A quality improvement approach to improving recognition of Māori tamariki (children) and assessing barriers to culturally responsive care in a paediatric ward setting

BACKGROUND

Health inequity persists in Aotearoa (New Zealand) and internationally amongst most indigenous peoples. To address these health inequities, countries need to contend with the ramifications of entrenched historical, cultural and systemic failures. Within Aotearoa part of the solution to rectifying persistent health inequities lies in shifting everyday healthcare practices towards a more culturally responsive, patient-centred approach that utilises Māori knowledge and principles. Although the need for culturally responsive services in healthcare settings is clearly evident, most practitioners struggle with the challenge of creating a culturally safe environment. Further to these challenges, there are issues related to accurate recognition of ethnicity within the time constraints of an overwrought hospital environment. Within this environment, the correct identification of ethnicity is a fundamental step in the process of moving towards culturally responsive and more inclusive care.

METHOD

The research was concerned with indigenous Māori patients being consistently and correctly identified so that they might receive culturally appropriate interaction and treatment. The research specifically focused on the impact of introducing a customised sticker prompt on the front cover of clinical notes of Māori tamariki (children) to assist with correct ethnicity identification. Surveys were conducted on the paediatric ward over a 3-week period, prior to and during the intervention to evaluate the effect of the customised stickers. This study sought to (1) assess the efficacy of a sticker to improve recognition of Māori tamariki (children), (2) examine key barriers to identifying ethnicity and (3) identify wider impacts of a sticker prompt on clinical practice.

RESULTS

Results showed wide ranging positive impacts on clinical practice and culturally responsive care. Sixty-four per cent of participants indicated that the stickers were a useful tool to improve identification of Māori tamariki. Respondents reported increased accuracy of identifying patients by ethnicity, as well as improved awareness of existing ethnicity documentation, and increased engagement regarding cultural needs and ethnicity.

CONCLUSIONS

This study identified that sticker prompts are a useful tool for healthcare workers to improve recognition and awareness of ethnicity and to increase dialogue around cultural needs. The stickers led to increased consideration of the wider elements of holistic wellbeing and therefore improved culturally responsive care for Māori tamariki.

Looking through the lens: a photovoice study examining access to services for newcomer children

PURPOSE

Canadian new immigrant families (also known as newcomers) encounter challenges navigating systems when trying to access programmes critical for their children's healthy development. The purpose of this study is to understand how newcomer families find and use early childhood programmes and services from the perspective of families and early childhood educators (ECEs) working within a settlement organization.

METHODS

Using photovoice methodology, newcomer family members (n = 8) with young children and ECEs (n = 6) participated in a series of virtual workshops to share photos and reflect on their experiences.

RESULTS

Participants discussed the systemic barriers that obstructed newcomer families' access to services for young newcomer children. Financial challenges due to unemployment/underemployment, language and cultural differences were emphasized. Despite these barriers and challenges, participants shared how culturally responsive programmes enhanced their connections to programmes and services. Both groups of participants discussed the critical role of social networks in supporting newcomers to use programmes by helping families become aware of available services and assistance with various processes such as registration.

CONCLUSIONS

This research illustrates the lived experiences of newcomer families and identifies opportunities to address inequities, improve early childhood programmes, and enhance families' access to programmes and services.

Systematic Review of the Psychometric Properties of Culturally Responsive Domestic Violence Measures

Domestic violence (DV) is a pervasive public health issue due to its high prevalence and the adverse effects it can have on individuals. Standardized measures can fail to account for within-group differences that are salient among diverse populations. The current review aims to systematically review and organize the psychometric studies of culturally responsive DV measures. The goal of the review is to inform researchers and practitioners about the validity and reliability of the existing measures to facilitate measure selection. Studies were included if they were validation studies of a DV measure, published in English in a peer-reviewed journal, demonstrated cultural responsivity, and provided evidence of validity or reliability. A total of seven studies were identified. Findings from this review showed that most participants were from South Asia or were South Asian immigrants. Some culturally specific tactics included being treated like a servant, eating last, being burned, and in-laws abuse. Most measures included in this review demonstrated compelling evidence of validity and reliability. More research is needed to develop and validate culturally responsive measures with distinctly diverse populations. Valid and reliable culturally responsive measures can be helpful for DV and non-DV service providers to precisely assess DV and provide appropriate services while documenting accurate DV prevalence rates.

