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Introduction: Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods: A literature search was completed as part of a larger systematic search of evaluations and measures of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results: Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications: We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. [ABSTRACT FROM AUTHOR]

Culture can broadly be defined as "the values, norms, and assumptions that guide human action" (Wilson 2008, 14). In contrast with the broader civilian society, the experiences and environments within the military community create a unique cultural subset. The United States armed forces are unified by their primary mission to provide external defense, security, and protection, and each branch (Army, Navy, Marine Corp, Air Force, Coast Guard and National Guard) shares a unique core set of values and norms. Because this culture is so complex and unique, it can sometimes be a challenge for many civilian professionals to work with this community, so having a strong competency in understanding military culture, as well as knowledge of specific conflicts and wars, one is not only able to begin to understand the lives and personalities of our soldiers but also able to recognize that this culture aids in survival. This paper will demonstrate and discuss the importance of competency in military culture when practicing music therapy or other interdisciplinary approaches within the process of group therapy with veterans. Other topics covered will include: issues of social transmission as it relates to transitioning into civilian society; the importance of being a witness to veterans' stories; and facilitators' ethical responsibilities when working with this population. [ABSTRACT FROM AUTHOR]

In this paper we present the current state of cultural diversity education for undergraduate medical students in three English-speaking countries: the United Kingdom (U.K.), United States (U.S.) and Canada. We review key documents that have shaped cultural diversity education in each country and compare and contrast current issues. It is beyond the scope of this paper to discuss the varied terminology that is immediately evident. Suffice it to say that there are many terms (e.g. cultural awareness, competence, sensitivity, sensibility, diversity and critical cultural diversity) used in different contexts with different meanings. The major issues that all three countries face include a lack of conceptual clarity, and fragmented and variable programs to teach cultural diversity. Faculty and staff support and development, and ambivalence from both staff and students continue to be a challenge. We suggest that greater international collaboration may help provide some solutions. [ABSTRACT FROM AUTHOR]

Recent years have witnessed an increasing attention to the vast and alarming health disparities in the United States. This paper explores provider factors in health disparities, considering the role of medical education in training health care providers to practice culturally responsive health care toward a diminution of health inequalities. The paper begins with a description of culturally responsive care along with an overview of the key elements of a comprehensive curriculum for health care providers in this arena. Next, the paper explores the key contributions from the field of psychology to collaborative instruction of health care providers in the areas of attitudes/awareness, knowledge and skills components of culturally responsive care. Finally, the paper concludes with a description of collaborative teaching from a family medicine residency program where a 33-h ‘cultural medicine curriculum within the curriculum’ is delivered over the course of 3 years. [ABSTRACT FROM AUTHOR]

There has been a growing interest among recreational services in becoming culturally competent in order to work with diverse communities. Many professionals have knowledge regarding cultural sensitivity or awareness of the importance of cultural differences when providing services. And even more have participated in culture-specific training to acquire skills needed to provide these services. However, there is now a need to view cultural competency as a system or quality of care issue where each recreation service provider is held accountable to providing responsive and culturally competent services. Given the demographic changes regarding people of color within the United States, much interest has centered on providing culturally appropriate approaches to recreation services. Why? Because we are continually reminded that the traditional "minority" groups will be the "majority" in the very near future. This is especially true when attempting to provide services to children and youth of color, where traditional programs and services developed by and for the European American culture have often failed to engage youth of color. Issues around misinterpretations, lack of knowledge, and racism exist for those with cultures other than European American and can lead many youth of color to appear to be disinterested and/or rebellious regarding recreational programs and services when those determinations may be inaccurate. Recent research also illustrates that youth of color benefit from strong culture-specific programs and from staff who are caring and sensitive regarding racial and cultural differences (Belgrave, Chase-Vaughn, Gray, Addison and Cherry, 2005). With the rising costs of delivering services and the increased emphasis on providing quality services, professional associations, local government parks and recreation departments, non-profit agencies and program funders are increasingly seeking definitions, assessments and guidelines for addressing cultural competency. Guidelines are important because they provide professionals a systematic source of recommended behaviors to follow. This paper is a starting point for the field by suggesting specific guidelines for becoming culturally competent when working with youth of color. As advocated in this paper, changes must take place not only in the provision of direct services but also in professional-community relations and, ultimately in the way recreational professionals and others are prepared to work with youth of color. The guidelines provided here emphasize a sociocultural framework that considers values, interactional styles, and cultural expectations as well as the influence of the family, cultural, social and environmental contextual factors. [ABSTRACT FROM AUTHOR]

