrounding 'saving face' and emphasis on collectivistic values may explain the nonlinear relationship between personal and interpersonal mental health experiences and stigma-related outcomes. Future anti-stigma interventions should tailor their approaches to the needs of people with different levels of familiarity with mental illness and include efforts to support the mental health of the overall population.

What African immigrant service providers can teach us about the needs of African immigrant survivors of FGM/C

Health and social service providers who immigrated from regions with high Female Genital Mutilation/Cutting (FGM/C) prevalence rates can provide unique insights on serving women with FGM/C experience. Specifically, we investigated African immigrant service providers' knowledge, experience, attitudes about FGM/C, and their recommendations on how to provide services to immigrants from sub-Saharan Africa who have experienced FGM/C. Derived from a larger study, interviews of 10 African service providers were selectively analyzed with a particular attention to cultural insights that could inform the framework in Western destination countries on how to serve women and girls with FGM/C experience.

Health-seeking, intercultural health communication, and health outcomes: An intersectional study of ethnic minorities' lived experiences

AIMS

To explore ethnic minorities' lived experiences of health-seeking and healthcare utilization in Hong Kong, and to examine the impact of intersectionality of sociocultural identities on intercultural health communication.

DESIGN

Qualitative exploratory design.

METHODS

Data collection methods were semi-structured interviews, unstructured observations, and unstructured informal group discussions. Twenty-five informants, including eight Pakistanis, seven Nepalese, five Indians, four Bangladeshis and one Sri Lankan, were recruited using the snowball sampling method and individually interviewed between 25th June and 23rd September 2019.

RESULTS

Sixteen females and nine males, aged 21-76 years, were in the study. Two-thirds could communicate in English, but eight required interpreters. Thematic analysis reveals four factors affecting intercultural health communication: healthcare professionals' cultural insensitivity, red-tapism and ethnic minorities' language improficiency and/or deficiency in medical knowledge. Health professionals' workplace stress and cultural insensitivity prompt ineffective intercultural communication, making ethnic minority patients feel disrespected despite having adopted the Hong Kong culture. The intersectionality of sociocultural identities plus health professionals' blocking behaviours results in health inequalities.

CONCLUSION

The unequal power relationship between health professionals and ethnic minority patients may lead to dehumanizing and depersonalized experiences for patients, as humanity is the heart and soul of medicine. Therefore, the government should raise healthcare providers' cultural sensitivity and diversity awareness, and offer ethno-specific care and more interpretation services.

IMPACT

The study addresses health inequalities among Hong Kong ethnic minority patients with different sociocultural identities. About the impact of ineffective intercultural health communication on health inclusion and health outcomes, policies and practices should ameliorate health professionals' cultural sensitivity, awareness of the unequal power relationship and respect for diversity.

PATIENT OR PUBLIC CONTRIBUTION

Referred by organizations serving ethnic minorities, the minority patients shared their lived experiences in health-seeking.

Cultural Sensitivity in Interventions Aiming to Reduce or Prevent Intimate Partner Violence During Pregnancy: A Scoping Review

Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem. Ethnic minorities and immigrant pregnant women experiencing IPV require culturally responsive health services. The aim of this scoping review was to identify aspects of cultural sensitivity in interventions to prevent or reduce IPV among ethnic minorities and immigrant pregnant women in high-income countries. Eight databases were searched in November 2019. Any type of scientific research, quantitative, qualitative, or mixed methods studies regarding interventions against IPV among pregnant women were considered for inclusion. Resnicow et al.'s definition of cultural sensitivity was used to identify aspects of cultural sensitivity. Ten papers relating to nine interventions/studies met our inclusion criteria. These studies, which included randomized controlled trials, a mixed methods study, a program evaluation, and a longitudinal study, were conducted in Australia, Belgium, Norway, and the United States. Aspects of surface cultural sensitivity, including the translation of intervention content into the language of the target group(s) and the involvement of bilingual staff to recruit participants, were identified in eight studies. Deep structure aspects of cultural sensitivity were identified in one study, where the intervention content was pretested among the target group(s). Results that could be related to the culture-sensitive adaptions included successful recruitment of the target population. Three studies were planning to investigate women's experiences of interventions, but no publications were yet available. This scoping review provides evidence that culturally sensitive interventions to reduce or prevent IPV among immigrant pregnant women are limited in number and detail.

