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Background: In the Netherlands, all women aged 30–60 years are invited to participate in the national cervical cancer screening programme, which is aimed at early detection and treatment of precancerous lesions. One fourth of the Dutch population has a migration background, with Turkish and Moroccan immigrants being the largest immigrant populations. Turkish‐ and Moroccan‐Dutch women show lower screening participation rates and a higher incidence of cervical cancer, compared to native Dutch women. Since current information materials are not tailored to these women's needs, we developed a short culturally sensitive educational video to facilitate informed decision‐making for cervical cancer screening among Turkish‐ and Moroccan‐Dutch women. This article describes the development process of this video and the lessons learned. Methods: Using the Entertainment–Education communication strategy, we collaborated with an interdisciplinary team of Turkish‐ and Moroccan‐Dutch women, researchers, public health experts, and creative media professionals. We developed the video following the different stages of the Media Mapping model: Orientation, Crystallization, Design/Production, Implementation, and Dissemination. Each stage is described in the paper. Results: The video was developed in Moroccan‐Arabic, ‐Berber and Turkish, and emphasized three main themes: (1) more certainty about having cervical (pre)cancer and the possibility to prevent treatment, surgery, or premature death, and because of this, being there for the children, (2) according to the Islam, a woman should take good care of her health, and (3) anxiety, shame, and privacy. Conclusions: A short culturally sensitive educational video, delivered as part of a larger intervention together with the current information brochure, was developed based on theory and grounded in the needs of Turkish‐ and Moroccan‐Dutch women. The value and effectiveness of this intervention to facilitate informed cervical cancer screening decisions are evaluated in a randomised controlled trial. Patient or Public Contribution: We collaborated with Turkish‐ and Moroccan‐Dutch women during the development process of a short culturally sensitive educational video. Turkish‐ and Moroccan‐Dutch women were also invited to watch the raw footage to verify whether the content and presentation matched their needs and requirements. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a cross-cultural comparison of the attitudes toward diversity among human resource managers working for the same multinational company in the Netherlands and Morocco. Design/methodology/approach – In total, 35 semi-structured in-depth interviews were conducted by telephone and were analyzed by the use of content analysis. Hofstede’s cultural dimensions were used as theoretical framework. Findings – The findings suggest that attitudes toward diversity are changing and not always in line with Hofstede’s scores from 2010. Differences between the Netherlands and Morocco are discussed and trends in both countries are outlined. Originality/value – While it has been argued that Hofstede’s cultural dimensions are relatively stable over time, the findings show that attitudes toward diversity are evolving in the light of the changing environment and that other cultural factors also play an important role. [ABSTRACT FROM AUTHOR]

Background: Low participation rates among ethnic minorities in preventive healthcare services are worrisome and not well understood. The objective of this study was to explore how adults of Turkish and Moroccan origin living in the Netherlands, aged 45 years and older, can be reached to participate in health checks for cardio-metabolic diseases and follow-up (lifestyle) advice. Methods: This mixed-methods study used a convergent parallel design, to combine data of one quantitative study and three qualitative studies. Questionnaire data were included of 310 respondents, and interview data from 22 focus groups and four individual interviews. Participants were recruited via a research database, general practitioners and key figures. Quantitative data were analysed descriptively and qualitative data were analysed using a thematic approach. Results: Regarding health checks, 50 % (95 % G 41;59) of the Turkish questionnaire respondents and 66 % (95 % G 57;76) of the Moroccan questionnaire respondents preferred an invitation from their general practitioner. The preferred location to fill out the health check questionnaire was for both ethnic groups the general practitioner's office or at home, on paper. Regarding advice, both groups preferred to receive advice at individual level rather than in a group, via either a physician or a specialised healthcare professional. It was emphasised that the person who gives lifestyle advice should be familiar with the (eating) habits of the targeted individual. Sixty-one percent (95 % G 53;69) of the Turkish respondents preferred to receive information in their native language compared to 37 % (95 % G 29;45) of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnic-matched professional, and to receive information in their native language. Conclusions: The general practitioner is considered as a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. It might be necessary to provide information in individuals' native language to overcome language barriers. In addition, (lifestyle) advice must be tailored. The obtained insight into preferences of Turkish and Moroccan adults regarding reach for preventive healthcare services could help professionals to successfully target these groups. [ABSTRACT FROM AUTHOR]

