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PubMed2002

A checklist to facilitate cultural awareness and sensitivity.

United States of America demographic profiles illustrate a nation rich in cultural and racial diversity. Approximately 29% of the population are minorities and demographic projections indicate an increase to 50% by the year 2050. This creates a highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. During times of stress, such as when injury strikes, problems associated with lack of cultural sensitivity are intensified. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients.

Attitude to Health↗
PubMedDate not supplied

Psychological distress, unmet need, and barriers to mental health care for women.

Using data from the Commonwealth Fund 1998 Survey of Women's Health, this article describes the characteristics of women in need of mental health services for depression or anxiety, and identifies factors related to why women do not get needed care. Depressive/anxiety symptoms are common and access to care for psychological distress remains a problem for many women, especially for minorities, those with less education, and those without a usual source of health care. Sources of unmet need include patient factors, clinician factors, and characteristics of the health system, such as costs of mental health care.

Adolescent↗
PubMed1998

Operation Pacific Haven: humanitarian medical support for Kurdish evacuees.

This article reviews the medical aspects of the humanitarian assistance mission Joint Task Force Operation Pacific Haven from September 1996 to April 1997. It reviews the effectiveness of the deployable medical units used to support the medical screening, treatment, and processing of more than 6,600 Kurdish evacuees applying for political asylum in the United States. The distinct cultural mores and language barriers of the Kurdish population made the provision of even basic medical care a challenge. Designed for combat service support, these deployable medical units were successful in the performance of the comprehensive public health and humanitarian assistance medical support mission because of the support of two on-island military treatment facilities. In short, for military medicine to successfully conduct humanitarian assistance and/or disaster relief missions, deployable medical units need to be designed, equipped, staffed, and trained to perform these operations.

Adolescent↗
PubMed2002

Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization.

OBJECTIVE: To determine the impact of interpreters and bilingual physicians on emergency department (ED) resource utilization. DESIGN: Cohorts defined by language concordance and interpreter use were prospectively studied preceding and following the availability of dedicated, professional medical interpreters. SETTING: Pediatric ED in Chicago, Ill. PARTICIPANTS: We examined 4146 visits of children (aged 2 months to 10 years) with a presenting temperature of 38.5 degrees C or higher or a complaint of vomiting or diarrhea; 550 families did not speak English. In 170 cases, the treating physician was bilingual. In 239, a professional interpreter was used. In the remaining 141, a professional medical interpreter was unavailable. MAIN OUTCOME MEASURES: Incidence and costs of diagnostic testing, admission rate, use of intravenous hydration, and length of ED visit. RESULTS: Regression models incorporated clinical and demographic factors. Compared with the English-speaking cohort, non-English-speaking cases with bilingual physicians had similar rates of resource utilization. Cases with an interpreter showed no difference in test costs, were least likely to be tested (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.56-0.97), more likely to be admitted (OR, 1.7; 95% CI, 1.1-2.8), and no more likely to receive intravenous fluids, but had longer lengths of visit (+16 minutes; 95% CI, 6.2-26 minutes). The barrier cohort without a professional interpreter had a higher incidence (OR, 1.5; 95% CI, 1.04-2.2) and cost (+$5.78; 95% CI, $0.24-$11.21) for testing and was most likely to be admitted (OR, 2.6; 95% CI, 1.4-4.5) and to receive intravenous hydration (OR, 2.2; 95% CI, 1.2-4.3), but showed no difference in length of visit. CONCLUSION: Decision making was most cautious and expensive when non-English-speaking cases were treated in the absence of a bilingual physician or professional interpreter.

Chicago↗
PubMed2004

South Asian patients' views and experiences of clinical trial participation.

