Lack Of Cultural Competence Research Articles

Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation.

Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.

Identifying Barriers and Facilitators to Prenatal Care for Spanish-Speaking Women.

BACKGROUND Early access to quality prenatal care is an essential component of improving maternal and neonatal outcomes as it allows for early intervention and risk stratification. Women who receive late or infrequent prenatal care are at high risk for complications including preterm birth, infant death, and stillbirth. We sought to better understand the barriers Spanish-speaking women face in accessing quality prenatal care and to identify facilitators in obtaining timely quality prenatal care.METHODS We recruited a homogeneous group of 11 women with Spanish as their primary language who were pregnant or had given birth within the last six months. We then conducted two focus groups in Spanish. The focus groups were recorded, translated, and transcribed, and then coded using grounded theory.RESULTS In our cohort of participants, the three major themes included desire for psychosocial support, health care system logistics, and barriers due to Latinx ethnicity.LIMITATIONS Our study has several limitations, including a small sample size and single site design.CONCLUSION Latinx women experience unique barriers to care including language barriers, a lack of cultural competency on the part of health care personnel, and ethnic discrimination. Additional research is needed to develop patient-centered interventions to address these barriers.

Assessing the LGBT cultural competency of dementia care providers.

IntroductionAlthough dementia risk factors are elevated in lesbian, gay, bisexual, and transgender (LGBT) older adults and are perpetuated by a lack of cultural competency, no known studies have quantified LGBT cultural competency among dementia care providers.MethodsDementia care providers (N = 105) across the United States completed a survey consisting of the 7‐point Likert LGBT‐Development of Clinical Skills Scale.RESULTSDementia care providers reported very high affirming attitudes (M = 6.67, standard deviation [SD] = 0.71), moderate knowledge (M = 5.32, SD = 1.25), and moderate clinical preparedness (M = 4.93, SD = 1.23). Compared to previously published data, they reported significantly lower knowledge than medical students. There were no differences compared to psychiatry residents.DiscussionThe current state of dementia care providers’ LGBT cultural competency has significant, yet modifiable, gaps. Better education, including more LGBT patient exposure, is necessary to improve the care being provided to members of the LGBT community impacted by dementia illness.

Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh

ABSTRACT Objectives Bangladesh has achieved notable success in improving maternal health by increasing women’s access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities’ perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities’ perspectives on challenges and opportunities for improving MHC service access in the CHT. Design This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. Results Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. Conclusion Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.

«Living with rheumatoid arthritis» in an indigenous qom population in Argentina. A qualitative study

IntroductionRheumatoid arthritis (RA) is a chronic disease which impacts patients’ quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina. MethodsQualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis. ResultsA total of 33 interviews were conducted in 29 individuals with RA. The results showed a “normalization” of their symptoms and of their limitations in performing daily tasks. The individuals’ relationship with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence). ConclusionsRA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.

Evidence-Based Practice in Mental Health Care to Ethnic Minority Communities

Evidence-based practice (EBP) has contributed substantially to the advancement of knowledge in the treatment and prevention of adult mental health disorders. A fundamental assumption, based on documented evidence of effectiveness with certain populations, is that EBP is equally effective and applicable to all populations. However, small sample sizes of ethnic minority populations in randomized clinical trials prevent strong and clear conclusions about the effectiveness and generalizability of EBP with regard to people of color. In addition, the appropriateness of EBPs to ethnic minority communities has rarely been investigated. This article critically examines the applicability and dissemination of adult mental health EBP to diverse ethnic minority populations. It highlights limitations of EBP rooted in its epistemological narrowness, exclusion of communities of color, and lack of cultural competence and examines whether the practice of EBP has overstepped its evidence. This article presents a framework characterized by pathways of epistemological partnership and substantive inclusion of racial and ethnic minority groups to facilitate the promotion of culturally responsive EBPs and to inform mental health practice and policy implementation.

«Living with Rheumatoid Arthritis» in an Indigenous Qom Population in Argentina. A Qualitative Study.

Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina. Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis. A total of 33 interviews were conducted in 29 individuals with RA. The results showed a «normalization» of their symptoms and of their limitations in performing daily tasks. The individual relationships with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence). RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.

Development of a telehealth intervention to promote care-seeking among transgender women of color in Washington, DC.

Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC-specific telehealth intervention to increase access to care. Formative qualitative semi-structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC≥18years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day-long meetings with TWC and stakeholders were convened to develop the intervention. Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population-specific challenges to care. Further development of this model may be able to improve health outcomes among TWC.

