Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision

Language of Caregiver and Pediatric Day-of-Surgery Cancellations

OBJECTIVE

To examine the relationship between language used by a caregiver and day-of-surgery cancellations, and to distinguish whether neighborhood opportunity influences this relationship.

STUDY DESIGN

We performed a retrospective study of 173 533 children <18 years of age at a single institution who were scheduled for ambulatory surgery from 2017 through 2022. We estimated the odds of day-of-surgery cancellation by caregiver language, stratifying by neighborhood opportunity. We then determined the relative excess risk due to interaction of language other than English (LOE) with neighborhood opportunity.

RESULTS

Day-of-surgery cancellation occurred in 3.7% and 5.2% of children with caregivers using English and LOE, respectively (P < .001). Children from disadvantaged neighborhoods with caregivers using English had 23% lower odds of cancellation than those using LOE for care (OR 0.77, 95%CI 0.71-0.85; P < .001). Children from advantaged neighborhoods with caregivers using English had 38% lower odds of cancellation than those using LOE for care (OR 0.62, 95%CI 0.52-0.72; P < .001). The interaction between language and neighborhood advantage was not significant, indicating that neighborhood advantage does not appear to buffer those using LOE from cancellations (relative excess risk due to interaction: -0.06, 95%CI -0.21 to 0.08; P = .40).

CONCLUSIONS

Children with caregivers using LOE for care experience higher odds of day-of-surgery cancellation than children with caregivers using English, regardless of neighborhood opportunity. Decreasing language barriers is key to equitable surgery access.

Cultural and linguistic competence in chiropractic university students: Insights from a cross-sectional study

OBJECTIVE

Cultural and linguistic competence in health care is a universal necessity, compelling educational institutions to prepare graduates for diverse, multicultural environments. This study aimed to explore chiropractic students' perceptions of cultural and linguistic competency at a South African university.

METHODS

A cross-sectional anonymous survey was distributed to bachelor of health sciences and master of health sciences chiropractic students at the University of Johannesburg from February 27, 2023, to March 24, 2023. The survey consisted of 33 Likert-scale questions related to 3 subscales: cultural competence, role of language, and student responsiveness. A digital presentation explaining cultural competency was provided to all potential participants. Data were analyzed using frequencies, descriptive statistics, exploratory factor analysis, and reliability testing.

RESULTS

The response rate was 43.56% (n = 105) with participants predominantly aged 18-23 years (74.3%, n = 78), female (76.2%, n = 80), White (70.5%, n = 74), and identifying as Christian (63.8%, n = 67); 68.6% (n = 72) were bilingual. Students showed high agreement on the importance of cultural and linguistic competence in health care but expressed a need for additional training in these areas. An interesting association was found between the role of language and the year of study (p = .043) with junior students perceiving higher linguistic competency. The survey demonstrated acceptable reliability (α = 0.877).

CONCLUSION

Student respondents expressed the importance of cultural competence and language proficiency and further demonstrated a clear need for further training to enhance their ability to serve diverse cultural and linguistic groups. The value of respecting patients' cultural backgrounds in clinical settings was aligned with global trends.

How to promote cultural competence in nursing practice

RATIONALE AND KEY POINTS

Cultural competence, which encompasses cultural awareness, cultural skills, cultural desire, cultural encounters and self-efficacy, is essential for delivering effective, equitable, person-centred care and improving health outcomes in a diverse population. This 'How to' article details ways in which nurses can promote cultural competence in nursing practice, by taking practical steps to ensure they and the organisations they work for are providing accessible and culturally relevant care and services that meet the needs of local populations. • Nurses should critically reflect on their cultural background and consider how it may influence their practice and interactions with patients from backgrounds different to their own. • Reviewing, evaluating and updating local resources related to cultural competence can help to ensure these are current and fit for purpose. • Interacting with diverse cultural groups, for example through local community events, can enhance cultural awareness and connection between healthcare providers and patients from diverse backgrounds. • Requesting and sharing constructive feedback on interactions with and care approaches to patients from diverse cultural backgrounds can help nurses to identify cultural competence development needs. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when delivering care to individuals from cultural groups different from your own. • How you could use this information to educate nursing students or enable colleagues to practise and promote cultural competence.

Comparative analysis of influenza healthcare disparities in the United States using retrospective administrative claims from Medicaid and commercial databases, 2015-2019

BACKGROUND

Influenza-related healthcare utilization among Medicaid patients and commercially insured patients is not well-understood. This study compared influenza-related healthcare utilization and assessed disease management among individuals diagnosed with influenza during the 2015-2019 influenza seasons.

METHODS

This retrospective cohort study identified influenza cases among adults (18-64 years) using data from the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) and Optum's de-identified Clinformatics® Data Mart Database (CDM). Influenza-related healthcare utilization rates were calculated per 100,000 patients by setting (outpatient, emergency department (ED), inpatient hospitalizations, and intensive care unit (ICU) admissions) and demographics (sex, race, and region). Rate ratios were computed to compare results from both databases. Influenza episode management assessment included the distribution of the index point-of-care, antiviral prescriptions, and laboratory tests obtained.

RESULTS

The Medicaid population had a higher representation of racial/ethnic minorities than the CDM population. In the Medicaid population, influenza-related visits in outpatient and ED settings were the most frequent forms of healthcare utilization, with similar rates of 652 and 637 visits per 100,000, respectively. In contrast, the CDM population predominantly utilized outpatient settings. Non-Hispanic Blacks and Hispanics exhibited the highest rates of influenza-related ED visits in both cohorts. In the Medicaid population, Black (64.5%) and Hispanic (51.6%) patients predominantly used the ED as their index point-of-care for influenza. Overall, a greater proportion of Medicaid beneficiaries (49.8%) did not fill any influenza antiviral prescription compared to the CDM population (37.0%).

CONCLUSION

Addressing disparities in influenza-related healthcare utilization between Medicaid and CDM populations is crucial for equitable healthcare access. Targeted interventions are needed to improve primary care and antiviral access and reduce ED reliance, especially among racial/ethnic minorities and low-income populations.

An interview study exploring healthcare professionals' experiences of supporting health behaviors in migrant women after childbirth with special emphasis on mHealth

Migrant health, including reproductive health, is a public health priority. The time after childbirth is considered an important period for health behavior change and mobile health (mHealth) interventions have shown promise in influencing health behaviors. Healthcare professionals have an important role in providing support for health behaviors and implementing mHealth tools in clinical care. This study therefore examined healthcare professionals' experiences of health behavior promotion in migrant women and the potential for an mHealth intervention to improve health behaviors after childbirth. Twenty healthcare professionals in Sweden participated in individual semi-structured interviews. The informants had different professional backgrounds, ages, working experiences and all were females. Data was analyzed using thematic analysis and three main themes were generated. The first theme "Priorities and routines of health behavior promotion after childbirth" described a lack of priority for health behavior promotion after childbirth. The second theme "Social influences of health behaviors" described several factors that influenced possibilities for healthy behaviors after childbirth. In the third theme "mHealth in supporting health behaviors after childbirth", informants stressed that a culturally appropriate smartphone app with reliable information had the potential to promote health behaviors after childbirth although further research is needed.

