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Background: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. Aim: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. Method: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. Results: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. Conclusion: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education. [ABSTRACT FROM AUTHOR]

Higher Education (HE) can play a fundamental role in the achievement of sustainable development, and particularly the Sustainable Development Goals (SDGs) as captured in the Incheon declaration. However, what approach HE should take in this mission is a contested space. In this paper, we interrogate the idea of indigeneity. The pursuit to ascertain how an indigenised approach to internationalisation can support or enhance the contribution of HE curricula towards sustainable development is driven by the understanding that for sustainable development to be achieved at all, the process of knowledge creation must strive to make integral those epistemologies that exist beyond the "West"; an understanding that aligns, in particular, with Target 7 of the United Nations (UN) SDG 4 and seeks to empower victims of epistemic violence. In doing so, we employed a bibliographic research which captured a dual approach consisting of a bibliometric analysis of literature and a review of case studies. The findings from both methods suggest that internationalisation appears in different disciplinary contexts, but these are not always aligned with indigenisation. We maintain that the construct of (inter)culturality can address aspects within the framework of indigeneity to boost the internationalisation of HE curricula and outcomes for sustainable development. Central to this are four factors, namely: the need for effective human engagement with (inter)cultural competence, medium/place of curricula interaction, the initiative form and the reach of the development. [ABSTRACT FROM AUTHOR]

The field of artificial intelligence (AI) is presently having a substantial influence on the advancement of career counseling education by enabling tailored guidance and evidence-based decision-making for learners. This paper aims to provide an overview about the utilization of AI in Bangladesh's early career planning education. The utilization of AI has already been deployed in many first world country, however this is quite new to the third world country like Bangladesh. Significantly, artificial intelligence (AI) has surpassed its traditional function in professional growth and extended its reach to encompass social and emotional education. The examination of AI studies in Bangladesh requires the careful examination of several elements, such as cognitive advancement, parental engagement and oversight, and cultural heritage. This paper reveals overall all the facets of implementing AI in career planning in context of Bangladesh. Although there are several limits associated with the utilization of artificial intelligence for career assessment, it has undeniably yielded a multitude of benefits and discoveries. In the result, the two areas of data-informed making choices and career exploration are where the phenomena mentioned above are most frequently seen. Additionally, there is a growing need for cultural competency in the educational sector for both the delivery of individualized career counseling and AI-assisted employment suggestions. [ABSTRACT FROM AUTHOR]

The paper aims to develop a critical sociocultural understanding on the epistemological and historical analysis of evidence-based (EB) paradigm in contemporary psychological knowledge-production (research) and knowledge-application (practice). It firstly retraces the emergence of EB in medical disciplines, its paradigmatic status, and its subsequent adoption by mainstream psychological sciences. The description of EB historical roots and key concepts leads to the second part, where the paper reflects on key epistemological criticalities scholars have raised toward the EB paradigm. Then, we develop our sociocultural perspective to enrich the epistemological analysis and critique of EB. Specifically, we propose a hermeneutic and interpretative understanding which frames EB as a re-enactment of the positivist scientific research ambition to reach for a complete formalization of biological/psychological phenomena (endo-genetical dynamics), and of new socioeconomic, political, and individual needs posed by contemporary Western societal institutions to scientific knowledge (exo-genetical dynamics). Furthermore, building on such understanding, we suggest that EB works as a contemporary epistemic indicator and threshold, serving two functions: selective filtering and exclusion. Finally, we speculate that EB endo-genetical and exo-genetical developmental dynamics can be interpreted as an expression of the contemporary presentist regime of temporality and as a shift towards the regime of performative techniques instead of context-specific and future-oriented relational competences, also tracing a determining factor that has directed, directs and will continue to direct scientific research in psychology. [ABSTRACT FROM AUTHOR]

Background: Diversity, equity, and inclusion have been an intentional focus for SAGES well before the COVID-19 pandemic and the coincident societal recognition of social injustices and racism. Longstanding inequities within our society, healthcare, and the surgery profession have come to light in the aftermath of events that rose to attention around the time of Covid. In so doing, they have brought into focus disparities, injustices, and inequalities that have long been present in the field of surgery, selectively affecting the most vulnerable. Methods: This White paper examines the current state of diversity within the field of surgery and SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) approach and effort to pave the way forward to meaningful change. We delineate the imperative for diversity, equity, and inclusion for all. By all, we mean to be inclusive of the diversity of gender and sexual orientation, race, ethnicity, geography, sex, and disability in the field of surgery. Results: SAGES is an organization that lives at the intersection of education and innovation. It has a vital role in assisting the surgical profession in addressing these issues and needs and being a force alongside others for sustained and necessary change. SAGES can only realize these goals through a commitment across all aspects of the organization to embed diversity, equity, and inclusion into our very fabric. Conclusion: True diversity, equity, and inclusion within a surgical organization is vital for its longevity, growth, relevance, and impact. Unfortunately, the absence of DEI limits opportunity, robs the organization of collective intelligence in an environment in which its presence is critical, contributes to health inequities, and impoverishes all within the society and its value to all with whom it interfaces. SAGES is an organization that lives at the intersection of education and innovation. It has a vital role in assisting the surgical profession in addressing these issues and needs and being a force alongside others for sustained and necessary change. SAGES can only realize these goals through a commitment across all aspects of the organization to embed diversity, equity, and inclusion into our very fabric. Strategies like those highlighted in this White Paper, may be within our grasp and we can learn yet more if we remain in a place of humility and teachability in the future. [ABSTRACT FROM AUTHOR]

