Cultural Awareness Training Research Articles

Cardiac Rehabilitation for Aboriginal and Torres Strait Islander people in Western Australia.

BackgroundCardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people.MethodsCardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people.ResultsInterviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services.ConclusionThe under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed.

What Do Teachers Need toSupport English Learners?

This study explored K-8 teachers’ perceptions of their preparation and the challenges they encountered in delivering instruction to culturally and linguistically diverse learners. Using a mixed method research design, data were collected through a web-based survey from teachers in the state of Michigan. Researchers used chi-square tests to investigate the relationship between teachers’ preparation and their knowledge of their diverse learners’ learning needs. Qualitative comments were examined, organized, and summarized to illustrate key themes in each question under study. Findings revealed that teachers’ perceptions of their preparation to teach linguistically and culturally diverse students were correlated with cultural diversity or lack of cultural diversity in their classrooms. Whereas teachers stated they felt prepared to teach heterogeneous classes, they encountered challenges in delivering instruction to English learners. In addition, teachers stated that cultural awareness training did not adequately prepare them to integrate cultural elements in their daily instructional practices.

Between practicing and rehearsing: cultural awareness challenges in the military

In this article, we confront the tradition that understands cultural awareness training as the individual acquisition of intercultural competences with recent developments in the theorizing of culture and education. The question we ask is how to understand cultural awareness training if dealing with cultural diversity is not depending on individual competences but rather on the interaction between people on the ground. We will take three steps to discuss this point. In a first step we consider the challenge of cultural diversity for military organizations. The second step consists in a reflection on the notion of intercultural competences and the idea that intercultural competences can be acquired by individuals. In the third step we develop an alternative understanding of the preparation for intercultural interaction, based on Sennett's distinction between practicing and rehearsing (Sennett, 2012).

Building social resilience in soldiers: A double dissociative randomized controlled study.

Can social resilience be trained? We report results of a double-dissociative randomized controlled study in which 48 Army platoons were randomly assigned to social resilience training (intervention condition) or cultural awareness training (active control group). The same surveys were administered to all platoons at baseline and after the completion of training to determine the short-term training effects, generalization effects beyond training, and possible adverse effects. Multilevel modeling analyses indicated that social resilience, compared with cultural awareness, training produced small but significant improvements in social cognition (e.g., increased empathy, perspective taking, & military hardiness) and decreased loneliness, but no evidence was found for social resilience training to generalize beyond these training foci nor to have adverse effects. Moreover, as predicted, cultural awareness, compared with social resilience, training produced increases in knowledge about and decreases in prejudice toward Afghans. Additional research is warranted to determine the long-term durability, safety, and generalizability of social resilience training.

Black and Minority Ethnic Groups’ Perception and Experience of Early Intervention in Psychosis Services in the United Kingdom

In the United Kingdom, Black and minority ethnic (BME) service users experience adverse pathways into mental health care. Ethnic differences are evident even at first-episode psychosis; therefore, contributory factors must operate prior to first presentation to psychiatric services. This study examines the cultural appropriateness, accessibility, and acceptability of the Early Intervention (EI) for Psychosis Services in Birmingham (the United Kingdom) in improving the experience of care and outcomes for BME patients. Thirteen focus groups were conducted with EI service users ( n = 22), carers ( n = 11), community and voluntary sector organizations ( n = 6), service commissioners ( n = 10), EI professionals ( n = 9), and spiritual care representatives ( n = 8). Data were analyzed using a thematic approach and framework analysis. Findings suggest that service users and carers have multiple, competing, and contrasting explanatory models of illness. For many BME service users, help-seeking involves support from faith/spiritual healers, before seeking medical intervention. EI clinicians perceive that help-seeking from faith institutions in Asian service users might lead to treatment delays. The value of proactively including service user’s religious and spiritual perspectives and experiences in the initial assessment and therapy is recognized. However, clinicians acknowledge that they have limited spiritual/religious or cultural awareness training. There is little collaborative working between mental health services and voluntary and community organizations to meet cultural, spiritual, and individual needs. Mental health services need to develop innovative collaborative models to deliver holistic and person-centered care.