Factors that influence the delivery of chiropractic services to equity-deserving groups in Canada: a qualitative study

BACKGROUND

Health inequities disproportionately impact equity-deserving groups, which include individuals marginalized due to race, ethnicity, Indigenous identity, sex and gender, socioeconomic status, and other social determinants of health. This qualitative study aimed to explore Canadian chiropractors' experiences and perceptions in delivering care to equity-deserving groups and identify individual and institutional factors that may influence care delivery.

METHODS

We utilized interpretive description for data development, sampling, collection, and analysis. Participants were recruited as part of a larger mixed-methods research study, where we conducted a cross-sectional survey assessing Canadian chiropractors' diversity and cultural competency. We used maximum variation sampling to recruit chiropractors who indicated their interest in participating in the qualitative study.

RESULTS

Fourteen participants (N = 7, female) were included in this study, ranging from 28-64 years of age. We identified three major themes: 1) Perceived role of institutions to advance cultural competency, describing the approaches and strategies of professional associations and educational institutions in making changes concerning diversity, equity, and inclusion (DEI), 2) Fostering a culturally responsive clinical practice, describing factors that impact the delivery of care to equity-deserving groups (e.g. ensuring clinicians' cultural awareness and sensitivity, promoting culturally competent behaviours, and understanding patients' cultural values), and 3) Understanding the contextual determinants in accessing care (e.g., socioeconomic status, lack of accessibility, patient advocacy).

CONCLUSION

The results suggest that culturally congruent care involves top-down and bottom-up approaches that integrate DEI practices at institutional and clinician levels. Specifically, the incorporation of DEI training within curricula, the development of policies that foster diversity, the engagement of equity-deserving groups to understand unique cultural needs, and tailoring treatments to each patient rather than a one-size-fits-all approach.

The cultural competence of health professionals in the care of cancer patients: a scoping review

OBJECTIVE

To explore the available evidence on the cultural competence of health professionals in the care of cancer patients.

METHODS

Scoping review carried out between April and May 2024. The databases Scopus, Medline (via Pubmed) and BVS (Lilacs) were used as sources. The sample included articles from the last ten years, resulting from primary research, literature reviews and systematic reviews in English, Portuguese and Spanish. Data were manually extracted and analyzed using an inductive thematic construction process.

RESULTS

31 studies were included, mostly quantitative research produced in North America. Four themes emerged from the synthesis: 1) Barriers to culturally competent care in oncology settings; 2) Strategies for implementing cultural practices; 3) Intervention measures to improve the cultural competence of oncology care providers; and 4) Outcomes of cultural competence on patient satisfaction and professional development.

CONCLUSION

Evidence reveals that cultural barriers limit effective cancer care. However, strategies and interventions to improve cultural competence increase patient satisfaction and benefit providers' professional development in oncology care.

Unraveling the link between language barriers and cancer risk

PURPOSE

Clear patient communication with the physician is an integral aspect of cancer treatment and successful health outcomes. Previous research has shown improved cancer screening in cases of patient navigator assistance to limited English proficient patients, but no research has analyzed the relationship between language isolation and cancer incidence rates in the United States.

METHODS

Using state-level data from the United States Census Bureau and the National Cancer Institute, we analyzed the correlations between language isolation and age-adjusted incidence rates across 19 different invasive cancers.

RESULTS

A complex relationship between language isolation and cancer incidence rates was found. States such as California, New York, Texas, and New Jersey show high language isolate prevalence and elevated cancer incidence rates. Cancer subtype incidence rates varied between states, indicating the multifactorial importance of lifestyle, genetics, and environment in cancer. California had the highest language isolation ranking of 8.5% and elevated rates of ovarian (10.4/100,000) and stomach (9.1/100,000) cancers. New York, with the second-highest language isolation ranking of 7.6%, manifests a pronounced prevalence of ovarian (11.3/100,000) and stomach (10.9/100,000) cancers. Overall, positive correlations were observed between language isolation and ovarian/stomach cancers, while negative correlations were found with lung, kidney, melanoma, and colorectal cancers.

CONCLUSION

This study emphasizes the need to address language barriers and other social determinants of health in cancer prevention/control. Targeted interventions, such as culturally appropriate education, increased access to linguistically and culturally appropriate cancer screening, and language lessons, are crucial in improving health outcomes in linguistically diverse communities.

Improving Access to Contraception Care at a Local Nonprofit Clinic: A Quality Improvement Project

One Midwest, non-profit clinic aimed to increase access to contraceptive services by improving their care delivery process through the implementation of a population-specific, contraception education program. The program included patient education, timely follow-up appointments, and free contraception. In this quality improvement project, a total of twenty-two mostly Spanish-speaking women signed up for a group education session that lasted thirty minutes and was offered monthly. The session was led by a female, bilingual provider and focused on contraception benefits, side effects, and common myths. After the session, the clinic offered same-day initiation of contraception for oral contraceptives, Depo-Provera injections, and Nexplanon implants. In this clinic, offering the class in conjunction with immediate initiation of the chosen birth control method decreased the average time to care delivery, showing a positive impact on access to these essential services.

The Role of Socioeconomic Determinants in Children's Health

After many years of being portrayed as a major achievement of the health service, child health in Portugal has recently come under scrutiny after an increase in infant deaths. Commentators have pointed to unequal access to healthcare and poorly monitored pregnancies of migrant mothers as possible causes. In this context, we revisit the socioeconomic determinants of children's health, reflecting on how various factors such as parental income and education, immigration, ethnicity, and social policies exert their influence on child health. Socioeconomic determinants have long been recognised, but their importance is often overlooked in the field of child health. The authors discuss theoretical approaches such as the worlds of influence framework proposed by UNICEF and consider various pathways through which socioeconomic determinants shape children's health, namely, the so-called material, psychological, behavioural, and structural pathways. The authors then move on to consider the empirical literature, drawing attention to factors such as life course, socioeconomic disadvantage, deprived neighbourhoods, poverty and income, household and family characteristics, parental education, ethnic diversity, and immigration. Finally, policy implications are considered, with the authors arguing that a multisectoral and coordinated approach, embracing both social and public health interventions, is required. Guaranteeing universal access to services that promote healthy early child development - including early childcare and education and efforts to reduce childhood poverty - is central to promoting equity. Classic public health policies, such as health surveillance and prevention programs, especially targeted at the preconception period, gestation, and childhood, are also important. In geographical areas with a strong immigrant presence, specific programs designed to facilitate integration should be available. If we are to improve child health and make sure that none are left behind, we need to focus attention on a broad range of socioeconomic determinants.

Global Insights on the Involvement of Ethnic Minority Populations in Health and Social Care Research Priority Setting: A Systematic Scoping Review

BACKGROUND

Representing all population groups in health and social care research is essential for generating research relevant to decision making in everyday clinical and social healthcare policy and practice. Conducting research that is relevant to all, starts with ensuring equitable representation in research priority selection. This scoping review aimed to identify evidence of published and good practices in health and social care research priority-setting activities, which included people from ethnic minority backgrounds.

METHODS

The search was conducted using MEDLINE, CINAHL, Cochrane Library, PsycINFO, and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Studies that reported including ethnic minority community members in health and social care research priority setting from 2010 were considered. The research priority processes were evaluated using a checklist of good practices in research priority settings.

FINDINGS

Forty-seven articles representing 12 countries and various health topics were included. Group discussion was the most common approach for conducting the research priority setting activities. No study addressed all 20 recommended research priority-setting good practice principles. Most studies provided sufficient information about the context of the priority-setting exercise. Examples of good practices included community advisory boards, local approaches to health research, and multi-disciplinary steering groups.

