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PubMed1995

Promoting the health of women of non-English-speaking backgrounds in Australia.

Immigrants with non-English-speaking backgrounds face many linguistic and cultural barriers when trying to use Australia's health services. Gender inequities make matters especially difficult for women with such backgrounds, who largely belong to the lower socioeconomic categories. The present article describes two health promotion projects whose success is largely attributable to their recognition of the difficulties faced by these women and to the strategies devised to overcome them with the aid of liaison workers and bilingual community educators.

Communication Barriers↗
PubMedDate not supplied

Building an award-winning women's health ambulatory service and beyond.

Many barriers exist for the provision of high-quality health care to inner-city minority women. The barriers include access to care, compliance problems, financial concerns, system navigation issues, as well as language barriers. This article describes the transition of the Women's Ambulatory Health Services at Hartford Hospital from a traditional clinic model to a culturally sensitive private practice model. The road to transition was paved by valuable input from staff as well as patients. The final product was a much more efficient, inviting model that catered to the needs of the community.

Adult↗
PubMed1982

Beating the language barrier.

It appears from available information that although nations such as Canada and the United States are making concerted efforts to come to terms with the linguistic and health requirements of their ethnic communities. Australia is leading the way in terms of having found an effective solution to the problem. The New South Wales Health Commission's scheme is comprehensive, covering all aspects of health care in public hospitals and in the community. We envisage that other states will soon follow the example set by New South Wales.

Australia↗
PubMed1998

Screening issues in gynecologic malignancies for women with disabilities: critical considerations.

There are 25 million women with disabilities in the United States. They have biologically similar risks to other women for developing all cancers, including gynecologic malignancies. Unfortunately, barriers to comparable cancer screening include lack of knowledge by women themselves, lack of awareness on the part of health care providers about special health concerns clinicians might encounter, and physical access barriers. Together, these factors conspire to delay diagnosis and treatment of many common gynecologic malignancies. Additionally, medications taken by some women with chronic disease states may adversely affect their risk for developing certain types of cancer, and they may be at increased risk for contracting underdiagnosed sexually transmitted diseases linked to cervical cancer. This article describes some important issues regarding incidence and screening for gynecologic malignancies in women with disabilities.

Adult↗
PubMed2005

Barriers to HIV/AIDS knowledge and prevention among deaf and hard of hearing people.

This study investigated knowledge about HIV/AIDS and barriers to HIV/AIDS education and prevention among deaf and hard of hearing people. Focus groups and individual interviews were used to elicit information from various groups of people with a hearing loss in different regions of New York State. Themes elicited in the interviews suggested that deaf sign language users are less knowledgeable about HIV/AIDS than oral deaf and hard of hearing participants, and that deaf adolescents have more knowledge than deaf adults. These findings likely reflect differences in levels of education and English proficiency. In addition, participants living in urban areas and in sizeable deaf communities are more exposed to information about HIV/AIDS than other participants. All participants reported difficulties in communication with medical providers, limiting their access to health information and proper medical care. Recommendations for the design and dissemination of educational materials and greater access to services for deaf and hard of hearing people are provided.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Whose information is it anyway? Informing a 12-year-old patient of her terminal prognosis.

OBJECTIVE: To examine students' attitudes and potential behaviour towards informing a 12-year-old patient of her terminal prognosis in a situation in which her parents do not wish her to be told, as they pass through a modern medical curriculum. DESIGN: A cohort study of students entering Glasgow University's new medical curriculum in October 1996. METHODS: Students' responses obtained before year 1 and at the end of years 1, 3, and 5 to the "childhood leukaemia" vignette of the Ethics in Health Care Survey Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of the students' multichoice answers enabled measurement of the movement towards professional consensus opinion. An analysis of their written justifications for their answers helped to determine whether their reasoning was consistent with professional consensus and enabled measurement of changes in knowledge content and recognition of the values inherent in the vignette. Themes on the students' reasoning behind their decision to tell the patient or not were also identified. RESULTS: Unlike other vignettes of the EHCI in which autonomy was a main theme, few students chose the consensus answer before year 1 and there was no significant movement towards consensus at any point during the course. In defence of their decision to withhold information, the students expressed strong paternalistic opinions. The patient's age was seen as a barrier to respecting her autonomy. CONCLUSIONS: It is important to identify students' perceptions on entry to medical school. Transformative learning theory may provide the basis for an approach to foster doctors who consider the rights of young people. Small-group teaching is most conducive to this approach. The importance of positive role modelling is also emphasised.