A study was conducted with the aim of identifying themes about the lived experiences of Black men in relation to law enforcement. An all-black male focus group was engaged in discussions on the topic 'Do Black Lives Matter' at an annual conference on counseling racial and ethnic minorities. The group participants consisted of counselors, counselor educators, undergraduate students, graduate students, and a law enforcement representative. Data from the discussion were qualitatively analyzed to identify themes and to give voice to Black male experiences. This paper presents findings regarding these themes (anger, fear, training/re-education) based on the group discussion and group process observations as well as indications on how the findings can be used toward action and change. [ABSTRACT FROM AUTHOR]

Background: Pen-pal clubs (PPC) are used worldwide for students to learn about different cultures and other skillsets without the need for travel. Many medical students are interested in global health opportunities abroad but costs, scheduling, and other barriers allow few to participate in such experiences. It is important that medical students have nuanced global medical perspectives and can contribute to the global medical community. Objective: The purpose of this study is to demonstrate that an international medical student PPC improves medical students' perspectives of cultural competency and global health engagement. Methods: In 2021, a novel medical student PPC was established that began between an American and Japanese medical school. Following a shareholders meeting, it was decided that the number of medical schools involved globally be expanded through previous institutional affiliations and online presences. In total, the club connected 50 American medical students and 52 medical students from 17 high- and middle-income countries. The primary form of communication was online; pen-pals were encouraged to communicate monthly using provided topics, although frequency and way of communication was their discretion. In February 2022, American PPC members were emailed a qualitative survey to assess the PPC's impact. Results: The survey was completed by 42% of American PPC members, 95% of which were 22-26 years. Participants were preclinical medical students, 60% whom were female and the majority either white (47%) or Asian (43%). Overall, the PPC positively influenced American medical students' perception of global medicine, medical education, and their cultural competency after joining the PPC compared to prior (P = 0.004). Conclusion: PPCs encourage medical students to think from a global perspective and foster open-mindedness within varying social and cultural contexts. Having a global communication platform for students during medical school education may be an additional way to train aspiring global leaders. [ABSTRACT FROM AUTHOR]

Introduction: Educators require focused training to foster the development of intercultural competence in nurses. Training programs for educators need to be based on a comprehensive profile with a focus on intercultural learning. This study aims to define and validate a profile of the Intercultural Nursing Educator (INE). Method: The Delphi method was used with an iterative, multi-stage process to transform opinions into group consensus. A total of 46 European, African, and American experts from the nursing and intercultural field participated. Inclusion criteria required English at a level of B2, expertise in the field of intercultural competence, experience in teaching intercultural competence in the nursing context, and publications focused on intercultural topics. Results: The INE profile was developed and all 126 competencies were validated. Discussion and conclusion: The profile is freely available on the project website and provides the basis for curricula, training programs and assessment of the required competences. [ABSTRACT FROM AUTHOR]

This paper presents a compelling case for training physical therapist assistants to be culturally competent practitioners as well as a model for teaching this important skill in a physical therapy curriculum. Cultural competence objectives progress through five domains: awareness, knowledge, sensitivity, competence, and proficiency. The taxonomy of physical therapist assistant behaviors in a cultural competence curriculum is outlined. Curriculum goals, objectives, and learning outcomes are specified and threaded throughout the educational experience. [ABSTRACT FROM AUTHOR]