CONCLUSION

Representation of ethnic minority populations' involvement in research across different countries and broader health and social care areas is limited. Recommendations to address these challenges are presented and could help inform researchers, funders, and policymakers to understand what health and social care research topics are prioritised by ethnic minority communities.

Research with Black Communities to Inform Co-Development of a Framework for Anti-Racist Health and Community Programming

Study BackgroundThe effects of systemic racism were exacerbated and amplified throughout the COVID-19 pandemic. The resurgence of the "Black Lives Matter" movement in North America brought awareness to the public, especially white people, of the impacts of systemic racism in society and the urgent need for large-scale and institutional anti-racism work.PurposeIn collaboration with a local Community Health Centre, this research focused on identifying priority areas for tailored and co-developed anti-Black racism interventions in health services and community programming, as well as examining how purposeful relationships can be created with African, Caribbean, and Black (ACB) communities in London, Ontario.MethodsSemi-structured interviews were conducted in either French or English with nine formal or informal leaders from London's ACB communities. Interpretive description methodology guided analysis and interpretation.ResultsParticipants indicated that anti-Black racism is ever-present in the community and in their lives, with systemic racism causing the most harm. Racism should be addressed by creating ACB-specific services, and education for non-Black communities; increased representation, inclusion, and engagement of ACB people within organizations, especially in leadership roles, are essential. A framework based on study findings to guide how organizations can develop authentic and purposeful relationships with ACB communities is presented.ConclusionsOrganizations will continue to perpetuate systemic racism unless they actively seek to be anti-racist and implement strategies and policies to this end. The proposed framework can guide partnerships between health and community organizations and ACB communities, and support co-development of strategies to address anti-Black racism.

Cultural Humility Practices in Occupational Therapy Services: A Scoping Review

IMPORTANCE

Cultural humility may improve the quality of occupational therapy services, but how occupational therapy practitioners apply this approach in their practice contexts has not been clearly described in the literature.

OBJECTIVE

To describe peer-reviewed rehabilitation literature on the practice of cultural humility and align the findings with occupational therapy practice using the Canadian Practice Process Framework (CPPF).

DATA SOURCES

Nine databases were searched, using the term cultural humility to identify relevant peer-reviewed rehabilitation literature. Google Scholar and six journals were hand-searched to identify additional studies.

STUDY SELECTION AND DATA COLLECTION

This substudy of a larger knowledge synthesis was guided by Arksey and O'Malley's (2005) scoping review methodology. Titles, abstracts, and full texts of studies were screened using Covidence. Study descriptors, context, population, and cultural humility elements defined by Tervalon and Murray-García (1998), and recommendations were extracted, analyzed, and mapped onto the CPPF.

FINDINGS

In total, 11 studies were included. Cultural humility elements of self-reflection and critique (n = 7; 63.6%), self-awareness and egolessness (n = 8; 72.7%), and supportive interaction (n = 5; 45.4%) were identified. Most cultural humility elements aligned with the societal (n = 11; 100%) and practice (n = 10; 90.9%) contexts of the CPPF.

CONCLUSIONS AND RELEVANCE

Findings highlight how occupational therapists could integrate cultural humility at each stage and in each context of their practice. Additionally, these insights can inform occupational therapy education on integrating cultural humility into training programs and guiding practitioners in applying cultural humility principles to enhance their practice. Plain-Language Summary: Cultural humility may improve the quality of occupational therapy services. How occupational therapy practitioners apply cultural humility has not been clearly described in the literature. This review describes literature on the practice of cultural humility. The findings were aligned with occupational therapy practice using the Canadian Practice Process Framework. The findings highlight how occupational therapists could integrate a cultural humility approach at each stage, in each practice process and context, and into training programs. The findings also provide a foundation for future research on how to apply cultural humility principles to improve occupational therapy services.

Unlocking potential: innovative "private-non-profit" partnership for empowering children with disabilities in resource-limited settings in Nepal

Background

Physical disabilities affect approximately 240 million children globally, with limited access to comprehensive care in resource-constrained settings. In Nepal, an estimated 2% of children under 16 experience physical disabilities, facing significant barriers to healthcare access, education, and social integration. Traditional healthcare models often struggle to provide affordable, accessible, and sustainable care for these children.

Objectives

To evaluate the effectiveness and sustainability of an innovative private-nonprofit partnership model between the Hospital and Rehabilitation Centre for Disabled Children (HRDC) and B&B Hospital in Nepal, designed to provide comprehensive care for children with physical disabilities in resource-limited settings.

Methods

The study analyzes a 40-year experience implementing a unique healthcare delivery model combining HRDC's non-profit expertise with B&B Hospital's private sector resources. The model integrates four key components: identification through mobile camps and community outreach, comprehensive medical treatment, rehabilitation services, and social reintegration programs.

Results

The partnership achieved a 62% reduction in treatment costs compared to private healthcare institutions. Over 40 years, HRDC has performed more than 55,000 surgeries, benefiting over 116,000 children surgically. The program has distributed 100,000+ assistive devices, raised disability awareness among 1.5 million+ people, and trained over 700 primary rehabilitation therapists. The model's community-based approach has enabled coverage of all 77 districts in Nepal through rotating mobile clinics.

Conclusion

The HRDC-B&B partnership demonstrates that private-nonprofit collaboration can effectively address healthcare barriers for children with physical disabilities in resource-limited settings. The model's success in combining cost efficiency, quality care, and community integration provides a replicable framework for similar interventions in other developing countries. Key factors for success include diverse funding sources, strong community engagement, and integrated service delivery under one roof.

Sexual and Gender Minority Migrants' Experiences of Health Service Access and Utilisation: A Qualitative Meta-Synthesis

AIMS

To describe and synthesise qualitative studies exploring sexual and gender minority migrants' experiences of health service access and utilisation.

DESIGN

Systematic meta-synthesis of qualitative studies.

DATA SOURCES

Systematic searches in four databases and citation screening were conducted in 2023 and 2024. English-language empirical qualitative studies published in scientific journals within 10 years were included. Of 1109 screened, 21 reports were included.

METHODS

Included reports were appraised using CASP and JBI checklists. Extracted results were analysed with inductive content analysis in a collaborative process.

RESULTS

All reports had acceptable quality, including 365 participants from 72 countries. A range of external and internal barriers to accessing health services were reported, including financial constraints and fears. Although migrants expressed an appreciation of health services, they also experienced non-affirming behaviours and discrimination related to their intersecting identities. Several essential components in health services necessary to cater to the needs of migrants were addressed, including the personality and manner of health professionals as well as adherence to confidentiality.

CONCLUSION

Barriers to health services, intersectional discrimination and non-affirming behaviours when interacting with health services are pressing issues that need further attention.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Ensuring safety through affirming support is key to achieving high-quality and accessible health services for sexual and gender minority migrants. Nurses and other health professionals need to carefully consider intersectional layers related to sensitivity and safety when supporting sexual and gender minority migrants. Open, friendly, validating, respectful and encouraging communication is essential in clinical settings.

IMPACT

This review addressed experiences of health services amongst a marginalised population. The findings highlight the importance of affirming care and are relevant for health professionals, stakeholders and decision-makers.

