Health Care For Ethnic Minorities Research Articles

Health and social care experience and research perception of different ethnic minority populations in the East Midlands, United Kingdom (REPRESENT study)

AbstractIntroductionEthnic minority populations experience significant health and social care disparities; despite experiencing a greater burden of diseases, these groups are underrepresented in health and social care research. Consequently, related research can be less applicable to these population groups. The REPRESENT study aims to explore the health and social care experiences of ethnic minorities and other minoritised populations, their research interests and appropriate research practices.MethodsFocus groups and semistructured interviews were conducted between May and September 2022 with members of a number of ethnic minority communities in England. Data were audio recorded, transcribed and thematically coded using NVivo 12. Rigour was determined through extensive sampling, iterative data collection and analysis.FindingsFifty‐two ethnic minority members were engaged in group interviews and one‐to‐one interviews. Participants included representatives of the following groups: African Caribbean, Eastern European, Gypsy Travellers, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual+, Refugee/Asylum Seekers, Somali and South Asian communities. Interviews were also conducted with ethnic minority healthcare providers and researchers. Three overarching categories were identified: health information, medical service experiences, health and social care concerns and health research. Health and social care services challenges were mostly attributed to discrimination, delayed services, poor cultural relevance and language and cultural barriers. The most influential information sources were local community organisations and word‐of‐mouth. The main health and social care concerns were chronic long‐term health conditions, mental health, maternal health and child development. Recommendations for research involved understanding the motivations for participation, improving communication and empowering communities. Top research priorities were long‐term health conditions, health promotion and education, early care interventions and understanding community needs.InterpretationDiscrimination and bias in health and social care provision have severe implications for worsening ethnic health inequalities. Healthcare commissioning authorities and policymakers can leverage the preference of ethnic minority groups for pharmacy services and community organisations to improve access to care. Improving research interest and engagement requires understanding individual community needs, community sensitivity, research relevance and cultural appropriateness.Patient or Public ContributionMembers of ethnic minority Patient and Public Involvement and Engagement group and Community Advisory Board supported the REPRESENT study design, conceptualisation and report development.

Race and ethnicity in the COVID-19 Critical Care Consortium: demographics, treatments, and outcomes, an international observational registry study

BackgroundImproving access to healthcare for ethnic minorities is a public health priority in many countries, yet little is known about how to incorporate information on race, ethnicity, and related social determinants of health into large international studies. Most studies of differences in treatments and outcomes of COVID-19 associated with race and ethnicity are from single cities or countries.MethodsWe present the breadth of race and ethnicity reported for patients in the COVID-19 Critical Care Consortium, an international observational cohort study from 380 sites across 32 countries. Patients from the United States, Australia, and South Africa were the focus of an analysis of treatments and in-hospital mortality stratified by race and ethnicity. Inclusion criteria were admission to intensive care for acute COVID-19 between January 14th, 2020, and February 15, 2022. Measurements included demographics, comorbidities, disease severity scores, treatments for organ failure, and in-hospital mortality.ResultsSeven thousand three hundred ninety-four adults met the inclusion criteria. There was a wide variety of race and ethnicity designations. In the US, American Indian or Alaska Natives frequently received dialysis and mechanical ventilation and had the highest mortality. In Australia, organ failure scores were highest for Aboriginal/First Nations persons. The South Africa cohort ethnicities were predominantly Black African (50%) and Coloured* (28%). All patients in the South Africa cohort required mechanical ventilation. Mortality was highest for South Africa (68%), lowest for Australia (15%), and 30% in the US.ConclusionsDisease severity was higher for Indigenous ethnicity groups in the US and Australia than for other ethnicities. Race and ethnicity groups with longstanding healthcare disparities were found to have high acuity from COVID-19 and high mortality. Because there is no global system of race and ethnicity classification, researchers designing case report forms for international studies should consider including related information, such as socioeconomic status or migration background.*Note: “Coloured” is an official, contemporary government census category of South Africa and is a term of self-identification of race and ethnicity of many citizens of South Africa.

