Multiethnic Setting Research Articles

Multi-Ethnic, Multisource Grounded Theory: Illustration From a Study Investigating Why Inequities in Survival Occur By Ethnicity

Equity in healthcare is the ideal state where everyone shares equal rights and opportunities. To date, research methodologies are limited in their scope to translate into more equitable healthcare policies and practices. We present a re-interpreted grounded theory methodology to contribute to active dialogue toward optimizing equity through research. This re-interpreted research methodology is presented within a study investigating why ethnic disparities in infant survival from critical congenital heart disease occur in a multi-ethnic national setting in New Zealand. Using dialectical pluralism, we developed an innovative Multi-ethnic, Multisource Grounded Theory methodological concept by deliberately integrating Indigenous and multi-ethnic intersectional perspectives on health inequities from diverse data sources (literature reviews, retrospective case studies, and interview transcripts). Central to the process was the uplifting and centralizing of Indigenous voices. Conceptually, Multi-ethnic, Multisource Grounded Theory could reframe an existing research domain to equip researchers with a framework to intentionally integrate cultural considerations when building information from diverse data in the health equity space. Theoretically, this approach could enhance methodological rigour and support the translation of responsible, ethical, and equitable healthcare models.

Epidemiology and Impact of Disorders of Gut-Brain Interaction in Multiethnic Malaysia: An In-Depth Analysis of Local Data From the Rome Foundation Global Epidemiology Study.

Previous epidemiology studies from Malaysia on disorders of gut-brain interaction (DGBI) have utilized variable criteria. Furthermore, the impact of DGBI on quality of life (QoL), healthcare utilization, diet, work productivity, and sleep in a multiethnic Asian setting like Malaysia remains underexplored. Here, we aimed to determine the epidemiology and impact of DGBI among multiethnic Malaysians based on the Rome IV criteria. 2072 Malaysian participants from the Rome Foundation Global Epidemiology Study (RFGES) with complete data on DGBI were included in the in-depth analysis. We assessed the prevalence of DGBI diagnoses, psychological distress, QoL, healthcare utilization, dietary patterns, impact on sleep, work productivity, and activity impairment. The overall prevalence of any DGBI in Malaysia was 19.3% (95% CI 17.6%-21.0%). The top three most prevalent DGBI diagnoses were functional constipation (5.1%; 95% CI 4.2%-6.1%), functional dyspepsia (3.4%; 95% CI 2.7%-4.3%), and functional diarrhea (1.6%; 95% CI 1.1%-2.2%). Participants with DGBI reported higher levels of psychological distress (somatization, anxiety, and depression), significantly higher healthcare utilization, and dietary change (low FODMAPs but higher Mediterranean-based diet and probiotics). Furthermore, there was greater daytime sleepiness and higher proportions of presenteeism, overall work impairment, and activity impairment in individuals with DGBI. The disease burden of DGBI is significant in Malaysia, with increased psychological distress, healthcare utilization, dietary change, greater daytime sleepiness, and greater overall work and activity impairment.

E052 Evaluating real-world use and efficacy of teriparatide in osteoporosis management

