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Wagner GJ, Bogart LM, Klein DJ, Lawrence SJ, Goggin K, Gizaw M, Mutchler MG. Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV. AIDS Behav 2024; 28:408-420. [PMID: 38060112 PMCID: PMC10876751 DOI: 10.1007/s10461-023-04233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
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Hicks T, Stillwater B, Koller K, Palmer L, Thomas T. Developing a culturally relevant physical activity guide for Alaska Native Head Start students in rural Alaska: the Got Neqpiaq? Study. Int J Circumpolar Health 2023; 82:2287791. [PMID: 38010792 PMCID: PMC10997299 DOI: 10.1080/22423982.2023.2287791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Concern was voiced by Elders, teachers, and parents that and playtime activities of the Head Start preschool programme were not aligned with the local Alaska Native culture in their communities.Methods: The Alaska Native Tribal Health Consortium partnered with 12 Head Start preschool programmes, administered by Rural Alaska Community Action Program in rural Alaska, to explore with community members Alaska Native value-based solutions to the concerns they raised. Local input was gathered via focus groups, interviews, and surveys.Results: We worked together with communities to create a physical activity guide specific to preschool-age children in the region. The guide includes activity descriptions, lesson plans, flash cards, and photos of traditional Alaska Native physical activities and games specific to the region. This manuscript details the community engagement process foundational to the physical activity guide's adoption and implementation.Conclusions: The processes by which the guide was developed were strength-based and participatory. Widespread community engagement and participation led to a guide that was readily adopted because the community had taken ownership of the content. The lessons learned have been invaluable in developing long-term community-based partnerships and in setting the precedent to further incorporate local/regional culture into rural Alaska Head Start programmes.
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Affiliation(s)
- Teresa Hicks
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| | - Barb Stillwater
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| | - Kathryn Koller
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| | - Lea Palmer
- Rural Alaska Community Action Program, Inc, Anchorage, AK, USA
| | - Timothy Thomas
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
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Dudgeon P, Carlin E, Derry K, Alexi J, Mitchell M, Agung-Igusti RP. Evaluating a social and emotional well-being model of service piloted in Aboriginal Community Controlled Health Services in Western Australia: an Aboriginal Participatory Action Research approach. BMJ Open 2023; 13:e075260. [PMID: 37816565 PMCID: PMC10565315 DOI: 10.1136/bmjopen-2023-075260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The delivery of services to improve Aboriginal health and well-being must centre culture and integrate a social and emotional well-being understanding and approaches. These approaches are essential in increasing access to, and engagement with, health services, as well as ensuring culturally safe, person-centred and community-centred care. This study will evaluate the Aboriginal Health Council of Western Australia's social and emotional well-being model of service being piloted in five Aboriginal Community Controlled Health Services across five of Western Australia's regions. The model of service includes the establishment of interdisciplinary social and emotional well-being teams and a four-pillar approach to service delivery. METHODS AND ANALYSIS An Aboriginal Participatory Action Research methodology will be undertaken which calls for Indigenous leadership and governance, capacity-building of community co-researchers and engagement in reflexive practice. The evaluation will take a mixed-methods approach to data collection, including at each pilot site, yarns with up to five clients engaging with social and emotional well-being services; qualitative interviews with up to five service providers at each site, and up to five key knowledge holders from stakeholders including funders and commissioning bodies; the collection of clinical data; facilitated discussion using the social and emotional well-being Systems Assessment Tool; and document analysis and cost-estimation. Analysis will be guided by a client journey mapping framework, and data will be collectively analysed through a socioecological framework to understand the connections and inter-relatedness between client outcomes and experiences, social and emotional well-being team and service provider experiences, service systems and governance structures. ETHICS AND DISSEMINATION This evaluation was approved by the Western Australian Aboriginal Health Ethics Committee (HREC1204). The findings will be disseminated through the production of an evaluation report and academic publications and presentations. Findings will also be disseminated through community forums and plain language summaries. These outputs will detail evaluation findings and recommendations, the process of evaluation through an Aboriginal Participatory Action Research approach and the collaborative stakeholder relationship-building that underpinned the project.
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Affiliation(s)
- Patricia Dudgeon
- School of Indigenous Studies, The University of Western Australia, Perth, Western Australia, Australia
| | - Emma Carlin
- Rural Clinic School, University of Western Australia, Broome, Western Australia, Australia
| | - Kate Derry
- School of Indigenous Studies, The University of Western Australia, Perth, Western Australia, Australia
| | - Joanna Alexi
- School of Indigenous Studies, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Mitchell
- School of Indigenous Studies, The University of Western Australia, Perth, Western Australia, Australia
| | - Rama Putu Agung-Igusti
- School of Indigenous Studies, The University of Western Australia, Perth, Western Australia, Australia
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Pham TV, Wilbur RE, Gone JP. Ideals of counseling practice: Therapeutic insights from an Indigenous first nations-controlled treatment program. J Couns Psychol 2023; 70:451-463. [PMID: 37199952 DOI: 10.1037/cou0000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Indigenous Canadians suffer disproportionately from mental health concerns tied to histories of colonization, including exposure to Indian Residential Schools. Previous research has indicated that preferred therapies for Indigenous populations fuse traditional cultural practices with mainstream treatment. The present study comprised 32 interviews conducted with Indigenous administrators, staff, and clients at a reserve-based addiction treatment center to identify community-driven and practical therapeutic solutions for remedying histories of coercive colonial assimilation. Thematic analysis of semi-structured interviews revealed that counselors tailored therapy through cultural preferences, including the use of nonverbal expression, culturally appropriate guidance, and alternative delivery formats. Additionally, they augmented mainstream therapeutic activities with Indigenous practices, including the integration of Indigenous concepts, traditional practices, and ceremonial activities. Collectively, this integration of familiar counseling approaches and Indigenous cultural practices in response to community priorities resulted in an innovative instance of therapeutic fusion that may be instructive for cultural adaptation efforts in mental health treatment for Indigenous populations and beyond. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital
| | - Rachel E Wilbur
- Department of Global Health and Social Medicine, Harvard Medical School
| | - Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School
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Jameel A, Penny L, Arabena K. Closing the miscommunication gap: A user guide to developing picture-based communication tools for Aboriginal and Torres Strait Islander peoples in emergency departments. Emerg Med Australas 2023; 35:873-875. [PMID: 37402479 DOI: 10.1111/1742-6723.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE To document an illustration-based methodology for culturally safe communication between Indigenous patients and clinicians in an urban ED. METHODS We co-designed a pre-ED visual tool to minimise miscommunication when triaging First Nations patients. Our steps included establishing project governance, conducting a literature review, obtaining ethics approval and designing illustrations. We then consulted relevant stakeholders, finalised the resource and contributed to the evidence base and to knowledge exchange. RESULTS Co-design is an important principle in reducing miscommunication and ensuring cultural safety in EDs. CONCLUSIONS Co-design methodologies can guide improvements in culturally safe clinical communication with First Nations patients in EDs.
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Affiliation(s)
- Aishah Jameel
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren Penny
- Karabena Consulting, Riddells Creek, Victoria, Australia
| | - Kerry Arabena
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Karabena Consulting, Riddells Creek, Victoria, Australia
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Dawson AP, Warrior E, Pearson O, Boyd MA, Dwyer J, Morey K, Brodie T, Towers K, Waters S, Avila C, Hammond C, Lake KJ, Lampard ‘UF, Wanganeen ‘UF, Bennell O, Bromley D, Shearing T, Rigney N, Czygan S, Clinch N, Pitson A, Brown A, Howard NJ. Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study. Front Public Health 2023; 11:1206371. [PMID: 37809004 PMCID: PMC10556859 DOI: 10.3389/fpubh.2023.1206371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing. Methods This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing. Results Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified. Conclusion Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.
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Affiliation(s)
- Anna P. Dawson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Eugene Warrior
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Mark A. Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Judith Dwyer
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Kurt Towers
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sonia Waters
- Aboriginal Services, AnglicareSA, Adelaide, SA, Australia
| | | | - Courtney Hammond
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Katherine J. Lake
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Indigenous Health Equity, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - ‘Uncle’ Frank Lampard
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - ‘Uncle’ Frank Wanganeen
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - Olive Bennell
- Executive Office, Nunga Mi:Minars Inc., Adelaide, SA, Australia
| | | | - Toni Shearing
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nathan Rigney
- Aboriginal Health Promotion, Wellbeing SA, Adelaide, SA, Australia
| | | | - Nikki Clinch
- Statewide Operations, South Australian Department for Corrections, Adelaide, SA, Australia
| | - Andrea Pitson
- Aboriginal Education Directorate, South Australian Department for Education, Adelaide, SA, Australia
| | - Alex Brown
- Indigenous Genomics, Telethon Kids Institute, Adelaide, South Australia, Australia
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
| | - Natasha J. Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Vitsupakorn S, Pierce N, Ritchwood TD. Cultural interventions addressing disparities in the HIV prevention and treatment cascade among Black/African Americans: a scoping review. BMC Public Health 2023; 23:1748. [PMID: 37679765 PMCID: PMC10485990 DOI: 10.1186/s12889-023-16658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
Culture is an important determinant of HIV risk and protective behaviors; yet, we know little about how it is integrated in HIV interventions. This scoping review characterizes the integration of culture in HIV prevention and treatment interventions focused on Black/African Americans. We searched MEDLINE, PsycINFO, CINAHL, and Google Scholar for peer-reviewed manuscripts published between July 1, 2011, and June 28, 2021. Twenty-five interventions were identified, with 96% focused on prevention. Most (40%) targeted men who have sex with men or transgender women. Only three were grounded in cultural theory. Although all interventions were labeled "culturally based," only two explicitly defined culture. Moreover, there was much diversity regarding the ways in which interventions integrated cultural elements, with some conflating race/ethnicity with culture. To improve uptake and HIV-related outcomes, interventions integrating culture are greatly needed. Additionally, HIV interventions purporting to be "culturally based" must include basic information to support rigor and reproducibility.