Creating lasting and fulfilling careers for Indigenous Australians

Recruiting Indigenous Australians is part of the oil and gas industry’s social responsibility. Indigenous recruits need to be ensured that they have lasting and fulfilling careers. In Transfield Services’ experience, retention is often the greatest challenge and significant time and resources is spent to identify strategies to help Indigenous employees progress their careers positively. The first and, arguably, the most important element is to engage early with Indigenous communities to identify key local Indigenous stakeholders and establish strong and trusting relationships. This provides a contextual platform and understanding that guides not only the recruitment process and role fit, but also the support required for individuals through their employment. Indigenous employees then are assigned a mentor to assist in developing their occupational skills. Mentors can be volunteers from across the company but they must work closely with Indigenous development managers to ensure full cultural awareness. Cultural awareness training should also be carried out extensively across an organisation and be backed up by day-to-day application of human resource polices that accommodate cultural elements specific to Indigenous Australians. Critically, organisations must also hold themselves accountable. Publicly available Reconciliation Action Plans (RAPs) must set transparent targets for recruitment and retention, and progress must be continually monitored by informed and independent advisory boards. In 2007, Transfield Services launched its first Indigenous participation strategy. It then became the first service provider to implement a RAP in 2009. Since then, it has launched an updated RAP, which earlier this year was endorsed by Reconciliation Australia—one of only a handful in the country to have this accreditation.

Cultural Training as Behavior Change

People working overseas require knowledge of the local culture, as well as competence in dealing with cross-cultural situations. Acquiring the necessary knowledge, skills, and abilities can be difficult, not just because there is much to learn but because differences between cultures can result in discomfort and act as an affective barrier to learning. Busy adults have limited time to learn, which exacerbates the problem. VCATs (Virtual Cultural Awareness Trainers) have proven to be highly effective at promoting cultural awareness, in spite of these challenges. This paper presents a theoretical framework for understanding how cultural learning takes place in VCATs, in terms of behavior change. Virtual role-play together with other learning activities appropriate for each stage in the learning process promote readiness to learn and behavior change. The resulting approach has been applied successfully in cultural awareness training courses for over eighty countries, with over 60,000 learners to date. A longitudinal evaluation with VCAT learners suggests that it has long-term effects on behavior in cross-cultural settings. The paper concludes with some recommendations for further improvements of the VCAT model, through ongoing adaptive training resulting in stronger and more sustained learning outcomes.

The Employment of Aboriginal and Torres Strait Islanders in Local Government: Issues, Benefits, and Ways Forward

In Australia today, Aboriginal and Torres Strait Islander people experience significant ongoing disadvantage around employment, education, health, housing, and social inclusion. Local government agencies and others often now have roles for Aboriginal people to work and deal with relevant issues. Ten people working, or formerly working, in Aboriginal-related roles in local government were interviewed about the issues and benefits of such roles. Themes to emerge included the importance of properly resourcing the positions, having wide-ranging Aboriginal employment policies, providing mentoring and support for Aboriginal workers, and continuing to build cultural awareness in councils. Many of those interviewed described cultural awareness training as valuable for councils, but also questioned the efficacy of the way they are commonly run. Implications for local government include the need to ensure that what is already known about the effective implementation of policies in organisations is being applied; for example, by making Aboriginal employment policies the responsibility of each work area.

Consequence of Cross Cultural Misunderstanding – A Shipboard Perspective

Cross cultural issues are on the rise, be it a shore based environment or a shipboard environment. If cross cultural issues are not identified at the grass root level, it can cause disharmony in an individual or group productivity eventually affecting the integrity in a working environment. Several research studies are being done on this issue to haul out feasible solutions to subdue and surmount cross cultural issues before it could surface. One such solution is to provide cross cultural awareness training to an individual during the induction process and progress it throughout the period of employment. At times solutions that are implementable in a shore based set up may not bring out the much expected outcome in a shipboard environment. This paper brings out the impact of cross cultural issues more so in the case of shipboard working environment.

The fairness, predictive validity and acceptability of multiple mini interview in an internationally diverse student population--a mixed methods study.

BackgroundInternational medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population.MethodsThis was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students.Results109 students participated (45% of class). Of this 41.3% (n = 45) were Non-EU and 35.8% (n = 39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r = 0.5, P<0.01). Correlations emerged between First Year results and IELTS (r = 0.44; p = 0.006; n = 38) and EU school exit exam (r = 0.52; p<0.001; n = 56). MMI predicted EU student OSCE performance (r = 0.27; p = 0.03; n = 64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates.ConclusionMMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-014-0267-0) contains supplementary material, which is available to authorized users.

Ethnic variation in patients' ratings of communication: analysis of National Cancer Patient Experience Survey data

