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Background: Recently, there has been an increasing concern regarding matters concerning the LGBT community that should not be overlooked. Even though the Philippines is among the Asian nations with strong public tolerance towards homosexuals, numerous individuals still encounter discrimination. And while studies have been conducted elsewhere, the literature is limited among Filipino nursing students. Objective: This research assessed the knowledge and attitude towards lesbian, gay, bisexual, and transgender (LGBT) healthcare concerns among nursing students in the Philippines. Methods: A descriptive, cross-sectional survey was conducted among nursing students (N = 354) in a public university in the Philippines. The Nursing Students’ Knowledge and Attitudes of LGBT Health Concerns was used to gather survey data online in April 2022, and data were analyzed using IBM SPSS version 26 software. Results: While a large majority of nursing students had positive attitudes, many had only low to moderate knowledge about LGBT healthcare concerns, although no significant correlation (p = 0.081) was found between knowledge and attitude. There were significant differences in knowledge based on gender (p = 0.049), religious affiliation (p = 0.023), and academic year level (p

Provider directories may serve as a bridge solution until lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) education becomes a requisite within standard medical education. The three national LGBTQ+-competent provider directories in the United States were evaluated. Two directories served the LGBTQ+ community while one served the gender minority community. All enumerated thousands of providers. One allowed provider-specific feedback. All provided searchable criteria (e.g., provider name, location, specialty, population identity, service type, payment types, gender identity, and languages spoken). By implementing these key features, existing and future directories could better provide equitable healthcare access for the LGBTQ+ population. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the relationship between cultural intelligence and cultural competence (CC) of the school of nursing and midwifery students from the Zanjan University of Medical Sciences in 2020-2021. Methods: This cross-sectional study was conducted on 245 from 600 nursing and midwifery students of the Zanjan University of Medical Sciences from November 24, 2020, to March 18, 2021. Data were collected using three questionnaires of demographic information, Cultural Intelligence Scale, and The Nurse Cultural Competence Scale. Data analysis was done through Pearson's test and the logistic regression model using SPSS Version 22. Results: The response rate was 40.83%. The results showed that the total score of cultural intelligence had a strong positive relationship with CC (r = 0.88). Also, the logistic regression model showed that the cultural intelligence variable could predict nursing and midwifery students' CC (B = 0.1, P =.013). Conclusion: It is recommended to pay more attention to increasing the cultural intelligence and CC of nursing and midwifery students. [ABSTRACT FROM AUTHOR]

This study uses a sequential mixed-method design to test a measure of service user oppression in human service organization. A five-factor measurement model of service user oppression is tested using confirmatory factor analysis of cross-sectional survey data (n = 374), followed by qualitative focus groups to provide context. All five factors of the Service User Oppression Scale were confirmed indicating that 84.5% of service users had experienced oppression. The research provides a valid and reliable tool to assess service user experiences of oppression. This study found that service users experience oppression in the form of marginalization, exploitation, violence, powerlessness, and cultural imperialism while receiving services from human service organizations. This study developed a measurement tool to assess the extent and experience of service user oppression by human service organizations. The Service User Oppression Scale is found to be a valid and reliable measure of service user experiences of oppression in human service organizations. Understanding oppression from the experiences of service users can highlight areas for organizational development, adaptation, and innovation in human service organizations. [ABSTRACT FROM AUTHOR]