Engaging African American family Caregivers in Developing a Culturally-responsive Interview Guide: A Multiphase Process and Approach

Qualitatively eliciting historically marginalized populations' beliefs, values, and preferences is critical to capturing information that authentically characterizes their experiences and can be used to develop culturally-responsive interventions. Eliciting these rich perspectives requires researchers to have highly effective qualitative interviewing guides, which can be optimized through community engagement. However, researchers have had little methodological guidance on how community member engagement can aid development of interview guides. The purpose of this article is to provide a series of steps, each supported by a case example from our work with African American family caregivers, for developing an interview guide through community engagement. We conclude by highlighting how involving historically marginalized community members in these early stages of research study development can build trust, research partnerships, and acknowledge their contribution to the development of new knowledge.

Engaging in culturally responsive and globally sustainable practices

Purpose: This article highlights critical issues facing speech, language and hearing educators, clinicians, and scholars that pertain to culturally and linguistically responsive and globally sustainable practices.Method: Points included in this article pertain to the usefulness of understanding causes and consequences of world changes; and the importance of critically examining and reconceptualizing practices in ways that eliminate the vestiges of ableism, racism, and colonialism embedded in those practices.Result: This article provides strategies for moving away from positivist science and a medical model to critical science and a social model of disability for critically analysing the impact that the changing social, political, and global landscapes have on our practices.Conclusion: These strategies will help members of the discipline to rethink policies and standards that can transform practices into those that continue to be culturally responsive, globally sustainable, and relevant in this new global context.

A Research Publication and Grant Preparation Program for Native American Faculty in STEM: Implementation of the Six R's Indigenous Framework

Faculty members in science, technology, engineering, and mathematics (STEM) disciplines are typically expected to pursue grant funding and publish to support their research or teaching agendas. Providing effective professional development programs on grant preparation and management and on research publications is crucial. This study shares the design and implementation of such a program for Native STEM faculty (NAF-STEM) from two tribal colleges and one public, non-tribal, Ph.D. granting institution during a 3-year period. The overall development and implementation of the program is centered on the six R's Indigenous framework - Respect, Relationship, Representation, Relevance, Responsibility, and Reciprocity. The role of NAF-STEM and their interactions with the program, as members of the community formed by their participation, impacted the program. Their practices and the program co-emerged over time, each providing structure and meaning for the other. Through such reciprocity, NAF-STEM and the program research team continually refined the program through their mutual engagement. They took on the shared responsibility of the program while they participated in and shaped its practices. The process and results of formative and summative assessment and the impact of COVID-19 on the program are reported. Results of the program offer lessons on the implementation of six R's framework in professional development at institutions of higher education.

Enabling Better Nutrition for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents

The unyielding obesity epidemic in adolescents from Middle Eastern (ME) backgrounds warrants culturally-responsive and co-designed prevention measures. This study aimed to capture the opinions of ME parents residing in Australia on the crisis and their enablers and barriers to healthy eating interventions given their influence on adolescent eating behaviors. Twenty-six semi-structured interviews were conducted with ME mothers, aged 35-59 years, and most residing in low socioeconomic areas (n = 19). A reflexive thematic analysis using the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework was conducted. Parents expressed confidence in knowledge of importance of healthy eating, but were reluctant to believe behaviours were engaged in outside of parental influence. Time management skills are needed to support working mothers and to minimize reliance on nearby fast-food outlets, which was heightened during COVID-19 with home-delivery. Time constraints also meant breakfast skipping was common. A culture of feeding in light of diet acculturation and intergenerational trauma in this diaspora was also acknowledged. Parents pleaded for upstream policy changes across government and school bodies to support parental efforts in the form of increased regulation of fast-food and subsidization of healthy products. Opportunities for weight-inclusive programs including parenting workshops underpinned by culturally-responsive pedagogy were recommended.