Understanding the experiences and needs in autism education: A semi-structured interview among Chinese American parents of autistic children

Background and Aims

The diversity of the autistic population seeking professional services and education in the United States has increased. As the diagnosis of autism increases among the Chinese American immigrant population, there is also an increasing need to learn about this population and provide appropriate intervention and education for this group. However, current education and intervention provided for autistic individuals tend to be culturally blind. Gaps were found in our understanding of the cultural context and its relationship with the education mechanisms among Chinese American autistic families. The current study intends to investigate how Chinese American parents perceive the education materials and intervention strategies received by their autistic children as well as their experiences and needs in the education process.

Method

Semi-structured interviews were conducted among 10 Chinese American parents (one father and nine mothers) online. They all had children who had a formal diagnosis of autism spectrum disorder and received some intervention or education. Thematic analysis was used to analyse the results.

Results

The study suggested that most Chinese American parents were satisfied with the current education materials and intervention strategies provided to their autistic children. Due to cultural-related stigma, parents differ in their perceptions of children's autism diagnosis and characteristics as well as their expectations of children's culturally sensitive education. A theoretical model was created to provide culture-centered interpretation of the interconnected relationship between their pre- and post-immigration contexts and parenting attitudes.

Conclusions

Culture plays a critical role in understanding Chinese American parents' experiences, needs, and expectations of culturally sensitive education for their autistic children. Interconnected relationships were found between contexts and parenting attitudes, which were largely influenced by cultural-related stigma.

Implications

Suggestions and implications were provided for institutions and professionals working with Chinese American families and children. It is critical for them to learn about the experiences, needs, and attitudes of Chinese American parents to provide Chinese American autistic children with more appropriate and culturally sensitive education.

Promoting weight-loss maintenance among Black women primary care patients: A cluster RCT of a culturally sensitive versus standard behavioural approach

The prevalence of obesity is higher among Black women (56.6%) compared to Hispanic women (50%) and non-Hispanic White women (42%). Notably, interventions to reduce obesity typically result in initial weight loss that is not maintained. This study tested (a) the effectiveness of a 6-month Health-Smart Weight Loss (HSWL) Program for Black women patients with obesity implemented by community health workers (CHWs) within primary care clinics and (b) the comparative effectiveness of two 12-month physician-implemented weight loss maintenance programs-a Patient-Centred Culturally Sensitive Weight Loss Maintenance Program (PCCS-WLM Program) and a Standard Behavioural Weight Loss Maintenance Program (SB-WLM Program). Black women patients (N = 683) with obesity from 20 community primary care clinics participated in the HSWL Program and were then randomized to either maintenance program. The HSWL Program led to significant weight loss (i.e., 2.7 pounds, 1.22 kg, p < .01, -1.1%) among the participants. Participants in both the PCCS-WLM Program and the SB-WLM Program maintained their weight loss; however, at month 18, participants in the PCCS-WLM Program had a significantly lower weight than those in the SB-WLM (i.e., 231.9 vs. 239.4 pounds or 105.19 vs. 108.59 kg). This study suggests that (a) the HSWL Program can produce significant weight loss among Black women patients with obesity when implemented in primary care clinics by CHWs, and (b) primary care physicians can be trained to successfully promote weight loss maintenance among their Black women patients.

Norwegian nursing students' experience during clinical placement in an African country: Communication, relationship building and nursing identity. A qualitative study

AIM

The aim of this study was to gain a deeper understanding of the experience of Norwegian bachelor nursing students during clinical placement in an African country, with a focus on communication, relationship building and nurse identity.

DESIGN

Explorative, qualitative methods were used.

METHODS

The data consisted of individual written reflection notes from 8 students' clinical placement in Africa, and transcripts from one semi-structured focus group interview. The materials were analysed with systematic text condensation.

RESULTS

The students described their experience with the community of practice as challenging and enlightening. They found themselves in contexts where communication and language problems occurred. The students described how important relationships were for their practical training, and how this helped shape their nursing identity.

