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PubMed2004

Diversity, cultural sensitivity, unequal treatment, and sexual harassment in a school of dental hygiene.

PURPOSE: The purpose of this study was to assess the cultural environment in the School of Dental Hygiene at the University of Texas Dental Branch (UTDB) at Houston. METHODS: A 36-item questionnaire was developed and administered to first- (DH1; n=34) and second-year (DH2, n=33) dental hygiene students. Questions explored satisfaction with diversity and interactions with faculty, staff, patients, and other students relative to gender, ethnicity/race, age, and sexual orientation. Data were analyzed using 2x3 and 2x5 contingency tables to calculate the chi square test statistic. RESULTS: Ninety-one percent of the 67 DH students responded. While the majority of students reported satisfaction with the cultural diversity and their interactions at UTDB at Houston, 76% of the DH2 students and 62% of the DH1 students reported that the curriculum did not prepare them to work with patients whose primary language is not English. Eighty-two percent of DH1 students and 59% of DH2 students reported that the curriculum did not prepare them to work with patients with different sexual orientations and religious backgrounds. The DH2 students reported unequal treatment by faculty of another gender (24%) and ethnicity (21%), and sexual harassment by other students (6%). DH1 reported 6%, 12%, and 0%, respectively. CONCLUSION: Data indicate that dental hygiene students in the UTDB at Houston dental hygiene program experienced unequal treatment and sexual harassment by either faculty, staff, patients, or other students. To create a more culturally sensitive environment, the students, faculty, and staff could benefit from training on diversity, cross-cultural competence and awareness, and sexual harassment prevention and management. The dental hygiene curriculum should be reviewed for the inclusion of topics related to diversity, cultural competence, and sexual harassment.

Cultural Diversity↗

PubMed2000

Language as a constitutive: critical thinking for multicultural education and practice in the 21st century.

Postmodern understandings of language can function as revolutionary critical thinking tools and enable multicultural education in a way yet to be resolutely embraced by the discipline. This thesis is illustrated with critical thinking examples relevant to topics in nursing education, such as maternal infant attachment, HIV prevention education, standardized instruments measuring quality of life and self-esteem, domain of person, and adolescent male identity formation. Working through postmodern positions on language produces important questions. It offers nursing provocative ways of thinking about education and provides radically different approaches to critical thinking and cultural competence. Capitalizing on postmodern sensibilities about language to create multicultural education and practice will take persistent self-reflective educational practices that question the ground that nursing stands on, as well as good intentions regarding a deep and broad embrace of complexly understood cultural competence.

Attitude to Health↗

PubMed2002

Ethnocentrism in a pluralistic society: a concept analysis.

Development of culturally competent nursing care requires an examination of ethnocentric values and behaviors. Ethnocentric practices, as shown in the literature, have resulted in adverse patient care outcomes. Although it is recognized that awareness of personal values is the key to developing cultural competence, ethnocentrism is woven into the fabric of one's own cultural makeup. Ethnocentrism is not clearly defined in the nursing literature and use of the term is vague and ambiguous. This article utilizes the Walker and Avant method of concept analysis to clarify the meaning of ethnocentrism resulting in a new definition.

Attitude of Health Personnel↗

PubMed2002

Native Hawaiian traditional healing: culturally based interventions for social work practice.

Developing cultural competence is a key requirement for social workers in the multicultural environment of the 21st century. However, the development of social work interventions that are syntonic with specific cultural groups is a great challenge. Interventions that are based on the traditional healing practices of a particular culture ensure cultural relevance and consistency with its values and worldview. This article discusses the importance of culturally based interventions within a cultural competence framework and offers examples of such interventions used with Native Hawaiians. Two interventions are discussed, targeted to the micro (direct practice) level and macro (community practice) level of practice. Culturally based social work interventions may be most appropriate for client systems within a particular culture; however, some methods, such as ho'oponopono, have been successfully used with clients from other cultures as well.

Attitude to Health↗

PubMedDate not supplied

Upholding the principles of primary care in preceptors' practices.