BackgroundEthnic inequalities in cancer patient experience are known to exist; however, variation by ethnic subcategory is not well-explored. Information provision and communication, key domains of patient experience, are also likely to vary by ethnic subcategory, but there have been few detailed analyses to date. The aim of this study was to identify and quantify ethnic variation in cancer patients' experiences of information provision and communication through analysis of data by ethnic categories and subcategories. MethodsThe National Cancer Patient Experience Survey 2012–13 was sent to all adult cancer patients treated in a National Health Service (NHS) hospital from Sept 1, 2012, to Nov 31, 2012. The publically available dataset contained responses to 70 multiple-choice questions and associated demographic information for 68 737 cancer patients from 155 NHS trusts. In this secondary analysis, multivariate logistic regression was used to investigate associations between ethnicity and patients' ratings of overall care, information provision, and communication as measured by 24 questions. FindingsPatients' ratings of communication and information provision varied greatly by ethnicity. For example, non-white patients, in particular Asian patients, were less likely than white patients to receive understandable written information about treatment side-effects (adjusted odds ratio 0·60, 95% CI 0·51–0·70; p<0·0001), and Bangladeshi patients were the least likely within the Asian category to receive such information (0·37, 0·20–0·70; p=0·002). Similarly, non-white patients, in particular Asian patients, were less likely to receive understandable answers to important questions from doctors (0·49, 0·41–0·58; p<0·0001), and Bangladeshi patients were the least likely within the Asian category (0·12, 0·06–0·25; p<0·0001). InterpretationEffective communication and information provision are key aspects of the patient experience, and are very important to ensure that all patients are well informed and receive the best possible patient care. Ethnic inequalities, such as those identified here, should be addressed at both practice and policy level. Health-care professionals should be aware of the inequalities that exist and of their personal ethnic bias. Cultural and racial awareness training would help them to tailor their consultation to the cultural and linguistic needs of their patients. Future policy should be guided by ethnically diverse patient focus groups, and further work should aim to understand causes of ethnic variation in ratings of communication and information provision. FundingHW and LM-L are supported by the National Institute for Health Research Imperial College Healthcare NHS Trust Biomedical Research Centre and Imperial College Healthcare Charity.

Moral Emotions during Military Deployments of Dutch Forces

Which emotions are generated by the behavior of “the other” in intercultural interactions that Dutch soldiers perceive as conflicting with their own values? How are these emotions related to types of behavioral reactions of Dutch military personnel? This preliminary study explores the emotional and behavioral reactions of Dutch military personnel deployed in unfamiliar cultural settings. Using a grounded theory approach, a total of 121 situations were studied. The narratives were derived from interview sessions with servicemen reflecting on their recent deployment. The results of this explorative study indicate that violations of standards with regard to an individual’s position in society evoke most emotions. The more a situation is experienced as reprehensible and “strange,” the stronger the negative emotions. Although most soldiers did not react in accordance with their strong and negative emotions (they started a dialogue or reported the incident), the consequences of such emotions and subsequent reactions can have quite an impact on the individual level as well as on the organizational and international political level. We therefore underline the importance of combining ethical dilemma and cultural awareness training during predeployment.

The Effect of Authentic and Inauthentic Materials in Cultural Awareness Training on EFL Learners’ Listening Comprehension Ability

This paper aimed to examine the effect of authentic and inauthentic materials in cultural awareness training on the listening comprehension ability of EFL learners. To this end, the Cambridge ELT placement test was given to 116 students, 60 of them who were at intermediate level were chosen as the sample. The participants were randomly divided into two equal groups, the control and experimental groups. They also took a listening pretest to investigate the possible difference between them. The control group underwent listening activities through inauthentic materials, while the experimental group dealt with authentic materials. Test scores in pre- and post-test were compared. Using SPSS, the Kolmogorov-Smirnov test of normality was run for the post-test scores to check the applicability of parametric statistics. A Paired-Sample T-Test proved that the listening comprehension ability of the participants has improved in a statistically significant way. A One-way ANOVA test was then run to compare the mean-scores of the groups in the post-test. All tests were at the alpha level of .05. The results revealed that the listening ability of learners in the experimental group had improved better than the learners in the control group. This study may have implications for improving EFL learners’ listening ability.

What Do Teachers Need to Support English Learners?

This study explored K-8 teachers’ perceptions of their preparation and the challenges they encountered in delivering instruction to culturally and linguistically diverse learners. Using a mixed method research design, data were collected through a web-based survey from teachers in the state of Michigan. Researchers used chi-square tests to investigate the relationship between teachers’ preparation and their knowledge of their diverse learners’ learning needs. Qualitative comments were examined, organized, and summarized to illustrate key themes in each question under study. Findings revealed that teachers’ perceptions of their preparation to teach linguistically and culturally diverse students were correlated with cultural diversity or lack of cultural diversity in their classrooms. Whereas teachers stated they felt prepared to teach heterogeneous classes, they encountered challenges in delivering instruction to English learners. In addition, teachers stated that cultural awareness training did not adequately prepare them to integrate cultural elements in their daily instructional practices.

Longitudinal integration of cultural components into a physician assistant program's clinical year may improve cultural competency.