Age Factors↗
PubMedDate not supplied

Meeting minority health needs through special MCH projects.

The maternal and child health programs of the Public Health Service have always been directed to minority populations; however, the recent surges of immigrants from Asian and Central American countries have caused the agency to appraise its efforts to meet the special health needs of these people. Through grants for special projects of regional and national significance (SPRANS), the Office of Maternal and Child Health is funding projects to break down language, culture, and access barriers to health services for pregnant women, infants, and children. Recent and current SPRANS projects have taken innovative approaches to solving the special health problems of the minority populations. They range from a breastfeeding initiative in the Commonwealth of the Northern Mariana Islands to an areawide genetic service program in the Virgin Islands. Examples of projects that have been conducted are presented.

Asia↗
PubMed1983

A replication and validation of the Spousal Inventory of Desired Changes and Relationship Barriers (SIDCARB): elaborations on diagnostic and clinical utilization.

In this article, the authors present the findings of a study designed to validate the factor structure of the Spousal Inventory of Desired Changes and Relationship Barriers (SIDCARB). Results from this research reveal that the original factor structure remained essentially the same. Scoring and interpretations of the couple profile are discussed and treatment decisions based upon the couple profile are outlined. Although the development of SIDCARB grew out of a social learning-behavioral philosophy of marital and family interaction, this instrument yields information that can be useful to structural marital and family therapists as well.

Adult↗
PubMed2000

Defining mental illness and accessing mental health services: perspectives of Asian Canadians.

Asian Canadians consistently underutilize mainstream mental health services. This study investigates how the definition and meaning of mental illness relates to barriers Asian Canadians find in accessing mental health services. Personal interviews were conducted with 60 Asian Canadians in a northern community in the province of British Columbia. Content analyses revealed six themes that defined a mental health problem: (a) feeling a lack of purpose in life, (b) feeling lonely, (c) difficulties understanding and dealing with a new environment, (d) high anxiety levels, (e) descriptions of mental health problems as somatic illnesses, and (f) perceptions of mental illness as serious and potentially not treatable. It was also found that poor English language ability and a lack of understanding of mainstream culture were major barriers to accessing mental health facilities. Findings of this study provided valuable insights concerning Asian immigrants' hesitancy accessing and utilizing mainstream mental health facilities. The many poignant personal anecdotes illustrate that the migration and adaptation processes can be painful and full of anguish. Unless their experiences are better understood and accepted, many Asian Canadians will likely remain outside of the available mainstream mental health facilities.

Adolescent↗
PubMed2004

Exploring access to cancer control services for Asian-American and Pacific Islander communities in Southern California.

During the last 25 years, numerous studies have been conducted to promote breast cancer and cervical cancer screening. Most of these studies focused on individual-level factors predicting screening, but we are unaware of any that directly examined community and ecological influences. The goal of this project, Promoting Access to Health for Pacific Islander and Southeast Asian Women (PATH for Women), was to increase community capacity for breast and cervical cancer screening and follow up in Los Angeles and Orange counties. We focused on Southeast Asian and Pacific Islander women because, although they have the lowest rates for cancer, compared to all other ethnic groups, relatively few programs have specifically targeted Asian-American and Pacific Islander (AAPI) women to promote and sustain screening practices. The PATH for Women project involved a partnership between 5 community-based organizations and 2 universities, and included 7 Asian-American and Pacific Islander communities: Cambodians, Chamorros, Laotians, Thais, Tongans, Samoans, and Vietnamese. In this paper, we share our experiences in developing a Geographic Information System (GIS)-mapping evaluation component that was used to explore availability and accessibility to culturally responsive breast and cervical cancer screening services for Southeast Asian and Pacific Islander women in all 7 communities. We describe the methods used to develop the maps, and present the preliminary findings that demonstrate significant geographic and language barriers to accessing healthcare providers, services for breast and cervical cancer screening, and follow up, in each of the communities. Finally, we discuss implications for programs designed to promote breast and cervical screening and policy education.