Background The burden of cardiovascular risk is distributed unequally between ethnic groups. It is uncertain to what extent this is attributable to ethnic differences in general and abdominal obesity. Therefore, we studied the contribution of general and abdominal obesity to metabolic cardiovascular risk among different ethnic groups. Methods We used data of 21 411 participants of Dutch, South-Asian Surinamese, African-Surinamese, Ghanaian, Turkish or Moroccan origin in Healthy Life in an Urban Setting (Amsterdam, the Netherlands). Obesity was defined using body-mass-index (general) or waist-to-height-ratio (abdominal). High metabolic risk was defined as having at least two of the following: triglycerides ≥1.7 mmol/l, fasting glucose ≥5.6 mmol/l, blood pressure ≥130 mmHg systolic and/or ≥85 mmHg diastolic and high-density lipoprotein cholesterol <1.03 mmol/l (men) or <1.29 mmol/l (women). Results Among ethnic minority men, age-adjusted prevalence rates of high metabolic risk ranged from 32 to 59% vs. 33% among Dutch men. Contributions of general obesity to high metabolic risk ranged from 7.1 to 17.8%, vs. 10.1% among Dutch men, whereas contributions of abdominal obesity ranged from 52.1 to 92.3%, vs. 53.9% among Dutch men. Among ethnic minority women, age-adjusted prevalence rates of high metabolic risk ranged from 24 to 35% vs. 12% among Dutch women. Contributions of general obesity ranged from 14.6 to 41.8%, vs. 20% among Dutch women, whereas contributions of abdominal obesity ranged from 68.0 to 92.8%, vs. 72.1% among Dutch women. Conclusions Obesity, especially abdominal obesity, contributes significantly to the prevalence of high metabolic cardiovascular risk. Results suggest that this contribution varies substantially between ethnic groups, which helps explain ethnic differences in cardiovascular risk. [ABSTRACT FROM AUTHOR]

Background The burden of multimorbidity is likely higher in ethnic minority populations, as most individual diseases are more prevalent in minority groups. However, information is scarce. We examined ethnic inequalities in multimorbidity, and investigated to what extent they reflect differences in socioeconomic status (SES). Methods We included Healthy Life in an Urban Setting study participants of Dutch (N = 4582), South-Asian Surinamese (N = 3258), African Surinamese (N = 4267), Ghanaian (N = 2282), Turkish (N = 3879) and Moroccan (N = 4094) origin (aged 18–70 years). Educational level, employment status, income situation and multimorbidity were defined based on questionnaires. We described the prevalence and examined age-adjusted ethnic inequalities in multimorbidity with logistic regression analyses. To assess the contribution of SES, we added SES indicators to the age-adjusted model. Results The prevalence of multimorbidity ranged from 27.1 to 53.4% in men and from 38.5 to 69.6% in women. The prevalence of multimorbidity in most ethnic minority groups was comparable to the prevalence among Dutch participants who were 1–3 decades older. After adjustment for SES, the odds of multimorbidity remained significantly higher in ethnic minority groups. For instance, age-adjusted OR for multimorbidity for the Turkish compared to the Dutch changed from 4.43 (3.84–5.13) to 2.34 (1.99–2.75) in men and from 5.35 (4.69–6.10) to 2.94 (2.54–3.41) in women after simultaneous adjustment for all SES indicators. Conclusions We found a significantly higher prevalence of multimorbidity in ethnic minority men and women compared to Dutch, and results pointed to an earlier onset of multimorbidity in ethnic minority groups. These inequalities in multimorbidity were not fully accounted for by differences in SES. [ABSTRACT FROM AUTHOR]

Background Diabetes type 2 is more prevalent in people from ethnic minorities in the Netherlands, and outcomes of care are worse compared with other Dutch people. Dieticians experience difficulties in managing these groups in self-management and adherence to dietary advice. The aim of this study was to explore the views regarding a healthy diet and dietetic care among ethnic minority type 2 diabetes patients. Methods Semi-structured interviews were held with 12 migrants with diabetes from Turkey, Morocco, Iraq and Curacao, who visited a dietician. Inclusion went on until saturation was reached. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model and Kleinman's explanatory model of illness. Interviews were held in the language preferred by the respondent. Transcripts were coded and thematically analyzed. Results Several respondents expected a more rigorous, directive and technical approach of the dietician. All respondents acknowledged the importance of a healthy diet. What they considered healthy was determined by culturally influenced ideas about health benefits of specific foods. Important hindrances for dietary change were lack of self-efficacy and social support. Social influences were experienced both as supportive and a hindrance. Conclusions Migrant diabetic patients' opinions about healthy food are determined by culturally influenced ideas rather than by dietary guidelines. Dutch dietary care is not tailored to the needs of these patients and should take into account migrants' expectations, cultural differences in dietary habits and specifically address the role of family. [ABSTRACT FROM AUTHOR]

