Cultural Competence Research Articles

Reflection Comics: Draw Attention to Intercultural Communication in Context

ABSTRACTMultilingual students learning English face changes in developing intercultural communicative competence outside the classroom. This Classroom Exploration, informed by frameworks of intercultural communicative competence, willingness to communicate, and cultural adaptation, explores the use of reflection comics in a service‐learning course for first‐year international university students. Students created comics depicting key moments during their volunteer work. Analysis of a comic reveals how the medium of a comic with images, speech bubbles, and thought bubbles focuses a student's attention on verbal and nonverbal communication with other participants within a specific social context.

Beyond the classroom: The transformative experience of short rural immersion programs for health professional students: A narrative review.

Rural areas house nearly half the global population yet face a significant shortage of skilled health professionals, exacerbating health inequities. Short-term rural immersion programs offer a cost-effective approach to exposing health professional students to the unique challenges of rural healthcare. Transformative learning theory is well suited to examining how these programs foster critical reflection and perspective shifts in students. To explore the potentially transformative impact of short-term (<6 weeks) rural immersion programs on health professional students through the lens of transformative learning theory. This review synthesised findings from various studies on the impact of rural immersion programs. Comprehensive searches were conducted across multiple databases, identifying 17 studies published between 2001 and 2024. Data extraction and thematic synthesis were guided by Mezirow's transformative learning framework, identifying key patterns and insights through an iterative process. Rural immersion programs deepen students' understanding of the unique health needs of rural and remote communities. These experiences promote personal and professional growth, enhance critical thinking, problem-solving abilities, cultural competence and social accountability and foster a commitment to serving underserved populations. The collaborative role of the community, student cohort and academic staff in facilitating transformative learning is emphasised. Short-term rural immersion programs offer invaluable and transformative educational opportunities that extend beyond traditional learning environments.

Modeling the relationship between online L2 motivational self-system and EFL learners’ virtual exchange self-regulations: the mediator and moderator roles of L2 grit

Abstract While previous studies in computer-assisted language learning have extensively explored sociolinguistic factors, such as cultural competence, important psycholinguistic factors such as online L2 motivational self-system, L2 grit, and online self-regulation in relation to virtual exchange (VE) have remained widely unexplored. To address this gap, a study was conducted with 92 Spanish English as a foreign language learners who exchanged language and culture with Cypriot and Irish students and responded to questionnaires adapted for the study context, as part of the SOCIEMOVE (Socioemotional Skills Through Virtual Exchange) Project. The partial least squares structural equation modeling approach showed that language learners who set positive personal goals for the future and evaluate their current learning progress in VE can regulate their learning in it. Interestingly, the sign of authenticity gap was found in the study context, since learners’ motivation to learn in VE was higher compared to their previous language learning contexts, resulting in more effort and consistency of interest in setting their goals, evaluating their progress, and asking for help from others. Furthermore, learners’ L2 grit moderated and mediated the correlation between learners’ online motivation and online self-regulation, indicating that VE success requires long-term perseverance of effort and consistency of interest. Accordingly, a new conceptual framework for VE was developed. In addition, one of the main implications is that teachers who employ VE should focus more on learners’ current needs and the goals they wish to achieve when exchanging information rather than only focusing on their accomplishments based on the course syllabus.

Manifestation of Chronic and Non-Communicable Diseases Among Filipino Internationally Educated Nurses in Finland: A Qualitative Study.

Limited research has explored the impact of migration on the manifestation of noncommunicable diseases (NCDs) among internationally educated nurses (IENs) in Finland. This study aimed to describe Filipino IENs' experiences with the manifestation of NCDs among them. Secondary data from 10 IENs working in two hospitals were analyzed using Braun and Clarke's thematic analysis. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist. Three key themes emerged: insufficient knowledge and lack of interest in health promotion, migration as a factor, and occupational health challenges. Migration was found to impact NCD occurrence. Inadequate knowledge and underutilization of occupational health services were identified as a barrier to prevent the risk of getting NCDs. Long waiting periods for appointments and language barriers exacerbated these risks. Limited awareness of available occupational health services and disinterest in health promotion contributed to NCD manifestation among IENs. Lengthy waiting times highlighted the need for educational campaigns on health-promoting activities. Cultural competence training for local healthcare providers can improve culturally sensitive occupational healthcare for IENs. Health promotion education should be provided to IENs before their migration. Upon arrival, nurse managers should inform the nurses about the availability of occupational healthcare services provided by the employer, ensuring easy access. Additionally, efforts should be made to ensure that nurses integrate well into society, including facilitating access to recreational activities.