REPORTING METHOD

ENTREQ.

PATIENT OR PUBLIC CONTRIBUTION

Two persons with lived experience were involved in the meta-synthesis.

Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis

BACKGROUND

Immigrants with disabilities (IWDs) are disproportionately affected by a lack of access to healthcare services and face unique challenges compared to the general population. This qualitative meta-synthesis examines the barriers, facilitators, and lived experiences of IWDs accessing healthcare in the U.S. and Canada.

METHODS

A theory-generating qualitative meta-synthesis approach was used to analyze and synthesize raw qualitative data. Using eight databases, 752 studies were retrieved, and 10 were selected and synthesized after a three-stage review. The final articles were assessed using the Critical Appraisal Skills Program (CASP) checklist, and a PRISMA flow chart was used to report on the selection process.

RESULTS

The analysis identified structural barriers, including the bureaucracy and complexity of the system, healthcare costs, transportation, communication, long wait times, and a lack of integrated services. Cultural barriers included denial and trust, stigma and discrimination, awareness and language gaps, and lack of social support. Facilitators of access included support from immediate family members, community health centers, and social workers.

CONCLUSIONS

The findings highlight the need for policy reforms to reduce bureaucratic hurdles, improve communication within healthcare systems, and enhance cultural competence among healthcare providers. Addressing these issues through integrated service models and targeted support can significantly improve the quality of life as a result of improved healthcare access for IWDs.

Community health workers supporting diverse family caregivers of persons with dementia: Preliminary qualitative results from a randomized home-based study

BACKGROUND AND OBJECTIVES

Culturally diverse informal caregivers of community-dwelling persons with dementia face challenges in accessing dementia care resources due to language barriers and cultural stigmas surrounding dementia. This study presents the perceived intervention experiences of a home-based approach which considers the cultural and linguistic needs of diverse family caregivers in dementia care. The intervention model includes home visits by trained bilingual, non-licensed community health workers (CHWs) whose cultural histories and understandings reflect that of the caregivers. The purpose of the present study was to understand family caregivers' experience in caregiving and their feedback on the intervention, which includes caregiver support through education and skill development.

METHODS

The present study thematically analyzed qualitative data from exit interviews with caregivers who participated in a CHW-led, 12-week home visit-based intervention program.

RESULTS

Among 57 caregivers (mean age = 63.5, SD = 14.3) who participated in the 3-month home-visit intervention and completed the exit interviews, 33% were Korean Americans, 28% Vietnamese Americans, 21% non-Hispanic Whites, and 17.5% Latino/Hispanic. The majority were females (81%) and spouses (51%). Main themes include, (a) Individual Level: Improvements in Caregiving Self-efficacy and Self-care Awareness, (b) Relational Level: Enhanced Communications and Relationships with Persons with Dementia, and (c) Community Level: Connection and Access to Community Resources and Support.

CONCLUSION

Interview data show that the culturally and linguistically tailored program supported diverse caregivers by increasing self-care awareness, improving knowledge about dementia and dementia care, strengthening communication skills, and facilitating access to community resources. Strong rapport between CHWs and caregivers enhanced the effectiveness of the intervention. Future approaches can focus on supporting caregivers with especially limited resources.

Diversity and Underserved Patient Populations in Epilepsy

OBJECTIVE

Despite advancements in epilepsy management, disparities and lack of inclusion of many people with epilepsy are associated with increased morbidity and mortality. Compounding these problems is the paucity of diversity among health care providers, research participants, and researchers. This issue as well as potential solutions are explored in this article.

LATEST DEVELOPMENTS

Prompted by recent social justice incidents, patient advocacy groups, epilepsy societies, and governing bodies such as the National Institute of Neurological Disorders and Stroke, US Centers for Disease Control and Prevention, and the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders have proposed initiatives to improve disparities in epilepsy care. Public health epilepsy research continues to expose deficiencies and disparities. Increased awareness of health care gaps and technologic advances should help foster improved epilepsy health equity and inclusivity.

ESSENTIAL POINTS

To deliver timely, effective care for people with epilepsy, we must be knowledgeable of sociodemographic obstacles to access. These include confounding factors such as historical determinants, unconscious bias, and lack of diversity. Improving awareness and promoting diversity in research participation can advance treatment for underserved populations and improve trust.

Culturally Sensitive and Inclusive IBD Care

As the prevalence of inflammatory bowel disease (IBD) increases within historically disadvantaged communities, it is imperative to better understand how intersectionality-defined as the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism)-intersects and social determinants of health influence the patient's experiences within the medical system when navigating their disease. Culturally sensitive care is characterized by the ability to deliver patient-centered care that recognizes how the intersectionality of an individual's identities impacts their disease journey. An intentional consideration and sensitivity to this impact play important roles in providing an inclusive and welcoming space for historically disadvantaged individuals living with IBD and will help address health inequity in IBD. Cultural competence implies mastery of care that understands and respects values and beliefs across cultures, while cultural humility involves recognizing the complexity of cultural identity and engaging in an ongoing learning process from individual patient experiences. Heightening our patient care goals from cultural competence to cultural sensitivity allows healthcare professionals and the systems in which they practice to lead with cultural humility as they adopt a more inclusive and humble perspective when caring for patient groups with a diverse array of identities and cultures and to avoid maintaining the status quo of implicit and explicit biases that impede the delivery of quality IBD care. In this article, we review the literature on IBD care in historically disadvantaged communities, address culturally sensitive care, and propose a framework to incorporating cultural humility in IBD practices and research.

Advancing health equity: evaluating AI translations of kidney donor information for Spanish speakers

Background

Health equity and access to essential medical information remain significant challenges, especially for the Spanish-speaking Hispanic population, which faces barriers in accessing living kidney donation opportunities. ChatGPT, an AI language model with sophisticated natural language processing capabilities, has been identified as a promising tool for translating critical health information into Spanish. This study aims to assess ChatGPT's translation efficacy to ensure the information provided is accurate and culturally relevant.

Methods

This study utilized ChatGPT versions 3.5 and 4.0 to translate 27 frequently asked questions (FAQs) from English to Spanish, sourced from Donate Life America's website. The translated content was reviewed by native Spanish-speaking nephrologists using a standard rubric scale (1-5). The assessment focused on linguistic accuracy and cultural sensitivity, emphasizing retention of the original message, appropriate vocabulary and grammar, and cultural relevance.

Results

The mean linguistic accuracy scores were 4.89 ± 0.32 for GPT-3.5 and 5.00 ± 0.00 for GPT-4.0 (p = 0.08). The percentage of excellent-quality translations (score = 5) in linguistic accuracy was 89% for GPT-3.5 and 100% for GPT-4.0 (p = 0.24). The mean cultural sensitivity scores were 4.89 ± 0.32 for both GPT-3.5 and GPT-4.0 (p = 1.00). Similarly, excellent-quality translations in cultural sensitivity were achieved in 89% of cases for both versions (p = 1.00).

Conclusion

ChatGPT 4.0 demonstrates strong potential to enhance health equity by improving Spanish-speaking Hispanic patients' access to LKD information through accurate and culturally sensitive translations. These findings highlight the role of AI in mitigating healthcare disparities and underscore the need for integrating AI-driven tools into healthcare systems. Future efforts should focus on developing accessible platforms and establishing guidelines to maximize AI's impact on equitable healthcare delivery and patient education.

