Congruent Care Research Articles

The Role of the Public Health Nurse in Collaborative Efforts to Manage COVID-19 in a Rural Hispanic Population: A Qualitative Inquiry.

While local health departments (LHDs) recognize the need to provide culturally congruent care to rural Hispanic populations, the COVID-19 pandemic tested their capacity to leverage available knowledge, skills, and resources to integrate effective transcultural collaborations to improve health outcomes. Twelve semi-structured interviews of community leaders were conducted and interpreted using qualitative thematic analysis. The role of the LHD's Public Health Nurse (PHN) in the pandemic response was examined using the Public Health Intervention Wheel (2019), specifically collaboration, coalition-building, and community organizing components. The PHN directed the community response to the pandemic. Four pivotal themes emerged from the data: identifying gaps, forming alliances, putting boots on the ground, and moving forward. The need to provide culturally congruent care to the Hispanic population required the development of transcultural knowledge through multi-faceted strategies. Sustaining relationships borne out of the pandemic is important to enhance community response to future disasters.

Exploring the Experiences, Cultural Values, and Perceptions of Mothers of Hospitalized Newborns in Malawi: An Integrative Review of the Literature.

Sub-Saharan Africa has the world's highest rates of neonatal mortality. Mothers are critical to the survival of these at-risk newborns. The aim of this integrative review is to appraise the published literature on the experiences, cultural values, and perceptions of mothers of hospitalized newborns in Malawi to inform future research. This integrative review utilizes Whittemore and Knafl's review model. CINAHL, PubMed, and Academic Search Elite databases were searched. Five summarizing themes were identified across ten articles relating to the mother as a caregiver, experiences of mother as a caregiver, cultural observations and perceptions of the mother, influence of others on the mother, and discrimination and stigma. Mothers' experiences of having a newborn requiring hospitalization in Malawi are complex. Results indicate a need for more studies to understand the experiences of mothers of newborns requiring hospitalization in Malawi in order to provide culturally congruent newborn care.

Abstract P114: Reducing Racial Disparities in Hypertension Control using Multicomponent, Equity-Centered Approach

Background: Black Americans have the highest prevalence of hypertension among all racial or ethnic groups in the United States and are five times more likely to die from hypertension compared to non-Hispanic whites. Perceived discrimination in healthcare, clinician and institutional bias, and socioeconomic and environmental inequities contribute to uncontrolled hypertension in this population. Multilevel, multicomponent interventions have effectively improved blood pressure control among Black Americans but remain inadequately implemented in the clinical setting. An integrated nursing/public health quality improvement study was designed to address this gap between evidence and integration into clinical practice. Methods: Using a one group pre/posttest design, we examined the effect of a 12-week intervention on blood pressure among Black Americans with uncontrolled hypertension aged 18 and older in the primary care setting. Intervention components included remote blood pressure monitoring, weekly phone coaching with culturally congruent care, medication intensification, and a standardized hypertension protocol. Results: The average age of the participants (n=35) was 64 years, and two thirds (n=23) were female (66%). The mean difference in both systolic and diastolic blood pressure decreased significantly (23 mmHg and 11mmHg, t-test –9.736 and –5.502, p-value <.001). At 12 weeks, 87% of participants had achieved blood pressure control. The intervention also significantly improved medication adherence and hypertension knowledge (p-value <.001). Conclusion: A multicomponent, culturally congruent quality improvement intervention significantly improved blood pressure among Black Americans. Implications: Scaled up implementation of multicomponent, equity-centered, culturally congruent approaches are needed to reduce racial disparities in hypertension control.

Barriers to Timely Dementia Diagnosis in Older Latinos With Limited English Proficiency: An Integrative Review.

Timely diagnosis is critical for persons with Alzheimer's disease and related dementias (ADRD) to ensure they receive adequate services; however, timely diagnosis may be prevented by a person's English language skills. The purpose of this integrative review was to understand how limited English proficiency (LEP) impacts older Latino's ability to access a timely ADRD diagnosis. Whittemore and Knafl's methodological approach guided the review. Searches in five databases yielded 12 articles for inclusion. Lack of culturally congruent health care systems, health care providers, and knowledge of ADRD resulted in delays in obtaining a timely ADRD diagnosis among older Latinos with LEP. Latinos with LEP and risk for ADRD benefit from language assistance and support in navigating the health care system. Nurses must be advocates, even when a language barrier is present, and recognize that interpreters are not a single source solution.

Engaging Students in a Bilingual Service-Learning Health Promotion Project.