An overview of Applied Behavior Analysis (ABA) and Autism Spectrum Disorder (ASD) in the Middle East was published by Kelly and colleagues in 2016. The focus of the review was to explore clinical services, educational opportunities, and published research in the six countries of the Gulf Cooperation Council, namely the Kingdom of Bahrain, the State of Kuwait, the Sultanate of Oman, the State of Qatar, the Kingdom of Saudi Arabia, and the United Arab Emirates. The objective of the current paper was to provide an update on the current status of ABA and ASD in the Gulf region, with a focus on successes, challenges, and recommendations for future directions. [ABSTRACT FROM AUTHOR]

In this paper, we draw on our recent research to inspect again some of the theoretical perspectives we have been using to analyze data and to characterize teaching-learning in university settings. We focus particularly, within a sociocultural perspective on Activity Theory and the construct the "Teaching Triad," seeking to embed the Triad within an Activity Theory perspective. To achieve this, we relate the Teaching Triad with aspects of the sociocultural setting both in and beyond direct interactions in face-to-face teaching. While this is mainly a theoretical paper, an example is taken from observations of teaching in university lectures in a Greek university to show how these theoretical perspectives have provided insights to the institutional and cultural complexities involved and in what ways the Triad construct has evolved. [ABSTRACT FROM AUTHOR]

This paper presents an application that can be taken when conducting mental health intervention within the Latino immigrant population. Using a social ecological lens, it provides an overview of experiences and factors to detail the characteristics, trauma, and resilience factors present within this population. Utilizing Ungar's framework on resilience, that decenters the individual from experiences of trauma to position them alongside their social network and resources, it proposes an application for future intervention and research efforts. Addressing intervention at a foundational level allows for the supplementing and shaping of current methods to address the mental health needs of this community. [ABSTRACT FROM AUTHOR]

In this paper, we explore associations among undergraduate students' perceptions of professor cultural competence, students' perceptions of professor growth mindset, and students' motivation to engage in intercultural interactions. In two studies (Nstudy 1 = 351, Nstudy 2 = 277), we find that when students perceive their professor to be more culturally competent, they report higher self-efficacy, value, and mastery-approach orientation toward intercultural interactions. However, somewhat unexpectedly, students who perceive their professors to have higher cultural competence also report higher performance-avoidance orientation toward intercultural interactions. When students perceive their professors to have a stronger growth mindset, they report lower emotional costs toward intercultural interactions. Further, in Study 1 but not Study 2, we find interactions between perceived professor cultural competence and perceived professor mindset such that the combination of perceiving high cultural competence and high growth mindset led to the highest student-reported self-efficacy and the lowest emotional cost toward engaging in intercultural interactions. Although exploratory and preliminary in nature, these findings suggest that students in classes where professors demonstrate high cultural competence may be more motivated to engage in intercultural interactions; however, it may be important for professors to also communicate a growth mindset if they want to reduce potential threats associated with engaging in intercultural interactions. [ABSTRACT FROM AUTHOR]

This review aims to identify healthcare providers' (HCPs) experiences with issues related to the quality use of medicines among culturally and linguistically diverse (CALD) patients, the underlying factors, and the enablers of and barriers to providing culturally safe care to promote quality use of medicines. The searched databases were Scopus, Web of Science, Academic search complete, CINHAL-Plus, Google Scholar and PubMed/Medline. The initial search returned 643 articles, of which 14 papers were included. HCPs reported that CALD patients were more likely to face challenges in accessing treatment and sufficient information about treatment. According to the theoretical domains framework, determinants such as social influences due to cultural and religious factors, lack of appropriate resources about health information and cultural needs, lack of physical and psychological capabilities such as lack of knowledge and skills, and lack of motivation could impede HCPs' abilities to provide culturally safe care. Future interventions should deploy multilevel interventions, such as education, training, and organisation structural reforms. [ABSTRACT FROM AUTHOR]

This special section of the journal focuses on the expanding horizons, challenges, and opportunities for the psychiatric educators. In the six papers that comprise this special section, the authors have covered a broad range of topics in both undergraduate medical education and graduate medical education including topics such as accreditation, technology, how providers can locate education resources, how trainees are taught about professionalism in the digital age, telepsychiatry, manualized psychotherapy treatments, and cultural competence. We hope that psychiatric educators, and others interested in this field, will find these papers helpful. [ABSTRACT FROM AUTHOR]

This paper discusses an Aboriginal cultural mentoring project for non-Aboriginal teachers that positions Aboriginal people front and centre as cultural and educational experts. In so doing it sets out to contribute to work in Australia that challenges 'common' understandings about mentoring in educational contexts where the expert is usually a western-educated non-Aboriginal teacher. In this project, non-Aboriginal teachers are supported in implementing culturally responsive curriculum and pedagogies into their classroom through building relationships with Aboriginal mentors and students. Analysis of thirteen pre and post surveys, four mentee interviews and one mentee focus group, illuminated the emergence of collaborative cultural mentoring processes, where teachers developed trusting, reciprocal and respectful relationships with Aboriginal people. We argue that a systematic, well-supported Aboriginal cultural mentoring program can be used to create and convert new knowledge into practice, and that this can have a positive impact on teachers' understanding of teaching/learning processes thereby contributing to Aboriginal student engagement in their learning. [ABSTRACT FROM AUTHOR]