Competency Development for E-Mentors of Undergraduate Nursing Students Using E-Delphi Method.

The supply of future registered nurses successfully matriculating from undergraduate nursing programs is critical to address the national nursing shortage. Mentoring in higher education increases recruitment and retention within nursing programs. E-mentoring is an innovative approach to mentorship within nursing education that can optimize undergraduate nursing graduation rates. Establishing E-Mentor Competencies (EMCs) for nurses may ultimately address the nursing shortage gap. The purpose of this study is to develop EMCs for mentors of undergraduate nursing students through expert group consensus via e-Delphi methodology. The EMC survey was developed by a subject matter expert group and electronically distributed to an expert participant group. Items were ranked using a 5-point Likert scale for importance and relevance during iterative survey rounds to reach consensus. Sixteen EMCs were identified and categorized as knowledge, skill, or attitude. This research study identified 16 competencies required of an e-mentor for undergraduate nursing students. The 3 most important competencies identified were relationship building (4.71), cultural competence (4.88), and empathy and support (4.55). The EMCs identified by expert participant group consensus will provide a standard level of knowledge, skills, and attitudes for e-mentorship of undergraduate nursing students. Results may lead to an enhanced e-mentorship experience for both mentee and mentor and support existing and future e-mentor programs.

Childbirth Experience, Mistreatment, and Migrant Status: A Retrospective Cross-Sectional Study.

Childbirth experience can affect women's long-term health and well-being. However, there is limited knowledge on whether migrant status affects woman's experience during childbirth. We aimed to answer the following research questions: (1) Is there a difference in childbirth experience between migrant and native-born women in Iceland; and (2) Are migrant women more likely to experience mistreatment in childbirth compared to native-born women in Iceland? An online survey was developed including the Childbirth Experience Questionnaire 2 to assess overall childbirth experience, and descriptive analysis and linear regression were conducted to determine differences between migrant and native-born women in Iceland. The mistreatment by care providers in childbirth indicators were used to evaluate mistreatment in childbirth, and frequencies and logistic regression were conducted. Both regression models were adjusted for sociodemographic and obstetric factors. A total of 1365 women participated. Migrant women reported statistically significantly lower scores for birth experience compared to native-born women (F [12, 1352] = 23.97, p < 0.001). There was no statistical difference between groups regarding mistreatment in childbirth. One in four of all women reported at least one form of mistreatment. This study suggests that there are areas in maternity care that can be improved upon, particularly in providing care for migrant women and addressing mistreatment in childbirth for all. Our results suggest further research in this area as well as evaluation of maternity systems, training in cultural competency and effective communication.

Evaluation of DF-1 cell culture based vaccine development for infectious bursal disease virus in Ethiopia.

Infectious Bursal Disease is a highly contagious, immunosuppressive viral disease of young chicks caused by the Infectious Bursal Disease Virus (IBDV). The study was carried out at the National Veterinary Institute (NVI) of Ethiopia to evaluate the competence of the DF-1cell culture adapted vaccine strain of IBDV as a vaccine candidate. DF-1cells at passage 27 confluent monolayer was infected with 1ml of LC-75 vaccine strain virus by adsorption method and recorded as passage 1 (P1). This procedure has been repeated up to seven serial passages with the same methods of virus infection onto DF-1cells. Minor CPEs were observed in the second passage, but vivid cytopathic effects (CPE) were observed starting from passage 3 (P3). The infectivity titer of DF-1cell adapted virus was determined, and the results showed a linear increase in titer with each passage number. Transcriptase polymerase chain reaction (RT-PCR) targeting the VP2 gene revealed positive 400-base pair amplification. The vaccinated experimental chicks from passages 5 and 7 and the CFC based vaccine showed no clinical signs and/or death. Efficacy test revealed that DF-1 adapted vaccinal strain protected the chicks from the challenged virus strain at passage 5 and 7. The control group, on the other hand, had 100% morbidity and 91% mortality. As a result, the DF-1cell could be used as a model to study IBDV kinetic growth, and the DF-1cell adapted virus could be a candidate for IBD vaccine development. Thus, IBD vaccine production using DF-1cells is recommended.