The relationship between sexual myths and intercultural sensitivity in university students

PURPOSE

In the study, it was aimed to investigate the relationship between sexual myths and intercultural sensitivity in university students.

METHOD

The study designed as cross-sectional research was carried out with the participation of 1,061 university students. Data collection tools used were the Personal Information Form, Sexual Myths Scale, and Intercultural Sensitivity Scale.

FINDINGS

It was determined that the students believed in myths at a moderate level. The students who thought that being together with different cultures did not have a positive contribution were found to believe in sexual myths at a higher level (p < 0.001). It was also determined that intercultural sensitivity was a significant predictor of sexual myths in university students (p < 0.001).

IMPLICATIONS FOR PRACTICE

While planning sexual education provided to relay sexual knowledge to societies accurately, cultural differences should be considered.

A Moderation Analysis of Perfectionism, Cultural Sensitivity, and Counselors-In-Training Attitudes Toward Non-Dominant Sexual Identities

The purpose of this study was to explore the moderating effect of maladaptive perfectionism on the relationship between cultural sensitivity and counselors-in-training attitudes toward non-dominant sexual identities. A total of 209 counseling graduate students participated in the study. Results showed that cultural sensitivity predicted attitudes toward individuals who identify with a non-dominant sexual identity after controlling for age. Also, a regression analysis demonstrated that maladaptive perfectionism is a moderator in the relationship between cultural sensitivity and attitudes toward individuals who identify with a non-dominant sexual identity among counselors-in-trainings. Implications in the counseling and education field and suggestions for future research are discussed.

Optimization of eHealth interventions for intimate partner violence and abuse: A qualitative study amongst Arabic-speaking migrant women

AIMS

This interview study focuses on the needs and wishes of Arabic-speaking migrant women in the Netherlands to culturally adapt and optimize the digital support platform SAFE (safewomen.nl) for intimate partner violence and abuse (IPVA) for their use.

DESIGN

This is a qualitative interview-based study.

METHODS

We conducted the study between March 2020 and 2021. The study entailed 16 semi-structured interviews with Arabic-speaking women in the Netherlands with a migration background.

RESULTS

Findings suggest that a cultural gap, a lack of knowledge of the Dutch law, and the prevalence of restrictive gender roles amongst the participants and their spouses affected their acknowledgement of the different forms of IPVA. Furthermore, mental health consequences of IPVA were also strongly stigmatized. Clear information in their native language, summarizing infographics and potential interactive features should be main components of any eHealth intervention for this target group.

CONCLUSION

The participants in our study deemed e-help a potentially valuable support option for women experiencing IPVA in their community. The impact of IPVA on mental health is currently overlooked within this target group and should be emphasized in future interventions.

IMPACT

Cultural sensitivity proved crucial in understanding the concepts of IPVA amongst women with migrant backgrounds. To ensure effective eHealth interventions for migrant women, they should be involved in the design and delivery of these interventions.

Cultural Sensitivity and Ethical Considerations

Global surgery is a burgeoning area of global health. Surgeons can engage in one-or many-of the facets of global healthcare delivery: clinical care, capacity building, education, research, etc. Working in an increasingly global community, surgeons must be aware of the richness of cultural diversity at home and around the world such that they can provide culturally sensitive care. This chapter focuses on the most common way in which surgeons engage in global surgery: surgical short-term experiences in global health (STEGHs). Surgical STEGHs pose an intricate set of ethical dilemmas. As team leaders, surgeons must understand the community they intend to serve on these trips. Further, they should confirm that everyone who joins them is prepared to deliver care in a culturally sensitive and competent manner. Finally, surgeons must consider potential ethical dilemmas that may arise before, during, and after surgical STEGHs and have strategies to navigate them.

Applying an authentic partnership approach to facilitate optimal health of Aboriginal children

The aim of this development paper is to inform the ongoing implementation of the partnership approach with Aboriginal families in Australia. As almost all Community Health Nurses employed by the Health Department of Western Australia, Country Health Service are non-Aboriginal, there are a number of factors that may, potentially, limit their capacity to work effectively with the primary caregivers of Aboriginal children.

