Cultural Competence Strategies Research Articles

Attitudes of nursing degree students towards end of life processes. A cultural approach (Spain-Senegal).

The concept of death is abstract, complex and has a number of meanings. Thus, its understanding and the approach taken to it depend, to a large extent, on aspects such as age, culture, training and religion. Nursing students have regular contact with the process of death and so it is of great interest to understand the attitudes they have towards it. As we live in a plural society it is even more interesting to not only understand the attitudes of Spanish students but, also, those of students coming from other countries. In the present article, we seek to identify and compare the attitudes held by nursing degree students at Hekima-Santé University (Senegal) and the University of Huelva (Spain) about end of life processes. The study identifies elements that condition attitudes and coping with death, whilst considering curricular differences with regards to specific end of life training. A descriptive, cross-sectional and multi-center study was conducted. The overall sample (N = 142) was divided into groups: Hekima-Santé University (Dakar, Senegal) and the University of Huelva (Huelva, Spain). The measurement instruments used were an ad-hoc questionnaire and Bugen´s Coping with Death Scale. Statistically significant differences (p = 0.005, 95%CI) were found in relation to overall Bugen Scale scores. We can confirm that specialized end of life training (University of Huelva, Spain) did not lead to better coping when compared with a population whose academic curriculum did not provide specific training and who engaged in more religious practices (Hekima-Santé University, Senegal). In cultures where religion not only influences the spiritual dimension of the individual, but acts in the ethical and moral system and consequently in the economic, educational and family sphere, the accompaniment at the end of life transcends the formative plane. Considering the plural society in which we live, the training that integrates the Degree in Nursing with regard to the care of the final process, must be multidimensional in which spirituality and faith are integrated, working emotional and attentional skills, as well as cultural competence strategies in this process.

A culturally-competent approach to emergency management: What lessons can we learn from the COVID-19?

The COVID-19 pandemic, like other disasters, is exposing and exacerbating social, economic, and health care inequalities. Although the ethical and clinical imperative of providing culturally-competent health care has long been recognized, the influence of culturally-competent interventions within emergency management has not been systematically examined. This paper discusses several culturally-competent strategies that were taken by the Israeli national and local authorities in high-risk areas and communities during the COVID-19 outbreak. In addition to controlling the pandemic outbreak, such an approach has the potential to reduce social disparities in health care, promote community resilience, and facilitate social cohesion. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Delphi investigation of strategies to develop cultural competence in physical education teacher education

ABSTRACT Background: The shifting demographics of the United States population remains a central challenge for the education sector. A pressing concern rests with the continued cultural gap that exists between a largely homogenous teacher labor force and an increasingly heterogeneous student population. Provided the longstanding existence of a cultural gap, there have been calls for scholars to identify strategies that could help current and future teachers bridge this gap in their classrooms. Purpose: The purpose of this study was to generate consensus regarding the strategies physical education teacher education (PETE) programs can adopt to develop cultural competence among physical education teacher candidates. Method: The study employed a three-round Delphi process involving the repeated circulation of a survey to panel members (N = 12) with a record of pedagogic and/or scholarly engagement with cultural competence. In Round-I, participants were provided an open-ended question that prompted them to list up to ten strategies a PETE program could use to promote cultural competence in teacher candidates. During Round-II, participants were then asked to rate the list of strategies regarding the impact and contextual feasibility within a PETE program. In Round-III, participants again rated the same list of strategies with the considerations of other panelists’ ratings. Results: The Delphi panel created an initial list of 37 strategies that could be used to develop cultural competence in teacher candidates. Round-II and Round-III data were analyzed using descriptive statistics to calculate group means. Expert consensus determined eight cultural competence strategies as the most impactful and feasible for PETE programs. The eight strategies illustrated how cultural knowledge, critical awareness, skill development, and environmental supports all need to be addressed. Faculty buy-in and departmental leadership were also identified as critical to executing those strategies. Discussion/Conclusion: The list of strategies is not intended to be exhaustive; however, it does provide a guide for PETE faculty to start the process of promoting cultural competence. In light of the growing societal emphasis on issues pertinent to the cultural gap in teaching, the authors encourage further investigation of the actual impact and feasibility of these strategies.

The Merits of Integrating Accelerated Experiential Dynamic Psychotherapy and Cultural Competence Strategies in the Treatment of Relational Trauma: The Case of "Rosa"

The psychological sequelae of prolonged and repeated exposure to relational trauma can manifest into a challenging clinical picture typically known as Complex PTSD. Accelerated Experiential Dynamic Psychotherapy (AEDP) is a multimodal and integrative model particularly designed to address attachment disturbances and extreme forms of affective avoidance and dysregulation commonly seen in survivors of relational trauma. Conducting this treatment in a language that is not the patient’s native tongue may interfere with emotional processing, a key component of AEDP. The purpose of this study is twofold. First, it aims to examine the benefits of experiential and attachment-based models for the treatment of "Rosa," a bilingual woman and survivor of relational trauma, who presented to treatment with depressive and Complex PTSD-like symptom. Second, the study explores whether actively incorporating Rosa’s bilingualism and ethnic identity into the treatment enhanced her capacity for emotional processing and other related aspects of AEDP. This exploration constitutes an ideal avenue for documenting the clinical challenges one may encounter in doing psychotherapy with bilingual trauma survivors. For in this type of therapy, the affective processing of traumatic memories can be lost in translation. This requires the creation of an individualized treatment plan that can address these barriers, amplifying the emergence of relational safety and ultimately facilitating the patient’s new experience of core state (Fosha & Yeung, 2006), an integrated state of clarity, ease, and self-compassion.

Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence

BackgroundRecruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research. ObjectivesThe purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia. DesignThe Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan. ProceduresThe approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data. ResultsRecruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies. ConclusionsThese findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.

Different and Similar at the Same Time. Cultural Competence through the Leans of Healthcare Providers.

Cultural competence (CC) for professionals and organizations has been recognized as a key strategy to reduce health care inequalities for migrants and to promote responsiveness to diversity. For decades its main aim has been matching health services to the cultural needs of migrant users. Otherwise literature highlighted the need to find a pragmatic middle way between the ‘static’ and the ‘dynamic’ views of culture that are recognizable in CC approaches. A pragmatic middle way to CC will be proposed as the way to respect diversity, even responding to cultural issues, without stereotyping or discriminating. To understand conditions that favor this pragmatic middle way this study aims to explore: (1) perceptions of healthcare providers in managing diversity; (2) strategies used to meet health needs at a professional and organizational level. A qualitative case study was conducted in a healthcare service renowned for its engagement in migrant sensitive care. Four different professional figures involved in CC strategies at different levels, both managerial and non-managerial, were interviewed. Data were analyzed using thematic analysis. Findings indicated that dealing with diversity poses challenges for healthcare providers, by confronting them with multilevel barriers to quality of care. A pragmatic middle way to CC seems to rely on complex understanding of the interaction between patients social conditions and the capacity of the institutional system to promote equity. Professional and organizational strategies, such as inter-professional and intersectional collaboration, cultural food adaptation and professional training can enhance quality of care, patient compliance responding to social and cultural needs.

Seat Belt Messaging for Diverse Populations

In the United States, Hispanics and African Americans are disproportionately killed and injured in motor vehicle crashes (MVCs) compared with non-Hispanic Whites. In 2013, more African Americans died from MVC-related injuries than any other unintentional injury, and 64.5% of fatally injured Hispanic youth (ages 15-20) were unrestrained or otherwise incorrectly belted at the time of the crash. As the minority population in the US continues to increase, it is imperative to develop effective and culturally sensitive countermeasures to reach those most at risk of death and injury from MVCs. The Hispanic Toolkit and the African American toolkit were developed using cultural competency strategies to encourage an increase in seat belt use. The Hispanic Toolkit includes bilingual brochures, posters, and radio/video public safety announcements that address common attitudes and practices among recently emigrated Latinos regarding traffic safety culture. The African American toolkit includes E-blasts, fact sheets, and an educational power point to engage local African American organizations in educating their communities and encourage traffic safety behaviors. Both toolkits are user friendly and can be downloaded online.

Refining the concept of cultural competence: building on decades of progress

Cultural competence strategies aim to make health services more accessible for patients from diverse cultural backgrounds. Recently, such strategies have focused on specific groups, and particularly Indigenous Australians, where services have failed to address large disparities in health outcomes. Limitations of cultural competence largely fall into three categories: lack of clarity around how the concept of culture is used in medicine, inadequate recognition of the "culture of medicine" and the scarcity of outcomes-based research that provides evidence of efficacy of cultural competence strategies. Narrow concepts of culture often conflate culture with race and ethnicity, failing to capture diversity within groups and thus reducing the effectiveness of cultural competence strategies. This also hampers the search for evidence linking cultural competence to a reduction in health disparities. Attention to cultural complexity, structural determinants of inequality and power differentials within health care settings not only provide a more expansive notion of cultural competence and a nuanced understanding of the role of culture in the clinic, but may assist in determining the contribution that cultural competence strategies can make to a reduction in health disparities.

Culturally Competent Interventions to Address Obesity Among African American and Latino Children and Youth

ABSTRACTWhile obesity impacts all ethnic groups in the United States, African Americans and Latinos are particularly at high risk for obesity. The purpose of this paper is to provide an analysis of the literature on evidence-based culturally competent strategies for addressing and preventing obesity and discuss roles for occupational therapists working with populations at risk for obesity in the school or therapeutic clinical environment. A review was conducted of over 80 research articles describing successful interventions conducted in schools and communities targeting African Americans and Latino children. Although unique single strategies are highlighted in this paper, obesity interventions are complex and involved a number of multilevel strategies. The results of the analysis of the literature are presented according to strategies that promote healthy eating, physical activity, and overall healthy lifestyles. Along with the cultural competent strategies, we recommend specific roles for occupational therapists in order to promote the implementation of each particular strategy. Lastly, implications for occupational therapy are discussed.

The Epistemology of Cultural Competence

Cultural competence is a high priority in social work, but it is not conceptualized in a way that can effectively guide practice. The author proposes an organization of cultural competence strategies into epistemologically defined paradigms for multicultural practice. The paradigms discussed are based in postpositivism, constructivism, critical theory, and postmodernism. These paradigms are presented as potential tools for developing a better understanding of what constitutes effective multicultural practice and what contributes to cultural impasses. The author suggests that cultural competence should be defined by the capacity to work across multiple paradigms to find ways to engage with clients.