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Affiliation(s)
| | - Nia Pierce
- College of Humanities and Social Sciences, North Carolina State University, Raleigh, NC, USA
| | - Tiarney D Ritchwood
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
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Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
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Crusan A, Roozen K, Godoy-Henderson C, Zamarripa K, Remache A. Using Community-Based Participatory Research Methods to Inform the Development of Medically Tailored Food Kits for Hispanic/ Latine Adults with Hypertension: A Qualitative Study. Nutrients 2023; 15:3600. [PMID: 37630791 PMCID: PMC10459164 DOI: 10.3390/nu15163600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
The Dietary Approaches to Stop Hypertension (DASH) eating plan is the most effective dietary intervention for cardiovascular disease (CVD), but it excludes the consideration of culture and cost. The Hispanic/Latine population is disproportionately affected by CVD, with risks increasing if persons are accustomed to a Westernized diet. This research aims to understand the cultural dietary practices aligned with a DASH eating plan and the social determinants of health impacting fruit and vegetable (F/V) consumption among immigrant Hispanic/Latine individuals at a community-based clinic in Minnesota. Utilizing community-based participatory research methods, a community survey informed the development of DASH-focused, medically tailored food kits of varying F/V modalities. Qualitative feedback was sought out regarding the kits when presented to 15 individuals during in-depth interview sessions to validate the cultural appropriateness of food kits for clinical use. Box A was the highest rated kit (66.7%) and consisted of fresh F/V. The average F/V consumption per day was 2.6 ± 1.4 servings. The food insecurity questionnaires showed high/marginal (40%), low (53.3%), and very low (6.7%) food security. The barriers to consuming F/V were money, time, and transportation. Understanding cultural dietary practices related to the DASH eating plan is necessary to mitigate CVD risk and provide inclusive medical nutrition therapy for Hispanic/Latine populations.
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Affiliation(s)
- Ambria Crusan
- Department of Nutrition and Dietetics, Henrietta Schmoll School of Health Sciences, St. Catherine University, St. Paul, MN 55105, USA
| | - Kerrie Roozen
- Department of Nutrition and Dietetics, Henrietta Schmoll School of Health Sciences, St. Catherine University, St. Paul, MN 55105, USA
| | - Clara Godoy-Henderson
- Department of Health Services Research, Policy and Administration, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kathy Zamarripa
- Department of Biology, School of Arts, Humanities, and Sciences, St. Catherine University, St. Paul, MN 55105, USA
| | - Anayeli Remache
- Department of Psychology, School of Arts, Humanities, and Sciences, St. Catherine University, St. Paul, MN 55105, USA
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Blumenfeld J, Kaufman S, Raimundi-Petroski M. Creating an Alianza: Group Perinatal Education for Newly Immigrated Latinx Pregnant People. J Midwifery Womens Health 2023; 68:517-522. [PMID: 37026569 DOI: 10.1111/jmwh.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/19/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
Pregnant people who are recent immigrants often face barriers navigating the health care system and establishing a support network to sustain them through pregnancy and new parenthood. The Cultivando una Nueva Alianza (CUNA) program from the Children's Home Society of New Jersey was created to address these obstacles. For over 20 years, CUNA has collaborated with local midwives to develop a program for newly immigrated, Spanish-speaking Latinx pregnant people. The curriculum, facilitated by trained members of the community, provides education around pregnancy, birth, and early parenting and connects participants with prenatal care and community resources while cultivating a social support network. The program's success is seen in improved clinical outcomes, ongoing involvement by graduates, and strong continued support from community stakeholders. The CUNA program has been replicated in nearby communities and offers a blueprint for a low-tech intervention to improve the health and wellness of this population.
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Affiliation(s)
- Julie Blumenfeld
- Nurse Midwifery and Dual Women's Health/Nurse Midwifery Program, Advanced Practice Division, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
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Nash K, Macniven R, Clague L, Coates H, Fitzpatrick M, Gunasekera H, Gwynne K, Halvorsen L, Harkus S, Holt L, Lumby N, Neal K, Orr N, Pellicano E, Rambaldini B, McMahon C. Ear and hearing care programs for First Nations children: a scoping review. BMC Health Serv Res 2023; 23:380. [PMID: 37076841 PMCID: PMC10116763 DOI: 10.1186/s12913-023-09338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs. METHOD A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services. RESULTS Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases. CONCLUSION The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
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Affiliation(s)
- Kai Nash
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia.
| | - Rona Macniven
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Liesa Clague
- Thurru Indigenous Unit, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Harvey Coates
- The University of Western Australia, Perth, Australia
| | | | | | - Kylie Gwynne
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | - Luke Halvorsen
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Leanne Holt
- Department of Indigenous Studies, Macquarie University, Sydney, Australia
| | - Noeleen Lumby
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Neil Orr
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | | | - Boe Rambaldini
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
| | - Catherine McMahon
- The Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Sydney, Australia
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McKimmy C, Levy J, Collado A, Pinela K, Dimidjian S. The Role of Latina Peer Mentors in the Implementation of the Alma Program for Women With Perinatal Depression. Qual Health Res 2023; 33:359-370. [PMID: 36794992 DOI: 10.1177/10497323231154369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study examines the role that compañeras (peer mentors) play in the implementation of a program, Alma, which was designed to support Latina mothers who are experiencing depression during pregnancy or early parenting and implemented in the rural mountain West of the United States. Drawing from the fields of dissemination and implementation and Latina mujerista (feminist) scholarship, this ethnographic analysis demonstrates how the Alma compañeras facilitate the delivery of Alma by creating and inhabiting intimate mujerista spaces with other mothers and create relationships of mutual and collective healing in the context of relationships de confianza (of trust and confidence). We argue that these Latina women, in their capacity as compañeras, draw upon their cultural funds of knowledge to bring Alma to life in ways that prioritizes flexibility and responsiveness to the community. Shedding light on contextualized processes by which Latina women facilitate the implementation of Alma illustrates how the task-sharing model is well suited to the delivery of mental health services for Latina immigrant mothers and how lay mental health providers can be agents of healing.
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Affiliation(s)
- Caitlin McKimmy
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Joseph Levy
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Anahi Collado
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
| | | | - Sona Dimidjian
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Hwang J, Cooley A, Cooley S, Hinck R. The Effects of the Culturally Tailored Narratives on COVID-19 Vaccine Confidence Among Hispanics: A Randomized Online Experiment. J Health Commun 2023; 28:168-181. [PMID: 37006173 DOI: 10.1080/10810730.2023.2191225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Guided by the health belief model (HBM), cultural sensitivity approach, and the theory of situated cognition, this study compares the effects of culturally tailored narratives and generic narratives on the COVID-19 vaccine confidence among Hispanics. It also examines an array of cognitive responses (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived side effects) associated with the COVID-19 vaccine confidence, and the interaction of these cognitive responses with the two narrative types of messaging. The findings suggest that Hispanics exposed to culturally tailored narratives are more confident in the COVID-19 vaccine compared to Hispanics exposed to generic narratives. The study provides support for the HBM, as the perceived benefit was positively related to vaccine confidence, and the perceived barrier was negatively associated with vaccine confidence. Finally, vaccine confidence was the strongest among Hispanics who had high perceived susceptibility and were exposed to culturally tailored narratives.
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Affiliation(s)
- Juwon Hwang
- School of Media and Strategic Communication, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Asya Cooley
- School of Media and Strategic Communication, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Skye Cooley
- School of Media and Strategic Communication, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Robert Hinck
- Air War College, Air University, Montgomery, Alabama, USA
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Liddell JL, Stiffarm AL. "I Think [Western] Healthcare Fails Them": Qualitative Perspectives of State-recognized Women Tribal Members on Elders' Healthcare Access Experiences. Am Indian Alsk Native Ment Health Res 2023; 30:70-96. [PMID: 37523642 DOI: 10.5820/aian.3002.2023.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Elder tribal members are important cultural and spiritual leaders and experts among many American Indian and Alaska Native (AI/AN) cultures. AI/AN Elders play a key role in the maintenance and transmission of traditional cultural knowledge and practices and are highly valued members of AI/AN communities. AI/AN populations face disparities in healthcare outcomes, and the healthcare needs of AI/AN Elders remain an understudied area of research, particularly among tribes in the South and for tribes who do not have federal recognition. Qualitative data was collected through semi-structured interviews among 31 women, all of whom are members of a state-recognized Tribe in the Southern United States. While the interview questions were specific to their own reproductive healthcare experiences, repeated concerns were voiced by the women regarding the health of the Elders in their community. Key findings captured several concerns/barriers regarding Elders' healthcare experiences including: (a) Language and communication barriers between Elders and healthcare workers; (b) Prior negative experiences with Western medicine; (c) Lasting impacts of educational discrimination; (d) Concerns over self-invalidation; (e) Transportation barriers; and (f) Need for community programs. Issues related to these barriers have resulted in a concern that Elders are not receiving the full benefit of and access to Western healthcare systems. The purpose of this analysis was to highlight the concerns voiced by women tribal members on the health and wellbeing of Elders in their community. Opportunities related to the importance of prioritizing and improving AI/AN Elders' healthcare experiences and access are also described.