Introduction: This service-learning, health promotion project used Leininger's Culture Care Theory to engage Baccalaureate Nursing students in a health promotion initiative specific to Hispanic community members. Methods: Thirty-seven students examined population health data, surveyed Hispanic community members to identify health priorities, and developed a population-specific intervention on diet and risk factors for diabetes. Students created a 5-min script focused on healthy eating plans with recognition of traditional foods associated with the Hispanic culture. Students delivered the script to community members attending an annual Hispanic Heritage Festival. Results: Seventy-six percent of the 488 community participants reported increased knowledge about diabetes risk factors and healthy eating habits. Each student completed a self-reflection on how the project impacted their transcultural skills and reported increased confidence related to engagement and communication with the Hispanic community. Discussion/Significance: Incorporating community-based service-learning into the undergraduate curricula is a powerful educational approach that can enhance students' ability to provide culturally congruent nursing care.

Medical tourist perceptions of hospitality across cultures

PurposeThis study aims to explore how the treatment, well-being and satisfaction of health tourists are affected by what is characterized as the hospitality culture of health care.Design/methodology/approachA qualitative research design focusing on in-depth semi-structured interviews was conducted with 28 Omani health tourists who visited Iran and received health-care services. Data were analyzed thematically using ATLAS.ti software.FindingsThe results revealed that a caring health professional is essential for patient healing and well-being. Cultural congruence is enhanced through effective communication between patients and health-care service providers. Additionally, a hospitality-certified workforce is essential for customer satisfaction and overall well-being. Finally, a hospitality-style approach and home-like atmosphere improve patient rehabilitation and performance.Research limitations/implicationsThe study’s exclusive focus on Omani health tourists necessitates caution in generalizing findings. Future research could encompass more diverse populations and inclusive samples to broaden applicability.Practical implicationsThe study highlights the key role of hospitality culture in the health-care sector, emphasizing the significance of building a culturally sensitive and hospitable environment to improve patient satisfaction and overall well-being. This includes the creation of welcoming environments and customized health-care experiences congruent with patients’ cultural values and beliefs.Originality/valueThe study emphasizes the crucial role of hospitality culture in health tourism and the potential to create a culture of care and respect in health-care settings, addressing patients’ holistic needs beyond physical amenities and enriching the patient experience. It also applies Leininger’s Culture Care Theory to hospitality, providing a novel viewpoint on culturally congruent, safe and meaningful care for health tourists.

Health Needs and Priorities of an Underserved Karenni Refugee Community: A Community Needs Assessment.

Southeast Asian refugee communities are frequently underserved by social and medical systems and experience profound health and health care inequities. The purpose of this study was to detail the health needs, priorities, and health care utilization of the Karenni, a Southeast Asian refugee community, in Forsyth County, North Carolina. A mixed-mode survey (i.e., online and in-person) was distributed in Kayah, Burmese, and English to Karenni adults in Forsyth County. Quantitative and qualitative questions focused on community health needs, health and public health service utilization, and social determinants of health. 101 Karenni adults completed the survey, with a total of 91 participants completing the quantitative portion (N = 91). Utilization of health care and public health services was low and impacted by individual- and contextual-level barriers, such as limited English profi-ciency and social determinants of health (e.g., lower levels of education and employment compared to state and national averages). Mental health, chronic pain, and health care access were highlighted as prominent community concerns while theh plaw theh jie (togetherness) and community organizations were described as community strengths. Data were collected using convenience sampling, and limited knowledge from the Karenni community regarding research served as a barrier to recruitment. Some sensitive questions (e.g., income) also experienced higher levels of missingness. This assessment highlights the need to increase engagement with and lower barriers to care for the Karenni community in Forsyth County, North Carolina. To produce culturally congruent and acceptable care, public health and health care systems should partner with the community to identify and address community needs and priorities, harness assets, and mitigate health and health care inequities.

Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review.

Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults. The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis. Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes. Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.

Unpacking the Paradox: Understanding the Gap Between Perceived and Actual Competence in LGBTQ+ Health Care.

Awareness about existing health disparities affecting sexual minorities remains insufficient, and nursing professionals often lack self-awareness about their biases and assumptions concerning lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) individuals. To explore how exposure to the LGBTQ community, during both classroom and clinical experiences, relates to nursing students' confidence in providing culturally congruent care to this group. This nonexperimental correlational study occurred at a Midwest 4-year public university, involving final-semester baccalaureate nursing students who completed demographic and educational preparation surveys regarding their confidence in providing health care to the LGBTQ population. Results indicate that participants with no direct care experience were more confident in their communication skills and culturally congruent patient care for sexual minorities compared to those exposed to sexual minorities in clinical settings. Nursing students' perceptions and experiences in delivering culturally congruent health care to sexual minorities provide an interesting perspective for examining the Dunning-Kruger effect.