South Asian (SA) Americans have a high risk of metabolic and cardiovascular disease. Prevention efforts should start in childhood and should be culturally appropriate. We sought to understand the challenges and barriers that pediatricians face in providing care for SA children to inform professional education on culturally effective care. Qualitative interviews were conducted with a diverse sample (N = 17) of pediatricians. Challenges reported included feeding problems, inadequate physical activity, and mental health concerns. Communication barriers included parents' anxiety around feeding, influence of grandparents, stigma around mental health, and cultural communication gaps. Effective strategies included clear communication, a gradual approach, ensuring buy-in from grandparents, greater attention to family history, and improved cultural knowledge in pediatrician. Addressing feeding problems was the most mentioned challenge, which is especially concerning given the high chronic disease risk in SAs. Education on culturally appropriate strategies can equip pediatricians to effectively counsel SA families to address these risks. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore and compare staff perceived challenges and facilitators in supporting resident self‐determination in ethno‐specific and mainstream nursing homes. Background: Staff and residents in ethno‐specific and mainstream nursing homes in most developed countries have shown increased cultural and linguistic diversity. This socio‐demographic change poses significant challenges for staff to support resident self‐determination of their own care. In‐depth understanding of those challenges in the two types of nursing homes is much needed to inform practice in nurse‐led nursing home care settings. Method: A qualitative description approach with thematic analysis was used in the study. Data were collected through five focus groups with 29 various direct care workers from two ethno‐specific nursing homes and a mainstream nursing home in Australia between March–September 2020. The study report followed the COREQ checklist. Results: Four themes were identified from focus group data. First, participants perceived communication challenges in identifying residents' preferences, especially in ethno‐specific nursing homes. Second, team efforts that included residents and their family members were highly valued as a way to meet residents' preferences. Third, participants described various levels of staff engagement in residents' care planning. In addition, staff in ethno‐specific nursing homes possessed richer resources to maintain meaningful relationships for residents compared with their counterparts in the mainstream nursing home. Conclusions: Staff in ethno‐specific nursing homes experience more challenges in supporting resident self‐determination but have richer resources to develop culturally safe and culturally competent care compared with their counterparts in the mainstream nursing home. Relevance to clinical practice: Findings provide new insights into challenges and practical solutions in supporting residents to self‐determine their own care in cross‐cultural aged care. Patient or Public Contribution: This study was co‐designed with three aged care organisations who funded the study. Staff employed by these organisations participated in the study. [ABSTRACT FROM AUTHOR]

Summary : This empirical qualitative study explores the application of a model of cultural competence in child protection practice with families from Black, Asian and minority ethnic backgrounds in the United Kingdom. Data were collected through audio-recorded and transcribed semi-structured interviews with a sample of 17 social workers and family support workers across two local government children's social care agencies. The interview route explored practitioners' experiences of professional work with children and families from Black, Asian and minority ethnic backgrounds. They were asked to describe good practices in relation to cultural competence around the initial contact, assessment and care planning. Transcripts of these interviews were uploaded to Nvivo12 software and coded in two stages, initially for emergent themes and subsequently in relation to the ASKED model of cultural competence. Findings : Data analysis revealed multiple examples of good practice which were analysed employing the five dimensions of the ASKED model, namely, cultural awareness, cultural skill, cultural knowledge, cultural encounter, and cultural desire. By mapping the approaches developed and employed by practitioners onto the five ASKED dimensions, these became discernible and therefore potentially transferable learning for others. Application : The ASKED model of cultural competence is a means of capturing good practice in a systematic and detailed way, making it sharable with other child protection professionals. ASKED is also a framework for moving beyond anti-oppressive theory to practical implementable antioppressive practices with families from Black, Asian and minority ethnic backgrounds [ABSTRACT FROM AUTHOR]

Minimal research exists exploring how emotional vulnerability relates to client and therapist identities. This study illustrates findings from a preliminary exploration of (a) the vulnerabilities clients experience when receiving feedback from a reflecting team and (b) the intersection between vulnerability, sexual orientation, and racial-ethnic minority identities. Using the concept of a gem, or an exceptionally significant excerpt in Interpretative Phenomenological Analysis (IPA), couples discussed the discomfort of emotional vulnerability which was exacerbated by the dissimilarity between their racial-ethnic minority and LGBTQIA + identities and the perceived identities of the reflecting team. [ABSTRACT FROM AUTHOR]

This research explores the effects of computer-aided education (CAE) on the education of folk cultural products. Folklore, encompassing tangible and intangible cultural artifacts, holds significant importance in defining the identity and values of a community. CAE, utilizing multimedia software and interactive teaching methods, has emerged as a promising approach to enhancing student learning experiences. This study aims to investigate the impact of CAE on students' achievement, retention, cultural competency, and classroom participation in the domain of folk culture education. A quasi-experimental pretest-posttest control group design was utilized, with an experimental group of 32 1st grade students receiving CAE and a control group of 32 1st grade students receiving traditional teaching methods in Almaty, Kazakhstan. Various assessment tools were employed to measure academic achievement, cultural competency, and classroom participation. The results indicate that students in the CAE group exhibited significantly higher academic achievement scores, improved retention of knowledge, enhanced cultural competency, and increased classroom participation compared to the control group. These findings provide empirical evidence supporting the effectiveness of CAE in fostering effective and engaging education, particularly in the context of preserving and promoting cultural heritage through folk culture education. [ABSTRACT FROM AUTHOR]