Speech-language pathologists' perceptions and experiences when working with Aboriginal and Torres Strait Islander children

PURPOSE

This study explored the perceptions of speech-language pathologists with regards to culturally responsive service delivery, assessment practices, and confidence when working with Aboriginal and Torres Strait Islander children.

METHOD

An online survey was used. Descriptive statistics were analysed with SPSS. Themes were derived from text responses using Braun and Clarke's thematic analysis method.

RESULT

The 48 respondents were almost all non-Indigenous, equally spread across metropolitan and non-metropolitan regions, and had varied levels of experience. Respondents reported moderate to high levels of confidence. Identified barriers included accessibility, policy, impacts of colonisation, awareness of services and expectations and speech pathologist knowledge, training and experience. Engagement emerged as a facilitator to provision of culturally responsive services. A variety of speech-language pathology assessment methods were reported, not all of which were consistent with current recommendations.

CONCLUSION

Identified barriers and facilitators were consistent with previous research exploring work with adults with acquired communication disorders. A need to explore the perspectives of Aboriginal and Torres Strait Islander communities as users of speech-language pathology services was identified. Clinical implications are described for future training, clinical guidelines, and flexible service delivery.

A Framework for Integrating Arts, Science, and Social Justice Into Culturally Responsive Public Health Communication and Innovation Designs

Objectives. To increase the scale and efficacy of health promotion practice, culturally responsive approaches to well-being are needed in both communication and practice innovation. This mixed-methods evaluation sought to identify specific mechanisms used in a promising practice model and offers a potential theoretical framework to support public health programs in integrating culture and social justice into communication and intervention programs. Study Design. Rooted at the intersection of ethnographic and phenomenological worldviews, this mixed-methods, retrospective process evaluation used publicly available empirical and experiential data centered on the arts, science, and social justice to identify critical mechanisms used and incorporate them into an emergent theoretical framework. Method. The retrospective process evaluation used an ethnography-informed approach combined with scientific literature reviews. To integrate adjacent ideas into the emergent theoretical framework, a phenomenologically informed theme development approach was used. Results. The evaluation resulted in a five-step framework, called MOTIF, with the potential to be utilized in diverse situational and geographic contexts. Data that surfaced from related literature reviews revealed adjacent mechanisms from positive psychology, critical consciousness theory, and innovation design that were incorporated into the emergent framework. Conclusion. MOTIF may offer a culturally responsive public health communication and innovation process capable of promoting health equity through the cultivation of relationships between artists, community participants, and public health agencies and researchers who collectively endeavor to craft innovative solutions for population health and well-being.

A Systematic Review of Culturally Responsive Approaches to Child and Adolescent Mental Health Care in Ethiopia

In 2012/2013, the prevalence of child mental illness was estimated to be between 12 and 25% in Ethiopia. The Federal Ministry of Health is currently considering the implementation of the second national mental health strategy guided by the World Health Organization's pyramid model for an optimal mix of services. This model states self-care as the fundamental concept and practice that can be facilitated by the formal and informal sectors surrounding an individual. Despite this remarkable move toward endorsing contemporary approaches to mental health services, Ethiopia struggles with a limited number of knowledgeable and skilled mental health professionals. This systematic review aims at identifying the main challenges Ethiopia might face while implementing the pyramid model. We will suggest ways to bridge the gap between the need for child/adolescent trained mental health professionals and training mental health professionals informed with the value of integrating the concepts of the pyramid model into the system of mental health care for Ethiopians. The paper also discusses the importance of integrating the Wellness based mental health approach into mental health professionals' training as a means of developing a culturally responsive approach to child and adolescent services. This review provides implications for further studies and mental health policy, systems and services in Ethiopia.