A qualitative study on diverse experiences of medication safety among foreign-born persons living in Sweden

BackgroundThe ongoing global migration has led to multicultural societies, with many migrants who do not speak the official language in the host country. This could contribute to communication problems with staff in healthcare and a risk to patient safety. Research on patient safety in medication use in migrants is an under-researched area. The aim was to explore diverse foreign-born people’s experiences and perceptions of self-management of medication and determine if home-based practice patterns have implications on medication safety, and what factors may support safe medication use.MethodsA qualitative explorative study, with individual semi-structured interviews and participant observations in the patients’ home. Qualitative content analysis was applied.ResultsA purposeful sample of 15 foreign-born persons identified by healthcare staff as having language difficulties in Swedish that may pose a safety risk in connection with medication use at home, was selected. Three categories were identified. The first category showed respondents being dependent on another person, having experiences of not receiving information about their medications due to language barriers, having difficulties getting access to the healthcare centre and feeling distrusted/misunderstood. The second category showed respondents being independent and self-motivated Although they struggled, they managed to get access/contact with the healthcare centre themselves and felt understood/listened to by the staff. The last category concerned factors that facilitating medication use; such as having a medication list in the respondents’ own language and offering a choice of language on the answering machine at the healthcare centre. Although they knew it was impossible to get an interpreter at the pharmacy, they felt safe knowing there was always a solution for receiving understandable information.ConclusionThe findings highlighted that language barriers can complicate the communication between migrants and the healthcare, which can affect the medication safety. Understanding of this group is essential to improve the cooperation between patients and staff, leading to culturally congruent care. This knowledge should be used in healthcare to understand the gap in communication to increase patient safety. Further research from other angles, e.g. pharmacy/healthcare staff and relatives is needed to identify and evaluate facilitation to improve the outcome of the intended medication treatment.

Patient Needs and Perceptions of Doula Care: A Survey Study [ID 2683478

INTRODUCTION: Doulas improve birth outcomes, and doulas that provide culturally congruent care are needed in historically marginalized communities who experience stark disparities in maternal mortality and morbidity. This study characterizes the needs and perceptions of doula care among patients from the same health care system. METHODS: This IRB-approved, cross-sectional study, in collaboration with community-based midwives and doulas, administered de-identified surveys in two obstetrics/gynecology clinics in South Florida. Surveys characterized 1) patient demographics, along with 2) patient understanding of, and 3) patient need for doula care. RESULTS: One-hundred seventy-six patients were surveyed and an alpha level of 0.05 was utilized for all statistical tests. Multivariate analysis showed that patients with an annual household income between $25,000 and $50,000 (OR = 4.87; 95% CI, [1.02–23.36]) were almost five times more likely than those with an annual household income below $25,000 to have an interest in doula care. Chi-squared analysis found no statistically significant relationship between race and interest in doula care, X2 (4, N = 176) = 2.80, P=.591. Among patients who expressed interest for doula care, χ2 analysis found a statistically significant relationship where Black and/or African American patients were less likely than White/Caucasian patients to be able to pay for doula care, X2 (8, N = 148) = 19.25, P=.014. CONCLUSION: Results illustrate an increased need for doula access among patients in a large academic, safety-net hospital, especially those from historically marginalized groups. This study encourages other health care systems to assess the need for increased doula support within their communities.

Development of the Indigenous Health Toolkit

Indigenous patients frequently experience bias and racism in society and within medical encounters. Biased health care relates to delayed and worsened health care, as well as worse health outcomes. Evidence exists that training can reduce bias and improve care. However, no recommendations or requirements around Indigenous health education exist. Therefore, a team of 7 experts was formed to create a training guide called the Indigenous Health Toolkit to train healthcare providers to provide more effective care to Indigenous patients. Indigenous methodologies were applied to this endeavor to create recommendations and training which included engagement with Indigenous elders, community, youth, and businesses. A 7-module toolkit was created over one year to train healthcare providers to provide culturally congruent and bias-free care to Indigenous patients in hopes of reducing the gap in health disparities that exists between Indigenous and non-Indigenous communities.

Lived Experiences Among Critically Ill and Near-Death Survivors Relating to the COVID-19 Infection: A Phenomenological Study.