The aim of this paper is to relay the reflections of my experience as a Latinx school social worker and about my work with children and families identifying as rural and migrant. A de-identified real-life mental health crisis case scenario is provided. The case scenario contains the voices of a child and a parent living in a rural migrant camp. The content of the voices was paraphrased from the school social workers' post-crisis contact with a high school student and her mother. Professional first-person content is the voice of the social worker, Rosario. The case vignette is followed by a combination of the social worker's observations and information drawn from the professional literature about challenges and opportunities for rural schools to provide culturally sensitive practices for migrant children and families. Specific practice recommendations are offered for working with rural, migrant youth, particularly pertaining to child mental health per the case scenario. [ABSTRACT FROM AUTHOR]

The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health--related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels. [ABSTRACT FROM AUTHOR]

Background: Everyday, nursing students interact with culturally diverse clients. Nursing education recognizes that cultural competence is a necessary outcome of nursing programs. Nurse educators expect all nursing students to provide culturally congruent care to multicultural clients. Therefore, nurse educators must be culturally competent in order to prepare culturally competent nursing students for clinical practice. This study aimed to evaluate the effect of virtual training program on the cultural competence of academic nurse educators. Methods: This randomized controlled study included nurse educators working in six nursing schools affiliated with medical universities of Kerman province in southeastern Iran. Sixty-nine nurse educators were randomly assigned to the intervention (n = 35) and control (n = 34) groups. The training program consisted of three 2-hour sessions for a month. Cultural Diversity Questionnaire for Nurse Educators Revised (CDQNE-R) was used to evaluate the cultural competence of educators before and one month after the virtual training program. Results: Both the intervention (3.29 ± 0.58) and control (3.24 ± 0.58) groups demonstrated a similar level of cultural competence before the training program (t = 0.05, p = 0.95). After the training, the intervention group showed a significant increase in cultural competence (3.80 ± 0.7) compared to the control group (3.23 ± 0.67). This improvement resulted in culturally competent participants becoming culturally proficient, as evidenced by a large effect size (t = -4.76, p = 0.001). Conclusion: The virtual training program had a positive impact on the cultural competence of nurse educators. Given the importance of cultural competence in nursing education, continuing education programs that focus on strengthening the cultural competence of nurse educators should be prioritized. The experiences gained from implementing virtual training programs can serve as a valuable resource for nurse educators seeking to enhance their cultural competence. [ABSTRACT FROM AUTHOR]

Background: To provide just equity in academic exchange, as well as to reduce prohibitive travel cost and address environmental concerns, the past paradigm of international student exchange has fundamentally shifted from one directional travel to mutually beneficial bidirectional remote communication between students all over the globe. Current analysis aims to quantify cultural competency and evaluate academic outcomes. Methods: Sixty students half from the US and half from Rwanda grouped in teams of 4 engaged in a nine-month project-focused relationship. Cultural competency was evaluated prior to project initiation and six months after completion of the project. Student perspective of project development was analyzed weekly and final academic outcome was evaluated. Results: Change in cultural competency was not significant; however, students did identify satisfaction in team interaction and academic outcomes were achieved. Conclusion: A single remote exchange between students in two countries may not be transformative but it can provide cultural enrichment and successful academic project outcome and may serve to enhance cultural curiosity. [ABSTRACT FROM AUTHOR]