The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety—not state compulsion—must remain the first principles of any engagement—including vaccination—with First Nations Peoples, families, and communities. [ABSTRACT FROM AUTHOR]

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing. [ABSTRACT FROM AUTHOR]

Diversity and inclusion have become key phrases within Marriage and Family Therapy education programs, particularly those accredited by the Commission on Accreditation for Marriage and Family Therapy Education, as there are standards related to these concepts. However, consistent guidelines regarding how to infuse diversity and inclusion into Marriage and Family Therapy education are lacking. The current article provides an outline of one Marriage and Family Therapy education program's preliminary efforts to 'closing the loop' on the instruction and evaluation of diversity and inclusion with the program. The closing the loop process involved six steps 1) explore the MFT literature and relevant organizations, 2) collect data from key practice oriented stakeholders using qualitative and quantitative measures, 3) review current procedures and brainstorm, 4) consult with key knowledge oriented stakeholders, 5) develop and implement a comprehensive and thorough assessment and evaluation plan, and 6) aggregate and evaluate data to engage in modification to the assessment plan as warranted. This paper has two goals. The first goal is that this paper will serve as an example for other programs who are struggling to infuse or demonstrate the infusion of diversity and inclusion within their programs. The second goal is to reflect on lessons learned from this program's quality improvement process. [ABSTRACT FROM AUTHOR]

Objectives: The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. Methods: PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. Results: An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support. Significance: Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care. [ABSTRACT FROM AUTHOR]

Public libraries in the United States (U.S.) are important sources of health information. Immigrants comprise a large portion of the U.S. population, and research suggests that public libraries help immigrants adjust to life in a new country. Public libraries help immigrants access information directly related to health and provide programs that have indirect impacts on health outcomes, including learning a new language and forging social ties. The purpose of this paper was to examine perspectives from librarians related to interactions with immigrant patrons and how their library supports them in this role. Public librarians (n = 205) from two selected U.S. states completed an online survey focusing on how comfortable they were in helping immigrants with inquiries related to health and the role of the public library in supporting librarians in this endeavor. Respondents generally reported high levels of comfort interacting with immigrants, although there was limited interaction on potentially sensitive topics (i.e., immigration, health). Library staff perceived that libraries overall were not effective in meeting the needs of immigrant populations and that librarians were infrequently offered professional training related to cultural competency and diversity. The findings echo previous studies that demonstrate the need for professional development to ensure that librarians are aware of library resources available to assist immigrant patrons. Findings from this study suggest opportunities for public health professionals and public librarians to collaborate to ensure the provision of reliable resources, health information, and referrals to community-based services. [ABSTRACT FROM AUTHOR]

Mental health challenges have been recognized as one of the most prevalent issues impacting children and families within the United States. Children and families of color are disproportionately affected by this due to lack of access to preventative and ongoing supports, and programs that can help address their overall well-being. These issues are even more severe for those that are at risk or interact with the child welfare system. Social workers use various clinical modalities to assess and support them. In the recent years, child welfare agencies have turned to Evidence based programs (EBPs) as a best practice to meet the needs of children and families. The Title IV-E Prevention Services Clearinghouse, established by the Administration of Children and Families is a landmark effort to review and promote such EBP's that prevents foster care placements, including mental health programs. While the Clearinghouse has reviewed 141 programs and services, out of which 71 have been rated as promising, supported, or well-supported, there is a dearth of culturally responsive programs that have met the Clearinghouse criteria. Given the overrepresentation of African American and Native American Families in the child welfare system, and the critical role of the Clearinghouse in reviewing and promoting EBPs, this paper highlights the philosophical, administrative, cultural and logistical barriers for culturally relevant programs to be accepted into the Clearinghouse. It also provides specific recommendations on how the Clearinghouse and researchers can build EBPs that account for the intersection between mental health, social location and cultural identities of the children and families that social workers serve. [ABSTRACT FROM AUTHOR]

It is estimated that the Roma are the largest ethnic minority population in Europe (HSE in Roma Intercultural Guide, 2020). There is a dearth of information in the Irish medical literature on the Roma in Ireland. The aim of this paper is to provide an overview of the Roma in Ireland, to identify Roma-specific culture, family structure, paediatric illness, and health equality within the context of the Irish population. To do this, a review was completed of the English language literature on Roma available from 2010 to 2021 using web of science databases. Relevant clinicians and organisations were contacted to compile data on the Irish Roma to inform appropriate action in Roma child health. Up until 2021, the national census in Ireland did not include Roma as a category in ethnicity (HSE in Roma Intercultural Guide, 2020). As such, it is difficult to get an accurate number of the population in Ireland. Pavee Point Traveller and Roma Centre in 2009 estimated a population of approximately 5000 (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). The majority of the Roma in Ireland are Romanian (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). There is limited understanding of their culture in Ireland (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Often overlooked, small indigenous groups or nomadic races have unmet medical needs (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Across Europe, they have a lower life expectancy and higher burden of illness due to lower socioeconomic status, discrimination, and poor access to health services (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Cultural competence is necessary to provide effective healthcare. [ABSTRACT FROM AUTHOR]