BACKGROUND AND OBJECTIVES: Family medicine preceptorships are crucial to educating future physicians, but there is a lack of research on how well preceptors are following the principles of primary care. This study used the Primary Care Assessment Tool (PCAT)-Provider Edition to determine how well medical preceptors provide quality medical care. METHODS: A total of 134 family medicine preceptors in the Maritime provinces of Canada answered questions about their practice behaviors, along with background information about themselves, their practice, and their practice population. RESULTS: The highest scores were for "coordination: integration of care," and the lowest were for "cultural competence." PCAT scores improved with the number of patients seen weekly. Scores for first contact accessibility were higher for females and for those with 11-20 years experience as a preceptor, who saw more patients weekly, and in urban centers. "Longitudinality: relationship" scores were higher among those with at least 11 years of practice experience and who saw more patients weekly. "Community orientation" scores were higher for preceptors who saw more patients weekly and accepted new patients. "Cultural competence" scores were higher for preceptors with a culturally diverse practice population and who accepted new patients. "Coordination: integration of care" scores were higher among rural practices. "Coordination: medical records continuity" scores were higher in practices with less than 5 years' experience. CONCLUSIONS: Maritime preceptors report providing quality primary care, and the PCAT can be used to benchmark the quality of primary care provided by preceptors.

Adult↗

PubMedDate not supplied

International and cross-cultural issues: six key challenges for our professions.

This paper discusses a number of key challenges facing professionals who work with people who have communication disabilities. The challenges are related to working internationally and in a cross-culturally competent way. Each challenge is discussed, drawing on material from a range of sources, including the papers in the final 2003 edition of FOLIA PHONIATRICA ET LOGOPAEDICA ('International and Cross-Cultural Issues'). The challenges discussed cover how experiences from majority world countries can be used to benefit services elsewhere, 'mainstreaming' commitment to cross-cultural competence, learning from relationships with other professionals, influencing research practice, responding to requests to work internationally and finally, dealing with cultural differences that challenge working practices. Some solutions are suggested and additional questions posed.

Communication Disorders↗

PubMedDate not supplied

Recruitment and retention of rural African Americans in diabetes research: lessons learned.

PURPOSE: The purpose of this article was to describe lessons learned about recruitment and retention of rural African Americans from published literature, the authors' research, and research experience. Two rural, community-based research studies with African Americans with diabetes are used to illustrate different issues and strategies in recruitment and retention. METHODS: Relevant MEDLINE articles and clinical studies were reviewed, and the design, implementation, and results of the 2 community-based studies were evaluated. Information from the literature, research results, and sample selection, participation, and attrition experiences were synthesized to determine effective approaches for recruitment and retention. RESULTS: Research funding, design, and implementation; recruitment methods; culturally competent approaches; caring, trusting provider-patient relationships; incentives; follow-up; and factors in the rural environment emerged as important issues influencing recruitment and retention. CONCLUSION: Recruitment and retention of African Americans in rural diabetes research is a significant challenge, and adequate funding should be sought early in the research process. Culturally competent approaches; caring, trusting relationships; incentives; and follow-up are important concepts in successful recruitment, participation, and retention of African Americans. The lessons learned may be applicable to the more widespread issue of recruitment and retention of rural African Americans in diabetes education programs.

Black or African American↗

PubMed1999

Efficacy of an international exchange via the Internet.

Nursing education is lacking in international and computer experiences needed in the current global health care system. No nursing studies were found that use international exchanges together with computer use as a teaching strategy to help students become more culturally competent as well as more knowledgeable in electronic information communication. Knowles' adult learning theory, Kolb's experiential learning theory, and Campinha-Bacote's cultural competence model undergird this pilot study. The study used a one-group, posttest design to measure the effectiveness of an international exchange via the Internet, designed to enhance global awareness and computer use of 25 nursing students enrolled in a rural university in the southeastern United States. Data were obtained on a 24-item Internet Exchange Evaluation Questionnaire at the end of the course. Descriptive statistics were used to analyze the data. International exchange via the Internet was determined to be an effective strategy for heightening international awareness and increasing Internet use. This pilot study suggests fostering international exchanges and improving computer use can be developed further through more sophisticated approaches. A model of improving global health through shared knowledge and professional collaboration will be pursued further.

Adult↗

PubMed2001

Assessing medical students' awareness of and sensitivity to diverse health beliefs using a standardized patient station.