Objective: The Deaf community is an ethnolinguistic minority group. Low sensitivity to Deaf culture contributes to health disparities among Deaf patients. This study determines the level of sensitivity to Deaf culture among otolaryngology-head and neck surgery (OHNS) and audiology trainees. Methods: Cross-sectional survey study of OHNS and audiology trainees from 10 large US institutions. Trainees were queried on their exposure to and comfort with Deaf patients and their education on, attitude toward, and awareness and knowledge of Deaf culture. Sensitivity to Deaf culture was operationalized as awareness and knowledge of Deaf culture. These were assessed using a 35-item instrument that was previously developed using a d/Deaf community-based participatory approach to research. We used T-tests to compare the sample to previous samples of medical students with training in Deaf culture (MS-TDCs) and general practitioners (GPs). Results: There were 91 completed surveys (response rate 44.5%). Almost all were aware of Deaf culture (97.8%). The mean knowledge score was 55.0% (standard deviation (SD) 13.4%), which was significantly higher than that for GPs at 43.0% (SD 15.0%) (95% confidence interval 8.1%, 15.8%, P <.0001) but significantly lower than that for MS-TDCs at 69.0% (SD 13.0%)(CI −20.3%, −7.6%, P <.0001). Knowledge scores were comparable for OHNS and audiology trainees (P =.09). Conclusion: This sample of OHNS and audiology trainees was more sensitive to Deaf culture than GPs but less sensitive than MS-TDCs. Developing specialty-specific education may be warranted. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: To assess the observed pain behaviours of Aboriginal residents with cognitive impairment in aged care facilities and compare these results with a matched national sample of non‐Aboriginal residents. Methods: Observed pain behaviours of Aboriginal residents (N = 87) with cognitive impairment in aged care facilities across the Northern Territory of Australia were assessed using PainChek® Adult and compared with data from a matched national sample of non‐Aboriginal residents (N = 420). Pain scores were derived from inbuilt automated facial recognition and analysis software plus a series of digital checklists requiring manual input by care staff. Results: The median total pain score for the Aboriginal residents was 2 (IQR 1–4) and for the matched external residents was 3 (IQR 2–5). In a multivariable negative binomial regression model, this difference in total pain score was statistically significant (p < 0.001). The pain score derived from the automated facial recognition and analysis component of the PainChek® Adult app was not statistically different between the two groups when adjusted for multiple observations and context of observation (odds ratio = 1.06, 95% confidence interval 0.97–1.16, p = 0.169). Conclusions: We found under‐reporting of observed pain signs and behaviours for Aboriginal aged care residents by assessors. Further training in the assessment of pain in Aboriginal and Torres Strait Islander aged care residents may be necessary and a continuing shift in clinical practice to using technology and point‐of‐care assessment. [ABSTRACT FROM AUTHOR]

Introduction: Cultural competency has been identified as a barrier to lesbian, gay, bisexual and transgender (LGBT) populations seeking care. Mystery shopping has been widely employed in the formal health care sector as a quality improvement (QI) tool to address specific client needs. The approach has had limited use in community-based organizations due in part to lack of knowledge and resource requirement concerns. Several mystery shopping initiatives are now being implemented which focus on the LGBT population with the goal of reducing barriers to accessing care. One subset targets men who have sex with men (MSM) to increase uptake of human immunodeficiency virus (HIV) testing. No study investigates the costs of these initiatives. Get Connected was a randomized control trial with the objective of increasing uptake of HIV-prevention services among young men who have sex with men (YMSM) through use of a resource-locator application (App). The initial phase of the trial employed peer-led mystery shopping to identify culturally competent HIV testing sites for inclusion in the App. The second phase of the trial randomized YMSM to test the efficacy of the App. Our objective was to determine the resource inputs and costs of peer-led mystery shopping to identify clinics for inclusion in the App as costs would be critical in informing possible adoption by organizations and sustainability of this model. Methods: Through consultation with study staff, we created a resource inventory for undertaking the community-based, peer-led mystery shopping program. We used activity-based costing to price each of the inputs. We classified inputs as start-up and those for on-going implementation. We calculated costs for each category, total costs and cost per mystery shopper visit for the four-month trial and annually to reflect standard budgeting periods for data collected from September of 2019 through September of 2020. Results: Recruitment and training of peer mystery shoppers were the most expensive tasks. Average start-up costs were $10,001 (SD $39.8). Four-month average implementation costs per visit were $228 (SD $1.97). Average annual implementation costs per visit were 33% lower at $151 (SD $5.60). Conclusions: Peer-led, mystery shopping of HIV-testing sites is feasible, and is likely affordable for medium to large public health departments. [ABSTRACT FROM AUTHOR]

Cultural diversity is still an obstacle in providing nursing care to patients in the ICU. That is related to the competence of nurses in cross-cultural care. Critical cultural competence (CCC) shows that nurses can understand and respect the patient's culture so that nursing care has been created by the culture of the patient and his family. This study aims to describe the cultural competency of nurses based on a critical cultural competence in the Intensive Care Unit. The method used is a literature review study with ten articles in six databases (Scopus, Science Direct, Web of Science, CINAHL, ProQuest, and Pubmed). Data analysis was conducted with the researcher's critical thinking and PRISMA. The result of this study indicate the ICU nurses so far do not have the skills that match the CCC. Implementation of critical cultural competence in the ICU setting will increase the optimality and quality of nursing care. [ABSTRACT FROM AUTHOR]