Pain Management Among Older Farsi and Azeri Speaking Immigrant Adults With Limited English Proficiency (LEP): Interpretive Approach

OBJECTIVES

Pain is a major public health issue in the United States. The ability to communicate the severity of pain with healthcare providers is crucial to receiving appropriate pain management. Many factors can limit this ability, including limited proficiency in the language spoken by providers. This body of research suggests gaps in the multidimensional approach to pain management for older adults with limited English proficiency (LEP). In this study, we describe the lived experiences of pain management of older adults with LEP living with chronic pain in the United States.

METHODS

We used a qualitative interpretive approach with semi-structured interviews from nineteen Farsi and Azeri-speaking older adults with LEP and chronic pain to describe the lived experiences of older adults with LEP.

RESULTS

Participants relied on alternative medicine to manage their pain and reported fears of becoming dependent on prescription pain medications. Some reported poor physician-patient rapport and felt unseen by healthcare providers, and all reported language barriers even with the use of translators.

CONCLUSIONS

Farsi and Azeri-speaking older adults with LEP and chronic pain felt the US healthcare system ignored their social, cultural, and linguistic needs. Pain management training for healthcare providers should address language barriers and include cultural competency.

Prohibiting Babel-A call for professional remote interpreting services in pre-operation anaesthesia information

INTRODUCTION

Language barriers within clinical settings pose a threat to patient safety. As a potential impediment to understanding, they hinder the process of obtaining informed consent and uptake of critical medical information. This study investigates the impact of the current use of interpreters, with a particular focus on of engaging laypersons as interpreters, rather than professional interpreters potentially affecting patient safety. A further objective is to explore the reliability of phone-based telemedicine in terms of the retention of important medical facts.

METHODS

In three groups (N per group = 30), we compared how using lay or professional interpreters affected non-German speaking patients' subjectively perceived understanding (understood vs. not understood) and recollection (recollected vs. not recollected) of information about general anaesthesia. Proficient German speaking patients served as the control group. Statistical analyses (χ2 tests and binomial) were calculated to show differences between and within the groups.

RESULTS

All three groups indicated similar, high self-reported levels of having understood the medical information provided. This was in stark contrast to the assessed objective recollection data. In the lay interpreter group, recollection of anaesthesia facts was low; only around half of participants recalled specific facts. For patients supported by professional interpreters, their recollection of facts about anaesthesia was significantly enhanced and elevated to the same level of the control group (fluent in German). Moreover, for these patients, providing information by means of phone-based telemedicine before anaesthesia yielded high levels of understanding and recollection of anaesthesia facts.

CONCLUSION

Phone-based telemedicine is a safe and reliable method of communication in the professional interpreter group and German speaking control group, but not in the lay interpreter group. Compared to lay interpreters, professional interpreters significantly improve patients' uptake of critical information about general anaesthesia, thus highlighting the importance of professional interpreters for patient safety and informed consent.

[The Emergence of Multiculturalism in Portuguese Neonatal Care: Challenges and Strategies]

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A faculty development series on race and ethnicity in pharmacy education

PURPOSE

Professional pharmacy associations are calling for greater cultural sensitivity in pharmacy. education. The faculty of a Midwestern School of Pharmacy set out to better address race and racism in the pharmacy curriculum through the implementation of a faculty development series.

DESCRIPTION

A year-long professional development program to increase awareness of Diversity, Equity, and Inclusion (DEI) by race and ethnicity was implemented for 30 faculty members. The program included four didactic lectures and four Grand Rounds discussion sessions.

ANALYSIS/INTERPRETATION

Attendance at the sessions averaged 22 (73 %) and 9 (30 %) for the didactic and Grand Rounds sessions, respectively. Faculty members showed a desire to learn about racism in pharmacy education and an openness to discuss ways to improve pharmacy education to make it culturally representative. Faculty went from a broad perception of health outcomes being impacted by race and racism, to actionable views on how race is addressed in the pharmacy curriculum, as well as the teaching methods such as facilitated discussions to address race and ethnicity appropriately.

CONCLUSIONS

Faculty members are willing and able to openly revisit the content and methods of their teaching to make it more accurate and inclusive about how race and ethnicity are handled in the. pharmacy curriculum.

IMPLICATIONS

Pharmacy faculty are willing to learn about racism in pharmacy education and do what is necessary to handle race and ethnicity topics in appropriate ways. Collaborative learning can assist faculty members to do so.

Discordance Between Clinician and Person-With-Diabetes Perceptions Regarding Technology Barriers and Benefits

The quality of clinician-patient relationship is integral to patient health and well-being. This article is a narrative review of published literature on concordance between clinician and patient perspectives on barriers to diabetes technology use. The goals of this manuscript were to review published literature on concordance and to provide practical recommendations for clinicians and researchers. In this review, we discuss the qualitative and quantitative methods that can be applied to measure clinician and patient concordance. There is variability in how concordance is defined, with some studies using questionnaires related to working alliance, while others use a dichotomous variable. We also explore the impact of concordance and discordance on diabetes care, barriers to technology adoption, and disparities in technology use. Published literature has emphasized that physicians may not be aware of their patients' perspectives and values. Discordance between clinicians and patients can be a barrier to diabetes management and technology use. Future directions for research in diabetes technology including strategies for recruiting and retaining representative samples, are discussed. Recommendations are given for clinical care, including shared decision-making frameworks, establishing social support groups optimizing clinician-patient communication, and using patient-reported outcomes to measure patient perspectives on outcomes of interest.

Factors affecting women's access to primary care in the United States since the Affordable Care Act: A mixed-methods systematic review

BACKGROUND

In the United States, the Affordable Care Act (ACA) expanded public and private health coverage, increased health insurance affordability, reduced healthcare costs, and improved healthcare quality for many. Despite ACA provisions, lack of insurance and other factors continue to affect working-age women's access to primary care services.

METHODS

We conducted a mixed-method systematic review to identify factors that affect women's access to primary care services since the ACA. In January 2021, MEDLINE, CINAHL, PsycINFO, and Web of Science were searched from 2010 to 2021 and an updated search was conducted in October 2023. We included 26 quantitative and qualitative studies reporting determinants, barriers and facilitators of women's primary care access for women (18 to 64 years). Studies reporting measures of potential access, such as health insurance, and measures of realized access-healthcare service utilization, were included. The Mixed-Methods Appraisal Tool (2018) was used to rate the quality of studies. Andersen's Behavioral Model of Health Services Use guided the narrative synthesis.

FINDINGS

We found consistent evidence that ACA provisions expanding state Medicaid eligibility led to improved insurance coverage, especially for lower-income groups. We found mixed evidence of associations between individual-level determinants, such as age, education, race/ethnicity, income, and different measures of access. Limited qualitative evidence suggests that insurance coverage, low-cost care, positive patient-provider relationships, social support, and translation services enhance access for immigrants and refugees. Barriers include lack of coverage, high healthcare costs, culturally unresponsive healthcare services, poor patient-provider relationships, and transportation issues.

CONCLUSION

Adoption of ACA's expanded Medicaid eligibility criteria would expand insurance coverage to women living in non-expansion states. Innovative healthcare policies, programs, and interventions at the federal, state, and local levels are needed. Suggested strategies include interventions expanding primary healthcare service availability and patient navigation services, and promotion of health literacy, culturally sensitive services, and provider bias education/training.