Abstract Background/Aims Teriparatide, a recombinant human parathyroid hormone, significantly reduces the risk of fractures in patients with postmenopausal and glucocorticoid-induced osteoporosis. In the UK, NICE has restricted its use to high-risk patient groups. This project aims to analyse the use of teriparatide at a large University teaching hospital with 55% ethnic catchment population, providing insight into the real-world patient demographic and evaluating the treatment’s effectiveness. Methods A retrospective analysis was conducted to evaluate the use of teriparatide in patients receiving treatment between 2014-2024 at our unit. Full demographic and clinical data was collected using electronic health records and a live multipurpose database. Dual-energy X-ray absorptiometry (DXA) scan results were reviewed to assess bone mineral density (BMD) both before the initiation of Teriparatide treatment and after completion. Data was analysed to provide insights into the demographic characteristics of the treated population, the efficacy of teriparatide based on BMD improvements, treatment adherence, and local compliance with national guidelines. Results A total of 486 patients were prescribed teriparatide over the ten-year study period. This data is a snapshot from the first 54 consecutive patients, all women with an average age of 72.7 years. Of these, 52 (96%) were White and 2 (4%) were Asian-Indian. Alendronate was the most common first-line bisphosphonate. On average, patients experienced two fractures before starting teriparatide. All patients had failed previous treatment with at least one bisphosphonate or Denosumab, averaging 12.6 years of prior treatment. Nine patients (17%) discontinued treatment early due to side effects. Pre-treatment, the average BMD was 0.771 g/cm² for the lumbar spine (L1-4) and 0.646 g/cm² for the left hip. Post-treatment, these values improved to 0.860 g/cm² and 0.684 g/cm², respectively. The mean lumbar spine T-score improved from -3.3 to -2.6, and the Left hip T-score from -2.8 to -2.6. After teriparatide, 40 patients (74%) transitioned to denosumab, 7 (13%) began zoledronic acid, 5 passed away, and 2 were lost to follow-up. Conclusion Our study demonstrates real world use of teriparatide in a multi-ethnic diverse setting. It shows that teriparatide is used predominantly in complex, multi-morbid older individuals with several prior fractures. Despite that, teriparatide remains effective for a wide range of individuals including those with inflammatory arthritis and/or concurrent steroid use. This is in line with recent meta-analysis of real life teriparatide use in complex osteoporosis with multimorbidity. Though NICE stipulates minimum two fractures requirement (unless T score <-4.0), in practice patients may have had more suggesting that clinicians are reserving it for patient with a high disease burden. Our study should enhance clinicians’ confidence in teriparatide prescribing. We believe that since the availability of more cost-effective teriparatide biosimilars, NICE ought to amend its guidance and provide easier access to anabolic therapies for better patient outcomes. Disclosure R. Vinda: None. M. Afzal: None. M.K. Nisar: None.

Validation of the Subjective Happiness Scale, Oxford Happiness Questionnaire and Pemberton Happiness Index among women with breast cancer in a multi-ethnic Asian setting

Validation of the Subjective Happiness Scale, Oxford Happiness Questionnaire and Pemberton Happiness Index among women with breast cancer in a multi-ethnic Asian setting

Kontroversi Penggunaan Permainan Bahasa dalam Komunikasi Antarbudaya di Pesantren Multietnis

The aim of the study is to analyze the implementation of Ludwig Wittgenstein’s language games theory in the context of intercultural communication at Pondok Pesantren Manahilil Ulum DDI Kaballangan. This research was employed a qualitative approach with participatory observation and in-depth interviews. Data were collected from utterances of students from various ethnic backgrounds, such as Buginese, Mandarese, Makassarese, and Pattinjonese, with two informants from each ethnic groups, to understand how differences in word meanings affect communication dynamics. The findings show that the different language games in each ethnic group’s local language cause significant misunderstandings, as seen in words like “bosi,” “buto,” and “doko.” However, these misunderstandings were resolved through communication adaptations, such as the use of Indonesian as a bridging language. The originality of this study lies in the application of language games theory in a multi-ethnic boarding school setting, which has not been extensively explored in the context of education. This research provides new insights into the dynamics of intercultural communication in boarding school and the adaptive strategies used by students to maintain harmony. The study’s implications highlight the importance of cross-cultural awareness and the appropriate use of language to enhance communication effectiveness in multi-ethnic boarding school settings

Effects of building resilience skills among undergraduate medical students in a multi-cultural, multi-ethnic setting in the United Arab Emirates: A convergent mixed methods study.

Although curricula teaching skills related to resilience are widely adopted, little is known about needs and attitudes regarding resilience training of undergraduate-medical-trainees in Middle-East-and-North-Africa-region. The purpose of this study is to investigate the value of an innovative curriculum developed through design-based-research to build resilience-skills among undergraduate-medical-trainees in the United-Arab-Emirates. Convergent-mixed-methods-study-design was utilized. Quantitative data collection was through controlled random group allocation conducted in one cohort of undergraduate medical students(n = 47). Students were randomly allocated into the respective resilience-skills-building-course(study-group) versus an unrelated curriculum(control-group). All students were tested at baseline(test-1), at end of 8-week course(test-2), and again 8 weeks after end of course(test-3). Then students crossed over to the opposite course and again tested at end of 8 weeks(test-4). Testing at four timepoints consisted of questionnaires related to burnout-Maslach-Burnout-Inventory; anxiety-General-Anxiety-Disorder-7; and resilience- Connor-Davidson-Resilience-Scale. Quantitative data were analysed descriptively and inferentially. Qualitative data, constituting of students' perception of their experience with the course, was captured using virtual-focus-group-sessions. Qualitative analysis was inductive. Generated primary inferences were merged using joint-display-analysis. Significant proportion of the students, at baseline, seemed to be at risk for burnout and anxiety, and would benefit from developing their resilience. There appeared to be no statistical differences in measures of burnout, anxiety, and resilience related to course delivery. Overall risk for anxiety among students increased following the COVID-19 lockdown. Qualitative analysis generated the 'Resilience-Skills'-Building-around-Undergraduate-Medical-Education-Transitions' conceptual model of five themes: Transitions, Adaptation, Added Value of course, Sustainability of effects of course, and Opportunities for improving course. Merging of findings led to a thorough understanding of how the resilience-skills'-building-course affected students' adaptability. This study indicates that a resilience-skills'-building-course may not instantly affect medical trainees' ratings of burnout, anxiety, and resilience. However, students likely engage with such an innovative course and its content to acquire and deploy skills to adapt to changes.