A Culturally Responsive Curricular Revision to Improve Engagement and Learning in an Undergraduate Microbiology Lab Course

We seek to increase student engagement and success to subsequently lead to increased retention and degree attainment for students at our Hispanic-serving institution. We hypothesized that using a culturally responsive approach in an undergraduate microbiology lab would increase engagement and learning gains. Using a culturally responsive approach allowed students to start their learning from their own place of understanding-centering students' lived experiences. Students interviewed family members to learn about "home remedies," and then devised experiments to test whether those home remedies affected growth of bacteria commonly implicated in gastrointestinal distress (Staphylococcus aureus, Bacillus cereus, and Escherichia coli) or sore throat (Neisseria gonorrhoeae, Streptococcus pyogenes, and Mycoplasma pneumoniae). As a final assessment, students generated project posters which they presented at a class symposium. Implementation of a culturally responsive research experience focused on the gut microbiome resulted in increased learning gains as evidenced by movement up Bloom's Revised Taxonomy Scale. Student feedback indicated increased engagement, increased confidence in communicating science and a deeper understanding and appreciation for microbiology. Taken together, the results indicate that students appreciate a more culturally responsive and student-centered approach to learning in microbiology and encourages expansion of this approach to other modules in the course. This paper includes responsive data to support this claim, as well as a sample course calendar and supplementary learning material to support the human microbiome approach to microbiology.

From panic to pedagogy: Using online active learning to promote inclusive instruction in ecology and evolutionary biology courses and beyond

The rapid shift to online teaching in spring 2020 meant most of us were teaching in panic mode. As we move forward with course planning for fall and beyond, we can invest more time and energy into improving the online experience for our students. We advocate that instructors use inclusive teaching practices, specifically through active learning, in their online classes. Incorporating pedagogical practices that work to maximize active and inclusive teaching concepts will be beneficial for all students, and especially those from minoritized or underserved groups. Like many STEM fields, Ecology and Evolution shows achievement gaps and faces a leaky pipeline issue for students from groups traditionally underserved in science. Making online classes both active and inclusive will aid student learning and will also help students feel more connected to their learning, their peers, and their campus. This approach will likely help with performance, retention, and persistence of students. In this paper, we offer broadly applicable strategies and techniques that weave together active and inclusive teaching practices. We challenge instructors to commit to making small changes as a first step to more inclusive teaching in ecology and evolutionary biology courses.

A Culturally Responsive Approach to Improving Replication of a Youth Sexual Health Program

Youth-serving agencies continually turn to evidence-based interventions that have been empirically assessed for effectiveness in influencing young people's lives, particularly those living in communities with considerable health inequities. Replicating promising evidence-based interventions requires thoughtful adaptation and modification to better fit participants' sociocultural context and to enhance their learning experiences. Due to the restrictive nature of a replication model, adaptations to the intervention curriculum must be minimized during full implementation. Implementers must find innovative ways to ensure content is relevant and engaging to participants without altering core elements of the curriculum. This article describes practical best practice strategies used in implementing a sexual health education program among socioculturally diverse youth in a northeastern city in the United States. The implementing agency applied Richard, Brown and Forde's framework for culturally responsive pedagogy as a heuristic approach to describe the application of implementation practices across three dimensions: institutional, personal, and instructional. The results not only highlight successful culturally responsive practices that enhanced the implementation process but also acknowledge areas in which such practices proved daunting to implement.

The impact of culturally responsive self-management interventions on health outcomes for minority populations: A systematic review

OBJECTIVES

The health of people from Indigenous and ethnic minorities is poorer than the remainder of the population. Frequently, Westernized health systems respond by introducing self-management interventions to improve chronic illness health outcomes. The aim of this study was to answer the research question: "Can self-management programs that have been adapted or modified still be effective for ethnic minority and Indigenous populations?"

METHODS

A systematic review across four databases was conducted.

RESULTS

Twenty-three publications met the inclusion criteria. As the studies were heterogeneous, meta-analysis was not possible. Overall, interventions resulted in more positive health outcomes than usual care, but findings were inconsistent.

DISCUSSION

We argue that rather than focusing on individual skills, knowledge, self-efficacy, and attitudes toward self-management, it may be more important to explore the structures and processes that underpin the sharing of information and skills within clinical or education encounters. Given that self-management is a Western cultural construct, creating empathic and responsive systems might be more effective for improving health of Indigenous and ethnic minority groups rather than relying predominantly on individual skill development.