«Сердце тьмы» и «Темный континент»: Африка и ее народы в польских СМИ и социальном восприятии

Objectives. The cognitive purpose of the article is to describe the stereotype of the Africans in the profiles of stereotypical perception of the Poles, created under the influence of the media and the low level of cultural competence of the Poles, as well as to identify the Poles’ attitudes towards the Africans and social problems arising in mutual relations. Background. The image of Africa and its inhabitants in the social perception of Poles is an issue still under-studied and burdened with deficit empirical knowledge. He is burdened with stereotypes created over many years by building a distorted image of Africa through the media and pop culture. An important determinant of the subjective image of the inhabitants of Africa in the perception of Poles is also their lack of cultural competence, which is based on the small population of Africans in Poland and limited contacts with them, as well as the lack of tendency of Poles to expand their knowledge about other nations. Methodology. The article is based mainly on qualitative research — on the analysis of secondary data (desk research) coming from research reports, which are supplemented by the results of quantitative research on the perception of refugees and immigrants in the opinion of the young generation of the Poles. The essence of the article is an attempt to answer the question: what is the image of Africans and Africa in Poland and to what extent is it changing? Conclusions. However, the stigmas of the past seem to be disappearing, and Polish society is also opening up to the world in terms of culture. thanks to this, changes in the perception of Poles are visible not only towards Africans but also to other nations. The increase in the population of „foreign” nationalities, including those from Africa, as well as the spatial mobility of Poles observed in Poland mean that the image of Africans is changing. It is still a slow process, but it shows change — moving away from misperception and stereotypes in favor of knowledge and openness.

A mixed-method evaluation study of a comprehensive cross-cultural training program in Stockholm

Abstract Background Global migration and increasingly diverse populations poses new challenges to mental health services. Cultural differences between refugees and mental health professionals and lack of cultural competency is described as challenging. Cross-cultural training has been proposed as one way to reduce these problems. There are few evaluations on cross-cultural mental health training outcomes. Between 2016-2018, 13 one-day cross-cultural training interventions was implemented in Stockholm to equip mental health professionals to respond to mental health needs in a time of high influx of refugees. Objectives To evaluate a comprehensive cross-cultural training program regarding participant’s knowledge development, their experiences and views of the training - and their perceptions about their capacity to deliver mental care to refugee patients. An embedded mixed-method design was applied. We used before and after training questionnaires (n = 248) and conducted six focus group discussions (FGD) with mental health professionals. Quantitative data were analyzed by paired t-test and factor analysis, qualitative data were analyzed by thematic content analysis. Preliminary results Before the training, significant differences of mean knowledge was found (p = 0.004) among participants. Principle axis Factoring resulted in 3 factors before and 4 factors after the training, explaining 78% of the covariance. Findings from the after training FGDs, revealed that refugee patients were described as different and challenging, and little was known about the reality they live in. The training contributed to a better understanding of migration, integration and refugee health- as well as the role of culture. Further, it promoted empathy and professional self-reflections. Conclusions Cross-cultural training can contribute to knowledge development, attitude changes and also be valuable for care provider’s professional role. Key messages Training mental health professional in cross-cultural issues may facilitate improved quality of care to refugee groups. The training can also strengthen participants in their professional role.

Exploring Working Relationships Between National and Expatriate RNs on Humanitarian Aid Missions: The Perspectives of Liberian Nurses.

Five focus groups involving 19 nurses and an individual interview with one nurse were conducted. A semistructured interview guide was used to gather perspectives and garner suggestions. A phenomenological approach was used to identify emergent themes. Regarding positive experiences, participants from all 10 NGOs reported that working with expats gave them opportunities to be mentored, learn new skills, and try out new techniques and equipment. Negative experiences included problems with disrespect and expats' lack of cultural competency. Participants spoke of adverse patient outcomes that resulted when expats made assumptions and wouldn't listen to national staff. The findings indicate that changes are warranted in the current work culture between national and expatriate nursing staff. Improving collaboration between national and expatriate RNs could lead to higher-quality care and better patient outcomes. Predeployment training for expatriates that incorporates the voices of national staff is recommended; this would raise awareness of the realities of nursing in low-resource settings and promote respect for national staff.

Policies and Professional Development: An Oil Boom’s Effect on Rural Schools and Teachers

In 2008, Western North Dakota experienced an extraordinary energy boom, creating waves of new residents seeking employment in the lucrative oil fields. Resultantly, many communities in the area, which were almost exclusively isolated and rural, dramatically changed. The purpose of this qualitative single-case study was to investigate the experiences of school staff in two rural schools within the North Dakota oil boom region. Data were teacher and administrator interviews with 15 participants and classroom observations. The findings indicated that teachers faced three key challenges in their classrooms as a result of the population influx, including: changing educational space, student academic proficiency, and a lack of cultural competence and pedagogical knowledge to effectively educate new, diverse students. Implications for policies and teacher professional development in rural boomtown areas are discussed.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity.