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Tane M, Stevenson LC, Cameron L, Gould GS. Evaluation of Aboriginal and Torres Strait Islander smoking cessation interventions with pregnant women in Australia: utilising a culturally appropriate tool. Aust J Prim Health 2022; 29:117-125. [PMID: 35836347 DOI: 10.1071/py22023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
Abstract
The purpose of this article was to review and evaluate three Australian projects with a focus on smoking cessation and Aboriginal and Torres Strait Islander pregnant women, funded under the Tackling Indigenous Smoking Innovation Grants Scheme, Australian Department of Health. The aim was to determine the impacts of culturally appropriate smoking cessation support for pregnant Aboriginal and Torres Strait Islander women. To provide an equity-focused lens to the review, our team of Indigenous and non-Indigenous researchers utilised an Australian-developed assessment tool: the 'Cultural Identity Interventions Systematic Review Proforma'. The tool was used to measure cultural approaches across a range of domains, and these were independently assessed by two reviewers, along with an assessment of the projects' smoking cessation outcomes. The results were compared to the evidence base in relation to aims, methods, results and conclusions, and consensus for scoring was reached. The review found that these Tackling Indigenous Smoking projects about pregnancy intentionally and effectively incorporated culturally based approaches that sought to work with the participants in culturally informed ways. Each project utilised existing social networks and partnerships to provide their participants with access to a range of community resources, adding value to existing programs.
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Affiliation(s)
- Moana Tane
- Northland District Health Board, Private Bag 9742, Whangarei 0148, New Zealand
| | - Leah C Stevenson
- Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia
| | - Liz Cameron
- Faculty of Arts and Education, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Gillian S Gould
- Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia
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Alberto CK, Kemmick Pintor J, Martínez-Donate A, Tabb LP, Langellier B, Stimpson JP. Association of Maternal-Clinician Ethnic Concordance With Latinx Youth Receipt of Family-Centered Care. JAMA Netw Open 2021; 4:e2133857. [PMID: 34757410 PMCID: PMC8581727 DOI: 10.1001/jamanetworkopen.2021.33857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Disparities in medical home provisions, including receipt of family-centered care (FCC), have persisted for Latinx youths in the US. OBJECTIVE To examine the association between maternal-clinician ethnic concordance and receipt of FCC among US-born Latinx youths. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional secondary analysis of data from the Medical Expenditure Panel Survey from January 1, 2010, to December 31, 2017, was conducted. Data analysis was performed from January 6 to February 3, 2020. Latinx youths (age, ≤17 years) born in the US who had a usual source of care and used care in the past year, their Latina mothers (age, 18-64 years), and youths' health care clinician characteristics (eg, race, ethnicity, and sex) were evaluated using χ2 tests and propensity-score matching methods. MAIN OUTCOMES AND MEASURES Maternal reports on whether their youths' clinician listened carefully to the parent, explained things in a way the parent could understand, showed respect, and spent enough time with the patient. RESULTS There were 2515 US-born Latinx youths with linked maternal characteristics during the study period; 51.67% (95% CI, 48.87%-54.45%) of the youths were male, mean (SD) age was 8.48 (0.17) years (30.86% [95% CI, 28.39%-33.44%] were between ages 5 and 9 years), 61.53% (95% CI, 57.15%-65.74%) had public insurance coverage, and 39.89% (95% CI, 32.33%-47.89%) had mothers who were ethnically concordant with the youths' medical care clinician. We found that for youths with maternal-clinician ethnic concordance, the probabilities of reporting FCC were significantly higher than they would have been in the absence of concordance: that the medical care clinician listened carefully to the parent (average treatment effect on the treated [ATET], 5.44%; 95% CI, 2.14%-8.74%), explained things in a way the parent could understand (ATET, 4.82%; 95% CI, 1.60%-8.03%), showed respect for what the parent had to say (ATET, 5.51%; 95% CI, 2.58%-8.45%), and spent enough time with the patient (ATET, 5.28%; 95% CI, 1.68%-8.88%). CONCLUSIONS AND RELEVANCE Given the increase of Latinx populations and the simultaneous shortage of underrepresented minority health care clinicians, the findings of this study suggest that increasing the number of clinicians from underrepresented minority backgrounds and ethnic-concordant parental-clinician relationships may help reduce disparities in receipt of medical home provision among US-born Latinx youths.
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Affiliation(s)
- Cinthya K. Alberto
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Ana Martínez-Donate
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Loni Philip Tabb
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Brent Langellier
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jim P. Stimpson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Đoàn LN, Chong SK, Misra S, Kwon SC, Yi SS. Immigrant Communities and COVID-19: Strengthening the Public Health Response. Am J Public Health 2021; 111:S224-S231. [PMID: 34709878 PMCID: PMC8561064 DOI: 10.2105/ajph.2021.306433] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (Am J Public Health. 2021;111(S3):S224-S231. https://doi.org/10.2105/AJPH.2021.306433).
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Affiliation(s)
- Lan N Đoàn
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Stella K Chong
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Supriya Misra
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Simona C Kwon
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Stella S Yi
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
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Soltero EG, Peña A, Gonzalez V, Hernandez E, Mackey G, Callender C, Dave JM, Thompson D. Family-Based Obesity Prevention Interventions among Hispanic Children and Families: A Scoping Review. Nutrients 2021; 13:nu13082690. [PMID: 34444850 PMCID: PMC8402012 DOI: 10.3390/nu13082690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 01/02/2023] Open
Abstract
This scoping review examined intervention and sample characteristics of family-based obesity prevention interventions among Hispanic youth. This review also examined the degree to which existing interventions were culturally-adapted, acknowledged social determinants of health (SDoH), and collaborated with community stakeholders. A comprehensive search across Medline Ovid, Embase, Scopus, PsycInfo, and Pubmed was used to identify 13 studies primarily based in the U.S. (92.3%). Data was extracted by two independent reviewers. Most used a randomized control trial design (69.2%), a behavior change theory (84.6%), and reported moderate to high (≥70%) retention (69.2%). Studies targeted improvements in physical activity (69.2%) and fruit and vegetable intake (92.3%) through nutrition education, cooking demonstrations, and tastings. Younger children from low socioeconomic backgrounds (61.5%) were well represented. Most interventions were culturally-adapted (69.2%), all studies reported collaboration with stakeholders, yet only half used strategies that acknowledged SDoH (46.2%). To increase our understanding of the underlying mechanisms by which family-based approaches can reach and engage Hispanic youth and families, future studies should rigorously evaluate theoretical constructs, family processes, and SDoH that influence program participation and health behaviors. This information will guide the design and development of future interventions aimed at reducing obesity disparities among Hispanic youth.
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Affiliation(s)
- Erica G. Soltero
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (E.G.S.); (E.H.); (G.M.); (C.C.); (J.M.D.)
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, 500 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Veronica Gonzalez
- Health Promotion and Health Education, School of Public Health, University of Texas Health, 1200 Pressler St., Houston, TX 77030, USA;
| | - Edith Hernandez
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (E.G.S.); (E.H.); (G.M.); (C.C.); (J.M.D.)
| | - Guisela Mackey
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (E.G.S.); (E.H.); (G.M.); (C.C.); (J.M.D.)
| | - Chishinga Callender
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (E.G.S.); (E.H.); (G.M.); (C.C.); (J.M.D.)
| | - Jayna M. Dave
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (E.G.S.); (E.H.); (G.M.); (C.C.); (J.M.D.)
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (E.G.S.); (E.H.); (G.M.); (C.C.); (J.M.D.)