The experience of racial discrimination among ethnic minority healthcare professionals in Ireland

Abstract Background Racial discrimination towards ethnic minorities permeates healthcare systems of many countries. This study aimed to strengthen the understanding of the experience of racial discrimination among ethnic-minority healthcare professionals in Ireland. The objective was to explore the lived experience of racial discrimination and its impact on the health and well-being of nurses and doctors in this local context. Methods Interpretative Phenomenological Analysis was used to explore participants' experiences. Purposive and snowball sampling strategies were used to recruit sixteen ethnic minority nurses and physicians, working in diverse roles across Irish private and public healthcare sectors. In-depth semi-structured interviews were employed to collect data. A brief questionnaire was used to obtain information on participants’ demographic profiles. Findings Ethnic minority healthcare professionals experienced racial discrimination from colleagues, patients, and families; and this discrimination was interpersonal, structural, and institutional. Three core themes, and a number of related sub-themes, were identified; including: (1) Experiences of racial discrimination ((a) overt and subtle, (b) excessive reporting, (c) lack of safe space and trust, (d) being overlooked), (2) Responses to racial discrimination ((a) navigating racism, (b) tolerating in silence, (c) surviving and thriving, (d) seeking support); and (3) Impact of racial discrimination ((a) psychological impacts, (b) physical impacts, and (c) financial impact). Conclusions This study demonstrated that ethnic minority healthcare professionals have experienced racial discrimination in the Irish healthcare setting, which significantly impacted their health and well-being. By giving voice to these healthcare professionals, this study highlighted challenges facing Irish healthcare systems and the need for drastic change.

“Data makes the story come to life:” understanding the ethical and legal implications of Big Data research involving ethnic minority healthcare workers in the United Kingdom—a qualitative study

The aim of UK-REACH (“The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers”) is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information governance associated with the linkage of HCWs’ registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust—of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a “Big Data Ethics by Design” approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research.

Understanding clinician barriers to providing equitable healthcare for ethnic minority populations

Abstract Background It has long been recognised that ethnic minority groups have worse health outcomes in the UK. Social determinants of health (SDH) contribute significantly to these inequalities. However, inequalities persist, even after controlling for these determinants. As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences. The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount. Recent focus has been placed on ensuring “cultural competence”. Whilst this is important, we suggest also examining the culture within healthcare itself. Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account. A seminal piece of work on this is the “culture of medicine” framework proposed by Boutin-Foster et al, which examines the impact of these factors. Aims and Methodology This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities. A formal literature review was conducted and 131 relevant studies were identified. Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster’s framework used as a structure. Results The review found that the concept of implicit bias was paramount in PCI. Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups. Conclusions Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations. A solution we propose is to acknowledge our own preconceptions. Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education. Key messages • Clinician implicit bias within the “Culture of Medicine” is a barrier to equitable healthcare for ethnic minority populations. • Awareness of our own culture and preconceptions is paramount to addressing these barriers.

Utilisation of village clinics in Southwest China: evidence from Yunnan Province.

Primary healthcare in rural China is underutilised, especially in village clinics in Southwest China. The aim of this study was to explore any relationships among the ethnicity of the healthcare provider, the clinical competence of the healthcare provider, and the utilisation of village clinics in Southwest China. This cross-sectional survey study involved 330 village healthcare providers from three prefectures in Yunnan Province in 2017. Multiple logistic regressions were adopted to investigate the utilisation of primary healthcare among different ethnic healthcare providers. Primary healthcare utilisation was higher in village clinics where healthcare providers were Han Chinese than those where healthcare providers were ethnic minority (151 vs 101, P=0.008). The logistic regression analysis showed that clinical competence was positively associated with the utilisation of primary healthcare (odds ratio [OR]=1.49, 95% confidence interval [CI]=1.12-2.00; P=0.007) and that inadequate clinical competence of ethnic minority health workers may lead to a lag in the utilisation of primary healthcare (OR=0.45, 95% CI=0.23-0.89; P=0.022). Our results confirm differences in the utilisation of primary healthcare in rural Yunnan Province among healthcare providers of different ethnicities. Appropriate enhancements of clinical competence could be conducive to improving the utilisation of primary healthcare, especially among ethnic minority healthcare providers.

UK ethnic minority healthcare workers' perspectives on COVID-19 vaccine hesitancy in the UK ethnic minority community: A qualitative study.