National extension workshop: Connecting learners and educators to broaden reach and maximize impact in the 21st century.

Disseminating training nationwide through the Cooperative Extension Service, particularly as global demand for poultry products continues to increase, is critical for sustainable poultry production. Increasing urbanization, globalization of the poultry industry, consumer interest in animal welfare and labor shortages present opportunities for Extension professionals to engage diverse audiences and increase agricultural literacy. As part of the Poultry Science Association's 2024 National Extension Workshop, we presented examples of initiatives aimed at connecting educators, teachers and learners to address some of the pressing issues facing the poultry industry. The Frontline to Farm Program (F2F) is an example of a multi-layered, tailored training and outreach approach that assists military veterans with their farming endeavors. The F2F program has reached 60,000 people to date and continues to assist veterans as they transition to civilian life. In addition to developing targeted Extension programs such as F2F and others, developing training opportunities for future Extension professionals is critical for the sustainability of the U.S. poultry industry. Many undergraduate students and youth are unaware of the career opportunities in Extension. Examples of successful approaches to incorporate younger generations into Extension are the Hatch-Out Program and poultry summer camps at Mississippi State University. Tailored to younger audiences, these programs use "bite-size" learning, technology and social learning techniques. Another approach to increase awareness of Extension opportunities is to connect students with Extension Educators as part of transformative learning opportunities. For example, the study abroad program to Vietnam offered at Purdue University, originally developed at Michigan State University, broadens students' perspectives of Extension and can lead to the development of intercultural competency, enabling students and Extension professionals to better communicate with diverse audiences. Communication is key to the success of Extension, and communicating with people who make decisions about animal agriculture, whether through their purchases or their votes, can significantly impact poultry production. Informal learning events, such as exhibits at state fairs, provide opportunities to reach broad audiences and increase their knowledge of agriculture. Continued success of Extension efforts at supporting stakeholders relies on multi-dimensional approaches to engage diverse audiences, which are enhanced by close collaboration among teachers, educators and scientists.

Creation and evaluation of a gender diversity focused cultural competency training for phlebotomists: Study protocol for a randomized controlled trial

Creation and evaluation of a gender diversity focused cultural competency training for phlebotomists: Study protocol for a randomized controlled trial

Implementing and Delivering Culturally Centred Pharmacy Services Tailored to Ethnically Minoritised Populations: A Qualitative Systematic Review and Meta-Ethnography.

Health inequities disproportionately affect people from ethnic minority communities and require a comprehensive effort across healthcare disciplines to tackle them. Ethnically minoritised populations continue to be underserved, despite the growing awareness of the detrimental link between ethnicity and poorer health- and medication-outcomes. Pharmacy has been recognised as an accessible and inclusive healthcare setting, with the ability to meet diverse patient needs. Yet, there still remain distinct gaps in knowledge of how to best design, implement and deliver culturally centred pharmacy services for members of ethnic minority communities. A systematic literature search was undertaken in November 2023, across four databases: MEDLINE, Embase, CINAHL and PsycINFO. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines- and health service inequalities affecting people from ethnic minority communities. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, according to Noblit and Hare, forming a qualitative evidence synthesis to further understanding. This meta-ethnographic systematic review synthesised data from 13 international studies eligible for inclusion. Four overarching third-order constructs (termed 'themes') were developed through reciprocal translation and focused on: (i) navigating pharmacy systems across the globe; (ii) understanding cultural needs and beliefs that may influence medicine use; (iii) strengthening relationships with pharmacists and other healthcare providers and (iv) addressing possible language and communication barriers. Pharmacists and policymakers should aim to raise awareness of pharmacy services, increase the provision of cultural competency training within the profession, build stronger relationships with minority communities, and facilitate access to interpretation services. A template of recommendations has been developed to further implement and deliver such services on an individual pharmacy-, community- and profession-basis. Future research should seek to utilise lived-experience narratives and participatory co-design methods to further explore ways to address wider healthcare accessibility inequalities for this minoritised population. Public contributors and authors (inequity research champions, G.K. and T.G.) informed and shaped this project during study design and conceptualisation; they helped to ensure that the study was conducted, and the findings were reported, with sensitivity.