Purpose - The population of the USA consists of a culturally diverse mix of individuals, many of them recent immigrants, from a wide range of ethnic and racial groups. Given an increasing multicultural and multilingual population, an urgent need for cross-cultural community and health services, and for culturally competent practitioners, has emerged in the profession of mental health. The reality of that diversity raises two crucial implications: the profession needs more culturally competent practitioners to work with multicultural service-users; and the clinical assessment and treatment of the population has become more challenging and complex. This paper seeks to explore vital cultural components in training mental health practitioners to work with multiethnic groups.Design/methodology/approach - A qualitative and purposive methodology with structured interview questions was employed to gather data for analysis. The process of data analysis included line-by-line transcription of each interview and then the data were coded and categorized. Professors, experienced clinicians, and researchers in the multicultural field were interviewed for data collection.Findings - Thefindings were organized into four essential componentsinachieving cultural competency in mental health training. Attitudinal components: cultural appreciation, learning curiosity, assumption free, and cognitive flexibility; emotional components: emotional knowledge, reflective ability, worldview knowledge, and cultural alertness; intellectual components: cultural knowledge, single culture, and clinical knowledge; and integrative practice components: cultural engagement, integrative assessment, and integrative intervention process.Originality/value - The findings contribute to an expanded understanding and integration of major cultural elements in mental health training and practice. [ABSTRACT FROM AUTHOR]

Disparities in health exist among ethnic/racial groups, especially among members with limited English proficiency (LEP). The session described in this paper aimed to teach medical students the skills needed to communicate with patients with LEP. Description - We created a required session titled ''Cross-Cultural Communication-Using an Interpreter'' for third-year medical students with learning objectives and teaching strategies. The session plans evolved over three years. Program Evaluation - Students' perceived efficacy using retrospective pre/post test analysis (n=110, 86% response rate) administered 7 weeks post-session revealed that 77.3% of students felt ''more prepared to communicate with a patient with LEP'', 77.3% to ''give proper instructions to an untrained interpreter'' and 76.4% to ''access a hospital language line''. Conclusion - Our curricular intervention was effective in increasing students' perceived efficacy in communicating with a patient with LEP, using untrained interpreters and accessing a hospital language line. Skills practice and discussion of using interpreters should be a part of medical education. [ABSTRACT FROM AUTHOR]

The lack of racial and ethnic match as a barrier to care in mental health treatment services has received considerable attention. In systems of care, which provide public mental health services to African American adolescents, the provider base is largely non-African American. This difference presents a challenge for African American adolescents and their parents who want a provider who is sensitive to the issues, which define their lives. Racial disparities in the utilization of mental health treatment services are well documented; and many providers want to development mental health treatment interventions, which increase access and utilization. However, the findings associated with increasing access and utilization are generally predicated on the structural barriers to care. Very little attention has been given to the non-structural barriers for access to and utilization of mental health treatment services. The purpose of this paper is to increase practitioners’ knowledge of the interpersonal barriers to treatment, which can result from the socio-cultural environment of many African American adolescents. Enhancing the provider knowledge base is viewed as one strategy to closing the racial disparity gap in access to and utilization of adolescent mental health services for African Americans. [ABSTRACT FROM AUTHOR]

The Institute of Medicine (IOM) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care is serving as a catalyst for the medical profession to re-examine the manner in which its institutions and training programs relate to cultural competence. This report found that racial and ethnic disparities exist in health care and that a lack of access to care does not fully explain why such disparities exist. The IOM study found bias, stereotyping, prejudice, and clinical uncertainty as possible contributing causes. The U.S. Surgeon General's Report on the Oral Health of the Nation also pointed to oral health disparities related to race, ethnicity, and culture. This paper discusses how medicine is responding to the Unequal Treatment report and the lessons to be considered for dentistry. Recommendations on how dentistry can apply the knowledge from this report to help reduce oral health disparities are suggested. [ABSTRACT FROM AUTHOR]

Arab Americans (ARAM) comprise approximately 3.7 million individuals in the United States (US). The Census Bureau classifies ARAM as white and does not acknowledge them as a minority group in the Middle East North African (MENA) category creating a challenge when assessing their health outcomes. Like other minority groups, ARAM have unique social behaviors and cultural attributes that directly affect their health outcomes. However, many health care professionals in the US are not well‐informed of their culture. Hence, it is important for clinical pharmacists to familiarize themselves with the Arab culture in order to engage the ARAM patient and provide culturally competent care. This article reviews ARAM demographics and some of their common health behaviors and associated outcomes. The authors also offer culturally sensitive recommendations addressing important areas of health care to mitigate health disparities for this growing patient population. [ABSTRACT FROM AUTHOR]