This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

Legal and Policy Issues for LGBT Patients with Cancer or at Elevated Risk of Cancer.

To understand the major legal and policy issues for lesbian, gay, bisexual and transgender (LGBT) cancer patients. LGBT health policy research. Major policy issues include discrimination, lack of cultural competency and clinically appropriate care, insurance coverage, family recognition, and sexual orientation and gender identity data collection. Nurses play a major role in providing affirming and competent care to LGBT cancer patients. Using correct names and pronouns with transgender patients, and collecting sexual orientation and gender identity data can send an affirming message to LGBT patients, as well as inform decision support and preventive screenings, and improve treatment outcomes.

Deaf Families' Unique Experiences and Obstacles.

This article focuses on deaf children of deaf parents who grew up using American Sign Language (ASL) in deaf culture. Deaf children of deaf parents described their unique experiences of struggling with obstacles, including quality of education, low expectations from professionals, unwanted sympathy, mental health therapists' lack of cultural competency, and not being asked for valuable perspectives or advice. The advice from deaf children of deaf parents is included in the article. By bringing greater attention to this population, mental health, school, and other professionals can increase their awareness of deaf families' unique needs in their work environment.

How to be a choni: Tutorial videos, class and gender in Spain’s economic recession

Abstract This article examines the construction of the choni (chavette) character through ironic and popular beauty tutorials created by Spanish vloggers and their connection with the economic recession in Spain. Our main objective is to discover the use of gender, cultural and class markers in this process and their relation to the dynamics of self-construction and self-differentiation existent on YouTube. In order to identify these characteristics, we are going to use a semiotic and Foucauldian discourse analysis based on the cultural approach to the chav phenomenon in the United Kingdom. The findings from our research illustrate how the figure of the choni is defined by the process of racialization and sexualization and by a lack of cultural competence.

“I'm Still Waiting On That Golden Ticket”: Attitudes toward and Experiences with Opportunity in The Streets of Black America

Fifteen residents (20‐48), formerly of the streets and/or criminal justice system, were organized into a street participatory action research team to conduct a street ethnographic community needs assessment of the Eastside and Southbridge neighborhoods of Wilmington, Delaware. This article is primarily a qualitative analysis of the educational and employment experiences of a community sample of street identified Black men and women between the ages of 18–35. This secondary analysis is guided by the question: How do street‐identified Black men and women frame their experiences with educational and employment opportunity? Mixed methods were employed to collect data in the form of: (1) 520 surveys; (2) 24 individual interviews; (3) four dual interviews; (4) three group interviews; and (5) extensive ethnographic field observations. All data were collected in the actual streets of Wilmington, Delaware (e.g., street corners, local parks, barbershops, local record/DVD stores, etc.). Two core themes emerged in qualitative coding for schooling opportunity, which include institutional removal and student–teacher interactions. Also, three subcodes emerged out of the student–teacher interactions theme: (1) lack of academic preparation, (2) lack of cultural competency, and (3) home/neighborhood conditions related to schooling experiences. Further, two subcodes emerged for the core theme employment: (1) neighborhood isolation and (2) employment after incarceration.

Shared Decision Making With Vulnerable Populations in the Emergency Department.

The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, andlack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients' situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group-specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED-based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations.

Barriers to healthcare for transgender individuals.

Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.

Challenges faced by gender-variant people in receiving appropriate care and ways to improve their care and lives – A UK study

IntroductionIt is only in the last decade that trans people have been accorded rights and give protection in law from discrimination. A survey of 10,000 people undertaken by the Equality and Human Right Commission showed that 1% of the population was gender-variant to some extent. Gender-variant people continue to suffer restricted opportunities, discrimination and harassment at work despite the existence of anti-discrimination and equalities legislation. It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help.ObjectiveReview of UK policies, guidelines, legislation and research on challenges faced by gender-variant people and ways to improve their care and lives.AimsTo improve gender-variant people access to care and ways to fight inequalities.MethodsMEDLINE, PsycINFO databases were searched for articles published between 2005–2015 containing the keywords “gender dysphoria”, “gender-variant people” and “transgender people”. Relevant policies, guidelines and legislations were also reviewed.ResultsTransgender people still face major health inequalities and discrimination. National statistics show that 80% have experienced harassment, 62% suffered discrimination at work or home and 54% reported being denied access to NHS care due to lack of cultural competency from staff. Guidelines, research, policies and equality legislation have begun to be implemented to protect transgender people from discrimination and accord rights.ConclusionsMany areas need attention and improvement including not only healthcare but also employment, education, housing and media perception. Promotion of equality in the general population with the aim of achieving cultural change and improvement of cultural competency of health professionals is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.