OBJECTIVES: This paper explores South Asian patients' views and experiences of clinical trial participation, as part of a larger study which sought to assess British South Asian under-representation in clinical trials. METHODS: The study was based on semi-structured interviews with South Asian trial participants in primary care and specialist treatment centres in the north of England. Fifteen South Asian patients who had participated in one of six different clinical trials to test pharmaceutical products comprised the study cohort. RESULTS: South Asian motivations to participate in clinical trials are similar to those of the majority 'White' population. Clear and concise trial information (provided by caring and understanding trial staff) was considered an important aspect of the respondents' experiences. Appealing to South Asian peoples' altruistic nature by making them aware of South Asian under-representation (especially in clinical trials that investigate illnesses prevalent in their community) was also identified as a strong motivational factor. Potential barriers to their participation included: trial burden (which bears heavily on the poor), language, and discriminatory practices in the NHS, which can lead to mistrust of health professionals. In addition, female modesty and preference for female trial staff was recognized as a 'cultural' barrier to participation. CONCLUSION: There are more similarities than differences between the experiences of British South Asians and 'White' trial participants. Present findings suggest that ethnicity operates at different levels. In addition to South Asian trial participants' culture, social class and gender are also as likely to affect their participation in clinical trials. To improve South Asian accrual rates, strategies should be designed to take into consideration linguistic differences and improving overall trust in the clinical trial team.

Adult↗
PubMed2005

Effective e-learning for health professionals and students--barriers and their solutions. A systematic review of the literature--findings from the HeXL project.

INTRODUCTION: In 2003/4 the Information Management Research Institute, Northumbria University, conducted a research project to identify the barriers to e-learning for health professionals and students. The project also established possible ways to overcome these barriers. The North of England Workforce Development Confederation funded the project. METHODOLOGY: The project comprised a systematic review of the literature on barriers to and solutions/critical success factors for e-learning in the health field. Fifty-seven references were suitable for analysis. This review was supplemented by a questionnaire survey of learners and an interview study of learning providers to ensure that data identified from the literature were grounded in reality. RESULTS: The main barriers are: requirement for change; costs; poorly designed packages; inadequate technology; lack of skills; need for a component of face-to-face teaching; time intensive nature of e-learning; computer anxiety. A range of solutions can solve these barriers. The main solutions are: standardization; strategies; funding; integration of e-learning into the curriculum; blended teaching; user friendly packages; access to technology; skills training; support; employers paying e-learning costs; dedicated work time for e-learning. CONCLUSIONS: The authors argue that librarians can play an important role in e-learning: providing support and support materials; teaching information skills; managing and providing access to online information resources; producing their own e-learning packages; assisting in the development of other packages.

Communication Barriers↗
PubMed1994

Emergency triage to intensive care: can we use prognosis and patient preferences?

OBJECTIVE: To identify predictors of 6-month mortality known before emergent admission to intensive care (IC) and to describe obstacles to the use of patient preferences in emergency triage decisions. DESIGN: Historical cohort. SETTING: A 600-bed university hospital. PATIENTS: 263 consecutive patients triaged in the emergency room to receive intensive care. MEASUREMENTS AND MAIN RESULTS: Medical records were abstracted for age, performance status, and chronic disease severity as predictors of 6-month survival. Acute Physiology Score (APS) in the emergency room was used as a measure of acute illness severity. Deaths during the 6 months following IC admission were determined from record review and death certificate data. Obstacles to communication of patient treatment preferences at the time of triage were described. Six-month mortality was 19 percent, and increased with increasing APS, age > or = 80 (43%), poor performance status (56%), and severe chronic disease (33%) (P < or = 0.01). In multivariate analysis, APS, age > or = 80 and performance status were independent predictors of 6-month mortality. Only APS predicted mortality in hospital. The most common obstacles to use of patient preferences in triage decisions were absence of documented advance directives (95%) and the brief duration of acute illness (72%). Mental status changes were very common in the emergency room for nonsurvivors (61%), but chronic cognitive impairment was rare (3%). CONCLUSIONS: Patients with poor performance status or very advanced age have increased mortality within 6 months of emergent triage to IC. Mental status changes, absence of advance directives, and time constraints are common barriers to communication of patient preferences at the time of triage. Primary care physicians need to elicit and record patients' preferences before the time of emergent decisions about IC.

