Intercultural Health Research Articles

Traditional medicine use to manage hypercholesterolemia, hyperglycaemia and hypertension in Ecuador

Abstract Background Although the use of traditional medicine (TM) to manage health issues is frequently reported, clinical guidelines often overlook this practice. This study aimed to describe the frequency of TM use to control 3 cardiometabolic risk factors for non-communicable diseases (arterial hypertension, hypercholesterolemia, and hyperglycaemia, collectively referred to as CMRF here); and associated sociodemographic, economic, and clinical characteristics. Methods Descriptive cross-sectional study with a representative population of two health districts in Ecuador, one urban in southern Quito and one in a forested rural area with diverse ethnic groups in Esmeraldas. We included 602 individuals with at least one CMRF and calculated the proportion of those who reported regular use of TM (herbal or traditional remedies) to control their CMRF. We used a multivariable logistic regression model to calculate Odds Ratios for TM use according to sociodemographic, economic, and clinical characteristics. Results TM was commonly used to control CMRF in both sociocultural contexts (39.4% Esmeraldas, 31.1% Quito), often in combination with conventional medicine (CM). A notable percentage of people (33.9% Esmeraldas, 39.0% Quito) did not take any treatment for their CMRF, and the rest used CM alone. In both settings, education was significantly associated with TM use. While in Quito people with higher education were more likely to use TM (aOR 2.04, 95%CI 1.03-3.90), in Esmeraldas, it was more common among people without formal schooling (aOR 3.76; 95%CI 1.59-8.88) as well as those of younger age (aOR per year 0.97; 95%CI 0.95-0.99) and from Afro-Ecudorian ethnicity (aOR 2.13; 95%CI 1.02-4.45). Conclusions Traditional medicine is used by a significant portion of Ecuador’s population, highlighting the need for a more accessible and intercultural approach to healthcare. Key messages • The use of traditional medicine to address hypertension, hypercholesterolemia, and hyperglycaemia appears to be widespread in different sociocultural and economic contexts of Ecuador. • To promote intercultural health, understanding the diverse sociocultural patterns associated with the use of traditional medicine, often combined with conventional medicine, is crucial.

Perception of Traditional Medicine During Pregnancy, Childbirth, and Postpartum in the Tacueyo Indigenous Reservation, Cauca, Colombia

Objective: The objective of this study is to investigate the perception of traditional medicine use during gestation processes in the Tacueyo Indigenous Reservation. The aim is to understand how indigenous women in the reservation perceive and utilize this resource during pregnancy, childbirth, and postpartum in the period 2021-2022. Theoretical Framework: This study is relevant in a context of high maternal and perinatal morbidity rates, focusing on ancestral practices to improve adherence to prenatal and postpartum care, contributing to the reduction of maternal mortality. Method: The study was guided by qualitative methodology and an ethnographic approach, using semi-structured interviews with 10 women. Results and Discussion: The results revealed the use of medicinal plants, interculturality as a protective factor, and barriers to accessing effective medical care. Research Implications: The implications of this research highlight the need to strengthen collaboration between traditional health practices and local health institutions within the framework of the Indigenous Own and Intercultural Health System (SISPI). Originality/Value: This study contributes to the literature by highlighting its intercultural approach and the integration of ancestral knowledge with modern public health to improve maternal health outcomes in indigenous communities.

"If They Help Us, We Can Help Them": First Nations Peoples Identify Intercultural Health Communication Problems and Solutions in Hospital in Northern Australia.