Health outcome priorities of people with multiple long-term conditions using the outcome prioritisation tool in the UK: A survey study and feasibility assessment.

The outcome prioritisation tool (OPT) is a simple tool to ascertain the health outcome priorities of people with MLTC. Use of this tool in people aged under 65 years with MLTC has not previously been investigated. This study aimed to investigate the feasibility of using the OPT in people with MLTC aged 45 years or above, in a multi-ethnic primary-care setting and describe the health outcome priorities of people with MLTC by age, clusters of long-term conditions and demographic factors, and to investigate any differences in prioritisation in light of the COVID-19 pandemic. This was a multi-centre cross-sectional study using a questionnaire for online self-completion by people aged 45 years or above with MLTC in 19 primary care settings across the East Midlands, UK. Participants were asked to complete the OPT twice, first from their current perspective and second from their recollection of their priorities prior to COVID-19. The questionnaire was completed by 2,454 people with MLTC. The majority of participants agreed or strongly agreed that the OPT was easy to complete, relevant to their healthcare and will be useful in communicating priorities to their doctor. Summary scores for the whole cohort of participants showed Keeping Alive and Maintaining Independence receiving the highest scores. Statistically significant differences in prioritisation by age, clusters of long-term conditions and employment status were observed, with respondents aged over 65 most likely to prioritise Maintaining independence, and respondents aged under 65 most likely to prioritise Keeping alive. There were no differences before or after COVID-19, or by ethnicity. The OPT is feasible and acceptable for use to elicit the health outcome priorities of people with MLTC across both middle-aged and older age groups and in a UK setting. Individual factors could influence the priorities of people with MLTC and must be considered by clinicians during consultations.

NAT2 Slow Acetylator Phenotype as a Significant Risk Factor for Hepatotoxicity Caused by Antituberculosis Drugs: Results From a Multiethnic Nested Case-Control Study.

Under standard therapies, the incidence of drug-induced liver injury (DILI) in patients with tuberculosis ranges from 2% to 28%. Numerous studies have identified the risk factors for antituberculosis DILI; however, none have been conducted in a multiethnic real-world setting. The primary outcome of the current study was to identify the risk factors that could be used as the best predictors of DILI in a multiethnic cohort. A nested case-control study was conducted in patients at the tuberculosis clinic of Luigi Sacco Hospital in Milan. The study included 102 patients (mean age [SD], 45.6 [15.6] years). For each patient with hepatotoxicity, 2 controls were matched for sex, age, body mass index, tuberculosis/tuberculosis infection diagnosis, and index date. We found that N-acetyltransferase 2 gene (NAT2) slow acetylator status was the best independent predictor of DILI (odds ratio, 5.97 [95% confidence interval, 1.38-25.76]; P = .02]. NAT2 genotype-guided dosing may help optimize antituberculosis drug treatment and prevent treatment failure. ClinicalTrials.gov NCT06539455.