Historically, much that has been written about the health and development of Aboriginal people in Australia has been negative and derogatory with wide criticism for their non-participation with health services and healthy lifestyle activities. Not only has this “deficit discourse” approach proved to be unhelpful in terms of improving the health and well-being of Aboriginal people but also there is mounting evidence that it has been detrimental to mental and physical health and capacity to achieve autonomy in all aspects of life.

In response to the voices of Aboriginal people, the partnership approach to care has been promoted for use by Community Health Nurses in Western Australia. However, the implementation of the approach is not always genuinely strength based, and it does not always focus on mutual goal setting within authentic partnership relationships. The partnership approach has the potential to improve the lives of Aboriginal people if it is implemented with appropriate cultural sensitivity, shared responsibility, dignity and respect.

Community Conversations About COVID-19

"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.

Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review

BACKGROUND

Moral distress is a phenomenon that all nurses experience at different levels and contexts. The level of moral distress can be affected by individual values and the local culture. The sources of the values shape the level of moral distress experienced and the nurses' decisions.

AIM

The present scoping review was conducted to examine the situations that cause moral distress in ICU nurses in different countries.

RESULTS

A scoping review methodology was adopted for the study, in line with the approach of Arksey, and O'Malley Literature was searched within PubMed/Medline, Scopus, Web of Science, and PsycINFO indexed keywords such as "moral distress", "Critical Care Nurse", and "Moral Distress Scale-Revised". Of the 617 identified citations, 12 articles matched the inclusion criteria.

CONCLUSION

The moral distress experienced in countries and regions with similar cultures and geographies was parallel. The situations that cause the most moral distress are futile-care to prolong death, unnecessary tests and treatments, and working with incompetent healthcare personnel.

Cultural Sensitivity in Preventive Infant Mental Health Care: An Example From the Developmental Guidance Project FIRST STEPS in Belgium

Preventive developmental guidance programmes have been applied on a large scale for several decades now in many western countries. But how do we adapt these programs to families with very different ethnic backgrounds? How can we concretise the concept of cultural sensitivity into that context? The plea of von Klitzing, the former President of the World Association for Infant Mental Health, for further reflection on the concretization of cultural sensitivity in the context of infant mental health care is the main source of inspiration to this article. von Klitzing speaks out against the point of view in which universal children’s rights or conditions that are seen as promoting a child’s development all around the globe, are criticized as being only western conceptions and thereby culturally biassed. Following this kind of reasoning, a culturally relativistic stance on what a facilitating environment is, should be adopted. Such a discussion in terms of universalism versus relativism, though, as argues von Klitzing, is an old antagonism that cannot inspire us for the adaptation of early health care practices or developmental guidance programs that are fitting in to the needs of families and their babies that are living in multicultural contexts. Although it could be interesting to think about how certain universal principles of good-enough child care can be formulated or embodied in an intercultural variety of ways, these variable expressions of the worldwide agreed upon principles of good early mental health care will only be culture-specific translations of these universal principles. They can’t in any way be seen as an argument against the universality of these principles, as argues von Klitzing, who is describing another way of solving the problem of the cultural relativist criticism on the universality of principles of good infant mental health: culture sensitive infant mental health services. But, to make the principle of cultural sensitivity work in practice, we need to fill it with content. This article is mainly on what it concretely means to work in a culture sensitive way in our preventive practice within the FIRST STEPS program, a Belgian project for immigrant and exiled mothers and their children from zero to three.

The effects of nursing students' conscientious intelligence on their cultural sensitivity levels

PURPOSE

This study was carried out to determine the relationship between the level of conscientious intelligence and cultural sensitivity among nursing students.

METHODS

This is a cross-sectional descriptive design. The sample of this study consisted of 172 nursing students. The study data were collected using a sociodemographic data form, the intercultural sensitivity scale, and the conscientious intelligence scale.

RESULTS

The mean intercultural sensitivity scale score was 80.07 ± 10.68, and the mean conscientious intelligence scale score was 120.89 ± 12.32. Also, a positive relationship was determined between both scales that the nursing students obtained.

PRACTICE IMPLICATIONS

The scale scores of nursing students were found to be a moderate level. As students' conscientious intelligence levels increased, their intercultural sensitivity was determined to increase, as well.