Activities of Daily Living↗
PubMedDate not supplied

Identifying and overcoming barriers to providing sexuality information in the clinical setting.

While the scope of the clinician-patient relationship in rehabilitation includes the opportunity to provide information on sexuality, all too often this does not occur. This article identifies barriers to providing information on sexuality and makes suggestions for overcoming them. At a preconference workshop, "Sexuality After Spinal Cord Injury: Understanding the Effects of Knowledge and Attitude on Dissemination Practices," held during the Association of Rehabilitation Nurses 22nd Annual Educational Conference, participants explored barriers to providing sexuality information to their patients and ways for nurse managers and staff members to ameliorate their own discomfort and that of their patients. The barriers identified included lack of time, lack of knowledge, personal attitudes about sexuality, and patient lack of readiness. Approaches that can improve the comfort levels of nurse managers and staff include using educational films and written materials, conducting role playing to explore typical patient questions, and initiating conversation about sexuality with patients. Participants' suggestions for increasing patient comfort level included adopting an open and nonjudgmental listening mode, distinguishing between the physical and emotional aspects of sexual issues, and promoting peer counseling.

Attitude of Health Personnel↗
PubMed1996

Health care access and preventive care among Vietnamese immigrants: do traditional beliefs and practices pose barriers?

Some have speculated that underutilization of Western health services among non-Western populations can be explained by traditional health beliefs and practices rooted deep within cultures. These beliefs and practices may act as barriers to access to and utilization of services. Among Vietnamese, in particular, a number of traditional health beliefs and practices have been identified which are said to pose barriers to Western medical care. No studies to date, however, have examined this hypothesis empirically. To examine this hypothesis, we measured traditional health beliefs and practices among Vietnamese in the San Francisco Bay area and analyzed the relationships between these factors and access to health care and use of preventive health services. The results of this study show clearly that many Vietnamese possess traditional health beliefs and practices which differ from those of the general U.S. population. Yet, the data do not support the hypothesis that these traditional beliefs and practices act as barriers to access to Western medical care or to utilization of preventive services. Being married and poverty status were the most consistent predictors of health care access. Furthermore, the components of access to health care (having some form of health insurance or having a regular doctor, for example) were the strongest predictors of preventive health care services utilization. Importantly, the cultural attributes of individuals did not explain either lack of health care access or underutilization of preventive health care services.

Adult↗
PubMedDate not supplied

Barriers to the use of interpreters in emergency room paediatric consultations.

OBJECTIVE: To identify barriers to the use of trained interpreters in emergency department (ED) paediatric consultations. METHODS: A cross-sectional survey of non-English-speaking-background (NESB) carers who presented a child aged 14 years or less to the Fairfield Hospital ED during a 3-month period was undertaken using a multilingual postal questionnaire or a phone interview with interpreter assistance. RESULTS: Of the 1388 paediatric consultations during the study period, 406 of the carers were registered as being of NESB, with 316 being eligible for study inclusion. Of the 278 (88%) respondents who completed the questionnaires, assistance with interpretation was required by 131 (47%) respondents: 55 (20%) used ad hoc interpreters, 47 (17%) used a trained interpreter and 21 (8%) did not receive the required assistance. Fifty-four (41%) carers who required interpreter assistance were identified as having this requirement at clerical registration in the ED, but only 18 of these were provided with a trained interpreter during the consultation. Limited English proficiency was self-reported by 127 (46%) respondents, with these respondents being more likely to need interpreter assistance (odds ratio (OR) 44.2; 95% CI 21.6-90.7), to have impaired understanding of the consultation (OR 8.2; 95% CI 4.7-14.1) and to consult a language concordant general practitioner (OR 10.1; 95% CI 5.1-19.4) compared with English proficient respondents. CONCLUSIONS: Barriers to the use of interpreters in ED paediatric consultations include poor identification of the need for and provision of an interpreter in the ED, and a preference for NESB carers to use ad hoc interpreters or no interpreter. Recommendations include the implementation in the ED of strategies to improve identification of NESB carers, as well as to improve awareness, access and use of trained interpreters during paediatric consultations. There is also a need to explore the experience of ED staff in accessing and using trained interpreters.