PURPOSE: To assess students' performances on a health-beliefs communication OSCE station to determine whether there were differences in cultural competence based on the students' ethnic backgrounds. METHOD: A total of 71 students completed a health-beliefs communication OSCE station in which they were required to address the health beliefs and cultural concerns of a standardized patient (SP) portraying an African American woman with diabetes. The SPs rated students' performances on a ten-item interview assessment checklist. Scores on the station were standardized within SPs to adjust for differences in their use of the rating scale. A factor analysis was performed to determine conceptual constructs on the interview assessment checklist. Subscale means were computed for each student. T-tests of these subscale scores were conducted to investigate gender and ethnic differences between subgroups of students. The underrepresented minority (URM) students (five African Americans and three Mexican Americans) were compared with all other students, and the white students were compared with all others. To assess the magnitudes of the differences between subgroups, effect sizes (ES(m)) were computed for means comparisons. RESULTS: Factor analysis formed two factors: Disease Beliefs and Management, and Cultural Concerns. Two remaining items loaded on a third factor that had reliability too low to support further analysis. Meaningful differences were found in cultural sensitivity based on students' ethnic backgrounds. The URM students performed better than did all other students in addressing the patient's concerns about altering culturally-based dietary behaviors for diabetes self-care [URM students' mean standardized score (SD) = 0.42 (0.15); all others = -0.01 (0.67); ES(m) = 1.05]. White students performed better than did all other students in assessing the patient's concerns about using insulin to control her blood sugar levels [white students' mean standardized score (SD) = 0.13 (0.40); all others = -0.10 (0.64); ES(m) = 0.4]. CONCLUSION: Cultural competency deficits and differences were measurable using a health-beliefs communications station, and these differences were meaningful enough to warrant faculty discussion and research about how to ensure that students master this competency.

Cultural Diversity↗

PubMed1994

Mental health issues and African-Americans.

This article discusses issues that are relevant for the delivery of culturally appropriate psychiatric care to African-Americans. The conceptual model of Cultural Competence in Psychiatric Mental Health Nursing is used as the organizer of information presented, however, the model is also critiqued. Suggestions for the provision of culturally competent psychiatric care are provided.

Black or African American↗

PubMed2001

A consumer perspective on informed consent and third-party issues.

Our two children were diagnosed with a rare genetic disorder, which led us to establish a research foundation. This led to in-depth consideration of issues surrounding informed consent from a consumer perspective. Third-party issues arose as central to the formulation of ethical policy in the establishment of a blood and tissue bank and an epidemiologic study. We suggest that a number of myths--privacy is possible, samples can be stripped of identifiers, humans are subjects, voluntary informed consent is attainable, genetics is about the individual only, genetic information is different than other medical information, research is altruistic, the public will learn truths about genetic research via media, and research is culturally competent--make it difficult to resolve the issues intrinsic to informed consent. A number of important elements could make policy decisions less complicated. These include conducting culturally competent research; conveying noncoercive hope, not hype; contacting the voluntary informant only; asking the informant to extend contact to other family members; requiring a comprehensive informed consent process for all contacted; and engaging in state-of-the-art data protections. There is a need for a "Genomic Hippocratic Oath," creating an ethical basis for research similar to the one vowed by health care professionals. Establishing ethical policies as a result of the collaboration of policy makers, researchers, and consumers will allow research to progress ethically at a rapid rate. If regulations are oppressive, they will thwart research; if they are too lenient, participants will not receive protections needed to participate safely.

Child↗

PubMed2004

Patient satisfaction and ethnic identity among American Indian older adults.

Work in the field of culturally competent medical care draws on studies showing that minority Americans often report lower satisfaction with care than White Americans and recommends that providers should adapt care to patients' cultural needs. However, empirical evidence in support of cultural competence models is limited by reliance upon measurements of racial rather than ethnic identity and also by a near-total neglect of American Indians. This project explored the relationship between ethnic identity and satisfaction using survey data collected from 115 chronically ill American Indian patients >or=50 years at a Cherokee Nation clinic. Satisfaction scores were high overall and comparable to those found in the general population. Nevertheless, analysis using hierarchical linear modeling showed that patients' self-rated American Indian ethnic identity was significantly associated with satisfaction. Specifically, patients who rated themselves high on the measure of American Indian ethnic identity reported reduced scores on satisfaction with health care providers' social skill and attentiveness, as compared to those who rated themselves lower. Significant associations remained after controlling for patients' sex, age, education, marital status, self-reported health, wait time, and number of previous visits. There were no significant associations between patients' American Indian ethnic identity and satisfaction with provider's technical skill and shared decision-making. Likewise, there were no significant associations between satisfaction and a separate measure of White American ethnic identity, although a suggestive trend was observed for satisfaction with provider's social skill. Our findings demonstrate the importance of including measures of ethnic identity in studies of medical satisfaction in racial minority populations. They support the importance of adapting care to patient's cultural needs, and they highlight the particular significance of interpersonal communication for patient satisfaction among American Indians. Results will be of special interest to health researchers, clinicians, and policy makers working in fields related to minority health.

Aged↗

PubMed1985

Competence related proteins in the supernatant of competent cells of Bacillus subtilis.