A Systematic Review of Assessment Tools Measuring Cultural Competence Outcomes Relevant to Pharmacy Education

Objective. To identify and describe validated assessment tools that measure cultural competence and are relevant to pharmacy education.Methods. A systematic approach was used to identify quantitative cultural competence assessment tools relevant to pharmacy education. A systematic search of the literature was conducted using the OVID and EBSCO databases and a manual search of journals deemed likely to include tools relevant to pharmacy education. To be eligible for the review, the tools had to be developed using a study sample from the United States, have at least one peer-reviewed validated publication, be applicable to the pharmacy profession, and be published since 2010.Results. The systematic literature and manual search identified 27 tools. Twelve assessment tools met the criteria to be included in the summary and their relevancy to pharmacy education is discussed.Conclusion. A review of literature demonstrates that assessment tools vary widely and there is no one tool that can effectively assess all aspects of cultural competence in pharmacy students or the Doctor of Pharmacy curriculum. As cultural competence is a priority within the accreditation standards for pharmacy education, PharmD programs are encouraged to develop additional tools that measure observed performance.

Survey of Japanese Medical Schools on Involvement of English-speaking Simulated Patients to Improve Students' Patient Communication Skills

PHENOMENON

With increasing mobility of people across borders and medical tourism, more countries are called to make their healthcare environment ready to accept foreign patients. Patient communication skills in English are indispensable for healthcare professionals in non-English-speaking countries. This is not only in caring for foreign patients within the country but also contributing to the global health by practicing outside of the country. Although Japanese-speaking simulated patients have been involved in medical education in Japan since the 1970s and with Objective Structured Clinical Examinations formally implemented in 2005, very few medical schools have been working with English-speaking simulated patients (ESSPs).

APPROACH

A nationwide survey was conducted to investigate the involvement of ESSPs at medical schools in Japan. A questionnaire with closed and open-ended questions was mailed to the deans of 80 medical schools to determine the current ESSP involvement and the problems educators were facing in regard to working with or not working with ESSPs. The survey was conducted from November 2015 through March 2016. Data were analyzed to find problems regarding ESSPs so that their involvement could be enhanced toward developing medical students' patient communication skills.

FINDINGS

Responses from 60 medical schools (75% response rate) were received and analyzed. Among them, 22 schools were working with ESSPs, and 23 schools were willing to introduce them into their programs. The background of ESSPs varied with international students or faculty often filling the role. Many ESSPs received less than two hours of training. ESSP programs were required in the preclinical years, and more often elective in the clinical years. Medical schools mentioned the difficulty of recruiting and training ESSPs and finding the funding to pay for their remuneration and travel expenses.

INSIGHTS

ESSPs were increasingly used in Japanese medical schools but they were haphazardly recruited from within the school or from the local community, not trained fully, and inconsistent performers. Nevertheless, an encounter with a non-Japanese English-speaking simulated patient was regarded effective in developing medical students' patient communication skills in English (language skills and cultural sensitivity). Ways must be found to assure the availability, quality, and sustainability of trained ESSPs so that more authentic practices and high-stakes skills exams can be introduced to ensure patient safety in the globalized world. As countries become more multicultural and international migration of healthcare professionals expands, ESSPs can be a valuable source for training and assessing international medical students and trainees' English-language patient interviewing skills. Regional hubs of ESSPs and the use of telehealth in collaboration with educators around the world could enhance the use of ESSPs worldwide.

Strategies for Providing Culturally Sensitive Care to Diverse Populations

ABSTRACT

Nurses are called to care for patients and families from many backgrounds and cultural groups. This article discusses the key strategies of cultural humility, conscientious practice, and establishing trust that promotes cultural sensitivity as well as congruence with Christian values. When implemented, these strategies can facilitate the provision of quality, culturally sensitive patient care that conforms to a biblical worldview.

Development of a culturally adaptable internet-based cognitive behavioral therapy for Japanese women with bulimia nervosa

BACKGROUND

The process of cultural adaptation of internet-based cognitive behavioral therapy (ICBT) programs for bulimia nervosa (BN) have rarely been reported despite the potential influence of cultural adaptation of psychosocial interventions on therapeutic response.