The COVID-19 pandemic has resulted in severe illnesses worldwide. Around 655.5 million cases were having been confirmed, including 6.6 million deaths. The extreme cases experienced near death in the intensive care unit (ICU). This study explored the survivors' experience of being near death while critically ill with the infection. A descriptive phenomenological study was employed. Data were collected through in-depth interviews with 14 participants from Northeastern Thailand. Content analysis was applied by using Creswell's strategy. Four themes emerged: (a) anxiety and fear of dying alone, (b) environmental chaos, (c) using Thai Buddhist teaching in coping, and (d) returning from the brink of death. Moreover, the patients felt great gratitude and were grateful to the health care team. Traumas experienced by patients in the ICU included physical and psychological distress, coping strategies, and an understanding of cultural awareness. Psychological and culturally congruent care should be implemented for patients in the ICU.

Limited English Proficiency and Outcomes in the Intensive Care Unit: An Integrated Review.

Language barriers place patients at risk of substandard care. Hospitalized patients with limited English proficiency (LEP) face unique challenges, especially in the intensive care unit (ICU). The purpose of this review is to critique and synthesize quantitative evidence on LEP and ICU outcomes. Quantitative studies published in English between 1999 and 2022 were queried using intentional terminology. Searches yielded 138 results, with 12 meeting inclusion criteria. The analysis resulted in the extrapolation of five themes pertinent to outcomes of ICU patients or families with LEP: (a) knowledge deficit relating to conditions and care; (b) lack of language-appropriate care; (c) alienation from care process; (d) decreased confidence and ownership of care; and (e) relationship to clinical quality indicators. Outcomes associated with LEP were largely negative and revealed unmet needs for ICU patients with LEP. More research is needed to improve linguistically and culturally congruent care in the ICU.

Cultural Advocacy for Indigenous Individuals With Serious Illness.

Indigenous American (I.A.) individuals with serious illness and their families have unmet needs. Often, this group is viewed as a minority within a minority. Numerous health challenges exist within the I.A. populations resulting in dire health care situations. Historical trauma and mistrust of the healthcare system impacts access to quality palliative care by this marginalized population. Given the range of social, spiritual, and cultural issues, the interprofessional team needs increased knowledge specific to the I.A. population to ensure holistic, culturally sensitive care. Utilizing a case study, this article reviews of the needs of I.A. individuals with serious illness and essential skills. The aim is empower palliative care clinicians the knowledge to provide culturally sensitive and congruent care to I.A. individuals with serious illness and their community.

Learning from the Cultural Community of Service Dog Teams: Culturally Congruent Healthcare for Individuals Teamed with Service Dogs

Background: Individuals with disabilities have the right to be teamed with service dogs for support. Healthcare professionals must be prepared to provide culturally congruent care to service dog teams. To provide culturally congruent care attributes that describe a culture must be known. Little to date is known about the perspectives of individuals teamed with service dogs. Purpose: This study examined characteristics of individuals teamed with service dogs, their perspectives on service dogs, benefits of their service dog, and experiences of receiving healthcare. Method: A cross-sectional survey was conducted with individuals teamed with service dogs in the United States (N =270). Discussion: While there is great diversity among individuals with disabilities within this culture is a community of individuals teamed with service dogs. Individuals teamed with service dogs, including those for vision and hearing, share attributes that describe them as a cultural community. This understanding is fundamental to culturally congruent care for service dog teams.

The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017.

Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05). These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.

Influences of Faith on Rural Appalachian Older Adult Health: An Ethnonursing Study.

Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality-health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.

Filipino Americans' Social and Cultural Experiences of Type 2 Diabetes Management: Cultural Paradox, Ownership, and Success Definition.

Although type 2 diabetes mellitus (T2DM) disproportionately affects Filipino Americans, they have not received much attention in the literature. Focusing on how Filipino Americans' social and cultural contextual experiences affect their self-management is critical. This study examined T2DM self-management among Filipino Americans by describing their sociocultural experiences, strategies, and significance of self-management. An interpretive descriptive qualitative design was used. Data were analyzed using thematic analysis. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Filipino Americans (n = 19) with T2DM were interviewed. Three themes emerged: (a) cultural paradox of being Filipino American, (b) movement from invisibility to ownership of T2DM, and (c) definition of successful management of T2DM. Results contribute to a greater understanding of Filipino Americans' T2DM self-management experiences. Implications include the provision of culturally congruent health care, being aware of Filipino Americans' sociocultural experiences, and involvement of family/community.

Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review.

Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication. We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations. Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations. Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.