Cross-cultural Clinical Encounters Research Articles

Introducing an integrated model of cross-cultural assessment

Objective With increasing levels of cultural diversity, it is important that mental health services are relevant and accessible to new migrant populations. Efforts have been made to bring attention to the unique experiences and needs of culturally and linguistically diverse (CALD) sub-groups in clinical settings, resulting in various frameworks and professional development workshops. While some of these strategies have raised awareness and persuaded service providers to accommodate different populations, few are effective and genuinely impact consumer outcomes. Conclusion This paper proposes an integrated cross-cultural assessment framework comprising both clinical and organisational components to improve cross-cultural clinical encounters and consumer satisfaction. The framework underscores the importance of the therapeutic alliance through the building of rapport and trust. Moreover, the framework is designed to be organisationally feasible, and locally and practically oriented.

Migrations, trauma and mental health: A literature update on psychological assessment

IntroductionMigrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology. Objectives and methodThe objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: “migrants”, “refugees”, “posttraumatic stress disorder”, “mental health”, “Psychopathology”, “risk factors”, “protection factors”, “posttraumatic growth” and “resilience”. We have also reviewed the reference lists of articles encountered from database searches. ResultsResponses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the “Cultural Formulation Interview”, are being developed. Discussion and conclusionEven if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants’ geographic or ethnic origins, but rather try to “unpack” culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.

\u201cHow can I do more?\u201d Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload

BackgroundAboriginal cultural awareness training aims to build a culturally responsive workforce, however research has found the training has limited impact on the health professional’s ability to provide culturally safe care. This study examined cultural awareness training feedback from healthcare professionals working with high Aboriginal patient caseloads in the Top End of the Northern Territory of Australia. The aim of the research was to assess the perception of training and the potential for expansion to better meet workforce needs.MethodsAudit and qualitative thematic analysis of cultural awareness training evaluation forms completed by course participants between March and October 2018. Course participants ranked seven teaching domains using five-point Likert scales (maximum summary score 35 points) and provided free-text feedback. Data were analysed using the Framework Method and assessed against Kirkpatrick’s training evaluation model. Cultural safety and decolonising philosophies shaped the approach.Results621 participants attended 27 ACAP sessions during the study period. Evaluation forms were completed by 596 (96%). The mean overall assessment score provided was 34/35 points (standard deviation 1.0, range 31-35) indicating high levels of participant satisfaction. Analysis of 683 free text comments found participants wanted more cultural education, designed and delivered by local people, which provides an opportunity to consciously explore both Aboriginal and non-Aboriginal cultures (including self-reflection). Regarding the expansion of cultural education, four major areas requiring specific attention were identified: communication, kinship, history and professional relevance. A strength of this training was the authentic personal stories shared by local Aboriginal cultural educators, reflecting community experiences and attitudes. Criticism of the current model included that too much information was delivered in one day.ConclusionsHealthcare providers found cultural awareness training to be an invaluable entry point. Cultural education which elevates the Aboriginal health user’s experience and provides health professionals with an opportunity for critical self-reflection and practical solutions for common cross-cultural clinical encounters may improve the delivery of culturally safe care. We conclude that revised models of cultural education should be developed, tested and evaluated. This requires institutional support, and recognition that cultural education can contribute to addressing systemic racism.

Language and Culture are Two Potential Misunderstanding Sources in Cross-Cultural Clinical Encounters

Nabi Fatahi* Author Affiliations University of Gothenburg, Sweden Received: November 15, 2019 | Published: November 22, 2019 Corresponding author: Nabi Fatahi, Department of Learning and Leadership for Health Care Professionals, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden DOI: 10.26717/BJSTR.2019.23.003862

Cultural awareness workshops: limitations and practical consequences

Cultural awareness training for health professionals is now commonplace across a variety of sectors. Its popularity has spawned several alternatives (i.e., cultural competence, cultural safety, cultural humility, cultural intelligence) and overlapping derivatives (diversity training, anti-racism training, micro-aggression training). The ever-increasing reach of cultural awareness initiatives in health settings has generally been well intentioned - to improve cross-cultural clinical encounters and patient outcomes with the broader expectation of reducing health disparities. Yet the capacity of cultural awareness training to accomplish or even impact such outcomes is seldom comprehensively scrutinized. In response, this paper applies a much needed critical lens to cultural awareness training and its derivatives by examining their underpinning philosophies, assumptions and most importantly, verification of their effectiveness. The paper finds cultural awareness approaches to be over-generalizing, simplistic and impractical. They may even induce unintended negative consequences. Decades of research point to their failure to realize meaningful outcomes in health care settings and beyond. Broader expectations of their capacity to reduce health disparities are almost certainly unachievable. Alternative suggestions for improving cross-cultural health care interactions and research are discussed within.

Clinical Communication Across Linguistic and Cultural Boundaries

Due to conflicts and natural disasters every day, thousands of people are leaving their own countries and moving to resettle in another part of the world. This leads, amongst other things, to cross-lingual and cross-cultural clinical encounters. In this context, mutual understanding between patients and healthcare professional is vital for the patients' safety and health outcome. A literature review and previous research showed that satisfactory clinical communication is essential to achieve adequate health outcomes. A prerequisite for mutual understanding between patients with a language barrier and healthcare professionalis a strong language bridge. The interpreter is the third person who facilitates this contact, and in order to avoid misunderstandings a competent professional interpreter is essential.