AIM

This study aimed to illustrate development process of an ICBT program for Japanese women with bulimia nervosa (BN).

METHODS

A mixed methods approach was used to assess cultural adaptation of the prototype of an original ICBT program by using the Cultural Relevance Questionnaire (CRQ). Five women with BN and seven clinicians were interviewed using the CRQ.

RESULTS

Quantitative analyses were conducted to assess cultural adaptation of the prototype of the program and participants rated cultural adaptation as high. A qualitative analysis of the mixed method supported the culturally sensitive changes implemented.

CONCLUSIONS

The results of this study show that a series of processes can make ICBT programs more culturally adapted.

A Scoping Review

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.

Objective

To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.

Design

The Campinha-Bacote model of cultural competence was used as the primary reference.

Method

A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.

Results

Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.

Conclusions

Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

Southeast and East Asian immigrant women's transnational postpartum experiences: A meta-ethnography

The increase in births to Southeast and East Asian (SEEA) immigrants in their adopted countries is of international importance. SEEA women experience the postpartum period differently than that of the general population. Despite the documented difference, there is limited representation of SEEA women in the literature. The purpose of this meta-ethnography is to synthesise the qualitative findings from different research studies examining the experiences of SEEA immigrant women during the first 4-6 weeks of the postpartum period and has been written in adherence with enhancing transparency in reporting the synthesis of qualitative research (PRISMA). Noblit and Hare's meta-ethnographic approach was used. Seven articles (four qualitative and three mixed-methods studies) were reviewed, analysed and synthesised. Four themes emerged: two were facilitators of birth culture (availability and quality of social support and maternity care provider cultural knowledge and response) and two were barriers to birth culture (lack of structural and social support and cultural alienation after childbirth). Due to lack of structural and social support in SEEA immigrant women's adopted countries, they also experienced social and economic hardships after childbirth and made conscious decisions to modify their postpartum cultural practices out of convenience and practicality. SEEA immigrant women also experienced discrimination from maternity care providers, which prevented them from fully engaging in postpartum cultural practices. Maternity care providers can advocate and intervene for SEEA immigrant women by eliciting any postpartum cultural beliefs, assess their social and economic needs early on in prenatal care and make culturally congruent referrals based on those assessments.

Tonsil Riots and Vaccine Hesitancy: A 100-Year Legacy of Medical Mistrust

The "tonsil riots" of 1906 were panics that developed at several public schools in historically immigrant-dominated neighborhoods of New York City (NYC). Per archived newspaper articles, several NYC public schools asked for parental consent to have Board of Health physicians come and perform tonsillectomy and adenoidectomy on their students. When children subsequently returned home from school "drooling mouthfuls of blood and barely able to speak," mothers reacted with panic and flocked to the schools demanding the safe return of their children. Police, ultimately, had to be called in to manage the crowds, and the events of 1906 largely faded from the public eye. However, these events can offer important lessons in communication and cultural humility as the United States continues its mass vaccination against coronavirus disease 2019.

An Opportunity to Integrate Cultural Sensitivity Training Into the Doctor of Pharmacy Curriculum

Instructors of pharmacy skills-based laboratory courses are positioned to prepare students to be practice-ready practitioners through use of hands-on instructional activities essential for pharmacists. This commentary explores an approach to developing cultural sensitivity in pharmacy students, a skill which is reflected in Accreditation Council for Pharmacy Education (ACPE) Standard 3.5 and viewed by the authors as a critical skill for all healthcare practitioners. This commentary challenges the Academy to develop best practices for promoting cultural sensitivity in student-learners with the goal of producing students aware of how their own experiences may influence health inequities. The authors propose, using the model of self-efficacy theory as a framework, that skills-based pharmacy education is an ideal platform for cultural sensitivity skill development and engagement because of its ability to go beyond knowledge attainment and influence student abilities, behaviors, and attitudes. The authors' recommendations include that members of the Academy self-assess personal and institutional cultural sensitivity, ensure integration of cultural sensitivity in curriculum, use self-efficacy theory as a guide to integrate best practices for providing culturally sensitive care in laboratory activities, and develop best practices.

Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study

OBJECTIVE

The increasing ethnic diversity in the European Union (EU) calls for adaptations to neuropsychological assessment practices. The aims of this study were to examine the current state of cross-cultural neuropsychological assessment in EU-15 countries and to provide recommendations for researchers and policy makers.

METHOD

Twelve experts from nine EU-15 countries participated in a Delphi consensus study involving two sequential rounds of web-based questionnaires and an in-person consensus meeting. The experts individually rated Delphi topics on the basis of importance (scale 1-10). The degree of consensus was determined by assessing first and third quartiles (Q1 and Q3) and medians.

RESULTS

Consensus outcomes showed the following priorities: (a) the development of tests (median importance rating 10, Q1-Q3: 9-10), (b) the collection of normative data (median importance rating 9, Q1-Q3: 8-10), and (c) more training, awareness, and knowledge regarding cross-cultural assessment among neuropsychologists in the EU (median importance rating 9, Q1-Q3: 8-10). Whereas memory tests were often available, tests measuring social cognition (median 9, Q1-Q3: 8-10) and language (median 9, Q1-Q3: 7-10) are particularly lacking. Recommendations were made regarding essential skills and knowledge necessary for cross-cultural neuropsychological assessment.

CONCLUSIONS

This study in a small group of experts suggests that the development and availability of cross-cultural tests and normative data should be prioritized, as well as the development and implementation of training initiatives. Furthermore, EU guidelines could be established for working with interpreters during neuropsychological assessment. Before implementing these recommendations, follow-up studies are recommended that include more minority neuropsychologists and community stakeholders.

Cultivating Student Belonging and School Connectedness

The effect on students from the COVID-19 pandemic, violence related to racism, and loss of customary school routines may cause loss of both school connection and a sense of belonging. School nurses can positively influence student belonging and school connection as they encounter students throughout in-person school and virtual school environments. School nurses build connections with students whom they know and outreach to students whom they identify as vulnerable in the areas of belonging and school connectedness. With a mind-set of the Framework for 21st Century School Nursing Practice and in collaboration with a school team implementing a multitiered system of support, school nurses intentionally outreach and cultural sensitivity to grow positive school climate that benefits students.

The Stroman Effect: Participants in MEN Count, an HIV/STI Reduction Intervention for Unemployed and Unstably Housed Black Heterosexual Men, Define Its Most Successful Elements

Interventionists often prioritize quantitative evaluation criteria such as design (e.g., randomized controlled trials), delivery fidelity, and outcome effects to assess the success of an intervention. Albeit important, criteria such as these obscure other key metrics of success such as the role of the interactions between participants and intervention deliverers, or contextual factors that shape an intervention’s activities and outcomes. In line with advocacy to expand evaluation criteria for health interventions, we designed this qualitative study to examine how a subsample of Black men in MEN Count, an HIV/STI risk reduction and healthy relationship intervention with employment and housing stability case management for Black men in Washington, DC, defined the intervention’s success. We also examined the contextual factors that shaped participation in the study’s peer counseling sessions. We conducted structured interviews with 38 Black men, ages 18 to 60 years (M = 31.1, SD = 9.33) who completed at least one of three peer counseling sessions. Analyses highlighted three key themes: (a) the favorable impact of Mr. Stroman, the lead peer counselor, on participants’ willingness to participate in MEN Count and disclose their challenges—we dubbed this the “Stroman Effect”; (b) the importance of Black men intervention deliverers with relatable life experiences; and (c) how contextual factors such as the HIV/AIDS epidemic, needs for housing and employment services and safe spaces to talk about challenges, and absentee fathers shaped participation. We discuss the study’s implications for sustainable programs after funding ends and future multilevel health interventions to promote health equity for poor urban Black men.