- Correspondence: ; Tel.: +713-798-7076
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McDonell MG, Hirchak KA, Herron J, Lyons AJ, Alcover KC, Shaw J, Kordas G, Dirks LG, Jansen K, Avey J, Lillie K, Donovan D, McPherson SM, Dillard D, Ries R, Roll J, Buchwald D. Effect of Incentives for Alcohol Abstinence in Partnership With 3 American Indian and Alaska Native Communities: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:599-606. [PMID: 33656561 PMCID: PMC7931140 DOI: 10.1001/jamapsychiatry.2020.4768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022]
Abstract
Importance Many American Indian and Alaska Native communities are disproportionately affected by problems with alcohol use and seek culturally appropriate and effective interventions for individuals with alcohol use disorders. Objective To determine whether a culturally tailored contingency management intervention, in which incentives were offered for biologically verified alcohol abstinence, resulted in increased abstinence among American Indian and Alaska Native adults. This study hypothesized that adults assigned to receive a contingency management intervention would have higher levels of alcohol abstinence than those assigned to the control condition. Design, Setting, and Participants This multisite randomized clinical trial, the Helping Our Native Ongoing Recovery (HONOR) study, included a 1-month observation period before randomization and a 3-month intervention period. The study was conducted at 3 American Indian and Alaska Native health care organizations located in Alaska, the Pacific Northwest, and the Northern Plains from October 10, 2014, to September 2, 2019. Recruitment occurred between October 10, 2014, and February 20, 2019. Eligible participants were American Indian or Alaska Native adults who had 1 or more days of high alcohol-use episodes within the last 30 days and a current diagnosis of alcohol dependence. Data were analyzed from February 1 to April 29, 2020. Interventions Participants received treatment as usual and were randomized to either the contingency management group, in which individuals received 12 weeks of incentives for submitting a urine sample indicating alcohol abstinence, or the control group, in which individuals received 12 weeks of incentives for submitting a urine sample without the requirement of alcohol abstinence. Regression models fit with generalized estimating equations were used to assess differences in abstinence during the intervention period. Main Outcomes and Measures Alcohol-negative ethyl glucuronide (EtG) urine test result (defined as EtG<150 ng/mL). Results Among 1003 adults screened for eligibility, 400 individuals met the initial criteria. Of those, 158 individuals (39.5%; mean [SD] age, 42.1 [11.4] years; 83 men [52.5%]) met the criteria for randomization, which required submission of 4 or more urine samples and 1 alcohol-positive urine test result during the observation period before randomization. A total of 75 participants (47.5%) were randomized to the contingency management group, and 83 participants (52.5%) were randomized to the control group. At 16 weeks, the number who submitted an alcohol-negative urine sample was 19 (59.4%) in the intervention group vs 18 (38.3%) in the control group. Participants randomized to the contingency management group had a higher likelihood of submitting an alcohol-negative urine sample (averaged over time) compared with those randomized to the control group (odds ratio, 1.70; 95% CI, 1.05-2.76; P = .03). Conclusions and Relevance The study's findings indicate that contingency management may be an effective strategy for increasing alcohol abstinence and a tool that can be used by American Indian and Alaska Native communities for the treatment of individuals with alcohol use disorders. Trial Registration ClinicalTrials.gov Identifier: NCT02174315.
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Affiliation(s)
- Michael G. McDonell
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
| | - Katherine A. Hirchak
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Jalene Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque
- Department of Psychology, University of New Mexico, Albuquerque
| | - Abram J. Lyons
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Karl C. Alcover
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | | | - Gordon Kordas
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | | | | | | | | | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Sterling M. McPherson
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
| | | | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - John Roll
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Program of Excellence in Addictions Research, Washington State University, Spokane
| | - Dedra Buchwald
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Institute for Research and Education to Advance Community Health, Washington State University, Spokane
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20
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West M, Sadler S, Hawke F, Munteanu SE, Chuter V. Effect of a culturally safe student placement on students' understanding of, and confidence with, providing culturally safe podiatry care. J Foot Ankle Res 2021; 14:9. [PMID: 33499892 PMCID: PMC7836510 DOI: 10.1186/s13047-021-00450-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For university-based podiatry education there are little data available documenting the delivery method and impact of Aboriginal and Torres Strait Islander health curricula or the use of, and outcomes from, immersive clinical placements generally or specific to podiatry practice. Therefore, the primary aim of this study was to evaluate the effect of undertaking clinical placement in a culturally safe podiatry service for Aboriginal and Torres Strait Islander Peoples on podiatry students' understanding of, and confidence with, providing culturally safe podiatry care. METHODS Final year University of Newcastle undergraduate podiatry students attending a culturally safe Aboriginal and Torres Strait Islander student clinic at a local hospital were purposively recruited to participate. Students completed a custom-made and pilot-tested cultural awareness and capability survey before and after placement. Survey domains were determined from a principle component analysis. The Wilcoxon Signed Rank test was used to compare pre-placement scores on each domain of the survey to the post-placements scores. Effect sizes were calculated and interpreted as small (0.1-0.29), medium (0.3-0.49), and large (≥0.5). RESULTS This study recruited 58 final year University of Newcastle podiatry students to complete baseline and follow-up surveys. For survey domain 1 (level of understanding of power relationships), domain 2 (level of understanding of the interrelationship between culture and self-perceived health), domain 3 (level of understanding of the importance of culture in clinical practice and access to health care), and domain 4 (level of confidence with providing culturally safe care) a statistically significant (p < 0.05) increase in scores was recorded post-placement. The effect sizes were medium to large. CONCLUSION This study demonstrated that an immersive student placement at a culturally safe podiatry clinic significantly improved students' understanding of, and confidence with, providing culturally appropriate care to Aboriginal and Torres Strait Islander Peoples. This study provides foundation evidence of the role that such placements have on developing students' cultural capability in a tertiary health care setting, and will help inform future curricula development at both educational institutions and health services, as well as form the basis for ongoing research.
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Affiliation(s)
- Matthew West
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Sean Sadler
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Fiona Hawke
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Shannon E. Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308 Australia
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21
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Sensoy Bahar O, Byansi W, Kivumbi A, Namatovu P, Kiyingi J, Ssewamala FM, McKay MM, Nyoni T. From "4Rs and 2Ss" to "Amaka Amasanyufu" (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context. Fam Process 2020; 59:1928-1945. [PMID: 32027763 PMCID: PMC7416434 DOI: 10.1111/famp.12525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.
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Affiliation(s)
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Apollo Kivumbi
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | - Joshua Kiyingi
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Thabani Nyoni
- Brown School, Washington University in St. Louis, St. Louis, MO
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Ramirez AG, Muñoz E, Long Parma D, Perez A, Santillan A. Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors. Cancer Med 2020; 9:7837-7848. [PMID: 32979042 PMCID: PMC7643682 DOI: 10.1002/cam4.3272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Breast cancer survivorship is a life-long process involving challenges to health-care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer-specific quality of life (QoL) in Latina breast cancer survivors (BCS). METHODS We conducted a 2-year, two-arm randomized controlled trial of the "Staying Healthy" program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]-G) and breast cancer-specific (FACT-B) QoL. RESULTS PN+ participants had significantly improved QoL measures compared to PN at 6-month follow-up on all subscales (P-values .007-.04) except physical well-being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT-G overall was 7.9 (3.1); P = .01. For FACT-B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7-3.1 (0.8-1.2); P-values .006-.04], except for PWB [1.5 (1.0); P = .16] and social/family well-being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline. DISCUSSION Multiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation-focused partnerships among patients, health-care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL.
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Affiliation(s)
- Amelie G. Ramirez
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
- The Mays Cancer CenterUT Health San Antonio MD Anderson Cancer CenterSan AntonioTXUSA
| | - Edgar Muñoz
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
| | - Dorothy Long Parma
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
- The Mays Cancer CenterUT Health San Antonio MD Anderson Cancer CenterSan AntonioTXUSA
| | - Arely Perez
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
| | - Alfredo Santillan
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
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Dyson L, Bedford H, Condon L, Emslie C, Ireland L, Mytton J, Overend K, Redsell S, Richardson Z, Jackson C. Identifying interventions with Gypsies, Roma and Travellers to promote immunisation uptake: methodological approach and findings. BMC Public Health 2020; 20:1574. [PMID: 33081730 PMCID: PMC7574499 DOI: 10.1186/s12889-020-09614-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 09/27/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In the UK, Gypsy, Roma and Traveller (GRT) communities are generally considered to be at risk of low or variable immunisation uptake. Many strategies to increase uptake for the general population are relevant for GRT communities, however additional approaches may also be required, and importantly one cannot assume that "one size fits all". Robust methods are needed to identify content and methods of delivery that are likely to be acceptable, feasible, effective and cost effective. In this paper, we describe the approach taken to identify potential interventions to increase uptake of immunisations in six GRT communities in four UK cities; and present the list of prioritised interventions that emerged. METHODS This work was conducted in three stages: (1) a modified intervention mapping process to identify ideas for potential interventions; (2) a two-step prioritisation activity at workshops with 51 GRTs and 25 Service Providers to agree a prioritised list of potentially feasible and acceptable interventions for each community; (3) cross-community synthesis to produce a final list of interventions. The theoretical framework underpinning the study was the Social Ecological Model. RESULTS Five priority interventions were agreed across communities and Service Providers to improve the uptake of immunisation amongst GRTs who are housed or settled on an authorised site. These interventions are all at the Institutional (e.g. cultural competence training) and Policy (e.g. protected funding) levels of the Social Ecological Model. CONCLUSIONS The "upstream" nature of the five interventions reinforces the key role of GP practices, frontline workers and wider NHS systems on improving immunisation uptake. All five interventions have potentially broader applicability than GRTs. We believe that their impact would be enhanced if delivered as a combined package. The robust intervention development and co-production methods described could usefully be applied to other communities where poor uptake of immunisation is a concern. STUDY REGISTRATION Current Controlled Trials ISRCTN20019630, Date of registration 01-08-2013, Prospectively registered.