The celebration of diversity is at the heart of global education initiatives. Yet, participation in study abroad and related programs in the United States – a purported ‘melting pot’ of races and cultures – remains, disproportionately, the domain of affluent whites. Against this background, this study seeks to learn from the experiences of underrepresented and hypersegregated students in international virtual exchange (IVE), an educational experience involving sustained interaction between geographically separated participants using technology and trained facilitators. Using a survey, semi-structured interviews, exchange field notes, and the researcher’s own abroad experiences, the data revealed five main themes: ‘Virtual connections beyond the classroom,’ ‘Bias reduction,’ ‘Color matters,’ ‘Equality in digital space,’ and ‘One step closer to abroad.’ Findings suggest that U.S. universities and other educational institutions serving underrepresented groups can increase student international experiences by promoting IVE on their campuses and encouraging more professors to include exchange as a component in their courses. [ABSTRACT FROM AUTHOR]

A number of conceptual frameworks have emerged with the goal of helping clinicians understand and navigate the intersections of the health system and broader political, economic, and cultural processes when they care for patients. In this study, we analyze the impact that one emerging framework, "structural competency," had on medical students' and physicians' understanding of societal problems affecting patient health and the practices of health systems. In this sub-analysis of a longitudinal qualitative study conducted between August and December 2020, we analyzed 19 semi-structured interviews with 7 first-year medical students, 7 upper-level medical students, and 5 physician course facilitators who participated in a course called Introduction to Medicine and Society at an medical school in the United States affiliated with a large urban academic medical center. This paper focuses on three main findings: how medical students and faculty describe "structures" and their effects on patients and patient care; how they use or imagine using structural competency to improve patient-physician communication and work interprofessionally to address social needs; and the emotional and personal reactions that confronting societal challenges provokes. We conclude that structural competency enhances existing efforts to improve patient-physician communication and to address patients' social needs. However, we highlight how structural competency efforts might fall short of their goal to shift physicians' perspectives "upstream" to the determinants of health due to both critical ambiguities in the concept and inattention to the emotional and personal impacts of addressing societal problems in the clinic. These findings have practical implications for how clinicians are trained to act on societal issues from within the health system and conceptual implications for refining how existing frameworks and curricula conceive of the intersection between healthcare and broader processes. • Ambiguity of 'structure' and 'structural competency' hinders applicability. • Emphasis on 'structure' may unintentionally essentialize marginalized patients. • Trainees' affective responses are key to addressing societal factors in the clinic. • Humility and self-reflection helped trainees better address 'structure'. [ABSTRACT FROM AUTHOR]

There has been a recent surge in project based service learning (PBSL) in engineering education. PBSL covers a spectrum of community-based projects both locally and internationally. While PBSL experiences can be embedded within courses, in many cases these activities are facilitated by non-academic organizations, such as Engineers Without Borders. These PBSL activities have undergone increasing levels of assessment, driven in part by the outcomes assessment requirements for engineering program accreditation in the U.S., but also because of apparent positive impacts to student participants. These studies indicate that the knowledge and skills gained by the students are at least on par with gains from traditional project-based learning (PBL). Attention is also increasingly being focused on the potential impacts of PBSL on student attitudes and identity. It is in these areas that differences in the influence of PBL versus PBSL appear more profound, yet small numbers of student participants in various programs and a lack of coordinated assessment efforts limits the statistical significance of these results. This paper highlights possible methods to determine the added value of service-based learning especially when coupled to project-based engineering education. Examples of evidence in the analysis of PBSL versus PBL in engineering are provided to further examine the state of this field. Considerable research will be needed to fully understand how service learning is impacting the education of engineers. [ABSTRACT FROM AUTHOR]

This paper describes the collaborative endeavors between researchers and the Hmong community to develop and test a quality of hypertension care survey instrument. In-depth interviews with community leaders and hypertensive patients enhanced the understanding of quality of care from Hmong socio-cultural perspectives. Knowledge gained from the Hmong community was integrated into the research process. The collaborative process led to generating a culturally sensitive survey instrument, overcoming cultural barriers for recruitment of survey participants, and facilitating community involvement in all aspects of research implementation. Applying community-sensitive research methods ensured the success of the project. [ABSTRACT FROM AUTHOR]