Cross-Cultural Bayesian Network Analysis of Factors Affecting Residents' Concerns About the Spread of an Infectious Disease Caused by Tourism

COVID-19 has had a severe impact globally, and the recovery can be characterized as a tug of war between fast economic recovery and firm control of further virus-spread. To be prepared for future pandemics, public health policy makers should put effort into fully understanding any complex psychological tensions that inherently arise between opposing human factors such as free enjoyment versus self-restriction. As the COVID-19 crisis is an unusual and complex problem, combinations of diverse factors such as health risk perception, knowledge, norms and beliefs, attitudes and behaviors are closely associated with individuals' intention to enjoy the experience economy but also their concerns that the experience economy will trigger further spread of the infectious diseases. Our aim is to try identifying what factors are associated with their concerns about the spread of the infectious disease caused by the local experience economy. Hence, we have chosen a "data-driven" explanatory approach, "Probabilistic Structural Equational Modeling," based on the principle of Bayesian networks to analyze data collected from the following four countries with indicated sample sizes: Denmark (1,005), Italy (1,005), China (1,013), and Japan (1,091). Our findings highlight the importance of understanding the contextual differences in relations between the target variable and factors such as personal value priority and knowledge. These factors affect the target variable differently depending on the local severity-level of the infections. Relations between pleasure-seeking via the experience economy and individuals' anxiety-level about an infectious hotspot seem to differ between East Asians and Europeans who are known to prioritize so-called interpersonal- and independent self-schemes, respectively. Our study also indicates the heterogeneity in the populations, i.e., these relations differ within the respective populations. Another finding shows that the Japanese population is particularly concerned about their local community potentially becoming an infectious hotspot and hence expecting others to comply with their particular social norms. Summarizing, the obtained insights imply the importance of considering both cultural- and individual contexts when policy makers are going to develop measures to address pandemic dilemmas such as maintaining public health awareness and accelerating the recovery of the local experience economy.

Cultural competency and sensitivity in the curriculum for palliative care professionals: a survey in Switzerland

BACKGROUND

Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals' interests in cross-cultural training.

METHODS

A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities.

RESULTS

A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients' linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one's own stereotypes.

CONCLUSIONS

Palliative care professionals' post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.

An evaluation of dietary intakes of a selected group of South Asian migrant women with gestational diabetes mellitus

Background: Women of South Asian descent have an increased risk of developing gestational diabetes mellitus (GDM), and type 2 diabetes mellitus compared to Caucasian women. Dietary advice provided by health practitioners to this group has been found to be culturally inappropriate. The aim of this study was to describe the dietary intakes of South Asian women with gestational diabetes and use this information to develop culturally appropriate dietary models for education and support of dietary management.Method: An in-depth diet and lifestyle survey was administered with 13 eligible women. Dietary histories were collected for pre-pregnancy, during pregnancy and post-GDM diagnosis to evaluate changes in dietary intake, diet and health beliefs and traditional foods consumed during pregnancy.Results: The diets of participants did not meet nutrient requirements for pregnancy; specific areas on concern were dietary fibre, calcium, iron, folate and iodine. Vegetarians were particularly at risk with regards to energy and protein intake. Generally dietary intakes of these women with GDM were not consistent with guidelines for management of GDM. Confusion about what they should eat for GDM, health practitioner advice and conflict with cultural expectations about foods to consume during pregnancy was evident.Conclusion: The dietary information collected from these women was used to model sample menus for GDM that were culturally appropriate and consistent with vegetarian and non-vegetarian eating patterns.

Forming an Affiliation Between Two Culturally Different Academic Institutions of Nursing Studies

Introduction

This article describes the association of two culturally different institutions opening a joint Bachelor of Science in Nursing (BSN) program for ultra-Orthodox Jewish (Haredi) women in order to enable them to find jobs due to changes in their society and increasing global demand for nurses in the labor market. The objective of this description is to illustrate the efforts and changes needed to facilitate the affiliation of two culturally and ideologically different organizations and the implications and conclusions of such a program.

Methods

The study is based on interviews with past administrators, a review of the literature, and supporting institution documents.

Conclusions

A joint nursing academic program was founded by two culturally different educational institutions for the ultra-Orthodox Jewish women population. Creating a culturally sensitive nursing academic program helped ultra-Orthodox women acquire an academic profession which enabled their integration into the academic professional's work world and add more nurses to the labor market.The authors reviewed the efforts and changes needed to facilitate the affiliation of two culturally and ideologically different organizations based on the Bolman and Deal four frames model.