Cultural Competence and Nursing Work Environment: Impact on Culturally Congruent Care in Portuguese Multicultural Healthcare Units

BACKGROUND

Cultural competence is central to ensuring effective culturally congruent care to patients and fostering positive work environments, particularly in multicultural settings.

OBJECTIVE

This study aimed to analyse the relationship between cultural competence, the nursing work environment, and the delivery of culturally congruent care in multicultural units of a healthcare organisation in Portugal.

METHOD

This was a quantitative, descriptive, and cross-sectional study, targeting nurses from multicultural units. Data were collected using both online and paper-based questionnaires, which included the Cultural Competence Questionnaire for Help Professionals, the Nursing Work Index-Revised Scale (NWI-R-PT), and a single question assessing nurses' perceptions of the adequacy of the culturally congruent care they provide.

RESULTS

A moderate, positive correlation was identified between cultural competence and the Fundamentals for Nursing, while the nursing work environment was influenced by organisational support, professional category, and unit type.

DISCUSSION

The findings suggest that enhancing cultural knowledge and technical skills and reinforcing management support may positively impact culturally congruent care delivery in multicultural settings.

CONCLUSION

This study contributes to nursing knowledge by highlighting the complex interactions between cultural competence and the work environment in Portuguese multicultural healthcare units. Future research should explore the impact of transcultural nursing leadership on multicultural work environments and in the delivery of culturally congruent care.

Diversity of Trauma and Orthopaedic Trainees and Workplace Culture of Orthopaedic Training in the United Kingdom: Insights From the 2022 British Orthopaedic Trainee Association (BOTA) Census

The British Orthopaedic Trainee Association (BOTA) conducted its latest census in 2022 of its membership. The results of wellbeing, diversity, equity, inclusion and bullying are discussed here. This highlighted several key focuses for improvement. Firstly, further work is required to improve diversity within trauma and orthopaedics. Secondly, burnout amongst trainees is increasing, and we risk losing colleagues from the speciality without action. Finally, bullying and harassment are still witnessed within orthopaedics, and ways to address this are discussed.

Cultural and linguistic diversity is associated with increased inter-dialytic weight gain among patients on long-term haemodialysis

BACKGROUND

Factors associated with suboptimal interdialytic weight gain have long been established. However, the influence of cultural and linguistic diversity on interdialytic weight gain among patients receiving haemodialysis is not well-understood.

OBJECTIVE

This study examined the relationship between interdialytic weight gain and cultural and linguistic diversity among patients receiving haemodialysis.

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS AND MEASUREMENTS

Demographic and clinical data were collected from electronic medical records of patients receiving haemodialysis at five dialysis units. Logistic regression analysis was performed to determine factors associated with suboptimal interdialytic weight gain.

RESULTS

Two hundred and sixty-nine patients, 62% of whom were female, with mean ± age of 65.8 ± 14.8 years, were studied. Most were from culturally and linguistically diverse backgrounds (60%) and a significant number belonged to the most disadvantaged socioeconomic group. Patients from culturally and linguistically diverse backgrounds had significantly higher relative interdialytic weight gain (2.40% ± 1.45%) compared to those from nonculturally and linguistically diverse backgrounds (1.83 ± 1.09%) (mean difference: 0.57%, 95% CI: 0.25-0.90, p = 0.001). Being from culturally and linguistically diverse backgrounds was associated with increased odds of higher relative interdialytic weight gain (OR: 2.40; 95% CI: 1.38-4.17, p < 0.01).

CONCLUSION

Among patients on maintenance haemodialysis, individuals from culturally and linguistically diverse backgrounds had higher interdialytic weight gain compared to those from nonculturally and linguistically diverse backgrounds. Future research focusing on co-developing culturally sensitive interventions to improve self-management capability of patients on maintenance haemodialysis from culturally and linguistically diverse backgrounds is needed.

The Influence of Diverse Cultures on Nutrition, Diabetes Management and Patient Education

Background/Objectives: Providing relevant, patient-centered care starts with recognizing that patients living with diabetes are racially and ethnically diverse, which will influence their dietary behaviors. Methods: The authors draw upon literature descriptions and personal experience in clinical practice dealing with ethnically diverse populations and include guidance offered in the literature regarding how to address these unique aspects when managing and educating patients with diabetes. Results: Proper interviewing techniques are described when dealing with culturally diverse populations, including ascertaining cultural, religious, and ethnic influences on dietary choices, and advice is given on how to improve nutritional behavior in these patients while acknowledging and validating these influences. Conclusions: When a proper nutrition interview is conducted, such as using motivational interviewing, aspects of the patient's cultural, religious, ethnic, and other influences can be ascertained, and appropriate advice can be given to the patient on how to modify these influences to achieve a healthier nutritional behavior.

Culturally Responsive Care in Veterinary Medicine

This article examines how culturally responsive care can enhance veterinary medicine by focusing on the interpersonal relationships between veterinarians, their teams, and pet owners. It begins by exploring the historical context of trust within veterinary practice and addresses stereotypes in pet ownership demographics, reinforcing the universal human-animal bond. The article outlines the components of culturally responsive care, noting the scarcity of research in veterinary settings and drawing extensively on the substantial research from human medicine, particularly nursing. It redefines veterinarians as trusted caregivers and details the benefits of culturally responsive care, advocating for more inclusive practices to inspire a more empathetic and culturally competent veterinary community.

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

BACKGROUND

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

METHODOLOGY

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

RESULTS

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

CONCLUSION

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

Exploring cultural competence barriers in the primary care sexual and reproductive health centres in Catalonia, Spain: perspectives from immigrant women and healthcare providers

BACKGROUND

Immigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services.

METHODS

An exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach.

RESULTS

Language barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles.

CONCLUSION

This study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

A Scoping Review of Limited English Proficiency and Immigration in Pediatric Surgery

INTRODUCTION

With increasing globalization and diversity, the intersection of immigration and language barriers can impact patient outcomes. This scope review aims to summarize current evidence on immigration and language barriers on pediatric surgical outcomes.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched with Medical Subject Heading terms describing pediatric surgery, immigration, limited English proficiency (LEP), and refugees between 2000-2023. Four independent reviewers screened and analyzed texts for final inclusion.

RESULTS

Thirty-three studies were included. Ten studies described disease incidence and severity, finding that LEP, immigrant, and refugee patients were more likely to present with severe disease in appendicitis and traumatic injuries. five studies described pain management, finding patients with LEP received fewer pain assessments, waited longer for analgesia, and had more discrepancies in pain scores. Seventeen studies investigated treatment receipt and delay, finding that immigrants and patients with LEP had longer time to and reduced rates of treatment. Seventeen studies described surgical outcomes, finding that patients with LEP have longer length of stay and more postoperative emergency department visits but fewer follow-up appointments. In kidney transplants, patients with LEP and immigrants had worse outcomes, but these trends are not seen in immigrants from Europe. Overall, immigrants and refugees have higher rates of complications and mortality.

CONCLUSIONS

Immigrants and patients with LEP and are more likely to present with advanced disease and severe injuries, receive inadequate pain management, experience delays in surgery, and suffer more complications. There is continued need to assess the impact of LEP and immigration on pediatric surgery outcomes.