Adult↗
PubMed2005

Intraepithelial lymphocytes express junctional molecules in murine small intestine.

Intestinal intraepithelial lymphocytes (IEL) that reside at basolateral site regulate the proliferation and differentiation of epithelial cells (EC) for providing a first line of host defense in intestine. However, it remains unknown how IEL interact and communicate with EC. Here, we show that IEL express junctional molecules like EC. We identified mRNA expression of the junctional molecules in IEL such as zonula occludens (ZO)-1, occludin and junctional adhesion molecule (JAM) (tight junction), beta-catenin and E-cadherin (adherens junction), and connexin26 (gap junction). IEL constitutively expressed occludin and E-cadherin at protein level, while other T cells in the thymus, spleen, liver, mesenteric lymph node, and Peyer's patches did not. Gammadelta IEL showed higher level of these expressions than alphabeta IEL. The expression of occludin was augmented by anti-CD3 Ab stimulation. These results suggest the possibility of a novel role of IEL concerning epithelial barrier and communication between IEL and EC.

Animals↗
PubMedDate not supplied

eHealth technology and Internet resources: barriers for vulnerable populations.

Disparities in accessing health information exist for various vulnerable populations. Reviewing access issues for those seeking and/or needing health information suggests that there are many factors that may inhibit access. These include a wide diversity in the education, background, and needs of those seeking information, and the distribution of information among many disciplines and information sources. The most needy among this group may require extensive, multispecialty healthcare and may have particular problems with access, treatment adherence, and working within the healthcare system.

Access to Information↗
PubMedDate not supplied

The Nuer Nutrition Education Program: breaking down cultural barriers.

Very little is known about the Nuer culture, partly because of its widely misunderstood language and because of the mixture of its people with the other tribes in Africa, according to Evans-Pritchard). However, it is known that the Nuer women's roles in the family seem to be centered around cooking duties. In the Nuer culture, no work is considered degrading, and the women know and accept their domestic duties. During the summer of 1996, a pilot project was conducted as an attempt to help Nuer refugee women of Des Moines, Iowa, incorporate nutritional concepts and American food preparation techniques into their existing methods of food preparation. The barriers faced involved the Nuer women's unfamiliarity with American foods and household items and their inability to read and understand English. Cultural issues and barriers were overcome when the health educator was willing to take the time to gain the trust and respect of the Nuer people. Structured interviews indicated an increase in knowledge of American foods and cooking skills. This education program in no way meant to replace traditional Nuer cooking methods; rather, it acted as a way to adjust to life in the United States.

Acculturation↗
PubMed2004

Barriers to cancer screening by rural Appalachian primary care providers.

CONTEXT: Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary care providers (PCPs). PURPOSE: To identify and investigate barriers to recommending and/or performing cancer screening among rural Appalachian PCPs. METHODS: A semistructured focus group research design was used to elicit perceived barriers to recommending and/or performing cancer screening from 36 rural Appalachian PCPs (in 5 groups), including physicians, nurse practitioners, and a physician assistant. FINDINGS: Findings indicate that rural Appalachian PCPs may not be performing recommended cancer screenings for a number of reasons. Time constraints, conflicting guidelines, and perceptions that patients do not value prevention were reported barriers to cancer screening. The PCPs in this study expressed frustration in attempting to encourage cancer screening and cited patient factors such as socioeconomic status, Appalachian culture, and cancer fatalism as barriers to cancer screening. CONCLUSIONS: Rural Appalachian PCPs encounter various barriers, such as lack of time and multiple cancer screening guidelines, to incorporating cancer screening into their practice routine. The findings underscore the negative impact of some cultural factors on preventive care delivered by PCPs. Increased provider education is needed on how best to encourage cancer screening within a cultural context and should include clarification and understanding of current cancer screening guidelines.

Anecdotes as Topic↗
PubMed1999

Teaching social inequalities in health: barriers and opportunities.