This research investigates how a sense of belonging functions as protective mechanism against loneliness. Inspired by the work of Berry (1980) on acculturation strategies (i.e. integration, assimilation, separation and marginalization), we distinguish migrants who feel a relatively strong or weak sense of belonging to larger society and those who feel a strong or weak belonging to the 'own group.' We expect that more national belonging contributes to less loneliness. We add a transnational perspective by arguing that feelings of belonging to the own group can take place in the country of settlement, but can also be transnational, i.e. a feeling of belonging to the country of origin. Transnational belonging can protect against loneliness, as it acknowledges the importance of place attachment. Using data from the Longitudinal Aging Study Amsterdam on older migrants aged 55-66, we employ latent class analysis and find five national belonging clusters, interpretable in terms of Berry's acculturation strategies. Further analyses reveal mixed evidence: some aspects of transnational belonging vary with belonging to the own group, but other aspects point to a third dimension of belonging. Regression analysis shows that those marginalized are loneliest and that a transnational sense of belonging contributes to more loneliness. We conclude that Berry's (1980) typology is useful for interpreting older migrants' national belonging and that a transnational sense of belonging is apparent among older migrants, but needs to be explored further. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, ethnic minority populations visit their general practitioner (GP) more often than the indigenous population. An explanation for this association is lacking. Recently, health literacy is suggested as a possible explaining mechanism. Internationally, associations between health literacy and health care use, and between ethnicity and health literacy have been studied separately, but, so far, have not been linked to each other. In the Netherlands, some expectations have been expressed with regard to supposed low health literacy of ethnic minority groups, however, no empirical study has been done so far. The objectives of this study are therefore to acquire insight into the level of health literacy of ethnic minorities in the Netherlands and to examine whether the relationship between ethnicity and health care use can be (partly) explained by health literacy.Methods: A questionnaire was sent to a sample of 2.116 members of the Dutch Health Care Consumer Panel (response rate 46%, 89 respondents of non-western origin). Health literacy was measured with the Health Literacy Questionnaire (HLQ) which covers nine different domains. The health literacy levels of ethnic minority groups were compared to the indigenous population. A negative binomial regression model was used to estimate the association between ethnicity and GP visits. To examine whether health literacy is an explaining factor in this association, health literacy and interaction terms of health literacy and ethnicity were added into the model.Results: Differences in levels of health literacy were only found between the Turkish population and the indigenous Dutch population. This study also found an association between ethnicity and GP visits. Ethnic minorities visit their GP 33% more often than the indigenous population. Three domains of the HLQ (the ability to navigate the health care system, the ability to find information and to read and understand health information) partly explained the association between ethnicity and GP visits.Conclusions: In general, there are no differences in health literacy between most of the ethnic minority groups in the Netherlands and the indigenous Dutch population. Only the Turkish population scored significantly lower on several health literacy domains. Some domains of health literacy do explain the association between ethnicity and higher frequency of GP visits. Further research is recommended to understand the pathways through which health literacy impacts health care use. [ABSTRACT FROM AUTHOR]

Background: To examine the preferences for comprehensive services and facilities in a new proposed birth center which will be established in a large Dutch city, specifically among pregnant women from different ethnic backgrounds.Methods: The analyses of this study were based on a survey among 200 pregnant women living in The Hague, the Netherlands in 2011. Multiple linear regression was applied to analyze if preferences differ by ethnic background, controlling for various other predictors.Results: Pregnant women had relatively strong preferences for comprehensive services and facilities to be offered by the new proposed birth center compared to both other dimensions of birth center care: extensive practical information and comfortable accommodation. With regard to ethnic differences, non-Dutch women had higher preferences for comprehensive care compared to Dutch women. This difference between Dutch and non-Dutch women increased with their level of education.Conclusions: Especially for non-Dutch women, birth centers that are able to provide comprehensive services and facilities can potentially be a good setting in which to give birth compared to hospitals or at home. In particular, higher educated non-Dutch women had a preference for the personalized care that could be offered by this new birth center. [ABSTRACT FROM AUTHOR]