More than 100,000 Somali refugees have resettled in the United States, creating a need for additional research about mental health needs and premigration experiences that precede resettlement. The purpose of this study was to learn more about premigration traumatic experiences, the process of acculturation following resettlement, and the relationship between premigration trauma, acculturation, and mental health. Eighty Somali refugees from two mid-sized Midwestern cities participated. It was hypothesized that acculturation would mediate the relationship between premigration trauma and mental health symptoms. The results partially supported this hypothesis, dependent upon the dimension of acculturation included in the path analysis. Unexpected relationships among the various acculturation dimensions in the model (American cultural identity, English language competency, and American cultural competency) occurred with traumatic experiences, mental health symptoms, and time in the United States. We discuss implications and directions for future research, practice, advocacy, and training. [ABSTRACT FROM AUTHOR]

Social work education's commitment to teaching inclusive social work practice must not only be evidenced in the explicit curriculum and teaching methods, it must also be present in the implicit curriculum including administrative policies, student support, and resources. Yet, accessibility and climate efforts often fall short of addressing disability and ableism as barriers to education, despite the clear call for disability to be included as part of the field of social work's commitment to social justice. A social work graduate program in the USA developed a mixed-methods disability needs assessment, completed by 586 respondents in 2016. The assessment highlighted the frequency with which students experience ableist microaggressions and lack of support they feel they have, as well as the need for a disability-focused community within the school. Results illuminated the need for education on the depth and breadth of disabilities, advocacy, principles of Universal Design for Learning, and ableist microaggressions. These findings can assist social work educators in developing tangible strategies for more inclusive social work education. [ABSTRACT FROM AUTHOR]

The full scope of women's health needs is not necessarily addressed in refugee camps and after resettlement, particularly pregnancy and postnatal services. The aims of this research are to examine the maternal care services provided to refugee women in camps and after resettlement to the United States, and to analyse organisational successes and challenges in service provision. With this understanding, policies can improve service delivery for refugee women. We interviewed respondents from five organisations, ranging from local non-profits to international non-governmental organisations. Most of the organisations do not provide direct medical care, but rather education and social service support to clients, and in some cases midwife training. Their success stemmed from a focus on client capacity building, individualised support, effective partnerships, and cultural competency. Respondents described the need for physical resources, effective leadership, and additional personnel, especially with linguistic capabilities. The dialogue in the interviews supports themes of education as empowerment and client self-sufficiency. Respondents emphasised the importance of funding and policies that support their work. This knowledge can lead to improved models of service delivery and inform the development of best practices and policies in maternal and reproductive health for refugee women. [ABSTRACT FROM AUTHOR]

Background: Transgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender-inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited.Objective: The Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado.Design and Participants: The Colorado Transgender Health Survey, based on the Behavioral Risk Factor Surveillance System (BRFSS), was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender-inclusive events and organizations.Main Measures: Responses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data.Results: Results from 406 transgender or gender-nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender-inclusive provider were more likely to receive wellness exams (76 versus 48%), less likely to delay care due to discrimination (24 versus 42%), less depressed (38 versus 54%), and less likely to attempt suicide (7 versus 15%) than those without.Conclusions: The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities. [ABSTRACT FROM AUTHOR]

Objective To examine chief nurse executives' perspectives on: (1) the provision of culturally and linguistically appropriate services in hospitals and (2) to identify barriers and facilitators associated with the implementation of culturally and linguistically appropriate services. Background Hospitals continue to face challenges providing care to diverse patients. The uptake of standards related to culturally and linguistically appropriate services into clinical practice is sluggish, despite potential benefits, including reducing health disparities, patient errors, readmissions and improving patient experiences. Method A qualitative study with chief nurse executives from one eastern United States (US). Data were analysed using content analysis. Results Seven themes emerged: (1) lack of awareness of resources for health care organisations; (2) constrained cultural competency training; (3) suboptimal resources (cost and time); (4) mutual understanding; (5) limited workplace diversity; (6) community outreach programmes; and (7) the management of unvoiced patient expectations. Conclusions As the American population diversifies, providing culturally and linguistically appropriate services remains a priority for nurse leaders. Being aware and utilizing the resources, policies and best practices available for the implementation of culturally and linguistically appropriate services can assist nursing managers in reaching their goals of providing high quality care to diverse populations. Implications for Nursing Management Nurse managers are key in aligning the unit's resources with organisational goals related to the provision of culturally and linguistically appropriate services by providing the operational leadership to eliminate barriers and to enhance the uptake of best practices related to culturally and linguistically appropriate services. [ABSTRACT FROM AUTHOR]