Effective intercultural communication between First Nations peoples and healthcare providers in colonised countries is required to deliver equitable healthcare and improve patient experiences and health outcomes. This paper presents First Nations peoples' perspectives and proposed solutions to problematic communication experiences at Royal Darwin Hospital in northern Australia. The study's methodological foundations comprise decolonising principles rooted in Critical Race Theory, Freirean pedagogy, and cultural safety. Eleven individuals from diverse First Nations backgrounds receiving treatment at the largest hospital in the Northern Territory, participated in in-depth interviews conducted in their preferred languages. Data were inductively analysed, adapted from a constructivist grounded theory approach and guided by First Nations knowledges. First Nations patients at Royal Darwin Hospital described a culturally unsafe hospital due to ineffective intercultural communication. Patient "counterstories" recounted instances of confusion, aggression, healthcare provider resistance to shared decision-making opportunities, pressure to abandon cultural protocols, and institutional neglect. Poor communication incited anger among staff and patients, and contributed to experiences of racism, missed appointments, clinical mistakes, patients prematurely discharging before completing treatment, and patients experiencing financial troubles and homelessness. In a spirit of generosity, patients proposed solutions focused on relationship building and mutual understanding so that new decolonised systems, which draw on First Nations and Western knowledges, can be codesigned. This study serves as a call to action for policymakers, administrators, and healthcare providers to prioritise improving intercultural communication by addressing the behaviour of staff and changing systemically racist policies in the pursuit of health equity and cultural safety for First Nations peoples.

Relational Ontology in the Mapuche Thinking: Possibilities for Indigenous Well-Being Amidst Colonial Settings

The imposition of a colonial mindset over indigenous peoples and their relational understanding of life is a common experience in the Global South. Forced displacement and subordination are also part of history in which cultural manners to preserve balance with the environment were severely altered. This article delves into the case of the Mapuche people, an indigenous group from Latin America that faces old and new expressions of colonialism. Because of structural discrimination, the health outcomes of the Mapuche people have been affected, including mental health. In this scenario, intercultural health experiences have been implemented to address the needs of the Mapuche population. Intercultural health policy emerges as an arena in which indigenous understanding of well-being is once again subjugated. From the author’s indigenous position, possibilities for well-being come through the negotiation of meanings and power that complicate indigenous life in colonial settings. Moreover, the subalternization of indigenous perspectives within scientific spaces is acknowledged as an obstacle to achieving horizontality in academic networks and to constructing meaningful interventions.

Therapeutic itineraries of snakebite victims and antivenom access in southern Mexico.

Access to antivenoms in cases of snakebite continues to be an important public health issue around the world, especially in rural areas with poorly developed health care systems. This study aims to evaluate therapeutic itineraries and antivenom accessibility following snakebites in the states of Oaxaca and Chiapas in southern Mexico. Employing an intercultural health approach that seeks to understand and bridge allopathic and traditional medical perceptions and practices, we conducted field interviews with 47 snakebite victims, documenting the therapeutic itineraries of 54 separate snakebite incidents that occurred between 1977 and 2023. Most victims used traditional remedies as a first line of treatment, often to withstand the rigors of a long journey to find antivenoms. The main obstacles to antivenom access were distance, poor antivenom availability, and cost. Standard antivenom treatment is highly valued and sought after, even as traditional beliefs and practices persist within a cultural framework known as the "hot-cold" system. The findings are crucial for informing future enhancements to antivenom distribution systems, health education initiatives, and other interventions aimed at mitigating the impact of snakebites in the region.

Emergency preparedness and response sensitive of migrant populations in Chile: post-pandemic perspectives.

On August 31, 2023, the Chilean government ended the health alert for COVID-19. This milestone invites us to reflect on lessons learned in emergency preparedness and response regarding migrant populations in the country. In this context, three perspectives are presented. The first focuses on avoiding pointing to individual responsibility for non-compliance with prevention measures, as this approach ignores structural and historical inequities. Emergency recommendations should be constructed considering a collective approach and diverse sociocultural and political contexts. The second perspective calls for considering and addressing migration as a social determinant of health. During the pandemic, changes in the governance of migration around the world made migration processes more precarious, with risks to the physical and mental health of migrants, which needs better planning and evidence-based decision-making in future pandemics. The third perspective focuses on promoting intercultural health, as effective communication of contagion risks and preventive measures were hampered among migrant populations with diverse worldviews and interpretations of health and disease processes. Responding to the needs of historically marginalized communities requires establishing ways of life that respect diversity in narratives and everyday practices. Governments and health systems must incorporate migration into their emergency preparedness and response strategies, creating the conditions for optimal compliance.