Symptomatic Intracranial Atherosclerosis in an Australian Context: Common and Underdiagnosed in Multiple Ethnic Groups

Background Intracranial atherosclerosis (ICAD) is a common cause of stroke globally. We calculated the proportion of patients with stroke with symptomatic intracranial atherosclerosis in an Australian multiethnic setting, as well as diagnostic rates by stroke physicians and radiologists. Methods This was a multicenter retrospective cohort study based in Melbourne, Australia. Demographic data (including self‐reported ethnicity) and data on vascular risk factors were collected. Symptomatic ICAD was independently identified by 2 blinded stroke neurologists using multiplanar reformats and maximum intensity projections of routinely acquired thin slice computed tomography angiography data, with disagreements resolved by a third blinded stroke neurologist. This diagnostic reference standard was compared to the proportion of patients with ICAD identified in the radiology report and stroke team clinical notes. Results Of 1328 patients included (mean age, 73 years; 43% female), the proportion of patients with centrally read symptomatic ICAD was 14%, of whom 39% were diagnosed by the stroke clinical team and 65% by the reporting radiologist. Patients of Asian ethnicity more commonly had symptomatic ICAD than patients of European ethnicity (21% versus 14%; odds ratio, 1.5 [95% CI, 1.0–2.23]). Conclusion Intracranial atherosclerosis is common and underdiagnosed in an Australian tertiary stroke care unit setting in patients from multiple ethnic backgrounds.

A fitness obligation or indispensable pastime? A capability-informed inquiry into the developmental impacts of tiyu(体育) on college students in multi-ethnic China

ABSTRACT While the developmental impacts of sport have been extensively researched, with significant attention given to sport-based interventional projects common in sport for development and peace (SDP), fewer studies have approached this focus by investigating ordinary sporting opportunities such as physical education and school sports (PESS). Grounded on an 18-month ethnographic fieldwork conducted in a border region of Southwestern China, this qualitative study targets a multi-ethnic college setting to examine the developmental impacts of regular sporting provisions on campus. Underpinned by relativist ontology and constructionist epistemology, qualitative data were collected from multiple sources through participant observation, online survey and in-depth focus group interviews. Drawing on ‘tiyu (体育)’ and the Capabilities Approach (CA) as conceptual and theoretical references, data were analyzed using reflexive thematic analysis whereby four themes with sub-themes were contextually and reflexively constructed. These themes include: (1) fundamental means and ends: tiyu is an essential functioning of health and education; (2) individual agency enables extra gains: tiyu for interpersonal affiliation, emotions and control over one’s environment; (3) from instrumental to elemental: tiyu is an indispensable capability of play; (4) developmental prospects are conditional: counter-stories of tiyu. By contextualizing tiyu’s impacts on capabilities and human development, we lastly discussed the malleable nature of tiyu (sport) and the prospects of improving ordinary sporting opportunities with explicit development concerns.

Beliefs on Causes of Cancer in the General Population, and the Association With Risk Perception and Lifestyle in a Multiethnic Setting.

Beliefs on causes of cancer, although sometimes aligned with known risk factors, may be influenced by personal experiences, cultural narratives, and misinformation. We investigated the prevalence of beliefs on causes of cancer and their association with cancer risk perception and lifestyle in a multiethnic Asian population. In total, 2,008 Malaysian adults with no previous cancer were surveyed using a 42-item questionnaire adapted from the Awareness Measure and the Cancer Awareness Measure-Mythical Causes Scale. Partial least squares structural equation modeling was used to evaluate measurement models. Despite high educational attainment, only about half of the respondents believed that 7 of the 21 listed established risk factors caused cancer. Factors associated with accurate beliefs included higher socioeconomic status (SES) and having family or friends with cancer. However, 14 of the 21 listed mythical/unproven factors were correctly believed as not cancer-causing by the majority. Women and those with lower SES were more likely to hold misconceptions. Beliefs on established risk factors were significantly associated with perceived risk of cancer. Individuals with stronger beliefs in established risk factors were less likely to be associated with healthy behaviors. Conversely, stronger beliefs in mythical or unproven factors were more likely to be associated with healthy lifestyles. Findings highlight the importance of prioritizing cancer literacy as a key action area in national cancer control plans. The counterintuitive associations between cancer beliefs and lifestyle emphasize the complexity of this relationship, necessitating nuanced approaches to promote cancer literacy and preventive behaviors.

Trends in Presentation, Management, and Survival of Women With Breast Cancer in a Multiethnic, Middle-Income Asian Setting.