Cultural sensitivity and inclusivity in teaching: International students' views on faculty competence

This study investigated international students’ (ISs) perceptions of faculty members’ intercultural teaching competence in US higher education. A cross-sectional quantitative survey design was employed using a newly developed instrument called the student measure of international teaching competence. In total, 198 ISs from 21 countries participated in the study. Exploratory factor analysis and descriptive statistics revealed that specific improvements are needed while ISs generally perceived their faculty as intercultural competent. These include reducing assumptions about students’ prior knowledge, enhancing their understanding of diverse learning styles, integrating cultural backgrounds into the curriculum and offering various assessment methods. These findings underscore the need for comprehensive faculty training programs and institutional policies that promote inclusive teaching practices, ultimately aiming to improve the academic experience and outcomes of ISs.

Diagnostic changes in a specialized psychiatric outpatient clinic for migrants: An observational study.

Culture significantly influences the understanding, presentation, diagnosis, and treatment of mental disorders, particularly among migrant patients. This observational study examines the frequency and timing of diagnostic changes among migrant patients in a specialized psychiatric outpatient clinic. Furthermore, the study includes a qualitative sub-study to provide insights into the diagnostic process. Out of the 119 migrant patients included in the study, 27.7% changed referral diagnoses during treatment. Diagnostic changes occurred in 15.7% of cases by the end of treatment, 13.4% at midterm, and 9.1% after the initial assessment. No significant associations were found between diagnostic changes and sociodemographic or treatment-related factors. While the qualitative sub-study primarily offered broader insights into the cultural aspects of treatment and the clinical encounter, rather than establishing causal effects on the diagnostic process, it revealed how acculturative stress and cultural identity influenced the presentation of symptoms. The study is conducted in a real-life clinical setting and, thus, reflects the everyday clinical practice of diagnostic changes at a specialized cultural psychiatric clinic. The findings from this study indicate that in addition to a culturally sensitive assessment, time is an important factor for diagnostic changes, which can be essential knowledge for clinical practice when planning diagnostic assessment and treatment. The findings underscore the need for enhancing clinicians' cultural competencies through targeted training, emphasizing cultural awareness in clinical practice.

Bridging Borders with a Project-based Approach to Enhance Bidirectional Cultural Awareness in Foreign Language Teaching and Learning

Cultural awareness is essential in foreign language education. This paper explores two projects that exemplify the integration of cultural elements into foreign language learning involving both first language (L1) and second language (L2) cultures. The first project was initiated in the course “German Cinema”. It focuses on the legendary English-language sketch “Dinner for One”, which has been part of traditional New Year’s Eve entertainment in the German-speaking world for over sixty years. Students explored its significance within German culture through surveys, translation, creative adaptations and organised an imaginary festival. These activities foster intercultural dialogue and understanding. The second project, “Die goldene Meergundel” (The Golden Goby), is an extracurricular activity that integrates Thai culture with the German language. A Thai fairy tale was performed in Likay-style theatre, but was spoken and sung entirely in German. The blending of Thai folklore with German pronunciation can enhance both cross-cultural appreciation and linguistic proficiency. These case studies underscore the significance of enhancing bidirectional cultural awareness in foreign language teaching and learning. Educators can act as facilitators by engaging students in projects that transcend linguistic boundaries, effectively bridging cultural borders, and cultivating foreign language learners to be equipped with intercultural competence and global citizenship.