Challenges in training healthcare professionals in Intercultural Health: Analysis of the Regulation of Article Nº. 7 of law No. 20,584

Challenges in training healthcare professionals in Intercultural Health: Analysis of the Regulation of Article Nº. 7 of law No. 20,584

Abstract A062: Intersecting acculturation and decision making about cancer screening among sub-Saharan African immigrant men: A qualitative study

Abstract Background: Sub-Saharan African immigrant (SSAI) men constitute one of the fastest-growing immigrant populations in the United States and a large heterogeneous group in cancer survivorship. Yet research has ignored decision making about health and behavioral risk factors among SSAI communities. Intersecting acculturation and culture-specific perceptions about cancer screening within decision-making frameworks may be an essential step towards developing meaningful interventions for immigrant men’s healthcare. Objectives: This study aimed to gain insight into cancer-related beliefs and health decision-making practices among sub-Saharan African immigrant men. Methods: A qualitative design intersecting grounded theory analysis was employed using 16 semi-structured, in-depth individual interviews with SSAI men residing in Georgia and Florida. Participants were recruited from health fairs, community events, and by snowball effect. The average age of participants was 51 years with country of birth including Cameroon, Ethiopia, Ghana, Kenya, and Nigeria. An interview guide was prepared with emphasis on SSAI’s perspectives on lifestyle factors for cancer and decision making about cancer screening. Data were audio-recorded, transcribed, and analyzed using open, inductive, and axial coding via NVivo 12 qualitative data analysis software. Results: Findings identified key cultural factors impacting barriers to and facilitators of SSAI men’s decision-making processes and health-seeking behaviors. Most participants making positive decisions reflected on intercultural health practices made in collaboration with clinicians, significant others and community partnerships. Most participants with negative decisions tended to consider socio-cultural barriers and shortcomings in US health-care system. Participants’ preventative care decisions about cancer screening differed. Conclusions: This qualitative study illuminated key cultural factors among SSAI men that influenced their decision making about cancer screening and health-seeking behaviors. Future research should investigate longitudinal and quantitative studies to test decision-making outcomes. Funding Source: This study is funded by the National Institute on Minority Health and Health Disparities (1R15MD017012-01A1). Keywords: Cancer health disparities, Decision-making, Immigrant men, Intersectionality, Qualitative study Citation Format: Assata Kokayi, Gladys Asiedu, Kaitlin Van Voorhis, Rae Walker, M.E. Young, Folakemi Odedina, Motolani Ogunsanya, Ernie Kaninjing. Intersecting acculturation and decision making about cancer screening among sub-Saharan African immigrant men: A qualitative study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A062.

My Health My Language bridging the gap in public healthcare messaging

Abstract Issue Like many other European countries there has been a sharp increase in the number of migrants in Ireland recently. 13.9% of migrants in Ireland have poor or no English (Census 2016) and are not reached with mainstream public health messaging. Prior to the COVID-19 pandemic, most intercultural health resources were written rather than audio-visual. A clear need to reach out to these communities was identified. Project In 2021 the Health Service Executive (HSE) National Social Inclusion Office (NSIO) initiated a project with Translate Ireland (TI) to address the gap in intercultural health resources. Through consultation, priority health protection and health service areas were identified for inclusion in a suite of videos in main migrant languages. NSIO consulted with mychild.ie, National Immunisation Office, Irish College of GPs, Public Health, HSE Communications and the Sexual Health/Crisis Pregnancy Programme to ensure the scripts were aligned with HSE policy. TI identified health professionals living and working in Ireland, that were part of the migrant communities, to deliver key messages in the videos. TI worked with the presenters in wording the scripts to ensure cultural appropriateness. Results 11 primary care/maternal care videos were produced in 17 languages (187 videos), for healthcare professionals and people seeking health information. A dedicated webpage was created to ensure the videos were easily accessible and the project was named My Health My Language. The project was formally launched in June 2022 by the Minster of Health. We engaged with migrant communities, NGOs and government departments to share the multi-media video messages. By June 2023 there are 14,055 views of the videos. Lessons As smartphones are widely used by underserved groups, video messaging is very effective, for those with limited English or where English is not their first language. Short URLs on social media are very effective in providing access to videos. Key messages • My Health My Language is a health equity initiative, addressing health information needs of people who have limited English or where English is not their first language. • Culturally appropriate healthcare videos by peer healthcare professionals speaking in their own language have had significant reach, with over 14,000 views since launching in April 2022.