Research demonstrates ongoing health inequities for those from the most marginalized communities. To address these health inequities, medical educators have attempted to incorporate education that targets cultural competence of providers. Over the last decade, increasing evidence has demonstrated limitations to a competency-based approach. In this paper, we outline how utilizing critical reflection strategies in clinical supervision can be a long-term, sustainable approach for addressing health inequities, while improving the existing cultural competency model. We begin by demonstrating how existing ideas of critical reflection can be adopted to enhance learning within supervision by encouraging providers to evaluate and re-evaluate existing beliefs and biases. We then propose how an existing approach to treatment (i.e., Metacognitive Reflection and Insight Therapy) may serve as an example for how to activate critical reflection in supervision using three essential factors. Finally, we propose three clinical implications for providers that may work to dismantle existing healthcare inequities including: an increased comfort in feedback seeking, improved confidence working with diverse populations, and increased insight into how inequities emerge in clinical practice and how best to respond when they do. [ABSTRACT FROM AUTHOR]

Increased globalization of the world economy, growth in human migration, and rapid developments in science and technology have required people to develop intercultural communication skills. Teachers play a crucial role in developing intercultural competence among students in our globalized, multilingual classrooms. The need for fostering collaborative discourse among students with diverse cultural and linguistic repertoires and building intercultural competence among students is a common blind spot in Science, Technology, Engineering, and Mathematics teacher praxis. This can inhibit efforts to cultivate safe and supportive learning environments for all students and can ultimately threaten multilingual student success. As part of a larger study, this narrative inquiry explores the phenomenon of intercultural competence development through the lived experiences of a Midwestern secondary science teacher. Time series data were collected from the participant (11 semi-structured, in-depth, online interviews over 8 months). Field notes and artifacts served as secondary data. Informed by Michael Byram's Multidimensional Model of Intercultural Competence, interviews were designed, conducted, transcribed, and member checked. Then, transcripts, field notes, and artifacts were coded and analyzed using Jean Clandinin and Michael Connelly's three-dimensional narrative inquiry framework to arrive at synthesized stories of experience around coalescing themes. The findings revealed the participant utilized several strategies aimed at developing intercultural communicative competence, particularly in support of multilingual students. This paper focuses on the four themes that relate most directly to intercultural communicative competence development. The findings and implications are discussed within the context of Byram's model and conclusions are drawn to inform current and future work in this area. [ABSTRACT FROM AUTHOR]

This paper seeks to provide an exploration of the interplay between global citizenship, culture, religion and spirituality. Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19–32, 2005) scoping literature review framework was utilised to qualify the research question, develop inclusion and exclusion criteria, select relevant studies, chart data and collate information. From the available peer-reviewed literature, a total of 44 articles were initially identified using the selection criteria, 19 of which were subsequently analysed. Eight main themes were identified within the literature; (1) development of global citizenship identity, (2) prosocial values and perspectives, (3) cultural competence and influence, (4) religion and religious teachings, (5) immersion experiences, (6) normative influence, (7) political compass and (8) spirituality. The literature suggests a clear link between global citizenship and spirituality. There were, however, some inconsistencies in the relationship between formalised religion and global citizenship across the studies, with evidence of religion both contributing to and detracting from prosocial values related to global citizenship. Additionally, cultural experiences, including immersion experiences, volunteering and study aboard were all positively linked to prosocial values related to global citizenship. Global citizenship provides individuals with an opportunity to develop intercultural skills, respect, sensitivity, empathy and concern for all of humanity. It is recommended that future global citizenship research should ensure adequate definitions of religion and spirituality, with caution to not generalise the two terms into one concept. Additional research into the relationship between spiritualty and global citizenship could provide a strong basis to increase understanding of the contributing factors to global citizenship identity. [ABSTRACT FROM AUTHOR]

Initial Teacher Education has been informed by diverse perspectives in recent years; while the debates around what constitutes teacher quality and adequate preparedness focus on the structure and focus of programs, entry and exit requirements, the current era presents new challenges to which teachers must respond such as an increased call for cultural responsiveness. In this context, the way that literacy itself is conceptualised within teacher education requires expansion. We argue in this paper that literacy plays a key role in the ontological and epistemological development of quality teachers, beyond the way it is currently conceived as either a hurdle requirement for the successful completion of an ITE program (Barnes & Cross Teachers and Teaching, 26(3-4), 307-325, 2020) or as a set of skills to support students to develop content knowledge across the disciplines (Scott et al. Teaching and Teacher Education, 73, 1-13, 2018). We contend that literacy is central to teacher's professional becoming (Matusov et al., 2019) and explore how a dialogic approach to teaching can support pre-service teachers' professional meaning making. The paper proposes a dialogic framework to embrace different levels of dialogue not merely as a means of 'doing' in the classroom, but as central in the process of knowing, being and becoming a professional teacher. [ABSTRACT FROM AUTHOR]

This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges. [ABSTRACT FROM AUTHOR]

Couple, marriage, and family therapists (CMFTs) are becoming more aware of clients' diversity. Model-specific research highlights the need for more culturally competent models and techniques. Some researchers argue that less emphasis needs to focus on developing culturally competent models and more attention placed on developing culturally sensitive therapists. Basing the principles of our paper on Fife et al. (J Marital Fam Ther 40(1): 20–33, 2014) meta-model, which places a therapist's way-of-being as the foundation of effective therapy, our paper aims to present a case for a therapist's way-of-being as the heart of effectively working with minority populations and culturally diverse clients. Common factors and cultural humility research speak to the importance of therapist factors in effective therapy outcomes. We will illustrate our points by presenting several case examples which highlight the impact a therapist's way-of-being has on work with minority populations. We will also outline clinical and training implications as we add to the therapist factors discussion regarding working with minority populations. [ABSTRACT FROM AUTHOR]