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Affiliation(s)
- Lisa Dyson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Louise Condon
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Carol Emslie
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lana Ireland
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Julie Mytton
- University of the West of England, Centre for Child and Adolescent Health, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Karen Overend
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Sarah Redsell
- Faculty of Health, Social Care and Education, Anglia Ruskin University East Road Campus, Cambridge, CB1 1PT UK
| | - Zoe Richardson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Cath Jackson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
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Rojas JG, Herrero R. Changing Home: Experiences of the Indigenous when Receiving Care in Hospital. Invest Educ Enferm 2020; 38:e08. [PMID: 33306898 PMCID: PMC7885541 DOI: 10.17533/udea.iee.v38n3e08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To understand the meaning of the experience of the indigenous when receiving care in a low-complexity hospital. METHODS Qualitative study with ethnographic approach conducted in a hospital of Antioquia, Colombia. The study had 12 indigenous participants who underwent semi-structured interviews. Observation was carried out in hospitalization wards, emergency, and outpatient services of the institution during 40 hours. The analysis process was performed descriptively. The methodological rigor was maintained by applying criteria of confirmability, credibility, transferability, and consistency. The study was approved by the Ethics Committee and authorized by the indigenous authorities to enter the field. RESULTS Five themes emerged: the context of caring for the indigenous, the need to consult the hospital, changes experienced by the indigenous in the hospital, experiences in relation with treatments, and relations established within the hospital. The meaning is constructed from a dichotomous perspective based on the favorable or unfavorable aspects of the situations and experiences, which for the indigenous is like "changing home". CONCLUSIONS The meaning of the experience of receiving care in hospital for the indigenous is constructed from the context in which they live and receive health services, the changes they live in the dimension of space by virtue of their traveling from their vital space to another space that, due to their physical characteristics, results strange and different, even not healing. Upon the difficulties, the indigenous develop strategies and actions to overcome limitations, whether through adaptation and learning.
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Affiliation(s)
| | - Raquel Herrero
- Departamento de Enfermería, Universidad de Granada, Spain,
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Kaushik P, Reed B, Kalirai S, Perez-Nieves M. Challenges in insulin initiation among Hispanics/Latinos with diabetes in the United States. Prim Care Diabetes 2020; 14:401-412. [PMID: 32063507 DOI: 10.1016/j.pcd.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/08/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The prevalence of diagnosed diabetes in the United States (U.S.) is particularly high among people of Hispanic/Latino ethnicity, placing this population at risk of developing diabetes-related complications. We conducted a systematic literature review to understand and communicate the current gaps and disparities, including myths and misconceptions, regarding insulin initiation among the Hispanic/Latino population in the U.S. METHODS We searched MEDLINE and MEDLINE In-process, e-pubs ahead of print (OvidSP), EMBASE (OvidSP), and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy combined free text and controlled vocabulary terms and was developed to identify challenges associated with insulin use and initiation, as well as myths/misconceptions associated with insulin use. The quality of included studies was assessed using the National Institutes of Health (NIH) quality assessment tool. PRINCIPAL RESULTS In total, 777 articles were identified, with 13 articles included for data synthesis. Frequently reported barriers to initiating diabetes treatment among the Hispanic/Latino community related to socioeconomic and sociocultural factors. In particular, limited health literacy and access to health care, as well as low education and economic status, were common factors preventing treatment initiation for diabetes. Cultural factors, including language, food preferences, and lack of family support were also evident, with misconceptions and fears concerning insulin being commonly reported. Patients also described barriers concerning health care providers, including interpersonal issues and difficulties with communication and language. MAJOR CONCLUSIONS Overall, the current literature highlights many obstacles facing Hispanic/Latino patients in initiating insulin treatment for diabetes. Although limited research was identified, we describe common barriers and themes among this minority population. Awareness of these barriers is important for health care providers, enabling them to identify and address insulin-related fears and misconceptions and to be mindful of their cultural competency. Additionally, knowledge of current barriers will guide further research aimed at developing tailored strategies and tools to improve long-term health outcomes and quality of life in this population.
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Affiliation(s)
- Puneet Kaushik
- Eli Lilly Services India Private Limited, Building Primrose (7B), Embassy Tech Village, Outer Ring Road, Bengaluru, India.
| | - Beverly Reed
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Samaneh Kalirai
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Magaly Perez-Nieves
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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Chen AMH, Cailor SM, Wicker E, Harper NG, Franz TT, Pahl B. Integrating Health Literacy and Cultural Competency Concepts Across the Doctor of Pharmacy Curriculum. Am J Pharm Educ 2020; 84:ajpe7764. [PMID: 33149324 PMCID: PMC7596614 DOI: 10.5688/ajpe7764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/16/2020] [Indexed: 05/22/2023]
Abstract
Objective. To determine the longitudinal impact of integrating health literacy and cultural competency content throughout the professional pharmacy curriculum and the impact of additional changes made to the curriculum based on the results of a longitudinal analysis. Methods. Health literacy and cultural competency concepts were integrated throughout a four-year professional pharmacy curriculum. A cohort of students were assessed using health literacy and cultural competency survey instruments at baseline, the end of the fall semester of the first professional (P1) year, and the end of each subsequent academic year. From the four-year assessment, a need for additional reinforcement in the spring P1 semester was identified, so a health literacy activity was incorporated into an introductory pharmacy practice experience (IPPE) for two cohorts of students. The outcomes were compared to those of a single cohort of students who had completed their P1 year prior to integration of the additional content. A health literacy survey instrument was given at the beginning and after completion of the semester to assess change. Preceptors also completed a brief survey. Results. Curricular integration improved health literacy and cultural competency attitudes and self-perceived ability in P1 students, as assessed by the instruments. However, declines in students' health literacy and cultural competency were identified when the students were retested in the spring semester. After implementing the health literacy IPPE activity, the health literacy scores of P1 students in the two subsequent years improved. Preceptors also gave positive feedback on the utility of this activity. Conclusion. Integrating health literacy and cultural competency content throughout the curriculum resulted in improvement in students' scores in these areas from the first to the fourth professional year, but when there were no integrated activities, scores dropped. Implementing additional activities improved student-perceived HL skills. Thus, it may be important to ensure there is inclusion of content in each semester of the curriculum to maximize effects.
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Affiliation(s)
- Aleda M H Chen
- Cedarville University, School of Pharmacy, Cedarville, Ohio
| | | | - Emily Wicker
- Cedarville University, School of Pharmacy, Cedarville, Ohio
| | | | - Thad T Franz
- Cedarville University, School of Pharmacy, Cedarville, Ohio
| | - Brenda Pahl
- Cedarville University, School of Pharmacy, Cedarville, Ohio
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Cooper DK, Wieling E, Domenech Rodríguez MM, Garcia-Huidobro D, Baumann A, Mejia A, Le HN, Cardemil EV, Acevedo-Polakovich ID. Latinx Mental Health Scholars' Experiences with Cultural Adaptation and Implementation of Systemic Family Interventions. Fam Process 2020; 59:492-508. [PMID: 30830697 DOI: 10.1111/famp.12433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An increasing number of culturally adapted family-level interventions address mental health disparities with marginalized populations in the United States. However, with these developments many barriers have arisen, such as challenges with degree of cultural fit, engagement, and sustainability. We conducted 12 elite phenomenological interviews with mental health scholars involved in prevention and intervention family research with various Latinx communities within and outside of the United States. These scholars discussed their experiences of overcoming barriers in their research. We used thematic analysis to code and analyze participant responses, and our findings support the gaps in previous literature and highlight potential pathways to overcoming barriers in cultural adaptation research. Themes included the need for: (a) better understanding of the intersection between culture and context; (b) community-centered approaches to addressing implementation challenges; and (c) structural changes within institutional, governmental, and political levels. We discuss implications for researchers and practitioners working with Latinx families.
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Affiliation(s)
- Daniel K Cooper
- Department of Family Social Science, University of Minnesota, St. Paul, MN
| | - Elizabeth Wieling
- Department of Family Social Science, University of Minnesota, St. Paul, MN
| | | | - Diego Garcia-Huidobro
- Department of Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ana Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
| | | | - Huynh-Nhu Le
- Department of Psychology, The George Washington University, Washington, DC
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Kuhn JL, Vanegas SB, Salgado R, Borjas SK, Magaña S, Smith DaWalt L. The Cultural Adaptation of a Transition Program for Latino Families of Youth with Autism Spectrum Disorder. Fam Process 2020; 59:477-491. [PMID: 30844083 PMCID: PMC7191653 DOI: 10.1111/famp.12439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
During the transition to adulthood, effective and culturally relevant supports are critical for families of youth with autism spectrum disorder (ASD). There is a dearth of documented program development and research on supports for Spanish-speaking Latino families during this life stage. The present work describes the cultural adaptation process of an evidence-based transition program for Latino families of youth with ASD. A model of the actions necessary to meaningfully conduct a cultural adaptation in this context is described. After implementing the culturally adapted program titled Juntos en la Transición with five Spanish-speaking families, parents reported high social validity of the program through surveys and interviews. The cultural adaptation process followed in this work is important for the further development of programs that address the transition needs of Latino youth with ASD and their families. Our impressions may also be useful to those who aim to develop culturally sensitive and ecologically valid multifamily group intervention programs for families from cultural and linguistic minority groups.
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Mandlik N, Kamat D. Medical Anthropology in Pediatrics: Improving Disparities by Partnering with Families. Pediatr Ann 2020; 49:e222-e227. [PMID: 32413150 DOI: 10.3928/19382359-20200421-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cultural health beliefs and practices often affect accuracy of diagnoses, health care delivery, and treatment plan adherence, which can lead to health disparity. However, the effect of these belief systems, and acceptance of health care provider recommendations is not commonly discussed. As the proportion of patients from a variety of ethnic and cultural backgrounds increases, an awareness of these belief systems can help achieve better health outcomes. A provider who is flexible and can understand and possibly integrate traditionally non-Western approaches into their treatment plans may build a stronger bond of trust with their patient, thus building a bridge to better health and well-being. [Pediatr Ann. 2020;49(5):e222-e227.].