Granular data on breast cancer (BC) are pertinent for surveillance, planning, and monitoring of cancer care delivery. We determined the trends in clinical presentation, management, and survival of women with BC in a multiethnic middle-income Asian setting over 15 years. Data of 7,478 Malaysian women newly diagnosed with invasive BC between 2005 and 2019 from three hospital-based cancer registries were included. Trends in demographic, tumor, and treatment characteristics were compared across period 1 (P1): 2005-2009, period 2 (P2): 2010-2014, and period 3 (P3): 2015-2019. Overall survival and net survival were determined. More women in P3 than P1 were older than 60 years at diagnosis. Only a marginal increase in proportion of women with stage I disease was observed (23.7% v 27.2% in P1 and P3, respectively, P = .004). Nonetheless, patients were increasingly presenting with smaller tumors, fewer axillary node involvement, well-differentiated tumors, and hormone receptor expression in recent times. Proportion of women with human epidermal growth factor receptor 2 (HER2)-overexpressed tumors significantly decreased. Among indicated patients, receipt of anticancer therapies was somewhat similar over the calendar periods, except for neoadjuvant chemotherapy and anti-HER2 therapy, where increases in administration were noted. Significant improvements in survival were observed over the 15 years, particularly for HER2-overexpressed BCs. Although the improvements in BC survival that we have observed validate ongoing cancer control efforts and treatment advances, study findings suggest that more could be done for earlier detection and improved access to effective therapies in our settings.

A social identity approach to understanding sustainability and environmental behaviours in South Africa

ABSTRACT In recent years, change in behaviour towards the environment has gained prominence as a policy tool to influence positive environmental value. Simultaneously, the role played by social identity in promoting pro-environmental action is gaining recognition. Within this work, the intersection between collective group identity and environmental behaviour has received very little attention. Group norms are considered a strong predictor of pro-environmental behaviour, yet the influence of social identity and collective action on environmental action has not been adequately investigated in a multi-ethnic setting. Within this context, this study examines the affective component of social identity influence on pro-environmental action. More succinctly, this study demonstrates how outgroups and in-groups’ relations and broader sociocultural structures, values, interest, and norms impact environmental and sustainability transitions behaviours. Through interviews with participants across the four dominant social groups in South Africa, this study provides compelling evidence that country-wide expressions of social identity and ingroup dynamics shapes the individual behaviour regarding environmental and sustainability concerns and further strengthen the individual’s perspective for social environmental transformation. This study advances the need for a social-identity centred approach to foster pro-environmental and sustainability outcomes. Highlights The influence that social contexts and social group memberships have on individual perception and behaviour provide important insights to build an empirical base for an inclusive environmental and sustainable action. We applied the theory of social identity to explore these processes and how normative group values and group interest shape environmental behaviour.

"Will anybody listen?" parents' views on childhood asthma care: a qualitative study.

Asthma is the most common chronic disease in children, resulting in considerable morbidity and health care utilisation, especially in geographical areas with high deprivation. Parents play a pivotal role in children's asthma management. To explore the views of parents whose children have asthma, regarding barriers and facilitators to receiving adequate asthma care. A qualitative study conducted in an urban, multi-ethnic setting with high socioeconomic deprivation and paediatric asthma related hospital admissions. The study used a pragmatic approach underpinned by a perspective of critical realism. Parents of children with asthma were recruited through purposive and convenience sampling and data collected through semi-structured interviews. Transcripts were analysed using thematic analysis, facilitated by NVivo software. 10 parents participated in nine interviews. Six themes were identified relating to: (1) the establishment of a new life dynamic following a diagnosis of asthma; (2) the turbulent and drawn-out process of asthma diagnosis; (3) the roles and expectations of the partnership established between parents and healthcare services; (4) the importance of schools in asthma management; (5) sources and access to relevant information; and (6) the importance of social support networks. Parents frequently felt unsupported and misunderstood, particularly during the diagnostic process. Unmet parental educational and emotional needs, particularly around the time of diagnosis were identified as a key barrier to adequate asthma management. Deeper understanding of gaps in support can instruct asthma care delivery and inform co-produced interventions, thus improving asthma outcomes in children.

Develop a curriculum for first-year students at Aksu vocational and technical college’s school of humanities and arts, focusing on teaching Chinese folk songs

This research investigates the integration of Chinese folk songs into the curriculum at Aksu Vocational and Technical College, situated in the culturally diverse Aksu region of Xinjiang, China. This study identifies significant gaps in current music education methods, particularly the disconnect between theoretical learning and practical application, which hinders students’ ability to engage deeply with the material and develop employable skills. Employing a mixed-methods research design, both qualitative and quantitative approaches were used to develop, implement, and evaluate a teaching package specifically designed for first-year students. The package aimed to enhance students' understanding and appreciation of Chinese folk music, thereby improving their cultural competence and engagement with the academic content. The findings suggest that the new curriculum significantly boosted the students' knowledge of and connection to folk music traditions. It also facilitated a better understanding of the music’s historical, cultural, and social contexts. Moreover, the teaching package fostered essential skills in cultural awareness and academic involvement, contributing effectively to vocational music education in a multi-ethnic setting. This approach not only bridges the gap between theory and practice but also enriches the students’ educational experience by embedding cultural appreciation into the learning process, making a substantial contribution to the field of music education.