A Bilingual Readability Assessment of Online Breast Cancer Screening and Treatment Information

INTRODUCTION

Presenting health information at a sixth-grade reading level is advised to accommodate the general public's abilities. Breast cancer (BC) is the second-most common malignancy in women, but the readability of online BC information in English and Spanish, the two most commonly spoken languages in the United States, is uncertain.

METHODS

Three search engines were queried using: "how to do a breast examination," "when do I need a mammogram," and "what are the treatment options for breast cancer" in English and Spanish. Sixty websites in each language were studied and classified by source type and origin. Three readability frameworks in each language were applied: Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, and Simple Measure of Gobbledygook (SMOG) for English, and Fernández-Huerta, Spaulding, and Spanish adaptation of SMOG for Spanish. Median readability scores were calculated, and corresponding grade level determined. The percentage of websites requiring reading abilities >sixth grade level was calculated.

RESULTS

English-language websites were predominantly hospital-affiliated (43.3%), while Spanish websites predominantly originated from foundation/advocacy sources (43.3%). Reading difficulty varied across languages: English websites ranged from 5th-12th grade (Flesch Kincaid Grade Level/Flesch Kincaid Reading Ease: 78.3%/98.3% above sixth grade), while Spanish websites spanned 4th-10th grade (Spaulding/Fernández-Huerta: 95%/100% above sixth grade). SMOG/Spanish adaptation of SMOG scores showed lower reading difficulty for Spanish, with few websites exceeding sixth grade (1.7% and 0% for English and Spanish, respectively).

CONCLUSIONS

Online BC resources have reading difficulty levels that exceed the recommended sixth grade, although these results vary depending on readability framework. Efforts should be made to establish readability standards that can be translated into Spanish to enhance accessibility for this patient population.

Registered nurses' perceptions of healthy lifestyle counselling for immigrants in primary healthcare: A focus group study

BACKGROUND

The use of primary healthcare and health promotion services is low among immigrants compared with native citizens. Immigrants are at risk of developing chronic diseases due to genetics, nutrition and a sedentary lifestyle. Registered nurses play an integral role in teaching, counselling for a healthy lifestyle and care coordination in primary healthcare.

AIM

We aimed to explore the perceptions of registered nurses on healthy lifestyle counselling for preventing type 2 diabetes and other chronic diseases among immigrants in the primary healthcare setting.

DESIGN

We performed a qualitative descriptive study using focus group interviews.

METHODS

Data were collected with semi-structured focus group interviews with a total of 23 registered nurses working in primary healthcare. We recruited the participants by using the purposive sampling method in the primary healthcare setting of four municipalities in Finland. Interviews were audio-recorded, transcribed verbatim and analysed with qualitative inductive content analysis.

RESULTS

The participants' perceptions were related to (1) uniform counselling practice for both immigrants and native citizens, (2) challenges in counselling immigrants, (3) understanding cultural factors influencing immigrant counselling, (4) the need to improve immigrant counselling and (5) utilizing insights from practical experience to improve the counselling service.

CONCLUSIONS

Developing a culturally sensitive health promotion service is suggested to support the health of immigrants. Moreover, both migrant communities and healthcare professionals should be involved in co-designing and implementing health promotion projects through a community-based participatory approach.

IMPACT

Our study contributes to healthcare practice and management by underscoring the need for culturally tailored health promotion services for the at-risk group of immigrants in primary healthcare. Cultural competence in nursing education needs to be reinforced. The provided recommendations inform researchers and policymakers about the health disparities and health needs of immigrants.

PUBLIC CONTRIBUTION

Healthcare professionals were consulted in the study design.

The Value of Qualitative Research in Diversity, Equity, and Inclusion

This article advocates for qualitative research in veterinary medicine, highlighting its importance for understanding diverse experiences, and thus providing the opportunity for improving diversity, equity, and inclusion in the field. It contrasts qualitative with quantitative methods and addresses the concept of epistemic violence. Emphasizing community-based, emancipatory approaches, it urges adopting humanizing and liberatory research frameworks that challenge traditional research methods, underscoring qualitative research's role in fostering equity, empathy, and deeper understanding within the field.

Strategic Enhancement of Healthcare Services During the Hajj Season in Makkah: A Comprehensive Geographic Information System (GIS) Analysis

Annually, over two million international pilgrims embark on the Hajj pilgrimage to Makkah, presenting a significant challenge for healthcare services. This study analyzes the spatial distribution of healthcare facilities in the Al Mashaer area using Geographic Information System (GIS) technology to enhance healthcare during this religious gathering. It evaluates the accessibility and efficacy of healthcare facilities, including primary care centers, clinics, and hospitals, each addressing distinct medical needs to ensure a holistic approach for pilgrims. The study maps the distribution, service radius, and services offered by each facility, along with an analysis of travel distances and times, to evaluate the viability of healthcare services. Identifying coverage gaps and accessibility issues is critical for making strategic recommendations to enhance resource allocation and distribution. The research addresses challenges such as data precision, population density, infrastructural constraints, and resource limitations. The study offers recommendations to optimize resource distribution, improve transportation strategies, expand healthcare capacity, and enhance cultural competency, resulting in improved healthcare accessibility, reduced congestion, quicker medical responses, and a safer pilgrimage experience, promoting a world-class pilgrimage management system.

Value-driven attitude surveys: Lessons from the refugee crisis in Greece

Community reaction to refugees and asylum-seekers is often gauged by attitude surveys that are not designed to overcome built-in bias. Questionnaires that do not account for context and background consequently yield results that misrepresent community attitudes and offer predictably negative responses to immigrant groups. Such surveys can alter public perception, fuel anti-refugee sentiment, and affect policy simply because of how they are constructed. This model survey among humanitarian aid-workers from nine Greek non-governmental organizations uses specific techniques designed to overcome these challenges by applying sample familiarity, non-inflammatory hypothesis-testing, educational question stems, intentional ordering of questions, and direct questioning rather than surrogate measures like statistical approximation. Respondents working in the refugee crisis in Greece demonstrate how empathy, education, and exposure to refugees serve to overcome the harmful stereotypes of outsiders as contributors to crime, terror, and social burden.

Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis

OBJECTIVE

To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery.

METHODS AND MEASURES

A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools.

RESULTS

Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains.

CONCLUSION

The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model

Background

Cross-regional settlement management is a key indicator of national health insurance system maturity. Given the significant demand for cross-regional medical treatment among Chinese patients with malignant tumors and the territorially managed health insurance system, further research is necessary to explore the relationship between hospital settlement methods and treatment-seeking behaviors among these patients. This study introduces and validates an evolutionary game model that provides a theoretical foundation for direct settlement policies in cross-regional treatment.

Methods

An evolutionary game model was constructed with patients and hospitals serving as strategic players within a dynamic system. This model integrates the patients' treatment utility, medical and nonmedical costs, and hospitals' financial and technological advancement benefits.

Results

The evolutionary stability analysis revealed seven-game outcomes between hospitals and patients with malignant tumors. The numerical simulations suggest an evolutionary convergence toward strategy (1, 0), indicating a trend where patients with malignant tumors opt for cross-regional treatment, yet hospitals choose not to implement a direct settlement policy. Parameter sensitivity analysis showed that the parameters set in this study affected player behavioral choices and game equilibria.