Limited research has examined how employees' cultural competency may influence customers experience and behaviors. Building on social exchange theory, this study proposed and tested a model focusing on how guest gratitude mediated the relationships between three dimensions of servers' cultural competency, cultural awareness, cultural knowledge, and cultural skills, on customers' future behavioral intentions. Using empirical data collected from cross-cultural service encounters in luxury hotels in Australia, findings of the study revealed that cultural awareness and skills were significantly related to guest gratitude that, in turn, significantly influenced customers future behavioral intention. This study contributes to social exchange theory by adopting gratitude as a mediator in the reciprocal relationship between servers' cultural competency and customer behavioral intentions. The study highlights the importance of training current hospitality employees and preparing future hospitality professionals. In particular, the findings emphasize the importance of enhancing hospitality employees' cultural competency in cross-cultural service encounters. [ABSTRACT FROM AUTHOR]

Given limited information about patient experiences with cultural competency within dermatology, we sought to characterize the perception of culturally competent care among skin cancer patients in the United States. We used the 2017 National Health Interview Survey (NHIS) to identify a sample of patients with skin cancer and analyzed responses to the following questions: "How important is it for providers to understand or share your culture?" and "How often are you able to see health care providers that understand or share your culture?" For each question, we calculated the overall prevalence along with adjusted odds ratios for each sociodemographic group. Overall, 31% (95% CI 27–35%) of skin cancer patients responded that it was very or somewhat important for providers to share/understand culture. Patients with income below 200% of the federal poverty level (aOR 1.52; 95% CI 1.02–2.25), foreign-born patients (aOR 3.33; 95% CI 1.25–8.88), and patients with the highest educational attainment of a high school diploma (aOR 1.50; 95% CI 1.08–2.09) all had increased odds of placing importance on sharing/understanding culture. Furthermore, 80% (95% CI 75–85%) of skin cancer patients responded that they were able to see providers that shared/understood their culture all or most of the time, and therefore 20% of patients had access to culturally competent care only some or none of the time. Our study revealed that many (31%) skin cancer patients highly value culturally competent care, with lower-income, foreign-born patients, and patients with the highest educational attainment of a high school diploma, placing greater importance on culturally competent care. However, as many (20%) skin cancer patients have limited access to culturally competent care, future research should focus on analyzing and improving care for patient groups affected by cultural barriers. [ABSTRACT FROM AUTHOR]

Summary: In the present study, we developed a bicultural model of social work with immigrants consisting of professional interventions rooted in the dominant and the immigrant cultures. We further developed scales measuring the two types of interventions and investigated their connections with acculturation orientations and burnout of social workers working with immigrants from the Former Soviet Union (FSU) in Israel. The study was cross-sectional. The sample included 313 social workers, 254 Israeli-born and 59 born in the FSU. The data were analyzed using structural equation modeling. Findings: In their work with immigrants, social workers equally used interventions rooted in the immigrant and the dominant cultures, and the two types of interventions were complimentary. Stronger adherence to the acculturation orientation related to preserving the immigrant culture was associated with more frequent use of interventions rooted in the immigrant culture. In addition, more frequent interventions rooted in the immigrant culture were associated with a higher level of personal accomplishment. On the other hand, more frequent use of interventions rooted in the dominant culture was associated with a higher level of burnout. Immigrant social workers reported a higher level of personal accomplishment but also a higher level of burnout than their colleagues belonging to the dominant group. Applications: The main conclusion of the present study relates to the importance of accepting the immigrant culture and learning to effectively apply professional interventions rooted in both the immigrant and the dominant cultures in social work with immigrants. [ABSTRACT FROM AUTHOR]

Dental public health competencies in predoctoral dental education ensure that students have the skills to succeed in an increasingly complex professional environment. This study examined existing public health curricula in US dental education and their alignment with national recommendations from the American Association of Public Health Dentistry (AAPHD) and guidance from the Healthy People Curriculum Task Force for health professions education programs. We contacted all US dental schools (N = 66) in November 2020–January 202 and requested syllabi for schools' first course with dental public health content. We received 34 syllabi, which provided textual data for content analysis. The authors used an initial content analysis tool to extract descriptive course characteristics. Then, direct and emergent coding was performed to summarize course content. Direct codes included the 23 dental public health topics specified by AAPHD recommendations. Uncategorized content was coded using an inductive approach to identify emergent course themes. Frequently covered topics included principles of dental public health (79% of syllabi) and access to care (79%). "Health disparities" was the most common emergent theme, with 50% of courses including related content. There was little consistency in how courses approached each topic. For example, the topic "access to care" covered healthcare delivery systems, determinants of health, legislative reform, and advocacy. Dental public health was often taught alongside unrelated content. Recommendations for dental public health competencies should be updated to include new educational priorities, align with current national recommendations, and align with Commission on Dental Accreditation Standards more clearly. [ABSTRACT FROM AUTHOR]