Incorporation of Professionals with Training in Interculturality into Sexual and Reproductive Health Services: Feasibility Analysis

This study evaluates the political, legal, organizational, and availability of resources for the onboarding of health professionals trained in interculturality for sexual and reproductive health care of the indigenous population in public health services. A case study was carried out using a qualitative methodology that implemented intercultural care strategies in reproductive health in two Mexican states with the presence of indigenous population. In regards of the political feasibility, the interest of the actors, positioning, and power were explored. In regards of legal feasibility, the presence of legal impediments was analyzed. In the case of organizational feasibility, we explored the organizational structure and functions of the personnel. Finally, for evaluating the availability of resources, we analyzed the budget available for hiring personnel with intercultural training. Political feasibility shows that the actors recognize the importance of including personnel with intercultural training for reproductive health care in indigenous population; despite this, in both states, there is no clear position in favor of it. In legal feasibility, no impediment for hiring these personnel was found. In organizational feasibility, the organizational structure of health services does not include a unit to oversee intercultural health services and practices and does not specify intercultural functions in the professional required profiles. In both states, there is no budget allocation for hiring personnel with an intercultural profile. Therefore, intercultural actions implemented are part of the local initiative of decision-makers to respond to reproductive health problems within indigenous population. The overall feasibility assessment does not show clear results in favor of incorporating health professionals trained in interculturality for sexual and reproductive health care for indigenous population. Therefore, it is still necessary to advocate on this issue so that intercultural hiring policies can be explicitly concretized in the acquisition of public health services.

Midwifery and Medicinal Plants in the Mazahua and Otomi Indigenous Group of the State of Mexico

The purpose of this study was to analyze midwifery practice in the Mazahua and Otomi (MO) indigenous community and its relationship with the persistence of the native language and the use of medicinal plants. A semi-structured survey with qualitative and quantitative information was designed and validated. Data were collected from the students enrolled in the Intercultural Health Degree at the Intercultural University of the State of Mexico, their parents, their grandparents, and people from their community of the MO ethnic group. The variables mother tongue and births attended by midwives among both MO and non-indigenous people were correlated with three generations (grandparents, parents, and grandchildren). In the MO indigenous group, births attended by midwives and mother tongue concerning the three generations were lost in proportions of 25.5% and 17.05%, respectively. There are 23% more midwife-attended births in the MO community than among non-ethnic people. The medicinal plants most used by the MO indigenous group are “too” (Montanoa tomentosa Cerv.) and “lengua de vaca” (Rumex crispus L.). As regards family economy, 79.3% of the adults surveyed consider that there is a saving of between 25% and 75% with midwifery practice in the MO community. There is a generational correspondence between the loss of native language and midwifery practice.

Role of bilingual guides in access to health care among Indigenous Wayuu population of Colombia

Anas Wayuu is an Indigenous-led non-profit health insurance organization in Colombia. It provides health care coverage to approximately 220,000 people, mostly Indigenous Wayuu, the largest Indigenous population in Columbia, living in La Guajira, the northeast region of the country, and in neighboring Venezuela. Anas Wayuu offers several intercultural health initiatives, among them the inclusion of bilingual guides for Wayuu families. The objective of the study was to describe the use of Anas Wayuu’s bilingual guides and determine whether use was associated with access and quality of care. A 34-item survey was conducted in 2020 to 2021 with a final sample of 2,113 Anas Wayuu enrollees and non-enrollees. Study findings demonstrated the relevance of bilingual guides programming. They suggested that bilingual guides improved individual’s capabilities to navigate the health care system, increased access to care, and increased their experience of quality of care. The findings strengthen the case for Indigenous self-governance over health care.