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Firdous T, Darwin Z, Hassan SM. Muslim women's experiences of maternity services in the UK: qualitative systematic review and thematic synthesis. BMC Pregnancy Childbirth 2020; 20:115. [PMID: 32070299 PMCID: PMC7029511 DOI: 10.1186/s12884-020-2811-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/13/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This review aimed to identify and synthesise evidence of Muslim women's experiences of maternity services in the UK. A systematic review and thematic synthesis of qualitative evidence, unrestricted by type of publication was conducted. Muslim women who had accessed maternity services in the UK, regardless of obstetric or medical history were included. METHOD Databases were searched from 2001 to 2019 and screened for inclusion using pre-determined criteria. The Critical Appraisal Skills Programme Qualitative Research Checklist was used to assess study quality and findings were synthesised using thematic synthesis, as described by Thomas and Harden. RESULTS Six studies were included. The following five themes were identified: Islamic practices and Individualised care; Talk, Teach and Translate; Injustice, Inequity and Intolerance; If Allah wills; and, 'It's not all that bad'. Synthesis highlighted the significance of Islam in shaping many of the women's decision-making relating to antenatal screening and medication, which was contrasted with healthcare professionals' limited awareness of the importance of Islam for motherhood. The majority of women experienced poor maternity care which at times indicated stereotypical and discriminatory behaviour. CONCLUSIONS Education for healthcare professionals is warranted, to enhance the quality and cultural competency in providing appropriate care that acknowledges and meets Muslim women's needs.
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Affiliation(s)
- Tasneema Firdous
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Zoe Darwin
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
| | - Shaima M Hassan
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.
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Benoit M, Rondeau L, Aubin E. [Coming from Afar and Rediscovering Oneself: Group Intervention for Immigrant and Refugee Women Having Experienced Violence]. Sante Ment Que 2020; 45:147-168. [PMID: 33651937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives This paper has a clinical perspective and presents an innovative intervention that could be offered in different institutions and practice environments. The object here is a group intervention addressed specifically to immigrant and refugee women having experienced different forms of violence. The consequences of being exposed to intentional and dehumanizing violence, paired with the challenges associated with migration and forced exile, can fragilize the individuals and challenge their capacity to adapt. Even though psychological and psychosocial support in the years following their arrival could be beneficial, immigrants and refugees rarely use institutional services, and experts point out that the services are not tailored to them. In that respect stems the importance of promoting the development of more meaningful interventions for immigrants and refugees, in accordance with the principle of equity and equality of chances to have access to appropriate services, but also to better equip the specialists by giving them access to safe and culturally sensitive interventions. Following that perspective, a group intervention for immigrants and refugees having experienced violence was created in 2010 with the collaboration of researchers from l'IUPLSSS and social workers from CIUSSS de l'Estrie-Chus. Method Firstly, this article aims to present this group intervention. Innovative features of the proposed program will be highlighted, followed by an overview of the clinical and empirical supports that recommend the use of groups and art to intervene with immigrants and refugees. A more detailed description of the intervention will follow, describing the objectives of the intervention as well as the intervention framework, including some necessary components to assure the therapeutic reach of the groups and the establishment of a safe space. Secondly, the article presents a brief summary of the preliminary results of a current study aiming to evaluate the impacts of the intervention. During this study, qualitative and quantitative data was collected from 3 groups (n = 17) and analyzed with content analysis and non-parametric analyses to measure the changes between pre and post intervention. Results The results of the qualitative and quantitative analyses show that women report positive changes at the end of the group, namely in regard to post-traumatic stress symptoms and different dimensions of their well-being. Conclusion To conclude, the advantages and limits of this intervention will be discussed, but also its relevance for the practice environments. Even if it isn't the only answer for the intervention in a post-violence context, it consists of a good option for providing adapted services to the reality and needs of immigrants and refugees.
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Affiliation(s)
- Maryse Benoit
- Département de psychologie, Université de Sherbrooke ; Institut universitaire de première ligne en santé et services sociaux (IUPLSSS)
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Wong SM, Kamaka M, Carpenter DAL, Seamon EM. A Review of the Literature on Native Hawaiian End-of-Life Care: Implications for Research and Practice. Hawaii J Health Soc Welf 2019; 78:41-44. [PMID: 31930201 PMCID: PMC6949468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The need for cultural understanding is particularly important in end-of-life (EOL) care planning as the use of EOL care in minority populations is disproportionately lower than those who identify as Caucasian. Data regarding the use of EOL care services by Native Hawaiians in Hawai'i and the United States is limited but expected to be similarly disproportionate as other minorities. In a population with a lower life expectancy and higher prevalence of deaths related to chronic diseases such as cardiovascular disease, diabetes, and obesity, as compared to the state of Hawai'i as a whole, our objective was to review the current literature to understand the usage and perceptions of EOL care planning in the Native Hawaiian population. We searched ten electronic databases and after additional screening, seven articles were relevant to our research purpose. We concluded that limited data exists regarding EOL care use specifically in Native Hawaiians. The available literature highlighted the importance of understanding family and religion influences, educating staff on culturally appropriate EOL care communication, and the need for more research on the topic. The paucity of data in EOL care and decision-making in Native Hawaiians is concerning and it is evident this topic needs more study. From national statistics it looks as though this is another health disparate area that needs to be addressed and is especially relevant when considering the rapid increase in seniors in our population.
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Affiliation(s)
- Shelley M. Wong
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Martina Kamaka
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Stojanovska L, Naemiratch B, Apostolopoulos V. Type 2 Diabetes in People from Culturally and Linguistically Diverse Backgrounds: Perspectives for Training and Practice from Nutritional Therapy and Dietician Professions. ACTA ACUST UNITED AC 2019; 38:15-24. [PMID: 28593887 DOI: 10.1515/prilozi-2017-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the perspectives of nutritional therapy and dietician practitioners, undergraduate students and academics working with people with type 2 diabetes and who are from culturally and linguistically diverse (CALD) backgrounds. METHODS A qualitative study design of in-depth semi-structured one-on-one interviews with a total of 24 participants (8 practitioners, 8 students and 8 academics) in the fields of nutritional therapy and dietetics. Open-ended questions focused on the perspectives and experiences (learning, practice and teaching) of working with people of CALD backgrounds who have type 2 diabetes. All interviews were recorded for thematic and textual analysis. RESULTS Inter-related themes which were confirmed with investigator triangulation were the understanding of (i) the concepts of culture and diversity, (ii) the concepts and influences of health, diabetes and food across cultures, (iii) influences within and across cultures and (iv) systems and resourcing. Overarching perspectives across these themes suggested frustration in having sufficient capacity to assess comprehensively, to deliver effective, comprehensive and high quality management plans, and to achieve required health behavioural changes with people from different CALD backgrounds. CONCLUSIONS There's a need for improvements in the undergraduate education and training and in professional development programs; training and resourcing of interpreters in delivery of health-related information and working with health professionals; for focus on culturally appropriate management plans that involve consultation with key decision makers in families and communities; and, reviews of the systems for supporting and resourcing nutritional therapists and dieticians in professional development from undergraduate to practice levels.
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Affiliation(s)
- Lily Stojanovska
- Centre for Chronic Disease, College of Health and Biomedicine, PO Box 14428, Melbourne VIC 8001
| | - Bhensri Naemiratch
- Centre for Chronic Disease, College of Health and Biomedicine, PO Box 14428, Melbourne VIC 8001 Australia
| | - Vasso Apostolopoulos
- Centre for Chronic Disease, College of Health and Biomedicine, PO Box 14428, Melbourne VIC 8001
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Kelley FR, Haas GL, Felber E, Travis MJ, Davis EM. Religious Community Partnerships: a Novel Approach to Teaching Psychiatry Residents about Religious and Cultural Factors in the Mental Health Care of African-Americans. Acad Psychiatry 2019; 43:300-305. [PMID: 30617998 DOI: 10.1007/s40596-018-1010-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/29/2018] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Promoting awareness in residency training about the influence of religion on the doctor's and patient's ability to negotiate a patient-centered treatment plan is challenging and yet important for improving the quality of mental health care for religious individuals. This paper aims to explore the use of community partners and non-psychiatry faculty to provide this education within psychiatry residency programs. METHODS Fifty-one psychiatry residents at an academic psychiatric hospital took part in a 4-h interdisciplinary workshop aimed at improving doctors' overall approach to treating African-American Christian patients. Community-based African-American clergy and mental health professionals, hospital-based psychiatrists, and primary care physicians facilitated educational sessions. A majority of the facilitators were African-American. A pre- and post-workshop survey was administered to measure change in participant attitudes and comfort levels associated with exposure to the workshop. Paired t tests on three subscales were used to calculate change in attitudes on pre- to post-workshop surveys. RESULTS Resident scores on each of the three factor subscales increased significantly between pre- and post-workshop assessments: comfort in discussions with patients about spirituality [t [17] = 2.758; p = 0.013]; willingness to collaborate with clergy [t [16] = 3.776; p = 0.002]; and importance of religion to mental health [t [17] = 3.645; p = 0.002]. CONCLUSION Findings suggest that collaboration between academic and community-based clergy, physicians, and other mental health providers may be a feasible method of improving psychiatry trainees' comfort in addressing religion in psychiatric care to ultimately provide more culturally competent care.