Effect of ethnic stereotype threat on academic performance: Experimental evidence from rural China

Effect of ethnic stereotype threat on academic performance: Experimental evidence from rural China

Vitamin D status of pregnant women with obesity in the UK and its association with pregnancy outcomes: a secondary analysis of the UK Pregnancies Better Eating and Activity Trial (UPBEAT) study.

Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial, we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI ≥ 30 kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17 ± 1 weeks' gestation were assessed using multivariable linear regression and reported as percent differences in serum 25-hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67 % had 25(OH)D < 50 nmol/l and 26 % had concentrations < 25 nmol/l. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = -33; 95 % CI: -39, -27), Asian (% difference = -43; 95 % CI: -51, -35) and other non-White (% difference = -26; 95 % CI: -35, -14) ethnicity compared with women of White ethnicity (n 1086; P < 0·001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D < 25 nmol/l compared with ≥ 50 nmol/l (OR = 1·58; 95 % CI: 1·09, 2·31), but the magnitude of effect estimates was attenuated in the multivariable model (OR = 1·33; 95 % CI: 0·88, 2·00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth or small for gestational age or large-for-gestational-age delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.

Teacher perceptions of parent collaboration in multi-ethnic ECEC settings

IntroductionFor teachers working in multi-ethnic early childhood education and care settings, a strong collaboration with parents may be an important mechanism for supporting young children's language development. However, little research has investigated how teachers perceive their communication with parents from diverse backgrounds and what centre-level factors predict the quality of teacher-parent collaboration.MethodsThis study sought to explore teacher-parent collaboration within early childhood education and care in urban multi-ethnic areas of Norway, using survey data from 266 teachers across 56 centres and 198 classrooms. We examined whether teacher characteristics (education, experience and self-efficacy) and centre linguistic diversity were related to teacher perceived communication with parents regarding ways of supporting children's dual language development and teacher experienced challenges in parent collaboration.ResultsResults revealed that teachers with higher self-efficacy communicated more with parents and experienced less challenges in collaboration with them. Furthermore, more experienced teachers working in more linguistically diverse centres identified more challenges in parent collaboration, while these characteristics were not related to communication. Teacher education was not associated with communication nor challenges in parent collaboration.DiscussionOur results indicate that professional development measures targeted at strengthening teacher self-efficacy might be an important mechanism to promote parent collaboration, particularly in multi-ethnic education settings.

Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays

BackgroundDespite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates.MethodsThe study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework’s steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.FindingsThe inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course.ConclusionIntegrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.

A Comparative Study of Three Dementia Screening Instruments (CSI-D, CMMSE, and ECAQ) in a Multi-Ethnic Asian Population

Background—There is no validated dementia screening tool for multi-ethnic Asian populations comprising Chinese, Malays, and Indians. This study aimed to establish the psychometric properties of the Community Screening Instrument for Dementia (CSI-D), Chinese Mini Mental State Examination (CMMSE), and Elderly Cognitive Assessment Questionnaire (ECAQ) in multi-ethnic Singapore. Methods—Participants were randomly drawn from a community-based neurological diseases study of older adults conducted in Singapore, with oversampling to allow similar subject numbers from the three major ethnicities: Chinese, Malay, and Indian. The CSI-D, CMMSE, and ECAQ were administered by trained research nurses using a standardised translated questionnaire in a language the participant was most conversant in. Participants were independently diagnosed as a case/non-case of dementia using the DSM-IV. Results—There were 259 participants (85 Chinese, 85 Malays, and 89 Indians, mean age 70.15 years, 65.4% female, 58.8% had no/minimal formal education); 22.8% (n = 59) had dementia. Correlations between the measures were substantial. All the measures had acceptable overall discriminative abilities. Diagnostic accuracies of the instruments did not differ across the ethnic groups. Effects of education were present in the cognitive screening measures. Conclusions—The CSI-D, CMMSE, and ECAQ are valid dementia instruments in this multi-ethnic Asian setting.