Conclusion

A strong demand for cross-regional medical treatment among Chinese patients with malignant tumors, and some hospitals require more incentives to implement cross-regional settlements. The key factors influencing the willingness of some patients with malignant tumors to resettle include the costs of in-area medical care, costs of cross-regional treatment without direct settlement, and the utility of cross-regional treatment. Technological advancement benefits and input costs influence some hospitals' motivation to adopt cross-regional settlements. Policy adjustments that effectively implement direct settlement policies can facilitate equilibrium, enhance the initiatives of some local health insurance management departments, improve the accessibility and efficiency of medical services, and reduce nonmedical expenses for patients.

Factors influencing general practice nurse's implementation of culturally responsive care, using normalization process theory: A cross-sectional study

AIMS

To explore levers and barriers to providing culturally responsive care for general practice nurses (GPNs) using normalization process theory.

DESIGN

A self-administered online cross-sectional survey.

METHODS

A participatory co-designed adapted version of the normalization of complex interventions measure (NoMAD) validated tool was distributed to a convenience sample of GPNs between December 2022 and February 2023. The sample comprised of GPNs working in general practice services in Ireland (n = 122). Data were analysed using descriptive and analytical statistics (Pearson correlations) and principles of content analysis. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

RESULTS

GPNs in this study indicated their familiarity with, acknowledged the importance of and were committed to, providing culturally responsive care. However, implementing culturally responsive care in daily practice was problematic due to insufficient education and training, scarcity of resources and supports and a lack of organizational leadership. Subsequently, GPNs experience difficulties adapting everyday practices to respond appropriately to the care needs of culturally and linguistically diverse (CaLD) patients.

CONCLUSION

This analysis highlights the necessity of exploring the intricacies of factors that influence capabilities and capacity for providing culturally responsive care. Despite demonstrating awareness of the importance of providing nursing care that responds to the needs of CaLD patients, GPNs do not have full confidence or capacity to integrate culturally responsive care into their daily work practices.

IMPACT

Using normalization process theory, this study elucidates for the first time how GPNs in Ireland make sense of, legitimize, enact and sustain culturally responsive care as a routine way of working. It illuminates the multitude of micro-level (individual), meso-level (organizational) and macro-level (structural) factors that require attention for normalizing culturally responsive care in general practice services.

PATIENT OR PUBLIC CONTRIBUTION

The study question was identified in a participatory research prioritization for Irish research about migrant health that involved migrants in the process.

COVID-19 pandemic related racial/ethnic disparities in the foster care system in the United States

BACKGROUND

The impact of COVID-19 pandemic on racial/ethnic differences in the US foster care system is unknown.

OBJECTIVE

To study the COVID-19 pandemic-related differences in racial/ethnic disparities in entry rates, exit rates, and adverse exits from foster care in US.

METHODS

Dataset: Adoption and Foster Care Analysis Reporting System (AFCARS) data from Census Bureau.

POPULATION

1,040,581 children entering and 1,140,370 children exiting foster care between 2017 and 22, under age 25 years.

ANALYSES

Age-group, sex, and race/ethnicity-specific entry rates were compared using Fisher's exact test. Exit rates and adverse exits were compared using Cox proportional hazard and logistic regression models respectively using difference-in-difference approach.

RESULTS

Entry rates increased for all children <1 year during COVID [entry ratio = 2.75 (2.72, 2.78)], especially American Indian/Alaska Native (AIAN) [entry ratio = 3.00 (2.80, 3.22)]. Exit rates decreased for all children during pandemic [exit ratio (ER) for white children = 0.399 (0.395, 0.403), p < 0.0001] with persistent disparities for AIAN [ER = 0.86 (0.83, 0.90)] and Hispanic children [ER = 0.96 (0.94, 0.97)] compared to white children. Adverse exits increased slightly during pandemic for most racial/ethnic groups [OR for white children = 1.09 (1.06, 1.12), p < 0.0001] with increase in disparities for most children of color, except Asian children. The greatest increase in disparities was for AIAN children [OR for adverse exits compared to white children post pandemic = 9.43 (8.82, 10.07), p < 0.0001].

CONCLUSION

The pandemic adversely affected all children in foster care. Entry rates disproportionately increased for AIAN children. Disparities in exit rates persisted for AIAN and Hispanic children. Disparities in adverse exits increased for most children of color, especially, AIAN children.

Barriers and facilitators to health care access for migrant children in Canada: A scoping review

PROBLEM

Migrant children face numerous challenges when settling in their new home. One of the challenges that exists is difficulties accessing health care, with many barriers existing and few facilitators to ease access. The goal of this paper is to analyze previous literature related to migrants' access to access to health care in Canada to better understand the barriers they face, and the factors that help them access services, or the facilitators.

ELIGIBILITY CRITERIA

Arksey and O'Malley's stages in scoping reviews was employed to search CINAHL, PubMed, Sociological Abstract, SocIndex, Scopus, Cochrane Library, Ovid MEDLINE(R), and Ovid Embase from 1997 to February 2020.

SAMPLE

A total of 26 Canadian studies met the inclusion criteria.

RESULTS

The review revealed the following barriers: language and culture barriers, low socioeconomic status, lack of health insurance, transportation, shortage of social support, lack of knowledge, fear of service providers/authorities, and discrimination. The facilitators for accessing health care for this population included outreach, benefit and assistance programs, cultural training, strengthening education, and various services.

CONCLUSION

The abundance of barriers to health care access and the existence of few facilitators may worsen migrant children's health, however further research is required to understand the impact.

IMPLICATION

There is a need to increase the understanding of migrant children's experiences with accessing health care services in order to inform policy, educate providers, and improve access and health outcomes.

Psychometric Testing of the Filipino Version of the Clients' Perceptions of Providers' Cultural Competency Instrument Among LGBTQ+ Population in the Philippines

Background and Purpose: Cultural competence is significant in addressing the health needs of vulnerable populations. This study conducted psychometric testing of a cultural competency instrument in the Philippines. Methods: Brislin's translation and a cross-sectional online design were used. Exploratory factor analysis (EFA) with varimax rotation examined construct validity of the 23-item scale among 157 adult LGBTQ+ residents. The scale revealed overall reliability (α = .85) including two subscales (α = .87, α = .81, and α = .61). The EFA yielded three theoretical factorial solutions. Conclusion: The Filipino version of the instrument demonstrated reliability and validity. Measuring clients' perceptions of provider and organizational cultural competency can improve the utilization of healthcare in Filipino LGBTQ+ communities. Future research will examine the dimensional structures of the instrument among expanded LGBTQ+ communities.

Culturally adapting relational savoring: A therapeutic approach to improve relationship quality

Relational savoring (RS) is a brief, strengths-based approach to heightening attentional focus to moments of positive connectedness within relationships. RS can be administered preventatively or within an intervention context when a therapist aspires to foster more optimal relational functioning. Typically administered within a one-on-one therapy setting, RS has demonstrated efficacy in enhancing intra- and interpersonal outcomes. To increase access to mental health services, the developers of RS are committed to engaging in an iterative approach of enhancing the cultural congruence and accessibility of this intervention within various cultural contexts, beginning with Latine groups in Southern California. In this article, we describe relational savoring and its theoretical and empirical support, including the process of culturally adapting the intervention within the context of three major studies, each with a distinct focus on Latine groups, a community that is underserved in mental health care settings. We then provide a vision for future research to improve upon the intervention's compatibility for Latine families and other populations.