Health care providers' perspectives on challenges and opportunities of intercultural health care in diabetes and obesity management: a qualitative study.

Migrants often face worse health outcomes in countries of transit and destination because of challenges such as financial constraints, employment problems, lack of a network of social support, language and cultural differences, and difficulties accessing health services. As understanding how the migrant context affects patient-provider engagement is critical to the provision of contextually appropriate care, this study aimed at understanding primary health care provider perspectives on challenges and opportunities of the intercultural care process for migrant patients with diabetes and obesity. This qualitative study within a multimethod, participatory research project involved primary care providers in clinics and primary care networks in Edmonton, Alberta, between September 2019 and February 2020. We explored health care providers' approaches to diabetes and obesity management, and experiences of and challenges with intercultural care. We conducted a thematic analysis using an interpretive qualitative approach. We conducted 9 interviews and 4 focus groups and identified 3 themes: a shift from traditional weight loss-centred approaches; relationships and navigating cultural distance; and importance of and limitations in identifying and addressing root causes and barriers. Health care providers encounter considerable nonmedical challenges when supporting immigrant patients, such as navigating cultural distance and working with patients' financial constraints. The nonmedical challenges we identified can hinder the process of chronic disease management. Thus, in addition to educational programs and trainings to enhance the cultural competency of health care providers, incorporating avenues for cultural brokering in health care can provide invaluable support in patient-provider engagements to mitigate these challenges.

Representaciones estereotipadas de la etnicidad en un hospital rural oaxaqueño: barreras a la salud intercultural

This article explores the knowledge that the personnel of a rural hospital in Oaxaca has of intercultural health and the ways in which they represent ethnicity. Based on semi-structured interviews with ten workers who interacted with indigenous language speaker patients, the article shows that the staff appreciated intercultural health but lacked a solid training in this area. Their representations of ethnicity emphasized negative cultural traits related to stereotypical ideas of what “being indigenous” means. Due to methodological limitations, the healthcare personnel’s practices towards their beneficiaries could not be observed so there are no findings on how representations may have influenced their conduct. The value of this investigation lies in its documentation of the contradictions and hardships of applying principles of interculturality in the health sector and the unveiling of cultural barriers which hinder positive interculturality as evidenced by the recurrent representations of indigenous health as defective and of indigenous people as ignorant, vulnerable, or stubborn.

Health-seeking, intercultural health communication, and health outcomes: An intersectional study of ethnic minorities' lived experiences.

To explore ethnic minorities' lived experiences of health-seeking and healthcare utilization in Hong Kong, and to examine the impact of intersectionality of sociocultural identities on intercultural health communication. Qualitative exploratory design. Data collection methods were semi-structured interviews, unstructured observations, and unstructured informal group discussions. Twenty-five informants, including eight Pakistanis, seven Nepalese, five Indians, four Bangladeshis and one Sri Lankan, were recruited using the snowball sampling method and individually interviewed between 25th June and 23rd September 2019. Sixteen females and nine males, aged 21-76 years, were in the study. Two-thirds could communicate in English, but eight required interpreters. Thematic analysis reveals four factors affecting intercultural health communication: healthcare professionals' cultural insensitivity, red-tapism and ethnic minorities' language improficiency and/or deficiency in medical knowledge. Health professionals' workplace stress and cultural insensitivity prompt ineffective intercultural communication, making ethnic minority patients feel disrespected despite having adopted the Hong Kong culture. The intersectionality of sociocultural identities plus health professionals' blocking behaviours results in health inequalities. The unequal power relationship between health professionals and ethnic minority patients may lead to dehumanizing and depersonalized experiences for patients, as humanity is the heart and soul of medicine. Therefore, the government should raise healthcare providers' cultural sensitivity and diversity awareness, and offer ethno-specific care and more interpretation services. The study addresses health inequalities among Hong Kong ethnic minority patients with different sociocultural identities. About the impact of ineffective intercultural health communication on health inclusion and health outcomes, policies and practices should ameliorate health professionals' cultural sensitivity, awareness of the unequal power relationship and respect for diversity. Referred by organizations serving ethnic minorities, the minority patients shared their lived experiences in health-seeking.