Background: Unhealthy dietary and physical activity (PA) patterns are highly prevalent in most Western countries, especially among lower-educated and ethnic minority groups. Therefore, interventions to promote healthy eating and physical activity that can reach large numbers of lower-educated people are needed. When developing interventions, the ethnic diversity of the lower-educated population may be taken into account to make intervention material more appealing to the target group. This article describes the development and evaluation of two computer-tailored nutrition and physical activity interventions for lower-educated Dutch, Turkish and Moroccan women. One version is tailored to sociocognitive variables (traditional tailoring), while the other is additionally tailored to ethnic identity (EI-tailoring).Method: Using intervention mapping, two evidence- and theory-based interventions were developed. In the traditional tailoring intervention, messages are tailored to health behavior, awareness of own behavior, attitude and self-efficacy. The behavior change techniques used to address these factors are: descriptive and evaluative feedback, arguments, modeling, goal setting, planning, barrier identification and advice on how to deal with barriers, stimulating resistance to social pressure, mobilization of social support (nontailored), active learning (nontailored) and iterative feedback. In the EI-tailoring intervention, the material is additionally tailored to ethnic identity (EI). This means that recipients who feel strongly attached to their ethnic background receive different intervention material than recipients with a weak attachment to their background. This includes, for instance, the use of more traditional colors, role models that match with their origin and advice messages that refer to their ethnicity of origin.Discussion: Developing an intervention that matches the needs of this specific target population was challenging due to the little evidence regarding the determinants of their health behavior, as well as the behavioral change techniques that have not been tested among Turkish and Moroccan women in the Netherlands before. Based on previous research among this and other target populations we hypothesize, however, that the determinants and strategies we use will be suitable. A randomized controlled trial will show whether the interventions are effective among our specific target group and whether EI-tailoring is beneficial.Trial Registration: Dutch Trial Registry NTR4506 , registration date: 1(st) may 2014. [ABSTRACT FROM AUTHOR]

Objective: To determine the health-related quality of life (HRQOL) of overweight and obese multi-ethnic children compared with normal-weight children; and to investigate differences in HRQOL between self- and parent-proxy reports and ethnic groups.Design: Prospective cross-sectional study.Setting: Out-patient clinic where children and their parents filled out a validated HRQOL questionnaire (KIDSCREEN-52) and height, weight, waist circumference and fat percentage were measured.Subjects: Overweight and obese children, aged 8-18 years (mean BMI Z-score 3·2 (sd 0·6)), from the obesity out-patient clinic.Results: Three hundred and eight self- and 213 parent-proxy reported questionnaires were completed. Global HRQOL and the Physical Wellbeing, Moods & Emotions and Self-Perception subscales were markedly reduced in our multi-ethnic obese cohort, relative to the Dutch reference values. Parent proxies reported significantly lower on the global HRQOL and the Physical Wellbeing, Moods & Emotions and Bullying subscales. In Caucasian children, multivariate analyses showed that BMI was associated with the quality-of-life subscales Moods & Emotions, Self-Perception and Bullying.Conclusions: HRQOL was markedly reduced in our multi-ethnic overweight and obese out-patient clinic cohort, with significantly lower parent-proxy scores compared with self-reported scores. We believe intervention programmes aiming to improve HRQOL should be directed to both parents and children, while ethnic-specific programmes to enhance HRQOL seem of less importance. [ABSTRACT FROM AUTHOR]

Background: In Western countries the prevalence of cardiovascular disease (CVD) is often higher in non-Western migrants as compared to the host population. Diet is an important modifiable determinant of CVD. Increasingly, dietary patterns rather than single nutrients are the focus of research in an attempt to account for the complexity of nutrient interactions in foods. Research on dietary patterns in non-Western migrants is limited and may be hampered by a lack of validated instruments that can be used to assess the habitual diet of non-western migrants in large scale epidemiological studies. The ultimate aims of this study are to (1) understand whether differences in dietary patterns explain differences in CVD risk between ethnic groups, by developing and validating ethnic-specific Food Frequency Questionnaires (FFQs), and (2) to investigate the determinants of these dietary patterns. This paper outlines the design and methods used in the HELIUS-Dietary Patterns study and describes a systematic approach to overcome difficulties in the assessment and analysis of dietary intake data in ethnically diverse populations.Methods/design: The HELIUS-Dietary Patterns study is embedded in the HELIUS study, a Dutch multi-ethnic cohort study. After developing ethnic-specific FFQs, we will gather data on the habitual intake of 5000 participants (18-70 years old) of ethnic Dutch, Surinamese of African and of South Asian origin, Turkish or Moroccan origin. Dietary patterns will be derived using factor analysis, but we will also evaluate diet quality using hypothesis-driven approaches. The relation between dietary patterns and CVD risk factors will be analysed using multiple linear regression analysis. Potential underlying determinants of dietary patterns like migration history, acculturation, socio-economic factors and lifestyle, will be considered.Discussion: This study will allow us to investigate the contribution of the dietary patterns on CVD risk factors in a multi-ethnic population. Inclusion of five ethnic groups residing in one setting makes this study highly innovative as confounding by local environment characteristics is limited. Heterogeneity in the study population will provide variance in dietary patterns which is a great advantage when studying the link between diet and disease. [ABSTRACT FROM AUTHOR]