Adolescent↗
PubMed2006

Exploring HIV prevention needs for nongay-identified black and African American men who have sex with men: a qualitative exploration.

OBJECTIVES: The objectives of this study were to describe ways in which black men who have sex with men (MSM) identify their sexual identities, explore their views of HIV prevention interventions, and assess barriers to recruiting men for future study participation. STUDY DESIGN: Focus groups were conducted with 25 black MSM who have sex with women. Thematic analyses were conducted. RESULTS: Factors influencing HIV/AIDS prevention perceptions included men's responses and reactions to homosexual labels and vies, sexual behaviors, contextual factors, and self-worth. Men also expressed a need to discuss ambivalent feelings about same-sex sexual encounters. CONCLUSION: The qualitative study provided insights into the significance of sexual identity and sexual labeling for black MSMs' HIV prevention needs.

Adult↗
PubMed1993

A study of patient satisfaction with primary health care services in Saudi Arabia.

Patient satisfaction is of value to primary health care providers. The main objective of this study was to estimate patient satisfaction with respect to primary health care services in Riyadh City, Saudi Arabia. Fourteen primary health care centers were chosen randomly to represent various geographic areas of Riyadh. Information was collected through a pre-tested questionnaire used by thirty well-trained final year medical students. Systematic sampling of family files was conducted and the household head was interviewed. Nine hundred respondents were interviewed concerning their satisfaction with the services delivered. The findings were as follows: 40% were dissatisfied. One third of the dissatisfied expressed the view that the center was too far; 19.4% complained that the working hours of the center were not suitable; 38.9% complained of the absence of specialty clinics; 19.4% had language barriers with the physicians; 63.9% complained about delays at the center; 16.7% of the satisfied and 38.9% of the dissatisfied complained that the physicians did not satisfactorily explain their health problems and treatments. In 22.7% of the dissatisfied category, physicians' explanations were neither clear nor understandable. Among the satisfied, 74.6% said that primary health care center was the first choice if they felt sick; 61.1% of the non-satisfied category gave this response. The implications of these findings are discussed, and recommendations are given to rectify certain problems.

Choice Behavior↗
PubMedDate not supplied

African-American injection drug users: tensions and barriers in HIV/AIDS prevention.

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.

Adult↗
PubMed2005

Application of cultural constructs in the care of first generation Latino clients in a community mental health setting.

As the Latino population in the United States grows, it is imperative to attend to the appropriateness of the mental health care that is being provided to its members. Latinos experience many of the same behavioral health disorders as other ethnic and cultural groups in the United States, but underutilize services relative to many other groups. Such underutilization may be related to issues such as stigma, language, and acculturation level, all of which often create barriers to treatment. First generation Latinos (i.e., individuals born outside the United States) are especially vulnerable to adverse experiences when seeking and receiving treatment. This may be due in part to acculturation and language issues which may further contribute to future underutilization of services. A well established therapeutic alliance developed through the appropriate use of cultural constructs may help mitigate some of the barriers faced by some Latino groups, especially those who are first generation. This paper reviews several cultural constructs that have been highlighted in the Hispanic behavioral health literature and discusses their potential implications for clinical care. This paper offers a number of practical clinical guidelines for mental health professionals who work with Latino groups. These clinical recommendations are based on a synthesis of selected cultural constructs and the clinical experiences of the authors' work in a large community-based Hispanic mental health clinic.