Research in indigenous communities is at the forefront of innovation currently influencing several new perspectives in engaged intervention science. This is innovation born of necessity, involving efforts to create health equity complicated by a history of distrust of research. Immense diversity across indigenous cultures, accompanied by variation in associated explanatory models, health beliefs, and health behaviors, along with divergent structural inequities add further complexity to this challenge. The aim of this Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States is to highlight the promising new approaches and perspectives implemented by a group of engaged researchers and their community partners, as they seek to move intervention research forward within indigenous communities. Case studies presented are from projects led by members of the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortioum, investigators who conduct health promotion and disease prevention research among American Indians, Alaska Natives, and Native Hawaiians. The promising practices profiled include new strategies in (a) community partnerships, engagement, and capacity building; (b) integration of indigenous and academic perspectives; (c) alignment of interventions with indigenous cultural values and practices; and (d) implementation and evaluation of multilevel interventions responsive to complex cultural contexts. The IRINAH projects illustrate the evolution of an intervention science responsive to the needs, realities, and promise of indigenous communities, with application to health research among other culturally distinct health inequity groups. [ABSTRACT FROM AUTHOR]

Indigenous groups throughout the world have experienced social exclusion and have been subjected to marginalization. Globalization has resulted in significant changes in traditional lifestyles and developmental programs have not been successful in integrating Indigenous people into communities with non-Indigenous people. Although there is substantial research on acculturation and adaptation within the field of cross-cultural psychology, there are few narrative reviews of this literature. The present paper provides such a review and examines the mental health concerns of Indigenous groups undergoing acculturation. We address the consequences of involuntary cultural change and review studies that have been conducted on mental health issues, psychosomatic symptoms, substance use, and suicidality in Indigenous groups. We conclude by offering suggestions to mitigate mental health problems. Directions for future research on the acculturation of Indigenous groups are also provided. [ABSTRACT FROM AUTHOR]

This trial represents the final stage of the CARESSES project which aimed to develop and evaluate a culturally competent artificial intelligent system embedded into social robots to support older adult wellbeing. A parallel group, single-blind randomised controlled trial was conducted across older adult care homes in England and Japan. Participants randomly allocated to the Experimental Group or Control Group 1 received a Pepper robot for up 18 h across 2 weeks. Two versions of the CARESSES artificial intelligence were tested: a fully culturally competent system (Experimental Group) and a more limited version (Control Group 1). Control Group 2 (Care As Usual) participants did not receive a robot. Quantitative outcomes of interest reported in the current paper were health-related quality of life (SF-36), loneliness (ULS-8), and perceptions of robotic cultural competence (CCATool-Robotics). Thirty-three residents completed all procedures. The difference in SF-36 Emotional Wellbeing scores between Experimental Group and Care As Usual participants over time was significant (F[1] = 6.614, sig =.019, ηp2 =.258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig =.031, ηp2 =.146). There were no significant changes in SF-36 physical health subscales. ULS-8 loneliness scores slightly improved among Experimental and Control Group 1 participants compared to Care As Usual participants, but this was not significant. This study brings new evidence which cautiously supports the value of culturally competent socially assistive robots in improving the psychological wellbeing of older adults residing in care settings. [ABSTRACT FROM AUTHOR]

This paper presents an overview of ethical issues in professional psychology. Specifically, it addresses the broad ethical ideas and views of psychological practices, in light of cultural competency. Its aim is to be the first Saudi document about ethics and professionalism, with a specific purpose as a guideline for trainees becoming culturally competent ethical psychologists. This paper describes the ethical code through three main categories: General Ethical Standards; Ethical Issues about Assessment and Treatments; and Cultural Competency and Professionalism Issues. Furthermore, it attempts to illustrate some of the cultural dilemmas connected with the application of international psychological ethical guidelines, particularly in Saudi Arabia. This project concludes it is essential for trainees, supervisors, and training program advisors to understand ethical and professional responsibilities, as they relate to culture competence and work, during trainees' internships. [ABSTRACT FROM AUTHOR]

Our increasingly diverse world of clinical practice and supervision necessitates clinical supervisors foster supervisees' abilities to attend to clients' cultural contexts, lenses, and frameworks (Patallo in Training and Education in Professional Psychology, 13(3), 227–232, 2019). Equally relevant is promoting clinicians' own critique of accepted clinical practices (Hardin et al. in American Psychologist, 69(7), 656–668, 2014). Such a stance is now being referred to as embodying cultural humility. It is emerging as central to culturally responsive and competent clinical practice (Patallo in Training and Education in Professional Psychology, 13(3), 227–232, 2019). Clinical supervision provides one context for fostering cultural humility. Clinical supervision has historically been delivered in one to one or group formats. However, across the last twenty years, triadic supervision has slowly and consistently made inroads as a legitimate and effective form of clinical supervision (Stinchfield et al. in International Journal for the Advancement of Counselling 32, 225–239, 2007). This paper will describe one such triadic supervision model, the Reflective Model of Triadic Supervision (RMTS, Kleist and Hill in: The reflective model of triadic supervision, 2003) as a viable model to foster the development of cultural humility in supervision. [ABSTRACT FROM AUTHOR]