BackgroundThe experiences of UK ethnic minority (UKEM) healthcare workers are crucial to ameliorating the disproportionate COVID-19 infection rate and outcomes in the UKEM community. We conducted a qualitative study on UKEM healthcare workers’ perspectives on COVID-19 vaccine hesitancy (CVH) in the UKEM community.MethodsParticipants were 15 UKEM healthcare workers (11 females; age range: 26–58 [43.3 ± 9.4] years). Data were collected using individual and joint interviews, and a focus group, and analyzed using thematic analysis.ResultsWe generated three themes: heterogeneity (two subthemes), mistrust (six subthemes), and mitigating (six subthemes). Therein, participants distinguished CVH in the UKEM community in educational attainment and ethnicity. They pointed to the role of mistrust in CVH in the UKEM community. They opined that the mistrust underlying CVH in the UKEM community is rooted in history and religion, conspiracy theories, the speedy development and novelty of the vaccines, post-vaccination complications/side effects, false positive test results, and social media and social support/influence. Participants recommended that interventions targeted at mitigating CVH in the UKEM community need to, in a non-judgmental way, tackle dis/misinformation and provide education, and incorporate UKEM healthcare worker endorsement. They also suggested such interventions be community-oriented, enhance the convenience of vaccination centers and the possibility of vaccine choice, and appreciate that overcoming CVH and accepting vaccination is a gradual process involving personal assessment of risks and benefits.ConclusionCVH in the UKEM community is a multifaceted phenomenon requiring multicomponent interventions.

Trust and vaccine hesitancy in ethnic minority healthcare workers.

Trust and vaccine hesitancy in ethnic minority healthcare workers.

"Just Throw It Behind You and Just Keep Going": Emotional Labor when Ethnic Minority Healthcare Staff Encounter Racism in Healthcare.

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The first is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the benefit of staff and patients.

Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings.

Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.

Some health indicators, risk behaviors and using health services among of Cham adolescents in An Giang in 2019

In order to improve the quality of healthcare services for Cham adolescents in the coming time, the study describes some health indicators, risk behaviors and using of healthcare services, basing on these, factors relating to healthcare services use are analyzed. This study is part of the state-level study project "Basic and urgent solutions for ethnic minority healthcare in our country at present", The study applied cross-sectional research methodology with the combination of quantitative and qualitative analysis. The author used data collected from 96 participants who are Cham adolescents in An Giang from the original study and analyzed data in both male and female groups, from April 2018 to October 2020. The result shows that the rate of adolescents with diseases within 03 months prior the study is 87.5%; within 12 months prior the study is 1.04% for chronic illness; 2.08% for risk behaviors due to injury; feeling bored, losing concentration in studying and working accounting for 7.29%; the proportion of sick adolescents that take recent medical services is 13%; with no treatment is 20.3%. Basing on this, it is recommended for families and schools to have immediate encouragement and share when they show the signs of boredom, to avoid negative effects on their studies, parents and adolescents should go to medical clinics for treatment to when sick, not treating themseves at home. Key words: Adolescent, health, health services, risk behavior, An Giang, Cham ethnicity.

Ethnic-minority health care workers discrimination: An example from Japan during COVID-19 pandemic.

Ethnic-minority health care workers discrimination: An example from Japan during COVID-19 pandemic.

Providers’ perspectives on factors complicating the culturally sensitive care of individuals with intellectual disabilities

BackgroundCulturally sensitive care is essential for improving healthcare for ethnic minorities with intellectual disabilities (ID), who require intensive, sometimes lifelong, care and support. AimsThe present study aimed to uncover factors that may complicate the delivery of culturally sensitive care for ethnic minorities with ID, which have not previously been studied for this group. Methods and proceduresBy means of in-depth interviews with care professionals we identified these factors at the care receiver, professional, and institutional levels. Outcomes and resultsEight factors were found to complicate the delivery of culturally sensitive care: abilities of the individuals with ID, communication with the family of the care receiver, cultural competency of the professional, personal attitude and experience of the professional, job position and responsibilities of the professional, resources, legislation and protocols, and the team of colleagues. The factors at the care receiver level were specific for the delivery of culturally sensitive care to individuals with ID. Conclusions and implicationsIn addition to the complicating factors previously identified for other forms of culturally sensitive healthcare, we identified novel complicating factors for the care of individuals with ID. Future research should investigate how these complicating factors could be overcome.