This study assessed the efficacy of longitudinal integration of cultural components into the clinical year of a 2-year master of science in physician assistant studies (MSPAS) program. Students submitted cultural reflection papers, gave a medical case/cultural presentation, and participated in cultural awareness discussion groups throughout the clinical year. Students completed the same cultural awareness survey at the conclusion of their clinical year that they had completed at benchmarked intervals during their didactic year. Additionally, cultural competency was assessed during the students' summative objective structured clinical examination (OSCE) using a combination of the program's objectives and established professional standards. Qualitative data suggested that students recognized the importance of cultural competency in providing quality patient care and recognized that remaining culturally competent is an ongoing process. Linear trend analyses revealed significant positive relationships between survey response scores and time in the program. The OSCE's cultural assessment scores indicated cultural competency in broad, general categories, but scores declined as cultural categories narrowed and became more detailed. Continued integration of cultural awareness training and assessment throughout the clinical year of a physician assistant (PA) program may have a positive impact on improving cultural competency. PA programs seeking to improve cultural competency in their students should consider continued integration of cultural components throughout the clinical year.

Aboriginal health promotion through addressing employment discrimination.

The Localities Embracing and Accepting Diversity (LEAD) program aimed to improve the mental health of Aboriginal Victorians by addressing racial discrimination and facilitating social and economic participation. As part of LEAD, Whittlesea Council adopted the Aboriginal Employment Pathways Strategy (AEPS) to increase Aboriginal employment and retention within the organisation. The Aboriginal Cultural Awareness Training Program was developed to build internal cultural competency and skills in recruiting and retaining Aboriginal staff. Analysis of surveys conducted before (pre; n=124) and after (post; n=107) the training program indicated a significant increase in participant understanding across all program objectives and in support of organisational policies to improve Aboriginal recruitment and retention. Participants ended the training with concrete ideas about intended changes, as well as how these changes could be supported by their supervisors and the wider organisation. Significant resources have since been allocated to implementing the AEPS over 5 years. In line with principles underpinning the National Aboriginal and Torres Strait Islander Health Plan 2013-23, particularly the focus on addressing racism as a determinant of health, this paper explores the AEPS and training program as promising approaches to health promotion through addressing barriers to Aboriginal employment. Possible implications for other large organisations are also considered.

Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department

IntroductionCultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs. AimTo determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people. MethodOne group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer. ResultsThe cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group. ConclusionFuture strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.

Humanitarian and Civic Assistance Health Care Training and Cultural Awareness Promoting Health Care Pluralism

Integration between traditional and contemporary health care in a host nation can be beneficial to nation- and capacity-building and, subsequently, to the overall health of the society. "Traditional" health care in this sense refers to the indigenous health care system in the host nation, which includes characteristic religious or cultural practices, whereas "contemporary" health care is also known as "conventional" or "Westernized"; integration is a synchronization of these two health care forms. However, the choice of integration depends on the political and cultural situation of the nation in which the Department of Defense health care personnel are intervening. Thus, cultural awareness training is essential to ensure the success of missions related to global health and in promoting a health care system that is most beneficial to the society. The present study attempts to show the benefits of both cultural training and health care integration, and how adequately evaluating their efficacy has been problematic. The author proposes that determinants of this efficacy are better documentation collection, extensive predeployment cultural awareness and sensitivity training, and extensive after-action reports for future development.

IDADA: The individual difference approach to assessing and developing diversity awareness

AbstractThis paper outlines a new approach to cultural awareness training, the Individual Differences Approach to Diversity Awareness (IDADA). IDADA is distinguished from other approaches in three ways: (a) it eliminates the need to characterise cultures, (b) it addresses unfair discrimination of any kind (e.g., weight, height, attractiveness), (c) it teaches employees to become aware of how their attitudes affect organisational performance, and (d) it focuses on job requirements. Initial evidence supports the validity of the model. The paper also introduces a new measure of diversity-openness called the Ideal Employee Inventory. Preliminary reliability and validity evidence for the measure is provided.

Experiences of ageing and aged care in Australia of older survivors of genocide

ABSTRACTThis qualitative study investigated the ageing and aged care experiences in Australia of two cohorts of older survivors of genocide: Jewish Holocaust survivors and older Cambodian genocide survivors. It was carried out in response to an identified need to better train aged care workers who are in contact with these groups. In-depth interviews were conducted with 21 community-dwelling survivors aged 65 and over. Credibility was ensured by methodological triangulation and peer debriefing. The study highlighted the importance of understanding older survivors’ ageing and aged care experiences in the context of their entire lifecourse and in terms of both vulnerability and resilience. It showed that trauma history can heighten older survivors’ sensitivity to many aspects of the social and physical environments in residential, community and home-based aged care settings. The study also uncovered the potential for aged care services to help older survivors cope with the psycho-social and emotional effects of resurfacing post-traumatic stress symptoms. The implications of the study findings for care practice include the importance of recognising older survivors of genocide as a distinct group of clients and the need to distinguish staff training for caring for this client group from general cultural awareness training.