Acculturation↗
PubMed2003

Linguistic services in ambulatory clinics.

A review of the literature reveals few studies that focus on the challenge of language barriers in primary care settings. Recognizing the need for a national consensus on cultural and linguistic standards for health care in the United States, the Office of Minority Health recently released a set of standards for culturally and linguistically appropriate services (CLAS). These standards were utilized to examine the linguistic services available at eight ambulatory care centers in a small New England state in an effort to determine compliance with recommended national standards. Although myriad studies have focused on provision of linguistically appropriate care in emergency rooms (ERs), few studies have specifically examined ambulatory care settings. Numerous strategies have been adopted by individual clinics in an attempt to deal effectively with linguistic barriers. Yet without clear national regulations and dedicated funding for interpreter services, a large spectrum of services exists. Survey data were obtained from on-site visits at select community health clinics to ascertain availability, need, and utilization of linguistic services for patients with limited English proficiency. The majority of patients served by the clinics surveyed were predominantly Spanish-speaking. Results reveal that although most of the clinics provided informal mechanisms of interpreter services, few directly addressed linguistic services as a component of culturally competent care.

Ambulatory Care Facilities↗
PubMed2003

Dental disease prevention and people with special needs.

People with special needs are the most underserved of the underserved in our society. They have more dental disease, more missing teeth, and more difficulty obtaining dental care than other segments of the population. Many individuals and groups, including the authors of this paper, have developed community-based systems to improve oral health for people with special needs. However, these systems have not been as successful as they might be because of lack of effective preventive protocols specifically designed for people with special needs. This paper reviews strategies for overcoming informational, physical, and behavioral barriers to oral health and presents a summary of the results of a conference titled "Practical Preventive Protocols for Prevention of Dental Disease in People with Special Needs in Community Settings." The rationale for using an Oral Health Care Plan is presented as well as a sample plan. These strategies and protocols are designed to complement the system of supported community-based oral health care. The goal of this system is to help people with special needs enjoy a lifetime of oral health the same as other members of our society.

Adult↗
PubMed2005

Surveillance of dietary habits and lifestyles among 5-6 year-old children and their families living in Central-North Italy.

OBJECTIVES: To study dietary habits and behaviours of a representative sample of 5-6-year-old children and their families. METHODS: A stratified population sample of the general population (5508 children out of 5551 residents) born in 1997 and attending a nursery school was analysed. Weight and height were measured. Information was collected via questionnaire. A "normal" body mass index (BMI) ranged between 13.61-18.09 and 13.31-19.79 kg/m2 for boys and girls respectively. RESULTS: The response rate was 89%. 79% of the boys had a normal BMI, 0.9% had a low BMI, 18% were overweight, and 1.8% was obese; 87% of the girls had a normal BMI, 2.6% had a low BMI, 10% were overweight, and 0.7% were obese. The main sources of dietary information were professionals of the national health system and mass-media. The main barriers to healthy dietary habits were busy daily activities, working timetable, time needed to cook and tasty and healthy food cost. The main changes in dietary habits occurred in the family habits after a child's birth. CONCLUSIONS: Our findings showed a crucial role played by professionals of the national health system and by mass-media on eating behaviours among children and their parents. Birth of a child is a receptive context to promote healthy habits.

Anthropometry↗
PubMed1997

The use of bilingual, bicultural paraprofessionals in mental health services: issues for hiring, training, and supervision.

Language and cultural barriers mitigate between refugee and immigrant populations and the mental health services they need to adjust to life in the United States. To bridge the gap between mental health professional and client, and to educate communities regarding services, agencies are recruiting paraprofessionals who are bilingual and bicultural to perform outreach functions and provide interpretation services. This article presents the recent circumstances that have created this situation, discusses the roles of paraprofessionals in mental health, and addresses the issues and problems that can arise around the hiring, training, and supervision of bilingual, bicultural paraprofessionals.

Communication Barriers↗