Ontology based intercultural patient practitioner assistive communications from qualitative gap analysis

Purpose – There is an increasing interest in using information and communication technologies to support health services. But the adoption and development of even basic ICT communications services in many health services is limited, leaving enormous gaps in the broad understanding of its role in health care delivery. The purpose of this paper is to address a specific (intercultural) area of healthcare communications consumer disadvantage; and it examines the potential for ICT exploitation through the lens of a conceptual framework. The opportunity to pursue a new solutions pathway has been amplified in recent times through the development of computer-based ontologies and the resultant knowledge from ontologist activity and consequential research publishing. Design/methodology/approach – A specific intercultural area of patient disadvantage arises from variations in meaning and understanding of patient and clinician words, phrases and non-verbal expression. Collection and localization of data concepts, their attributes and individual instances were gathered from an Aboriginal trainee nurse focus group and from a qualitative gap analysis (QGA) of 130 criteria-selected sources of literature. These concepts, their relationships and semantic interpretations populate the computer ontology. The ontology mapping involves two domains, namely, Aboriginal English (AE) and Type II diabetes care guidelines. This is preparatory to development of the Patient Practitioner Assistive Communications (PPAC) system for Aboriginal rural and remote patient primary care. Findings – The combined QGA and focus group output reported has served to illustrate the call for three important drivers of change. First, there is no evidence to contradict the hypothesis that patient-practitioner interview encounters for many Australian Aboriginal patients and wellbeing outcomes are unsatisfactory at best. Second, there is a potent need for cultural competence knowledge and practice uptake on the part of health care providers; and third, the key contributory component to determine success or failures within healthcare for ethnic minorities is communication. Communication, however, can only be of value in health care if in practice it supports shared cognition; and mutual cognition is rarely achievable when biopsychosocial and other cultural worldview differences go unchallenged. Research limitations/implications – There has been no direct engagement with remote Aboriginal communities in this work to date. The authors have initially been able to rely upon a cohort of both Indigenous and non-Indigenous people with relevant cultural expertise and extended family relationships. Among these advisers are health care practitioners, academics, trainers, Aboriginal education researchers and workshop attendees. It must therefore be acknowledged that as is the case with the QGA, the majority of the concept data is from third parties. The authors have also discovered that urban influences and cultural sensitivities tend to reduce the extent of, and opportunity to, witness AE usage, thereby limiting the ability to capture more examples of code-switching. Although the PPAC system concept is qualitatively well developed, pending future work planned for rural and remote community engagement the authors presently regard the work as mostly allied to a hypothesis on ontology-driven communications. The concept data population of the AE home talk/health talk ontology has not yet reached a quantitative critical mass to justify application design model engineering and real-world testing. Originality/value – Computer ontologies avail us of the opportunity to use assistive communications technology applications as a dynamic support system to elevate the pragmatic experience of health care consultations for both patients and practitioners. The human-machine interactive development and use of such applications is required just to keep pace with increasing demand for healthcare and the growing health knowledge transfer environment. In an age when the worldwide web, communications devices and social media avail us of opportunities to confront the barriers described the authors have begun the first construction of a merged schema for two domains that already have a seemingly intractable negative connection. Through the ontology discipline of building syntactically and semantically robust and accessible concepts; explicit conceptual relationships; and annotative context-oriented guidance; the authors are working towards addressing health literacy and wellbeing outcome deficiencies of benefit to the broader communities of disadvantage patients.

What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review.

IntroductionImmigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare.MethodsWe systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States ; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review.ResultOnly one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women.ConclusionNavigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers.

Adaptation of health care for migrants: whose responsibility?

BackgroundIn a context of increasing ethnic diversity, culturally competent strategies have been recommended to improve care quality and access to health care for ethnic minorities and migrants; their implementation by health professionals, however, has remained patchy. Most programs of cultural competence assume that health professionals accept that they have a responsibility to adapt to migrants, but this assumption has often remained at the level of theory. In this paper, we surveyed health professionals’ views on their responsibility to adapt.MethodsFive hundred-and-sixty-nine health professionals from twenty-four inpatient and outpatient health services were selected according to their geographic location. All health care professionals were requested to complete a questionnaire about who should adapt to ethnic diversity: health professionals or patients. After a factorial analysis to identify the underlying responsibility dimensions, we performed a multilevel regression model in order to investigate individual and service covariates of responsibility attribution.ResultsThree dimensions emerged from the factor analysis: responsibility for the adaptation of communication, responsibility for the adaptation to the negotiation of values, and responsibility for the adaptation to health beliefs. Our results showed that the sense of responsibility for the adaptation of health care depended on the nature of the adaptation required: when the adaptation directly concerned communication with the patient, health professionals declared that they should be the ones to adapt; in relation to cultural preferences, however, the responsibility felt on the patient’s shoulders. Most respondents were unclear in relation to adaptation to health beliefs. Regression indicated that being Belgian, not being a physician, and working in a primary-care service were associated with placing the burden of responsibility on the patient.ConclusionsHealth care professionals do not consider it to be their responsibility to adapt to ethnic diversity. If health professionals do not feel a responsibility to adapt, they are less likely to be involved in culturally competent health care.