We report that centrifugation at relatively high g-forces reduces the ability of competent cells of Bacillus subtilis to bind and take up DNA, and to be transformed. The centrifugation supernatant from competent cells restores this reduction of competence; the supernatant from non-competent cells is inactive. Phosphocellulose chromatography of centrifugation supernatants from radioactive competent cultures gave rise to six sharp peaks, together, these were shown by subsequent SDS polyacrylamide gel electrophoresis to contain over 60 different polypeptide bands. Peak II, which showed competence restoring activity, produced three polypeptides. When these bands were further examined, one of these exhibited DNA binding activity and the other two each contained a different endonuclease. Competence restoring activity was not recovered from the SDS polyacrylamide gel of peak II. The three peaks from non-competent cultures produced altogether five faint bands in gel electrophoresis. None of these bands were similar to those found in peak II.

Bacillus subtilis↗

PubMed2000

Japanese couples' childbirth experiences in Michigan: implications for care.

BACKGROUND: Subtle cultural differences in the childbirth experience for expatriate Japanese couples living in southeast Michigan can sometimes cause conflicts between them and American health caregivers. The purpose of this study was to examine Japanese couples' perceptions and experiences of prenatal care and childbirth in a region of the United States, and to explore the implications for providing culturally competent care. METHODS: In this qualitative study, in-depth interviews of 11 Japanese couples (n = 22) were conducted at an outpatient primary care clinic in southeast Michigan by a team of researchers fluent in the Japanese language and knowledgeable about the culture. Participants also completed a short questionnaire. RESULTS: The major themes that emerged comprised perceptions related to a language barrier, ultrasonography, prenatal vitamin supplementation, episiotomy, epidural anesthesia, and practitioner-patient relationship. Throughout these six themes it was evident that Japanese health care professionals had difficulty accepting health care that was different from the care provided in their home country. CONCLUSION: The most striking finding of this study was the difficulty for health caregivers to provide culturally competent care. Although the program has strongly invested in health professionals and support staff who were fluent in Japanese and knowledgeable about Japanese culture, conflicts still occurred.

Adult↗

PubMed2005

Health disparities: a barrier to high-quality care.

PURPOSE: Disparities in the treatment of cardiovascular disease, diabetes mellitus, and cancer among the sexes and racial groups and possible interventions are discussed. SUMMARY: The ongoing process to identify and reduce health disparities has engaged numerous federal agencies as they monitor the nation's progress toward policy-driven and health-related objectives. Cardiovascular disease disproportionately affects minority groups and is the leading cause of death among women in the United States, and both groups receive suboptimal care for the disease. Disparities in the treatment of diabetes mellitus in African Americans, women, patients with less than a high school education, and the elderly have been found. Many minority groups continue to suffer disproportionately from cancer. Racial disparities also exist in cancer screening and treatment. Minorities are underrepresented in clinical trials for multiple reasons, many of which may be related to cultural beliefs. At all levels of coinsurance, the poor are less likely to seek preventive care. Adherence to national screening and treatment guidelines, clinical trial recruitment and participation, addressing language and geographic barriers, and increasing access to insurance are part of the coordinated efforts required to reduce health disparities. Because pharmacists influence patients' health status directly through pharmaceutical care and indirectly by engaging patients in their treatment, it is essential for pharmacists to be able to provide culturally competent care. CONCLUSION: Despite significant efforts over the past several years, health disparities continue to exist, particularly among minority groups. Interventions aimed at eliminating these disparities should include ensuring cultural competence among health care providers and improving health literacy among patients.

Attitude of Health Personnel↗

PubMed2000

Characteristics of Latino mental health clinicians: a preliminary examination.

The purpose of this study was to explore a variety of characteristics of experienced Latino psychotherapists in an attempt to clarify elements of cultural competence. The sixty five subjects were from a sample of convenience recruited from mental health agencies serving predominantly Latino clients in the San Francisco Bay area. The first part of the study consisted of two focus groups with Latino clinicians to discuss culturally competent services and to generate ideas to inform a preliminary questionnaire. The second part consisted of administering the questionnaire to the sample. Results were mixed, revealing a combination of responses indicating clinical interventions based upon universally accepted principles, and those uniquely used with Latino clients which were more clearly associated with the cultural traits of Latinos.

Adult↗

PubMed1999

Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project.

Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.

Adult↗

PubMed2006

Comparing United States versus international medical school graduate physicians who serve African- American and White elderly.

OBJECTIVE: To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. DATA SOURCES: Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. STUDY DESIGN: Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and chi2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. DATA COLLECTION/EXTRACTION METHODS: Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. PRINCIPAL FINDINGS: Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. CONCLUSION: IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.

Black or African American↗