How have interventions targeting pregnant women from refugee, migrant and culturally and linguistically diverse backgrounds living in high-income countries been developed or tailored to meet community needs? A systematic scoping review of stillbirth-related literature

BackgroundPeople from migrant, refugee and culturally and linguistically diverse backgrounds experience significant disparities in pregnancy outcomes compared to the general population, including a higher risk of stillbirth. This study aimed to identify stillbirth-related programs or interventions for pregnant women from culturally and linguistically diverse backgrounds and explore how these interventions have been developed and/or tailored for culturally and linguistically diverse women.MethodsWe searched MEDLINE, CINAHL, Embase, and Scopus for articles published from inception to 12 Jan 2023. We included studies that report on the development and/or evaluation of a program or intervention to reduce the risk of stillbirth which has been specifically developed or tailored for pregnant women from culturally and linguistically diverse backgrounds living in high-income countries. Two independent reviewers conducted screening of the articles, data extraction, and quality appraisal. We first summarized the descriptive information of eligible studies using text and tables and then thematically grouped interventions based on approaches to meet community needs and synthesized data qualitatively.ResultsWe identified 1999 studies from the database search. After removing duplicates and screening for eligibility, 9 studies met our inclusion criteria and were included in the review. Studies were conducted in Australia, the UK, US and Denmark between 1986 and 2021, with multi-ethnic populations (n = 6) or specific cultural and language groups (n = 3) (e.g. Pakistani and Indian women; African American and Hispanic population groups). Approaches to tailoring included the use of interpreters and translated materials, linking women to existing community resources and networks and community outreach delivered to women outside of hospital settings. Training of staff in cultural competence and multi-component, multiagency interventions addressing the wider social determinants of health and system-based approaches to facilitate access to language services were also identified.ConclusionWhile there are currently few targeted interventions for pregnant women from migrant, refugee and culturally and linguistically diverse backgrounds, approaches to cultural tailoring identified in this review can be used as a starting point for effectiveness testing and wider application. Ongoing work is needed to continue to address significant disparities in pregnancy outcomes for minoritised community groups. Protocol registrationThe protocol for this review was registered in PROSPERO (CRD42021289321).

The Application and Practice of Intercultural Communicative Competence in English Teaching

The Application and Practice of Intercultural Communicative Competence in English Teaching

Development of a New ‘Engineering English for Intercultural Communication’ Online Course to Prepare New Engineers for Working in Intercultural Workplace Settings

This study aimed to develop a tailor-made online course called “Engineering English for Intercultural Communication (EEIC)” for undergraduate engineering students based on the self-report on English language proficiency, intercultural communication competence (ICC) as well as needs of a diverse set of stakeholders in the engineering professions and education. It comprises two phases: (1) analyzing the data from the stakeholders, and (2) designing and developing a course. In the first phase, a mixed-methods approach was adopted. A questionnaire was employed for a self-report on English language proficiency and problems in language use, as well as the ICC of 108 Thai engineering students at an autonomous university in Thailand and 22 Thai engineering professionals working in international companies. Then, semi-structured interviews on the necessity of engineering English and ICC for novice engineers were conducted with 16 engineering course lecturers. The second phase involves the design and development of the EEIC course. The ADDIE model was adopted and the findings from the analysis of the data collected in the first phase were used to guide the design and develop such a course with four units, each with a different focus, specifically. This study contributes to the ELT field by showcasing a course design process to meet the needs of a set of diverse stakeholders. Specifically, the course was developed based on real-life information obtained from both educational and professional contexts analyzed to provide guidance for the course design and development.

Developing culturally competent models for inclusive social work and healthcare interventions

Cultural competence has become a cornerstone of effective social work and healthcare practices in increasingly diverse societies. This review explores the development of culturally competent models to enhance inclusive interventions in these fields. Drawing on interdisciplinary frameworks and empirical studies, the paper examines key concepts, such as cultural awareness, humility, and intersectionality, while analyzing their practical applications in various settings. Current models, including the Purnell Model for Cultural Competence and the Cultural Competence Continuum, are critically evaluated to highlight their strengths and limitations. Challenges such as implicit bias, resource inequities, and the absence of standardized assessment tools are identified as significant barriers to implementation. The review also discusses innovative strategies, including technology-assisted training and community-driven approaches, as potential solutions to address these gaps.

Language barriers in mental healthcare: A critical analysis.