This paper aims to describe how healthcare providers perceived spirituality and spiritual care while caring for dying patients and their families in a hospice setting in Karachi, Pakistan. Using a qualitative interpretive description design, individual in-depth interviews were conducted among healthcare providers. Thematic analysis approach was used for data analysis. Spirituality and spiritual care were perceived as shared human connections, relating to each other, acts of compassion, showing mutual respect while maintaining dignity in care and empowering patients and families. Developing spiritual competency, self-awareness, training and education, and self-care strategies for healthcare providers are essential components promoting spiritual care in a hospice setting. [ABSTRACT FROM AUTHOR]

This paper discusses the Saudi Arabian case by Abdallah Adlan and Henk ten Have, published in a 2012 issue of the Journal of Bioethical Inquiry, regarding a congenitally disabled child enrolled in a research project examining the genetics of her condition. During the course of the study, her father was found not to be genetically related, and the case discussed the dilemma between disclosing to the family all findings as promised in consent documents or withholding paternity information because of the likely severe social repercussions. Using Adlan and ten Have's example, this paper proposes a framework to consider cases outside of the conventional bioethics frame of reference, splitting the bioethical task into three elements: understanding the problem from the patient's and the clinician's perspective and then engaging in dialogue to decide what to do next. The process of dialogue between affected parties is vital. Presuming that there is a common morality undermines the effectiveness of the dialogue needed to find a resolution. [ABSTRACT FROM AUTHOR]

Cultural competence literature and training aim to equip healthcare workers to better understand patients of different cultures and value systems, in an effort to ensure effective and equitable healthcare services for diverse patient populations. However, without nuanced awareness and contextual knowledge, the values embedded within cultural competence practice may cripple rather than empower the very people they mean to respect. A narrow cultural view can lessen cultural understanding rather than grow it. In its first part, this paper argues that a hasty, unrestrained, and uneducated willingness to accept something as a cultural good, despite being well intentioned, can still cause significant harms-particularly when based on false, misinformed, and stereotypical conceptions-including the minimization of issues, the reinforcement of stereotypes, and the impediment of cultural change. The second part of this paper examines medical autonomy within the context of Saudi Arabian women. It pushes back on the common perception that Saudi women, by virtue of culture and religion, view dependency on and deference to male relatives as a cultural good. Through a historical examination and a presentation of the current women's movement in Saudi Arabia, it is argued that the continued assumption that personal agency is a value external to Saudi women is false, misguided, and ethically problematic. Lastly, this paper considers some approaches to help providers navigate the narrow grounds between paternalism and patronization when caring for patients. [ABSTRACT FROM AUTHOR]

The recent crisis in the Middle East has prompted the exodus of millions of refugees from the region who are at present seeking shelter across Europe and in the United States. Among the most immediate needs of refugees upon arrival in a host country is health care, and it is one of the most sustained interactions they experience. Home visits are a common form of primary care for refugees. The authors review the literature to identify themes related to challenges and strategies for providing home based primary care to refugees. The literature review was performed by searching cross-disciplinary databases utilizing Onesearch, but focusing primarily on results produced through CINAHL, EBSCOHOST, and Pub Med databases. To maximize the number of studies included, there was no time frame placed upon publication dates of articles within the search. A total of 55 articles were included in this paper. [ABSTRACT FROM AUTHOR]

There are currently gaps in the training and provision of behavior-analytic services for appropriately acknowledging and responding to the racial and cultural context of children and families receiving services. The values and common training practices in applied behavior analysis (ABA), lack of diverse providers (from differing backgrounds and racial and ethnic identities), and omission of racially and ethnically diverse populations and variables in our research contribute to striking racial disparities in behavioral services (e.g., barriers in accessing and obtaining equally high-quality services). This paper is a call for action, based on the premise that systemic change toward cultural responsivity and reduction of racial disparities in ABA is made up of the individual awareness and actions of ABA instructors and supervisors. To this end, we first illustrate the extent of this problem and its personal and psychological toll on children and families in terms of experiences of racial stress, differential access to services, and unequal quality of care. Second, we outline actionable steps for instructors and supervisors to reduce racial disparities and promote culturally responsive behavior-analytic practice. We call for specific advocacy for and changes to graduate program coursework and requirements, experiential practice opportunities for trainees, culturally responsive supervision, and recruitment and support of diverse trainees in ABA. [ABSTRACT FROM AUTHOR]