Background: Problematic interethnic relationships, expressed by feelings of discrimination, may contribute to ethnic variations in health and health care utilization. The impact of daily perceived discrimination on (mental) health has been shown. Less is known about the effect of everyday discrimination on the health care utilization. We examined the relationship between perceived discrimination of Turkish and Moroccan patients on GP health care utilization in the Netherlands and on health services use in the home country. Methods: Cohort study within the second Dutch National Survey of General Practice (2001). Interviews were conducted with 416 Turkish and 381 Moroccan respondents, and repeated in 2005 among respectively 118 and 102 participants. Linear, logistic and zero-inflated binomial regression models were used for the analyses. Results: Perceived discrimination was associated with non-attendance to the GP. Perceived quality of GP care was not a mediator in this relationship. No evidence was found for substitution of health care utilization in the home country to health care in the host country. GP attenders had higher odds of using health care in the home country than non-attenders. Over time, a lasting discrimination feeling was related to persistent non-attendance at the GP practice. Conclusion: Ethnic minority patients who feel discriminated may avoid GP health care. Further research is warranted on magnitude and health effects of such potential underutilization. Information on perceived discrimination within health care settings would increase insight into the profile of non-attenders, and on possible measures to better target interventions at a group at risk of underutilization. [ABSTRACT FROM AUTHOR]

Background: This study examines the associations between perceived discrimination and depressive symptoms among Turkish–Dutch and Moroccan–Dutch adolescents and young adults living in the Netherlands. Methods: We analysed cross-sectional data from a sample of 199 Turkish–Dutch and 153 Moroccan–Dutch respondents, aged 15–24 years, using multiple logistic regression analyses. Discrimination was measured on group level and personal level. Depression was measured by the Centre for Epidemiologic Studies-Depression Scale (CES-D). Results: Respondents that experienced perceived discrimination on a personal level were more likely than those that experienced no perceived discrimination to have depression (OR = 3.21, 95% CI = 1.59–6.47). This association was larger for the Moroccan–Dutch (OR = 5.32, 95% CI = 1.75–16.16) compared with the Turkish–Dutch (OR = 2.76, 95% CI = 1.03–7.40). Analysis of separate group level discrimination items, measuring different domains, revealed an association between discrimination on school and depression for the Moroccan–Dutch (OR = 2.80, 95% CI = 1.16–6.78). Conclusion: Personal level perceived discrimination is associated with depressive symptoms among young minority group members with a Turkish or Moroccan cultural background. This indicates that discrimination is an important factor that should be taken into account in developing public health policies. [ABSTRACT FROM PUBLISHER]

Background: Migration and ethnic minority status have been associated with higher occurrence of common mental disorders (CMD), while mental health care utilisation by non-Western migrants has been reported to be low compared to the general population in Western host countries. Still, the evidence-base for this is poor. This study evaluates uptake of mental health services for CMD and psychological distress among first-generation non-Western migrants in Amsterdam, the Netherlands. Methods: A population-based survey. First generation non-Western migrants and ethnic Dutch respondents (N = 580) participated in structured interviews in their own languages. The interview included the Composite International Diagnostic Interview (CIDI) and the Kessler psychological distress scale (K10). Uptake of services was measured by self-report. Data were analysed using weighting techniques and multivariate logistic regression. Results: Of subjects with a CMD during six months preceding the interview, 50.9% reported care for mental problems in that period; 35.0% contacted specialised services. In relation to CMD, ethnic groups were equally likely to access specialised mental health services. In relation to psychological distress, however, Moroccan migrants reported less uptake of primary care services (OR = 0.37; 95% CI = 0.15 to 0.88). Conclusion: About half of the ethnic Dutch, Turkish and Moroccan population in Amsterdam with CMD contact mental health services. Since the primary purpose of specialised mental health services is to treat "cases", this study provides strong indications for equal access to specialised care for these ethnic groups. The purpose of primary care services is however to treat psychological distress, so that access appears to be lower among Moroccan migrants. [ABSTRACT FROM AUTHOR]