Cultural Humility for Consultation-Liaison Psychiatrists

Case presentation and analysis is a useful way to revisit key clinical themes, broad concepts, and teach others, especially when it comes to cross-cultural clinical issues. Patients from different cultural backgrounds tend to have different explanatory models of illnesses and related help seeking behaviors. Ineffective communication between clinicians and patients from nonmajority cultural groups may lead to less satisfaction with care and disparities in access to health care and in treatment outcomes. To address health disparities, psychiatrists need to be able to understand the illness beliefs of all patients, particularly those from diverse cultural backgrounds. Using cultural humility to work with patients from all cultures by understanding the patients' values and preferences is a key attitude for successful cross-cultural clinical encounters.

Cultural Intelligence for Clinical Social Work Practice

The concept of cultural competence has long been promoted as a key educational practice priority in the profession of social work. However, assuming uniformity in a given culture and its values and beliefs without allowing for within-group diversity and the consideration of the intercultural interaction is problematic. This article delineates the dynamics of tapping into “cultural intelligence”, which uses a different approach to understanding cultural diversity and cross-cultural interactions by focusing on the interactional field that operates in cross-cultural clinical encounters.

Cross-cultural medical education: Using narratives to reflect on experience

Introduction. Educating students in a multi-cultural society is a challenge as teachers, students and the community they serve all tend to represent various social groups. Skills alone are not adequate for competency in understanding cultural aspects of consultations. A combination of knowledge, skills and attitude is the most widely accepted current approach to teaching culturally competent communication to medical students. Collaborative reflection on narratives of experienced clinicians’ cultural encounters served to construct an understanding of how to develop these attributes. Process. An interest group of medical teachers met to address the specific needs of teaching a relevant cross-cultural curriculum. Participants offered narratives from their professional life and reflected on these encounters to understand how to improve the current curriculum to better address the needs of the students and patients they serve. Results. Through narratives, participants were able to reflect on how their experience had allowed them to develop cultural awareness. All stories represented how attitudes of respect, curiosity and unconditional positive regard were held above all else. The process of collaborative reflection with peers unpacked the complexity and potential in the stories and different learning opportunities were discovered. Learning was personalised because the stories were based on real experiences. Conclusion. The use of collaborative reflection on narratives of clinical encounters could facilitate insights about cultural aspects of medical practice. Elements such as curiosity, respect and unconditional positive regard are illustrated in a unique way that allows students to appreciate the real-life aspects of cross-cultural clinical encounters.

Negotiating within Whiteness in Cross-Cultural Clinical Encounters

Despite awareness in social work and related literatures that sociocultural power dynamics are reproduced in practice, there is little research on how whiteness manifests as an oppressive discourse in clinical settings. This article analyzes audio-recorded therapy sessions between white therapists and racialized immigrant clients from an urban community mental health center in Canada to explore the ways in which whiteness shapes clinical encounters. Using poststructural theories of discourse and conversation analysis, the authors examine how discursive strategies that therapists and clients use in therapy sessions produce and reify whiteness as a prominent feature of cross-cultural communication. The findings illustrate how therapists maintain whiteness as an unmarked norm in their assessment of individual development and the family life cycle and how clients respond to, negotiate with, and resist whiteness, which positions them as subordinate others in Canada. The authors conclude with a discussion of implications for practice and future research.

Expectations of Similarity and Cultural Difference in Conceptual Models of Illness: A Comparison of Medical Staff and Mexican Migrants

Cultural competency has increasingly become a central concept in medical education and practice, focusing on recognizing the variation in patients' health-related beliefs and practices in order to improve cross-cultural communication and health outcomes. While numerous anthropologists critique cultural competency concepts, approaches, and instruments, there is little research regarding the central question of how biomedical providers perceive the health-related beliefs and practices of patients from different cultural backgrounds, how these perceptions compare with patients' own stated beliefs, and how they vary from providers' own concepts of health and illness. Yet, perceptions of difference in conceptual models of health and illness may influence cross-cultural clinical encounters more than measurable variation as they may obscure existing differences while exaggerating others based on notions of cultural difference. We examine these issues by analyzing patterns of variation between Mexican migrants an...

Integrating cultural humility into health care professional education and training

As US populations become increasing diverse, healthcare professionals are facing a heightened challenge to provide cross-cultural care. To date, medical education around the world has developed specific curricula on cultural competence training in acknowledgement of the importance of culturally sensitive and grounded services. This article proposes to move forward by integrating the concept of cultural humility into current trainings, in which we believe, is vital in complementing the current model, and better prepare future professionals to address health challenges with culturally appropriate care. Based on the works of Chinese philosophers, cultural values and the contemporary Chinese immigrants' experience, we hereby present the QIAN (Humbleness) curriculum: the importance of self-Questioning and critique, bi-directional cultural Immersion, mutually Active-listening, and the flexibility of Negotiation. The principles of the QIAN curriculum reside not only between the patient and the healthcare professional dyad, but also elicit the necessary support of family, health care system as well as the community at large. The QIAN curriculum could improve practice and enhance the exploration, comprehension and appreciation of the cultural orientations between healthcare professionals and patients which ultimately could improve patient satisfaction, patient-healthcare professional relationship, medical adherence and the reduction of health disparities. QIAN model is highly adaptable to other cultural and ethnic groups in multicultural societies around the globe. Incorporating its framework into the current medical education may enhance cross-cultural clinical encounters.

Investigation of Cross-Cultural Practice: Implications for Curriculum Development

A study was conducted to explore British occupational therapists' perceptions of cross-cultural practice. A qualitative research approach was used to explore both the concerns and difficulties therapists experience in cross-cultural clinical encounters, and the attitudes, skills and knowledge they feel are essential for the provision of culturally sensitive practice. One of the most significant study findings was the identified need for a phenomenological approach during initial assessment and ongoing service provision. This approach requires that therapists engage in a process of introspective analysis of their own cultural and socio-economic background and belief systems. Therapists need to understand the influence these systems have on their clinical perceptions and interactions. Based on the analysis of the data, recommendations for professional education and development in cultural awareness have been made.