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Affiliation(s)
| | - Gretchen L Haas
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Emily Felber
- PGSP-Stanford Psy.D. Consortium, Palo Alto, CA, USA
| | - Michael J Travis
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Esa M Davis
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Farley CL, Jacobwitz J. Cooking up a delicious experiential learning activity. Nurse Educ Today 2019; 77:24-26. [PMID: 30925343 DOI: 10.1016/j.nedt.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Cindy L Farley
- Nurse-Midwifery/WHNP and WHNP Programs, Georgetown University, Associate Professor, 313 N. Winter Street, Yellow Springs, OH 45387, United States of America.
| | - Jeanne Jacobwitz
- Nurse-Midwifery/WHNP and WHNP Programs, Georgetown University, Adjunct Faculty, 2102 16(th) Street NW, Apt 822, Washington, DC 20009, United States of America.
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Zeh P, Cannaby AM, Sandhu HK, Warwick J, Sturt JA. A cross-sectional survey of general practice health workers' perceptions of their provision of culturally competent services to ethnic minority people with diabetes. Prim Care Diabetes 2018; 12:501-509. [PMID: 30145188 DOI: 10.1016/j.pcd.2018.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/26/2018] [Accepted: 07/28/2018] [Indexed: 12/01/2022]
Abstract
AIMS To explore General Practice teams cultural-competence, in particular, ethnicity, linguistic skillset and cultural awareness. The practice teams' access to diabetes-training, and overall perception of cultural-competence were also assessed. METHODS A cross-sectional single-city-survey with one in three people with diabetes from an ethnic minority group, using 35 semi-structured questions was completed. Self-reported data analysed using descriptive statistics, interpreted with reference to the Culturally-Competent-Assessment-Tool. RESULTS Thirty-four (52%) of all 66 practices in Coventry responded between November 2011 and January 2012. KEY FINDINGS (1) One in five practice staff was from a minority group in contrast with one in ten of Coventry's population, (2) 164 practice staff (32%) spoke a second language relevant to the practice's minority population, (3) 56% of practices were highly culturally-competent at providing diabetes services for minority populations, (4) 94% of practices reported the ethnicity of their populations, and (5) the most frequently stated barriers to culturally-competent service delivery were language and knowledge of nutritional habits. CONCLUSIONS Culturally-competent diabetes care is widespread across the city. Language barriers are being addressed, cultural knowledge of diabetes-related-nutrition requires further improvement. Further studies should investigate if structured cultural-competence training for diabetes service providers produces positive effects in diabetes-related outcome-measures in minority populations.
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Affiliation(s)
- Peter Zeh
- Faculty of Health and Life Sciences, Coventry University, Coventry, CV1 5RW, UK; Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
| | - Ann-Marie Cannaby
- School of Nursing and Midwifery, Birmingham City University, Birmingham B15 3TN, UK; The Royal Wolverhampton Trust, Wolverhampton WV10 0QP, UK.
| | | | - Jane Warwick
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Jackie A Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College, London, SE1 8WA, UK.
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Baumberger J, Yutrzenka B. A Qualitative Study of Hutterites' Perspective and Attitudes Toward Healthcare Providers. S D Med 2018; 71:489-493. [PMID: 30742747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As the U.S. becomes more diverse, so does the population presenting to healthcare providers. As a result, cultural competency has become a vital aspect of healthcare in the U.S. Providers need to understand not only how their treatments are appropriate for a specific cultural group, but also how they can most effectively communicate with and establish relationships with these patients. One of the distinct cultural groups living in South Dakota are the Hutterites. While members of the Hutterite colonies use mainstream medical facilities for their health care, there is little information about the preparation of mainstream healthcare providers for the culture of this group and how this preparation may impact the services they provide to Hutterites. The purpose of this phenomenological study was to understand Hutterites' experiences with healthcare providers. Individual interviews were conducted with eight adults from a local Hutterite colony who had experience with mainstream healthcare providers. The qualitative analysis of these interviews resulted in two major themes: issues of healthcare culture and use of medical services only when needed. Certain aspects of Hutterite culture should be acknowledged when they present for medical treatment.
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Coats H, Downey L, Sharma RK, Curtis JR, Engelberg RA. Quality of Communication and Trust in Patients With Serious Illness: An Exploratory Study of the Relationships of Race/Ethnicity, Socioeconomic Status, and Religiosity. J Pain Symptom Manage 2018; 56:530-540.e6. [PMID: 30025937 PMCID: PMC6242783 DOI: 10.1016/j.jpainsymman.2018.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Better understanding of clinicians' skill communicating with their patients and of patients' trust in clinicians is necessary to develop culturally sensitive palliative care interventions. Race/ethnicity, socioeconomic status, and religiosity have been documented as factors influencing quality of communication and trust. OBJECTIVES The objective of this study was to explore associations of seriously ill patients' race/ethnicity, socioeconomic status, and religiosity with patients' ratings of the quality of clinicians' communication and trust in clinicians. METHODS An observational analysis was performed using baseline data from a multicenter cluster-randomized trial of a communication intervention. We enrolled consecutive patients with chronic, life-limiting illnesses (n = 537) cared for by primary and specialty care clinicians (n = 128) between 2014 and 2016 in outpatient clinics in Seattle, Washington. We assessed patient demographics (age, gender, race/ethnicity, education, income, and self-rated health status), Duke University Religion Index, Quality of Communication Scale, and Wake Forest Physician Trust Scale. We used probit and linear regression and path analyses to examine associations. RESULTS Patients providing higher ratings of clinician communication included those belonging to racial/ethnic minority groups (P = 0.001), those with lower income (P = 0.008), and those with high religiosity/spirituality (P = 0.004). Higher trust in clinicians was associated with minority status (P = 0.018), lower education (P = 0.019), and clinician skill in communication (P < 0.001). CONCLUSION Contrary to prior studies, racial/ethnic minorities and patients with lower income rated communication higher and reported higher trust in their clinicians than white and higher income patients. More research is needed to identify and understand factors associated with quality communication and trust between seriously ill patients and clinicians to guide development of patient-centered palliative care communication interventions.
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Affiliation(s)
- Heather Coats
- College of Nursing, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Lois Downey
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Seixas AA, Trinh-Shevrin C, Ravenell J, Ogedegbe G, Zizi F, Jean-Louis G. Culturally tailored, peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks: study protocol for a randomized controlled trial. Trials 2018; 19:519. [PMID: 30249293 PMCID: PMC6154893 DOI: 10.1186/s13063-018-2835-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, New York School of Medicine, New York, NY USA
- Department of Psychiatry, NYU Langone Health, New York, NY 10016 USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Joseph Ravenell
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Ferdinand Zizi
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Girardin Jean-Louis
- Department of Population Health, New York School of Medicine, New York, NY USA
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Abstract
Patient-physician language discordance within the growing Spanish-speaking patient population in the United States presents a significant challenge for health systems. The Civil Rights Act, an Executive Order, and federal standards establish legal requirements regarding patients' legal right to access medical care in their language of origin and to culturally and linguistically appropriate services, and national competency standards for undergraduate and graduate medical education and licensing examinations support the importance of patient-physician communication. However, no requirements or guidelines currently exist for medical Spanish educational resources, and there is no standardized process to assess the competency of medical students and physicians who use Spanish in patient care. Relatedly, existing data regarding current medical Spanish educational resources are limited, and Spanish proficiency evaluations are often based on self-assessments. Future efforts should use a multifaceted approach to address this complex challenge. A standardized process for Spanish-language-concordant medical care education and quality assurance should incorporate the validation of medical Spanish educational resources, competency requirements for medical usage of Spanish, an incentivized certification process for physicians who achieve medical Spanish competency, and health system updates that include routine collection of language concordance data and designation of Hispanic-serving health centers.
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Affiliation(s)
- Pilar Ortega
- P. Ortega is assistant professor, Departments of Emergency Medicine and Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-5136-1805
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Brady B, Veljanova I, Schabrun S, Chipchase L. Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain: a pilot randomised controlled trial. BMJ Open 2018; 8:e021999. [PMID: 29980547 PMCID: PMC6042550 DOI: 10.1136/bmjopen-2018-021999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/17/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. DESIGN A participant-blinded and assessor-blinded pilot randomised controlled trial. SETTING Outpatient physiotherapy departments at two public hospitals and one district pain clinic. PARTICIPANTS Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. INTERVENTIONS 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. OUTCOME MEASURES Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. RESULTS 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. CONCLUSIONS Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000857404; Pre-results.
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Affiliation(s)
- Bernadette Brady
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Irena Veljanova
- School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Siobhan Schabrun
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Lucinda Chipchase
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
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Grundman Shem-Tov R, Zubery E, Loevy Hecht N, Latzer Y. "A Full Stomach": Culturally Sensitive Diagnosis of Eating Disorders among Ethiopian Adolescents in Israel. Isr J Psychiatry 2018; 55:22-30. [PMID: 30351277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In recent decades there has been a significant increase in the prevalence of eating disorders among non-Western populations. This article aims to address unique sociocultural issues regarding the procedure and dilemmas of the diagnosis process of eating disorders among Ethiopian adolescents in Israel. We will discuss cultural aspects relating to the perception of the disease and the circumstantial contexts relating to this population, such as the process of immigration, integration into Israeli society and issues related to identity and trauma. Diagnostic dilemmas relating to the differences between traditional vs Western perceptions of the illness will be discussed. For illustration, two case studies will be presented. In the discussion, a culturally-sensitive diagnostic model is proposed. Based on Cultural Formulation Interview, this model assumes that the observation of clinical cases from different cultural backgrounds cannot be achieved solely through a western diagnostic prism. Rather, we suggest that the diagnostic process should continue throughout the entire therapeutic process.