We use a unique data source to examine postimmigration investments in education among four immigrant groups in the Netherlands. We derive hypotheses from the Immigrant Human Capital Investment model (IHCI), which argues that immigrants' investments are an outcome of settlement intentions, skill transferability, and opportunity costs. The multinomial and ordered logistic regression analyses show that educational investments are stronger among immigrants with higher premigration education, immigrants from former colonies, immigrants who migrated for family reasons, and immigrants who arrived in periods of high unemployment. These findings generally support the IHCI model. [ABSTRACT FROM AUTHOR]

In this paper we investigate the role of several socio-economic and non-economic factors such as absolute and relative income, education and religion to explain the differences of happiness levels of Turkish and Moroccan Immigrants in the Netherlands by using ordered logit model. We focus on members of the Moroccan and Turkish communities, as these are the two largest non-EU immigrant communities in the Netherlands. Our findings reveal that Moroccans, although they have lower income levels and higher unemployment rates than Turkish immigrants, their happiness level is higher than the Turkish immigrants. In order to understand this dilemma a questionnaire survey was performed to 111 Turkish and 96 Moroccan immigrants in Rotterdam, Amsterdam, Den Haag, Utrecht and Arnhem in 2010. The main purpose is to investigate how reference group's self-reported life satisfaction is related to the level of absolute income; the level of relative income and other socio-economic factors. The main findings are that for Turkish sample relative income is significantly and negatively correlated with life satisfaction whereas, both absolute income (positively) and relative income (negatively) are significantly correlated with life satisfaction for Moroccan case.

Purpose: The lack of career movement of members of ethnic minority groups in work organizations has been widely documented. The purpose of this paper is to gain insight into conditions for the realization of diversity goals in the case of talent development. Design/methodology/approach: In a case study of management development in the Dutch national tax administration, the practice of fostering vertical mobility of ethnic minority personnel through diversity management has been analysed. The authors make use of theories regarding effective diversity management and career advancement of ethnic minority employees. Data were collected through semi-structured interviews with 12 participants in the management development course, and a further 25 functionaries involved in the project. Findings: With regard to diversity management as a means of fostering talent development of ethnic minorities, the authors come to the conclusion that key success factors mentioned in the literature such as top level commitment and strategic integration, are insufficient and overrated conditions. More important are "non-issues" in the formulation of diversity strategies, organizational alignment of relevant organizational players, strategic coherence and organizational culture. Research limitations/implications: The case study design used in this research facilitates case-sensitive analysis, but is limited in estimations of validity and explanatory strength of factors mentioned in the literature, as it is in generalizing across organizations. Practical implications: Interventions aimed at fostering ethnic diversity in talent development should start with precise analysis of cultural and organizational conditions and processes underpinning standard practices of talent and career development, and not only seek strategic integration and top management commitment but arrange for broad-based organizational alignment. Originality/value: While there are many theoretical and normative models tracing diversity outcomes to organizational conditions and diversity management strategies, there is a dearth of empirical studies in this field. The case study explores the merits of these models and adds new insights on an empirical basis. (Contains 2 tables.)

Purpose: The purpose of this paper is to examine the training provided to US and European expatriates in Morocco, and subsequently build the body of knowledge for international HRD in the Middle East and North Africa (MENA). Design/methodology/approach: The study used the models of Black and Mendenhall and Mendenhall and Oddou, subdividing the skills needed to be successful in a foreign country into three categories of skills; maintenance of self, interpersonal skills, and cognitive skills. The population for the study comprises 109 private companies in Morocco, with 34 responding, resulting in a response rate of 31 per cent. Findings: Pre-departure training was provided to all respondents, but none indicated receiving any training post-arrival. None of the respondents' spouses or children received any training. Further, there was no tuition in Arabic, and very few received tuition in French. Co-workers, locals, and neighbors were found to be major factors in assisting expatriates' adjustment. Research limitations/implications: The study is limited by the small sample size. The inconclusive results of this research provided some information that needs further exploratory studies to address the impact neighbors, co-workers, and locals may have on the expatriates' adjustment. Further research is needed to determine the effectiveness of training that assists expatriates' adjustment and performance in Morocco. Originality/value: Morocco is part of the countries that constitute the Middle East and North Africa region (MENA). MENA countries share similarities in culture that can impact global HRD practices. The results of the study add to the knowledge of international management and global HRD theory and practices. (Contains 2 tables.)