This article examines some of the main threats and new opportunities encountered by teachers of social inequalities in health in contemporary academia. Focusing mostly on the recent US and European experiences, I suggest that lay world views legitimating social inequalities are often in conflict with explanations arising from social epidemiology and medical sociology. The dominance of medicine in public health, through its often implicit assumptions about the biological determinants of human behaviour, is also identified as a barrier to teaching social inequalities in health. Educational elitism, which restricts higher education to members of the upper middle class, is identified as another barrier to teaching social inequalities in health. On the other hand, teachers in this field can benefit from a recent growth of empirical studies during the last decade aimed at understanding the social determinants of health inequalities. Finally, I suggest that familiarity with current critical scholarship within public health, as well as the use of techniques developed by sociologists to teach social stratification, can be valuable resources for teaching social inequalities in health.

Attitude to Health↗
PubMed2005

South Asian participation in clinical trials: the views of lay people and health professionals.

There is little UK-based empirical research on South Asian participation in clinical trials. The predominantly US literature rarely engages with mainstream debates about ethnicity, diversity and difference. This study was prompted by a lack of knowledge about how South Asian people perceive trial involvement and the risks and benefits involved. Face to face interviews were conducted with 25 health professionals (consultants, GPs, nursing staff, academics, non-medically trained trial co-ordinators, LREC and MREC members) and 60 South Asian lay people (20 Indians, 20 Pakistanis and 20 Bangladeshis) who had not taken part in a trial. The study took place in the Leeds and Bradford areas of England. It was found that lay South Asian attitudes towards clinical trial participation focused on similarities rather than differences with the general UK population, suggesting that the relevance of ethnicity should be kept in perspective. There was no evidence of antipathy amongst South Asians to the concept of clinical trials, and awareness was a correlate of social class, education and younger age. Lay factors that might affect South Asian participation in clinical trials included: age; language, social class; feeling of not belonging/mistrust; culture and religion. Approachable patients (of the same gender, social class and fluent in English) tended to be 'cherry picked' to clinical trials. This practice was justified because of a lack of time, resources and inadequate support. South Asian patients might be systematically excluded from trials due to the increased cost and time associated with their inclusion, particularly in relation to the language barrier. Under-representation might also be due to passive exclusion associated with cultural stereotypes. The paper concludes by applying the theoretical framework of institutional racism as a means of making sense of policy and practice. At the same time, caution is advocated against using ethnicity as the only form of discrimination facing minority ethnic populations.

Adult↗
PubMed1999

Dental service use and the implications for oral cancer screening in a sample of Bangladeshi adult medical care users living in Tower Hamlets, UK.

AIM: To assess the use of dental services, barriers to uptake of dental care and attitudes to regular dental examinations and the prevalence of tobacco and paan chewing habits in a group of Bangladeshi medical care users. DESIGN: Multi-centre cross-sectional study. SETTING: Four general medical practices' waiting areas in Tower Hamlets. SUBJECTS: Bangladeshi adults aged 40 years and over. INTERVENTION: An interview schedule. MAIN OUTCOME MEASURES: The prevalence of tobacco smoking and paan chewing with or without the addition of tobacco. The use of dental services, barriers to the use of dental services and attitudes to regular dental examinations. RESULTS: Results were obtained from 158 subjects (response rate 85%). 25% of the whole sample had never visited a dentist. These were significantly (P < 0.05) more likely to be women, who also thought regular check-ups were of little value. In their use of health services 73% experienced language difficulties. 33% of the sample were tobacco smokers. Paan was chewed by 78% of the sample with significantly (P < 0.05) more females than males adding tobacco to their quid and chewing more frequently than males. CONCLUSION: There are considerable barriers to be overcome if dental practices are to be the site for oral cancer screening and oral health promotion in this population. There are sex differences in reported behaviour and attitudes about use of dental services and in tobacco and paan use in this Bangladeshi sample. Further research is needed to establish why this ethnic minority attend general medical practices but not general dental practices.

Adult↗
PubMed1996

The InterpreCare System: overcoming language barriers in long-term care.

Differences in the language spoken by residents and staff in long-term care create a variety of problems. The InterpreCare System represents an intervention for dealing with this issue. We describe the nature and purpose of this intervention, and provide detailed instructions on the construction of Language Boards. Examples are given from our experience at Menorah Park Center for the Aging in enabling English-speaking staff to use Russian phrases while delivering care. Beneficial effects produced by the intervention are discussed.

Aged↗