Despite initiatives to increase the enrollment of racial and ethnic minorities into cancer clinical trials in the National Cancer Institute National Cancer Clinical Trials Network (NCCTN), participation by Latino and African American populations remain low. The primary aims of this pilot study are (1) to develop a Cultural Competency and Recruitment Training Program (CCRTP) for physician investigators and clinical research associates (CRAs), (2) to determine if the CCRTP increases cultural competency scores among physician investigators and CRAs, and (3) to determine the impact of the CCRTP on minority patient recruitment into NRG Oncology Radiation Therapy Oncology Group (RTOG) clinical trials. Sixty-seven CRAs and physicians participated in an in-person or online 4-h CRRTP training. Five knowledge and attitude items showed significant improvements from pre- to post-training. A comparison between enrolling sites that did and did not participate in the CCRTP demonstrated a pre to 1-year post-incremental increase in minority accrual to clinical trials of 1.2 % among participating sites. While not statistically significant, this increase translated into an additional 300 minority patients accrued to NCCTN clinical trials in the year following the training from those sites who participated in the training. [ABSTRACT FROM AUTHOR]

To expand the financial capability of Latinos, culturally sensitive interventions are needed. A literature search was conducted to examine how financial education interventions have been used to improve financial outcomes for Latinos. Just 7 peer-reviewed intervention studies were identified, suggesting a substantial gap in knowledge in this area. Although conclusions about the effectiveness of financial education interventions with Latinos are limited, each study finds positive changes in financial attitudes or behaviors. Using Resnicow’s (1999) cultural sensitivity framework, surface and deep structure methods of tailoring financial education were identified. Implications for designing and testing culturally sensitive financial education interventions are discussed. [ABSTRACT FROM PUBLISHER]

The article deals with revealing the essence and structure of Masters' of Public Administration professional training in the USA. It has been concluded that Public Administration studies the realization of government policies and trains future public administrators for professional activity; is guided by political science and administrative law; aims to improve the justice, equality, security and efficiency of public services. It has been indicated that the MPA degree is dedicated for those willing to work in public sector. It has been found out that MPA programs are designed to develop the abilities, skills and methods specialists use to realize policies, programs and projects as well as to resolve crucial issues within their organization and/or in society. It has been stated that in the United States of America Master of Public Administration (MPA) and Master of Business Administration programs (MBA) are quite similar, however, have certain differences. It has been defined that the MPA program focuses on different ethical and sociological criteria secondary for business administrators. Simultaneously MPA programs encompass economy courses to supply students with knowledge of microeconomic and macroeconomic issues. It has been specified that MPA programs are built on a range of core competencies defined by the Network of Schools of Public Policy, Affairs, and Administration (NASPAA). The list of the core competencies (to lead and manage in public governance; to participate in and contribute to the public policy progress; to analyze, synthesize, think critically, solve problems and make decisions; to articulate and apply a public service perspective; to communicate and interact productively with a diverse and changing workforce and citizenry) and their detailed characteristics have been presented. It has been identified that cultural competency of future public administrators has become an essential constituent of public affairs curricula. It has been concluded that the above-mentioned positive aspects of the experience may be used to improve future public administrators' professional training in Ukraine. [ABSTRACT FROM AUTHOR]

Limited research has investigated how culture impacts expressions of social support, which is crucial in developing culturally sensitive care. Using a classification based on theories of social support, we examined the social support experiences of 49 Chinese immigrant mental health consumers with psychosis, paying particular attention to frequency and sources. We found that the most common forms of social support were belonging and companionship, perceived emotional support, social control, and perceived instrumental support, while self-esteem and sense of mastery were the least common forms. Family and friends were the main sources of support. These results demonstrate the influence of Confucian values of renqing (or fulfillment of relational obligations) and guanxi (or social networks) and the negative effects of stigma in diminishing the social standing of these consumers by compromising 'personhood.' Clinical implications for increasing the cultural competency of clinicians and improving the mental health outcomes of Chinese immigrants are discussed. [ABSTRACT FROM AUTHOR]