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We aimed to find out the clinical students’ scores on cultural competencies and its different components (awareness and sensitivity, behavior, patient-centered communication, practice orientation, and self-assessment); to check the correlation between different components of cultural competency; and to examine the influence of students’ demographic characteristics on their cultural competency. A 48-item Schwarz’s Healthcare Provider Cultural Competence Instrument (HPCCI) comprising five scales was used to measure the cultural competency of Trinity Medical Sciences University students in clinical years. The descriptive statistics, Pearson’s correlation, and multivariable regression analysis were done using SPSS. The students obtained 81.8% in overall cultural competency, 83.3% in awareness and sensitivity towards cultural competency, 75.8% in behavior, 82.6% in patientcentered communication, 83.3% in practice orientation, and 92% in selfassessment of cultural competency. A significant positive correlation was found among different scales of HPCCI with some exceptions. Age, gender, race, school semester of study, and birth country of students and their fathers were found as independent predictors for different components of cultural competency measured. The medical students’ awareness/sensitivity toward cultural competence, concerning behavior, their patient-centered communication, and practice orientation skills need attention and have to be a driving point in the planning, developing, and implementing focused effective cross-culture curricula to better prepare the medical students for the benefit of diverse patients and communities they will serve. [ABSTRACT FROM AUTHOR]

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process. [ABSTRACT FROM AUTHOR]

This series of articles will explore the intersections of spirituality and the delivery of contemporary health care across several healthcare and nursing environments, with regard to both patient and service user groups. This seventh article will pick up on issues either raised briefly, or not covered, in earlier articles. [ABSTRACT FROM AUTHOR]

IntroductionMonash university in Australia has adopted the Human Library as a teaching activity aimed at enhancing occupational therapy (OT) students’ cultural awareness and sensitivity; however, its effect on cultural competence in healthcare profession students has not been previously investigated.AimTo examine whether participation in a Human Library can facilitate the development of OT students’ cultural awareness and sensitivity and to understand the factors contributing to changes in cultural competence from the students’ perspective.MethodThis is a mixed-method study. Quantitative data was collected by participant characteristic survey and pre/post-Human Library cultural competence assessment (CCA). The quantitative data was used to inform the selection of participants and questions for the second qualitative phase. Quantitative data were analyzed using independent samples and paired t-tests, analysis of variance and Pearson correlation. Qualitative data were analyzed using coding reliability thematic analysis.ResultsStatistically significant increases were noted in CAS, CCB and overall CCA scores from pre- to post-Human Library. Participant characteristics such as gender, work experience in aged care and the health sector had a positive effect on pre-Human Library CCA results. Qualitative data demonstrated that participants perceived they had a level of cultural competence prior to attending the Human Library however, still made gains in cultural awareness and sensitivity and were motivated and inspired to provide culturally congruent healthcare.ConclusionThe Human Library can be considered for inclusion within a suite of learning methods for healthcare professional student curricula as a cost-effective, flexible teaching method for the development of competencies for culturally congruent healthcare.

American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health.

The purpose of the present study was to explore diversity characteristics and experiences of discrimination in certified mental-performance consultants (CMPCs). The results of a questionnaire (N = 260) indicated that CMPCs remain a rather homogeneous population (>80% White, heterosexual, and able-bodied). Female and non-White consultants were significantly more likely to experience discrimination in the field. The findings indicate that minorities remain underrepresented among CMPCs. In addition, the profession is in need of interventional strategies to prevent experiences of discrimination in applied sport psychology. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions - including, when appropriate, employing tactics to mobilize family support.

An increasingly diverse population of older adults requires a diverse workforce trained to address the problem of differential healthcare access and quality of care. This article describes specific areas of training focused on addressing health disparities based on ethnic differences. Culturally competent care by mental health providers, innovative models of mental health service delivery such as collaborative care, and expansion of the mental health workforce through integration of lay health workers into professional healthcare teams, offer potential solutions and require training. Cultural competency, defined as respect and responsiveness to diverse older adults' health beliefs, should be an integral part of clinical training in mental health. Clinicians can be trained in avoidance of stereotyping, communication and development of attitudes that convey cultural humility when caring for diverse older adults. Additionally, mental health clinicians can benefit from inter-professional education that moves beyond professional silos to facilitate learning about working collaboratively in interdisciplinary, team-based models of mental health care. Finally, familiarity with how lay health workers can be integrated into professional teams, and training to work and supervise them are needed. A growing and diversifying population of older adults and the emergence of innovative models of healthcare delivery present opportunities to alleviate mental health disparities that will require relevant training for the mental health workforce.