Adaptation of health care for migrants: who is responsible for it? Results from the COMETH - COMpetences in EThnicity and Health - study

Adaptation of health care for migrants: who is responsible for it? Results from the COMETH - COMpetences in EThnicity and Health - study Background: In a context of increasing diversity, culturally competent strategies have been recommended to improve quality and access to health care for ethnic minorities. However, despite promising results, the implementation and the diffusion of cultural competences remain sparse among health professionals. Most programs of cultural competences assume health professionals have the responsibility to adapt to migrants but this assumption remains hypothetical. In this paper, we surveyed health professionals’ views on who have the responsibility. Methods: 569 health professionals from 24 Belgian inpatient and outpatient health services were selected according to their geographic localisation. All healthcare professionals were requested to fill in a questionnaire tapping responsibility attribution towards adaptation. We performed a factorial analysis to assess how different responsibility stakes cluster and multilevel regression models to investigate individual and service covariates of responsibility attribution. Results: Different features were associated with different responsibility assignments: the communication was reported as under the responsibility of the health professionals. On the contrary, 55.3% of health professionals expected the patients to adapt to the gender of the health professionals and to the values of the host country. Most respondents were indecisive concerning the adaptation to health beliefs. Three concepts emerged from the factor analysis: communication, negotiation of the values and health beliefs. Regression indicated that being Belgian (beta=0.46, p=0.0037), not being a physician (beta=0.31, p=0.0146), and working in a psychiatric unit (beta=0.32, p=0.0016) is associated with putting the burden of responsibility of adaptation on the migrant patients. Conclusions: The responsibility towards adaptation of health care to the migrants has to be considered as multidimensional, depending on the adaptation requested by the situation and on the perceptions of the professional roles. Responsibilities to adapt are between the health professionals and the patients.

Do ratings of African-American cultural competency reflect characteristics of providers or perceivers? Initial demonstration of a generalizability theory approach

Provider cultural competency is often identified as an important component of effective ethnic minority healthcare. However, there is limited knowledge of the manner in which cultural competency judgments operate. This study sought to provide an initial demonstration of a hitherto overlooked methodology for examining the extent to which provider cultural competency ratings reflect characteristics of providers, differences among perceivers, and also idiosyncratic pairings of specific perceivers and providers. Second and third year medical residents rated four attending physicians for cultural competency when treating African-American patients. Using a Generalizability Theory approach, cultural competency ratings were shown to most substantially reflect unique perceiver and provider pairings (47.0% relationship effect). However, cultural competency also strongly reflected differences among resident raters in their tendency to perceive attending physicians as culturally competent, regardless of the characteristics of physicians (35.0% perceiver effect). Although cultural competency significantly reflected the characteristics of providers this effect was small (3.0% provider effect). This study demonstrates an overlooked methodological approach and suggests important new directions for conceptualizing theory and research.

Services for ethnic minorities: a question of trust

SummaryMental healthcare for ethnic minorities is a government policy priority. However, debate about how services should develop has been overshadowed by public criticism over high rates of admission and sectioning in some ethnic groups, the implication being that racism is rife in mental healthcare. These criticisms are headline-seeking, scientifically crude and unfair to mental health professionals. However, it is true that some minority communities are mistrustful of the services available. We need to overcome this mistrust with a positive message – and a promise of fair treatment.

Cultural diversity training for UK healthcare professionals: a comprehensive nationwide cross-sectional survey

Healthcare inequalities within the UK based on patients' ethnicity have been found over the last five years in a large number of medical specialties. One possible explanation for this lies in ignorance of ethnic minority healthcare needs among professionals. Cultural diversity programmes have been shown to improve patient outcomes including compliance, yet these are not as yet requirements for any UK healthcare professionals with the exception of psychiatrists. This paper documents the frequency, regional variation, characteristics and motivations for cultural diversity training through a questionnaire survey of the educational leads of every UK medical school, postgraduate deanery and schools of nursing, physiotherapy, occupational therapy, speech and language therapy, and pharmacy. The results showed a wide variation in teaching practices between healthcare professions and geographical regions. This study provides evidence for the need for national guidelines to incorporate cultural competency training by all UK healthcare professional training bodies.