The goal of this study was to explore attitudes, health knowledge, and experiences with health care setting and providers among lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals and to identify areas for improvement. Members of Equality Florida™ residing in the five counties of the Tampa Bay region were recruited through e-mail invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with health care providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. A total of 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants were White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the health care setting (<10%). Health care settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. Results show high rates of sexual orientation disclosure, greater acceptance from providers of LGBTQ status, and the need for examination of hospital policies and improved cultural competency. [ABSTRACT FROM PUBLISHER]

This article reviews recent developments in health care law, focusing on controversy at the intersection of health care law and culture. The article addresses: emerging issues in federal regulatory oversight of the rapidly developing market in direct-to-consumer genetic testing, including questions about the role of government oversight and professional mediation of consumer choice; continuing controversies surrounding stem cell research and therapies and the implications of these controversies for healthcare institutions; a controversy in India arising at the intersection of abortion law and the rights of the disabled but implicating a broader set of cross-cultural issues; and the education of U.S. health care providers and lawyers in the theory and practice of cultural competency. [ABSTRACT FROM AUTHOR]

Social workers are expected to promote social justice for lesbian, gay, bisexual, and transgender (LGBT) people, and social work programs and their faculty are expected to prepare students for competent and ethical practice with LGBT people and communities. Faculty's LGBT social attitudes can play a central role in developing students’ competencies. Minimal attention has been given to the nature of faculty's LGBT social attitudes. This article presents the results of a national survey conducted in the United States with a random sample of graduate teaching faculty concerning their LGBT social attitudes (n= 161). Bivariate and multivariate predictors of LGBT social attitudes were identified. Although a number of factors were significant in bivariate analyses and initial multivariate analysis (controlling only for sociodemographics), the final estimated model suggests race and social attitudes about women and critical consciousness are significant. The authors outline recommendations to enhance faculty's attitudes to strengthen efforts to realize accreditation standards and better prepare students for culturally competent and ethical practice. In addition to examining other predictors of faculty's attitudes, future studies should investigate perceptions of each separate population comprising the LGBT community. [ABSTRACT FROM PUBLISHER]

Based on a survey of 1,124 social workers in the United States, this article examines how practitioners' attitudes towards immigrants and their general knowledge of immigration varied according to the content of their social work education. Although the majority of practitioners reported receiving coursework on practice with immigrants, this showed no effect on their attitudes or knowledge. In contrast, coursework on immigration policy predicted more favorable attitudes towards immigrants. Considering the mounting anti-immigrant sentiment and retrenchment of immigrants' rights in the United States, the results suggest the need to further explore what course work content is needed to prepare social workers for the current needs of the field. We argue that social work education must expand upon existing cultural competence models of practice with immigrants, to better prepare social workers to address the deepening social exclusion of undocumented immigrants in the United States. [ABSTRACT FROM PUBLISHER]

In response to an increasingly culturally and ethnically diverse population, accredited social work programs in the United States have been mandated to provide students with course content regarding cultural diversity as it pertains to race, ethnicity, gender, age, religion, ability, and sexual orientation. Typically, social work educators transmit this content to students by way of regular didactic teaching. While useful for imparting factual and descriptive content about diversity, this method of teaching is generally inadequate in stimulating students' cultural awareness and sensitivity, which research indicates are critical to the development of cultural competence. More useful in stimulating students' cultural awareness and sensitivity is a teaching method that incorporates experiential learning activities with an interactive group format. One such experiential learning activity is the cultural genogram, which challenges students to examine the development of their cultural values, after which they critically explore these values in a group setting with other students who have different experiences and perspectives. This article describes the cultural genogram, its use in an undergraduate introduction to social work class, and a retrospective study of its usefulness in stimulating the cultural awareness and sensitivity of social work students. [ABSTRACT FROM PUBLISHER]