As our understanding of the human mind, idioms of human distress and mental health has improved, it has become apparent that culture has an impact on all aspects of our lives, including mental illness. Systems of care across the globe need to adapt and adjust delivery of care in order to accommodate the impact of globalisation and therefore be able to deliver person-centred care. A key aspect of delivering personalised care is the development and delivery of culturally adapted interventions that benefit cultural minority groups in developed countries and the majority cultural groups in developing countries. The journey of acknowledging the need for culturally relevant services has begun but we are a long way from delivering the personalised care that people deserve. This paper makes a case for action in this important area. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Military cultural competence has been recognized as an important factor to delivering effective care to service members, who are a distinct population with unique exposures, and thus with different clinical implications-though only recently has the military service been recognized as a cultural identity that can impact treatment (Meyer et al. Curr Psychiatry Rep. 18:26:1-8, 2016). Competencies within this field do not share a universal definition but have been recognized by the Center for Deployment Psychology (CDP) to include four key components: (1) military ethos, (2) organization and roles, (3) military stressors and resources, and (4) treatment, resources, and tools (Atuel & Castro Clin Soc Work J. 46:74-82, 2018). This article summarizes research literature published in the last 6 years addressing common features and health needs of military families with the goal of improving military cultural competence. This includes recognizing that (a) The military carries its own culture as evidenced by its particular traditions, beliefs, language, and set of guiding principles (Sanghera Optom Educ J Assoc Sch Coll Optom. 42:8-16, 2017) and (b) military families-defined in this paper as active duty service members, their spouses, their children, and civilian warfighters in the form of National Guard and Reservists (NG/R)-face unique stressors as they access health care either in military treatment facilities (MTFs) or in civilian settings. Given the broad and unshared definition of military cultural competence, the CDP's framework for understanding military culture helped shape the focus of our review into literature addressing military stressors and resources, with a particular interest on the impact of deployment, reintegration after deployment, interfamily relationships strained by military service, mental health concerns related to military families, and the vulnerabilities of civilian warfighters.Recent Findings: A 2018 demographics profile revealed there were 1.3 million active duty service members, with 605,677 spouses and 981,871 children (Department of Defense, Office of the Deputy Assistant Secretary of Defense for Military Community Family Policy (ODASD (MC&FP)). 2018). Concerningly, military families exhibit above-average mental health issues-defined in this review to include increased susceptibility to mental health diagnoses and hospitalizations, worse academic achievement in their children, and higher rates of child maltreatment-and challenges related to military service such as frequent relocations and deployments, geographic isolation from social/support network, financial stressors, worries about infidelity, sexual trauma, and child maltreatment. The military has been described as the most engrossing and demanding institution in American society. Our review shows that military families exhibit above-average mental health issues, thought to be related, at least in part, to the challenges of frequent relocations and deployments. The implications for this are broad, given that 8% of the USA has served in the military, and a third is directly related to a service member (Meyer et al. Curr Psychiatry Rep. 18:26:1-8, 2016) This article describes unique challenges military families face and their impact on the service member, their spouse, and their children. [ABSTRACT FROM AUTHOR]

The current paper provides an overview of the history and development of mental health services with special emphasis on psychotherapy in China. Recent epidemiological surveys have revealed high prevalence rates of mental disorders that translate into a huge demand for mental health care. The Chinese government responds to such demand by increasing the number and types of mental health professionals in delivering mental health interventions, one of which is cognitive behavioural therapy (CBT). Due to unique Chinese cultural values, CBT needs to be adapted to these values so as to enhance its acceptability by Chinese people. Furthermore, training and supervision of Chinese therapists require some cultural adaptation in therapist's training and supervision skills. This paper concludes by providing some specific recommendations on improving the quality and accessibility of CBT in China. [ABSTRACT FROM AUTHOR]

The introduction of modern mental healthcare standards and services in the Kingdom of Saudi Arabia (KSA), has resulted in a gradual shift towards a more positive perspective on mental health issues and related services, and has increased the demand for qualified mental health professionals and psychological interventions (WHO 2016). Despite recent advances in mental healthcare services, psychopharmacology remains the main treatment modality for the majority of mental health issues in KSA. Psychotherapy has had a rather slow developmental trajectory in KSA, and its provision requires an understanding of many specific aspects of Saudi culture (Dubovsky 1983). This paper will shed light on the historical development and current challenges of psychiatric and psychological services and the availability of psychotherapy in KSA. By offering an explication of a selection of local social phenomena, this paper will attempt to explain how unique Saudi cultural constructs and social contexts influence the training, perception, and practice of psychotherapy in the country, outlining existing challenges as well as some expected future directions. [ABSTRACT FROM AUTHOR]

The current paper provides an overview of the cultural and religious background of Pakistan; the current situation of mental health in Pakistan with special emphasis on cultural adaptation of cognitive behaviour therapy (CBT) in Pakistan. In the context of Sufism- Islamic Mindfulness, it is interesting to note that it has been easy to explain the concepts of CBT to the therapists and clients in Pakistan, but the process to culturally adapt CBT in Pakistani culture, had to be based on patience while generating evidence for it. Our group has taken the responsibility to do that and so far, have been successful in the endeavours pertaining to research and service development, described in this paper. [ABSTRACT FROM AUTHOR]

The high prevalence of psychiatric conditions and the concomitant increase in need for mental illness have posed a challenge across the USA. Patients continue to encounter many barriers to accessing care with only 43% receiving treatment. This situation is even more challenging for LGBT individuals, who experience higher rates of some mental health conditions, with an increased risk of suicidality, due to stressors such as discrimination and trauma. Simultaneously, LGBT individuals face specific barriers at the individual level, clinician level, and systemic level. Telepsychiatry has emerged as an approach that can help overcome some of the challenges faced by LGBT individuals when it comes to healthcare access. This paper examines the ways in which telepsychiatry can overcome the aforementioned barriers and provides recommendations to enhance the quality of telepsychiatry services for LGBT patients. Recommendations include improving medical education, enhancing health-force training on cultural competency, and expanding culturally affirming telehealth programs. [ABSTRACT FROM AUTHOR]

Complex problem solving is an effective means to engage students in disciplinary content while also furnishing critical non-cognitive and life skills. Despite increased adoption of complex problem-solving methods in K-12 classrooms today (e.g., case-, project-, or problem-based learning), we know little about how to make these approaches accessible to linguistically and culturally diverse (LCD) students. In this paper, we promote a conceptual framework, based on an ethos of intentionality, that supports culturally responsive teaching (CRT). We provide specific questions to guide teachers' implementation of an ethos of intentionality, through critical reflection and meaningful action, and discuss a framework for culturally relevant practice that operationalizes key central tenets (e.g., high expectations, cultural competence, and critical consciousness). Finally, we include strategies that can help teachers and designers translate the principles of the CRT framework into action with a specific focus on complex problem solving in classrooms. [ABSTRACT FROM AUTHOR]