Originating from one of the poorest areas in Mexico, Mixtecs are one of the largest indigenous groups of workers in California. Providing health education to this group is challenging because many do not speak English or Spanish, and indigenous languages are mainly oral, not written. We explored the feasibility of conveying health information through the radio and in promotora-led workshops. The study included an evaluation of the workshops through surveys before the workshop and 4 to 6 months later in a subsample of 96 indigenous women. The number of radio listeners averaged more than 2,000 per month, and 500 community members attended a workshop. Among women who completed pre- and postworkshop assessments (N = 75), there was a statistically significant increase in knowledge of how to get a wellness visit, where to get a free mammogram, and mammography screening guidelines. Women who ever had a mammogram or wellness visit at baseline were significantly more likely to report receipt of this service during the follow-up period than women who never had this service. Educational workshops and radio are promising and culturally appropriate strategies to provide health information in this community. However, many women need additional assistance to navigate access to health care.

Decades of puberty research have yielded key scientific discoveries. Building on the field's rich history, we highlight four understudied populations: youth of color, boys, sexual minority youth, and gender minority youth. We explore why scientific study has been slow to evolve in these groups and propose paths forward for exciting new work. For ethnically racially diverse youth, we discuss the need to incorporate culture and context. For boys, we highlight methodological issues and challenges of mapping existing conceptual models onto boys. For sexual and gender minority youth, we discuss unique challenges during puberty and suggest ways to better capture their experiences. With an eye toward a new era, we make recommendations for next steps and underscore the importance of transdisciplinary research.

Abstract Background Failure to consider relevant cultural, ethnic and diversity parameters (and the intersection between these parameters) during trial protocol development and trial conduct may negatively impact recruitment, intervention development and delivery, and participant adherence and retention, potentially reducing overall internal validity. This case study aimed to evaluate the utility and comparability between the 9-item Gibbs Framework to measure cultural competency and the GRIPP-2(Short Form (SF)) 5-point checklist to assess patient and public involvement in the context of a complex clinical trial conducted in an African setting. Methods We identified and collated all relevant publications, source and procedural data related to the trial and integrated the documents into a dynamic trial timeline. Two independent investigators applied and scored the Gibbs Framework and the GRIPP-2(SF) checklist to the four publications arising from the trial, noting functionality and comparability between tools. Where cultural competency was not met, a third investigator screened all procedural and source data and identified if cultural competency had been achieved but not reported in the publications, or if the trial had not met appropriate cultural competency based on the documentation. Results Application of the Gibbs Framework found that the trial scored ‘2’ for seven of the nine Gibbs items, indicating full cultural competency for those questions. The Framework indicated that the trial research question was not driven by the articulated needs of patients, and neither were patients, caregivers and clinical providers involved in the development of the intervention. Comparability with the GRIPP-2(SF) checklist showed that the Gibbs performed better on evaluation of partnerships with the community, identification of culturally competent data sources and target populations, and appointment of trial staff in an inclusive manner. Conclusions Comprehensive evaluation of the trial’s cultural competency required scrutiny of both published manuscripts and source and procedural data, suggesting that there is a gap in current trial reporting standards with respect to cultural competence. Trial registration PACTR201610001825403. Registered on 17 October 2016.

Primary care professionals play a critical role in the care of their patients. In clinical practice, early detection and diagnosis of Mild Cognitive Impairment, Alzheimer's disease and related dementia are often missed or delayed. Disclosure of diagnosis is not timely or not revealed. Though the methods that could improve early detection and diagnosis have remained the same over the decades with little change, they provide opportunities for early intervention, treatment and improvement in patient care. Emerging research suggests that though the disease process begins years prior to the clinical diagnosis, the healthcare system and health care professionals remain distant and reluctant to provide the service of annual cognitive assessment, which has been recommended by the Medicare program for older adults aged 65 years and older. Findings support that Alzheimer's disease and related cognitive impairments have gone under detected, underdiagnosed and undertreated. This article seeks to provide valuable and equitable information in the form of a clinician's guide for removing the barriers to early detection and diagnosis of cognitive impairments and offers an unprecedented opportunity to improve the clinical outcomes and care of older adults with various levels of cognitive decline, including mild cognitive impairment, Alzheimer's disease, and related dementias. This article provides information on understanding and addressing the challenges faced by health care professionals, including primary care clinicians; removing the barriers to cognitive assessments; educating this professional group on the importance of brain health, early detection, and diagnosis for their older adult patients; and providing these professionals with the ability to transfer their knowledge into more defined care planning. Until cognitive screening has been fully accepted and implemented for the optimal the care of older adults, health-related efforts should include the promotion and education of brain health, early detection, and diagnosis in the education of health care providers.