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Affiliation(s)
- Rinat Grundman Shem-Tov
- Eating Disorders Treatment and Research Unit, Hanotrim Clinic, Ra'anana, Shalvata Mental Health Center, Clalit Health Services, Israel
| | - Eynat Zubery
- Eating Disorders Treatment and Research Unit, Hanotrim Clinic, Ra'anana, Shalvata Mental Health Center, Clalit Health Services, Israel
| | - Noa Loevy Hecht
- Eating Disorders Treatment and Research Unit, Hanotrim Clinic, Ra'anana, Shalvata Mental Health Center, Clalit Health Services, Israel
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel Eating Disorders Institution, Psychiatric Division, Rambam Medical Center, Haifa, Israel
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Staff A, Garvin P, Wiréhn AB, Yngman-Uhlin P. Patients requests and needs for culturally and individually adapted supportive care in type 2 diabetes patients: A comparative study between Nordic and non-Nordic patients in a social economical vulnerable area of Linköping, Sweden. Prim Care Diabetes 2017; 11:522-528. [PMID: 28779981 DOI: 10.1016/j.pcd.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/22/2022]
Abstract
AIMS This study sought to determine and compare the metabolic control of type 2 diabetes mellitus (T2DM) in non-Nordic immigrants and native Nordics. The aim was also to describe and compare the request of supportive care between these two groups. METHODS One hundred and eighty-four patients (n=184) coming to a routine check-up in a primary healthcare setting (PHC), were consecutively enrolled to the study during a period of one year. Data on therapeutic interventions, clinical measurements, healthcare consumption, and adherence to standard diabetes healthcare program were extracted from the patientś medical record. Structured interviews on supportive care were conducted by diabetes trained nurses. If needed, a qualified interpreter was used. Comparisons were made between Nordic patients (n=151) and non-Nordic patients (n=33). RESULTS Among T2DM patients in a setting of PHC, there was a difference in meeting the metabolic target HbA1c, between native Nordics and non-Nordic immigrants. There was also a difference in request on supportive care. The non-Nordic group significantly requested more and different supportive care. They also attended the standard diabetes program to a lesser degree. CONCLUSIONS Culturally/individually adapted prevention is not only medically warranted but also requested by the patients themselves.
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Affiliation(s)
- Angelica Staff
- Capio Primary Health Care Center Berga, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Sweden.
| | - Peter Garvin
- Department of Medical and Health Sciences, Linköping University, Sweden; Research & Development Unit in Local Health Care, Linköping, Sweden
| | - Ann-Britt Wiréhn
- Department of Medical and Health Sciences, Linköping University, Sweden; Research & Development Unit in Local Health Care, Linköping, Sweden
| | - Pia Yngman-Uhlin
- Department of Medical and Health Sciences, Linköping University, Sweden; Research & Development Unit in Local Health Care, Linköping, Sweden
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Browne CV, Ka’opua LS, Jervis LL, Alboroto R, Trockman ML. United States Indigenous Populations and Dementia: Is There a Case for Culture-based Psychosocial Interventions? Gerontologist 2017; 57:1011-1019. [PMID: 27048710 PMCID: PMC6281323 DOI: 10.1093/geront/gnw059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/08/2016] [Indexed: 12/14/2022] Open
Abstract
Dementia is an issue of increasing importance in indigenous populations in the United States. We begin by discussing what is known about dementia prevalence and elder family caregiving in American Indian, Alaska Native, and Native Hawaiian populations. We briefly highlight examples of culture-based programming developed to address a number of chronic diseases and conditions that disproportionately affect these communities. These programs have produced positive health outcomes in American Indian, Alaska Native, and Native Hawaiian populations and may have implications for research and practice in the dementia context of culture-based interventions. Evidence-based and culture-based psychosocial programming in dementia care for indigenous populations in the United States designed by the communities they intend to serve may offer elders and families the best potential for care that is accessible, respectful, and utilized.
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Affiliation(s)
- Colette V Browne
- Myron B. Thompson School of Social Work, Ha Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawaii, Honolulu
| | - Lana Sue Ka’opua
- Myron B. Thompson School of Social Work, Ha Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawaii, Honolulu
| | - Lori L Jervis
- Department of Anthropology and Center for Applied Social Research, University of Oklahoma, Norman
| | - Richard Alboroto
- Myron B. Thompson School of Social Work, Ha Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawaii, Honolulu
| | - Meredith L Trockman
- Myron B. Thompson School of Social Work, Ha Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawaii, Honolulu
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Deen JF, Adams AK, Fretts A, Jolly S, Navas-Acien A, Devereux RB, Buchwald D, Howard BV. Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need. J Am Heart Assoc 2017; 6:e007576. [PMID: 29066451 PMCID: PMC5721901 DOI: 10.1161/jaha.117.007576] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jason F Deen
- Division of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Alexandra K Adams
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT
| | - Amanda Fretts
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA
| | - Stacey Jolly
- Department of General Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Dedra Buchwald
- College of Medicine, Washington State University, Spokane, WA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
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Moleta CDI, Look MA, Trask-Batti MK, Mabellos T, Mau ML. 2016 Writing Contest graduate Winner: Cardiovascular Disease Training for Community Health Workers Serving Native Hawaiians and Other Pacific Peoples. Hawaii J Med Public Health 2017; 76:190-198. [PMID: 28721313 PMCID: PMC5511337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To help community health workers (CHW) meet increased demand for their services, it is essential to have data supported strategies for approaches to their training and capacity development. The objective of this paper is to report on the development, implementation, and evaluation of "Heart 101," a cardiovascular disease (CVD) training program, conducted among CHW in Hawai'i who serve Native Hawaiians and other Pacific Peoples (NHPP). Principles from Community-Based Participatory Research provided a framework to develop and implement the 5-hour training curriculum. Developers incorporated teaching strategies shown to be effective among learners that represent the majority of CHW, and included principles of adult learning theory and culture-based education. Training participants completed pre-, post-, and 6-months post-training knowledge tests, as well as demographic and participant satisfaction surveys. Data analysis based on pre- and post-training knowledge tests (n=30) indicated that Heart 101 significantly increased CVD knowledge by 32% (P < .001, t test). Long-term CVD competency measured at six-months post-training (n = 20) was also shown to be significant (P < .001, t test). Analysis of knowledge by subtopic suggested CHW strengths in clinical aspects of CVD and weaknesses in medical terminology and basic science aspects. These results, along with positive participant satisfaction, suggest that a culturally relevant and interactive course is a strong approach for CVD information dissemination to CHW serving NHPP communities, and provides insight on potential areas for special focus in their training. The demonstrated success of Heart 101 has positive implications for the standardization of CHW education and for their professional development.
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Affiliation(s)
- Chace DI Moleta
- Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI
| | - Mele A Look
- Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI
| | - Mililani K Trask-Batti
- Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI
| | - Tricia Mabellos
- Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI
| | - Marjorie L Mau
- Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI
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McEwen MM, Pasvogel A, Murdaugh C, Hepworth J. Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults. Diabetes Educ 2017; 43:272-285. [PMID: 28447545 PMCID: PMC6380685 DOI: 10.1177/0145721717706031] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes (T2DM). Methods Using a 2-group, experimental repeated measures design, 157 dyads (participant with T2DM and family member) were randomly assigned to an intervention (education, social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects. Results Significant changes over time were reported in diet self-management, exercise self-management, total self-management, diabetes self-efficacy for general health and total diabetes self-efficacy, physician distress, regimen distress, interpersonal distress, and total distress. There were likewise sustained effects for diet self-management, total self-management, diabetes self-efficacy for general health, total self-efficacy, physician distress, regimen distress, and interpersonal distress. Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive, longer, tailored interventions to achieve glycemic control.
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Affiliation(s)
- Marylyn Morris McEwen
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
| | - Alice Pasvogel
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
| | - Carolyn Murdaugh
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
| | - Joseph Hepworth
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
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Abstract
Transitional age youth were born into a world that is becomingly increasingly diverse. Youth who are ethnic or racial minorities encounter cultural stressors, including acculturative stress and discrimination that undermine their health and mental health. Decades of research demonstrate that cultural assets can serve as risk-reducing and resilience-enhancing mechanisms among minority and immigrant youth. Cultural assets include the development of a healthy ethnic-racial identity and maintenance of cultural values. Practitioners should assess for culturally relevant stressors and incorporate cultural assets such as ethnic-racial identity and cultural values to support the mental health of these youth.
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Affiliation(s)
- Deborah Rivas-Drake
- Department of Psychology, School of Education, University of Michigan, 530 Church Street, Ann Arbor, MI 48109-1043, USA.
| | - Gabriela Livas Stein
- Department of Psychology, University of North Carolina at Greensboro, 296 Eberhart Building, Greensboro, NC 27412-5001, USA
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