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed. [ABSTRACT FROM AUTHOR]

Collaborative Online International Learning (COIL) is often framed as an example of a broader practice known as Virtual Exchange (VE). The term Virtual Exchange has increasingly been used as an attempt to unify a fragmented field of Higher Education practice and is often used interchangeably with the term COIL. However, the design of COIL, with its strong focus on collaborative and intercultural learning, is often very different to other VE initiatives. Labelling all VE initiatives, including COIL, generally as VE, can lead to both educators and researchers having difficulty identifying and distinguishing COIL. Therefore, the purpose of this paper is to provide a critical review of VE and define COIL and its key characteristics. This article also describes how theory can inform practice and explains why continued interchangeable use of the term COIL with the umbrella term Virtual Exchange is unhelpful for future research and practice. [ABSTRACT FROM AUTHOR]

In southwestern Uganda, a custom of health and social support has been managed through collective organizations known as engozi for centuries. Subscribers advanced help for those who were not able to provide for themselves and their households. Participants pooled financial and food resources, offered emotional assistance, and aided in transporting patients to hospitals. The institution of "free government health amenities" caused the decline of the engozi custom. However, with an insufficient annual health sector budget allocation, the state health services cannot satisfactorily meet the needs. The Kisiizi neighborhood, while depending on the engozi practice, arrived at a CHI system in 1996 as a self-help innovation to eliminate financial obstacles and enhance access to quality health amenities. Numerous studies on CHI have examined the structure, registration and memberships, health-related advantages, and monetary-related benefits, but little has been documented on how cultural beliefs and customs have affected its application. This study aimed to identify the role of culture and customs in tackling healthcare disparities via a CHI strategy. This study adopted a case study methodology and qualitative methods. The study utilizes Woolcock's social capital theory and Cultural competence theory as the analytical framework. It identifies Brotherhood, Solidarity, Belonging, Cooperation, Volunteering, Reciprocity, and Respect for Authority and Leaders as key values upheld by the engozi tradition, strengthening social capital and laying a solid foundation for successful CHI. This study also identified that societal values and traditions have significantly impacted the implementation of the Kisiizi CHI scheme, as evidenced by the influence on CHI leadership and governance, collecting premium fees from subscribers, mobilization and registration of participants, and information dissemination. Lastly, the study identified that CHI has positively affected healthcare challenges within the community, evidenced by increased utilization of healthcare services, improved access to antenatal care, health promotion and disease prevention initiatives, and improved quality of services due to user feedback. [ABSTRACT FROM AUTHOR]

Objectives: Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC. Methodology: A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC. Results: Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency. Conclusion: Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada. Methods: The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0–10. Responses were then analyzed using factor analysis. Results: An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics. Conclusion: Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care. [ABSTRACT FROM AUTHOR]

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwáš'akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact. [ABSTRACT FROM AUTHOR]

Sharp increases in substance use rates among youth and the lack of evidence-based prevention interventions in Mexico are a major concern. A team of investigators from Mexico and the USA are actively addressing this gap by culturally adapting keepin' it REAL (kiR)-a former US SAMHSA model program-for Mexico. This paper reports on the processes and outcomes of the cultural adaptation of kiR for adolescents in Mexico. Multiple forms of data informed this cultural adaptation, including focus groups with students about gendered and violence experiences with substance use, feedback from teachers who previously implemented the original versions of kiR, lesson fidelity observations, and external expert reviews. The culturally adapted version of kiR integrates Ecological Validity and Cultural Sensitivity Models in the adaptation process. The process encompassed surface structure adaptations, like updating language, graphics, and videos, as well as deep structure adaptation components including cultural norms, attitudes, and beliefs salient among Mexican adolescents. Youth reported receiving alcohol offers from family members, links between substance use and violence, and that shifting gender norms result in more females initiating substance use offers. In adapted kiR activities, students practice navigating substance use offers in these contexts. This approach to cultural adaptation led to a true collaborative between investigators in two countries. This study advances knowledge about how to undertake cultural adaptations of efficacious US-based prevention programs in international settings. [ABSTRACT FROM AUTHOR]

The concept of cultural competence has become reified by inclusion as an accreditation standard in the US and Canada, in New Zealand it is demanded through an Act of Parliament, and it pervades discussion in Australian medical education discourse. However, there is evidence that medical graduates feel poorly prepared to deliver cross-cultural care (Weissman et al. in J Am Med Assoc 294(9):1058-1067, ) and many commentators have questioned the effectiveness of cultural competence curricula. In this paper we apply Hafferty's taxonomy of curricula, the formal, informal and hidden curriculum (Hafferty in Acad Med 73(4):403-407, ), to cultural competence. Using an example across each of these curricular domains, we highlight the need for curricular congruence to support cultural competence development among learners. We argue that much of the focus on cultural competence has been in the realm of formal curricula, with existing informal and hidden curricula which may be at odds with the formal curriculum. The focus of the formal, informal and hidden curriculum, we contend, should be to address disparities in health care outcomes. In conclusion, we suggest that without congruence between formal, informal and hidden curricula, approaches to addressing disparity in health care outcomes in medical education may continue to represent reform without change. [ABSTRACT FROM AUTHOR]