Construction of an intercultural care program for international migrants in northwestern Mexico.

To describe the construction process of an intercultural care program for international migrants in northwestern Mexico. Report of professional experiences, according to what was suggested by Daltro and Faria. The development and evolution of care for international migrants has favored the elaboration of a community-like Social Service Program for students of a public university in northwestern Mexico, so that intercultural health and health care for this population become part of the curricular training of the new generations of nursing graduates, in a context in which international migration is a topic of great social and cultural relevance. The construction and application of the Salud-Migrante program will enhance compliance with international recommendations on universal health for migrants, promoting respect for identity and cultural diversity in their actions.

Meanings and Practices in Intercultural Health for International Migrants.

In this article, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the city of Antofagasta in northern Chile. Methodology: The methodology was qualitative with a phenomenological descriptive design, through which discourses from health personnel in the public primary and secondary care system were explored (n = 23). Next, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the northern Chilean city of Antofagasta. Results: The participants presented trees of thematic categories. There were three thematic categories overall: (1) The meaning of interculturality included features of understanding of the concept, with respect for culture being the transversal axis in all discourses. (2) Practices in health care, where voluntariness, references, and the adequacy or non-technicality of the language are fundamental axes. (3) Training in the intercultural approach, where there is often self-knowledge and lack of supply in the health system. Conclusions: The findings show essential elements to consider in the care of international migrants, including the training and awareness of staff about the intercultural approach through strategies following the local reality in which each health establishment exists.

Concerted Model of Healthcare for Awá Indigenous of Nariño, Colombia.

Indigenous communities in Colombia are facing a critical health situation; alternative health care models based on the vision of the communities themselves are needed. The objective of this research was to create a health care model that decreases health inequities for the Indigenous Awá population of Nariño, Colombia. This study was guided by the paradigm of community-based participatory action research; the process was carried out in 2015 and 2016. The proposed Intercultural Health Care Model is essentially based on health promotion, disease prevention, community empowerment, social participation in health, decentralized health care and coordination between the two medicines (traditional and allopathic). Strategies such as those reported herein, with concerted efforts rather than imposition, maintain human rights and respect for the sovereignty and autonomy of Indigenous people.

La salud intercultural en la Amazonia peruana. Problemas y perspectivas en tiempos de pandemia

The notion of intercultural health refers to the culturally derived practices and their place in the contemporary health system, as well as to the political strategy concerning basic healthcare in multiethnic regions. This paper addresses the differences between the related perspectives of the indigenous and non-indigenous health professionals in the Peruvian Amazon. It places the problem within the context of the COVID-19 pandemic, focusing on the initiative Comando Mático of the group Shipibo-Conibo. The study is based on online research. It involves the critical analysis of the indigenous discourse shared on social media. The results serve to uncover the underlying thinking patterns, which impede the effective implementation of intercultural health policy in Peru.

The role of nursing in intercultural health: challenges in the Argentine context

The aim of interculturality is to build a more democratic society through the conceptualization, description and evaluation of patterns of appropriation and reconstruction of meaning among different human groups. This scientific article aims to describe the role of nursing in intercultural health, with special emphasis on the challenges in the Argentinean context. Nursing is a profession that is changing the ways of approaching health from different roles, if current approaches are taken into account, given that different social groups demand in relation to their belief systems, and how they perceive themselves in different socio-cultural and historical contexts. Interculturality expands our performance in the field of health and education, creating new specialties that will take shape in our research advances, so it is important to invest sustainably for our full development, scientific, technological and human, in order to provide a better quality of life for all humanity and all existences of life, to value and create awareness of the cosmogony of all origins