As the diversity of the United States (US) population continues to change, concerns about minority health and health disparities grow. Health professions must evolve to meet the needs of the population. The purpose of this editorial is to review current trends in the diversity of chiropractic students, faculty, and practitioners in the United States. This editorial was informed by a search of the literature, to include PubMed, using the terms chiropractic and diversity, minority, and cultural competency. Demographic information for the chiropractic profession was obtained from the National Board of Chiropractic Examiners and The Chronicle of Higher Education. These data were compared to diversity data for medical doctors and the national and state populations from the American Association of Medical Colleges and the US Census, respectively. Surprisingly little has been published in the peer-reviewed literature on the topic of diversity in the chiropractic profession. For the variables available (sex and race), the data show that proportions in the US chiropractic profession do not match the population. State comparisons to associated chiropractic colleges show similar relationships. No reliable data were found on other diversity characteristics, such as gender identity, religion, and socioeconomic status. The chiropractic profession in the United States currently does not represent the national population with regard to sex and race. Leaders in the profession should develop a strategy to better meet the changing demographics of the US population. More attention to recruiting and retaining students, such as underrepresented minorities and women, and establishing improved cultural competency is needed. (J Chiropr Educ 2012;26(1):1-13) [ABSTRACT FROM AUTHOR]

Background: The National Consortium for Multicultural Education for Health Professionals (Consortium) comprises educators representing 18 US medical schools, funded by the National Institutes of Health. Collective lessons learned from curriculum implementation by principal investigators (PIs) have the potential to guide similar educational endeavors.Objective: Describe Consortium PI's self-reported challenges with curricular development, solutions and their new curricular products.Methods: Information was collected from PIs over 2 months using a 53-question structured three-part questionnaire. The questionnaire addressed PI demographics, curriculum implementation challenges and solutions, and newly created curricular products. Study participants were 18 Consortium PIs. Descriptive analysis was used for quantitative data. Narrative responses were analyzed and interpreted using qualitative thematic coding.Results: Response rate was 100%. Common barriers and challenges identified by PIs were: finding administrative and leadership support, sustaining the momentum, continued funding, finding curricular space, accessing and engaging communities, and lack of education research methodology skills. Solutions identified included engaging stakeholders, project-sharing across schools, advocacy and active participation in committees and community, and seeking sustainable funding. All Consortium PIs reported new curricular products and extensive dissemination efforts outside their own institutions.Conclusion: The Consortium model has added benefits for curricular innovation and dissemination for cultural competence education to address health disparities. Lessons learned may be applicable to other educational innovation efforts. [ABSTRACT FROM AUTHOR]

At best, mainstream mental health services are often ineffective with Native American clients, and, at worst, they are a vehicle for Western colonization. As such, the authors explore the notion of abandoning the Western therapeutic project and rebuilding the helping process on the basis of indigenous knowledge foundations. To this end, they discuss a Native perspective on wellness that emphasizes balance among the interconnected areas of spirit, body, mind, and context or environment. From this perspective, mental health is a product of balance and harmony among these four areas. The authors conclude with a discussion of the practice implications of this relationally based perspective in which practitioners target interventions toward improving balance and harmony. [ABSTRACT FROM AUTHOR]

Cultural competence programs have proliferated in U.S. medical schools in response to increasing national diversity, as well as mandates from accrediting bodies. Although such training programs share common goals of improving physician-patient communication and reducing health disparities, they often differ in their content, emphasis, setting, and duration. Moreover, training in cross-cultural medicine may be absent from students' clinical rotations, when it might be most relevant and memorable. In this article, the authors recommend a number of elements to strengthen cultural competency education in medical schools. This "prescription for cultural competence" is intended to promote an active and integrated approach to multicultural issues throughout medical school training. [ABSTRACT FROM AUTHOR]

Growing consensus exists regarding the importance of spiritual assessment. For instance, the largest health care accrediting body in the United States, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now requires the administration of a spiritual assessment. Although most practitioners endorse the concept of spiritual assessment, studies suggest that social workers have received little training in spiritual assessment. To address this gap, the current article reviews the JCAHO requirements for conducting a spiritual assessment and provides practitioners with guidelines for its proper implementation. In addition to helping equip practitioners in JCAHO-accredited settings who may be required to perform such an assessment, the spiritual assessment template profiled in this article may also be of use to practitioners in other settings. [ABSTRACT FROM AUTHOR]