IntroductionDue to cultural, language, or legal barriers, members of social minority groups face challenges in access to healthcare. Equality of healthcare provision can be achieved through raised diversity awareness and diversity competency of healthcare professionals. The aim of this research was to explore the experiences and attitudes of healthcare professionals toward the issue of social diversity and equal access to healthcare in Croatia, Germany, Poland, and Slovenia.MethodsThe data reported come from semi-structured interviews with n = 39 healthcare professionals. The interviews were analyzed using the methods of content analysis and thematic analysis.ResultsRespondents in all four countries acknowledged that socioeconomic factors and membership in a minority group have an impact on access to healthcare services, but its scope varies depending on the country. Underfunding of healthcare, language barriers, inadequate cultural training or lack of interpersonal competencies, and lack of institutional support were presented as major challenges in the provision of diversity-responsive healthcare. The majority of interviewees did not perceive direct systemic exclusion of minority groups; however, they reported cases of individual discrimination through the presence of homophobia or racism.DiscussionTo improve the situation, systemic interventions are needed that encompass all levels of healthcare systems – from policies to addressing existing challenges at the healthcare facility level to improving the attitudes and skills of individual healthcare providers.

Introduction: In “Collaborative Online International Learning” (COIL) teachers/facilitators and students are expected to develop international awareness through dialogue with international peers. COIL´s potential for the development of global perspectives on professional themes without traveling abroad is unique. Objective: To identify obstacles and success criteria experienced during the development of a COIL module in nurse education. Methods: A qualitative study was developed with participants of a COIL module. Interviews with 11 students and 8 facilitators were included. The content analysis was performed on the data as a whole. Results: Four common categories emerged across students´ and teachers´ perspectives: positive experience; experienced difficulties; skills developed; and COIL suggestions. Additionally, opportunities provided by COIL were specific for teachers, and strategies used for the difficulties experienced were specific for students. Conclusion: COIL should be carefully planned and regulated like all programming of curricular activities. Different curricula, time zones, and schedules across education programs in different countries must be considered.

Learning about one’s implicit bias is crucial for improving one’s cultural competency and thereby reducing health inequity. To evaluate bias among medical students following a previously developed cultural training program targeting New Zealand Māori, we developed a text-based, self-evaluation tool called the Similarity Rating Test (SRT). The development process of the SRT was resource-intensive, limiting its generalizability and applicability. Here, we explored the potential of ChatGPT, an automated chatbot, to assist in the development process of the SRT by comparing ChatGPT’s and students’ evaluations of the SRT. Despite results showing non-significant equivalence and difference between ChatGPT’s and students’ ratings, ChatGPT’s ratings were more consistent than students’ ratings. The consistency rate was higher for non-stereotypical than for stereotypical statements, regardless of rater type. Further studies are warranted to validate ChatGPT’s potential for assisting in SRT development for implementation in medical education and evaluation of ethnic stereotypes and related topics.

IntroductionProviding care for refugees and asylum seekers requires special knowledge and training. Refugees and asylum seekers often have unique health needs that require specialized care.PurposeThis research focused on the need and relevance of incorporation of refugee and asylum seekers’ health in undergraduate medical curriculum teaching at King’s College London GKT Medical School.MethodsA mixed method approach was adopted involving review of available literature on refugee health in the medical curriculum, followed by interview and e-survey on the perspectives of tutors and students, respectively.DiscussionThe research points to an overwhelming agreement on the need, learning outcomes and challenges of integrating refugee and asylum seeker health into undergraduate medical and dental education both from the perspectives of clinical teachers and medical students.ConclusionA collaborative approach involving students, teachers and refugee stakeholders will help in developing an effective refugee curriculum to provide equitable healthcare in the UK.