In multicultural healthcare settings, language barriers pose significant challenges, particularly in mental health where nuanced communication is vital. This manuscript examines the impact of limited English proficiency (LEP) on mental healthcare in New Zealand, where a substantial portion of the population and healthcare workforce are foreign-born. Despite official recommendations, professional interpreter use remains low, compromising care quality for LEP patients. The paper explores interpreters' roles beyond interpretation, including cultural mediation, while noting limitations in interpreter-mediated consultations. It also addresses communication difficulties arising from strong accents and dialects, even when a common language is shared. Multifaceted strategies to improve communication are proposed, including enhanced cultural competency training, patient-centered protocols, and language matching in healthcare teams. Emphasizing a polycultural approach, the manuscript advocates for comprehensive interventions addressing linguistic, cultural, and cognitive aspects of communication in mental healthcare. It calls for further research and policy changes to integrate language access and cultural competency into healthcare quality assessments, aiming to reduce disparities and improve outcomes for diverse patient populations.

A mosaic of medicine: Acquainting pharmacy education with the rich tapestry of African-descent immigrant cultures.

There is an increasing number of African-descent immigrants to the United States, often from the Caribbean, South America, and Africa. These immigrants tend to have different healthcare needs than native-born Black Americans because they come from diverse backgrounds with unique cultural health practices and beliefs. While these immigrants may be healthier when they initially present to the United States, research has found that this health advantage is not long-lasting. Acculturation, cultural beliefs, systemic, and social factors have been closely linked to the health and well-being of Black immigrants, especially with increased years of residency in the United States. Culturally competent care involves understanding the influence of culture, ethnicity, and social factors on health. It is crucial that student pharmacists are trained in understanding the cultural considerations of our continuously evolving and diverse patients. While pharmacy schools have begun incorporating cultural competency and implicit bias training in PharmD curricula, there is still room for improvement to bring about meaningful change in health outcomes. This review calls for an end to oversimplified views of Black immigrant health, advocates for better recognition of distinct African-descent cultures, and recommends tools and strategies to incorporate this population into multicultural pharmacy education.

P-1818. Pilot Testing of a Stakeholder-driven, Patient Education Intervention in Primary Care to Reduce Use of Antibiotics without a Prescription

Abstract Background Antibiotic use without a prescription (non-prescription use) is a highly prevalent issue that poses significant individual and population level risk. We designed a patient-focused educational brochure to reduce non-prescription antibiotic use and report patient survey results about the brochure’s acceptability, appropriateness, and usability.Figure 1.Brochure Usability, Appropriateness, and Acceptability For the three criteria of usability, appropriateness, and acceptability, responses of "completely agree" and "agree" were categorized as positive while "neither agree or disagree," "disagree," or "completely disagree" were categorized as negative responses. n = 100 respondents. Methods The brochure was developed with input from six racially/ethnically diverse community advisory board members plus 2 experts in health literacy and cultural competency in Hispanic communities. Brochure content included information on safe means of obtaining antibiotics, antibiotic side effects, non-antibiotic treatment of common symptoms, and how to access care at the public clinics. From October 2023 to February 2024, brochures (in English or Spanish) were distributed to 100 patients at two local clinics (50 each). Patients completed a survey about the brochure acceptability, appropriateness, and usability, followed by an open-ended question about suggestions for improvement. Results Survey participants were on average 53 years old, 72% female, 72% college educated, and primarily Black (35%), Hispanic or Latino (30%), or Caucasian (28%). 81% had adequate health literacy. Respondents largely found the brochure acceptable (98%), appropriate (98%), and usable (100%). 96% of respondents said the brochure was useful, referencing learning about antibiotic indications (23%), over the counter alternatives for symptom relief (23%), and antibiotic side effects (14%). The most common reason respondents did not find the brochure useful was they already “knew everything in [the] brochure” (n = 4). 15 respondents (15%) had suggestions for improvement such as having an alternative media form (e.g., an audio version) and having the brochure available at the pharmacy (27% each). Conclusion We designed a brochure about antibiotic safety that was considered acceptable, appropriate, and usable by our diverse clinic patients. Key learning points reported by patients included antibiotic indications, side effects, and over the counter alternatives. Next the brochure will be the focus of an intervention to reduce non-prescription antibiotic use among our socially vulnerable patient population. Disclosures Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant