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PubMed2006

Cultural differences in medical communication: a review of the literature.

OBJECTIVE: Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor-patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor-patient communication. In addition, a research model for studying this topic in future research is proposed. METHODS: A literature review using online databases (Pubmed, Psychlit) was performed. RESULTS: Findings reveal major differences in doctor-patient communication as a consequence of patients' ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients. CONCLUSION: Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor-patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients' preferences for doctor-patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective. PRACTICE IMPLICATIONS: Using a cultural sensitive approach in medical communication is recommended.

Attitude of Health Personnel↗
PubMed2006

More than nation and knowledge: cultural micro-diversity and organ donation in Switzerland.

OBJECTIVE: While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation. METHODS: We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings. RESULTS: The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs--differences that persist even in the context of strong national identity, relatively homogeneous cultural background, and the public good nature of organ donation. CONCLUSION: The results demonstrate a need to consider and address cultural factors and barriers when designing organ donation campaigns. PRACTICE IMPLICATIONS: Centrally designed organ donation campaigns are not likely to be effective and efficient. Message strategies should rather be tailored to different (micro-) cultural groups.

Attitude to Health↗
PubMed2005

Neighbourhood life and social capital: the implications for health.

Social capital has been linked to health outcomes, though there are some inconsistencies in the research and the link is dependent on the measures of social capital and health used. In this paper, we argue that social capital is multifaceted and its relationship with health is complex. We explore the relationship between a number of elements of neighbourhood life and neighbourhood-based social capital, and health, using both qualitative and quantitative methods. The paper reports on a study of the Western suburbs of Adelaide and the analysis of 2400 questionnaires and 40 in-depth interviews. A partial least-square path analysis was undertaken with the questionnaire data. It considered the impact of perceptions of the physical environment, neighbourhood connections, neighbourhood trust, reciprocity, perceived safety and local civic action, and a number of demographic variables, on physical and mental health as measured by the SF-12. Of the neighbourhood-related variables, only perceived neighbourhood safety was related to physical health, with neighbourhood safety and neighbourhood connections related to mental health. Of the demographic variables, higher-income level and educational achievement were related to better physical and mental health. In addition, physical health was lower and mental health higher within older age groups. The inter-relationships between the neighbourhood variables and demographic differences in experience of neighbourhood were also examined. The thematic analysis of the interviews linked a number of social aspects of neighbourhood, the physical neighbourhood environment, perceptions of safety, civic activities and availability of local services, to health outcomes. The paper concludes that there is a need for more complex measures of social capital and that socio-economic factors are of relatively greater importance in determining health.

Adolescent↗
PubMed2005

Psychometric and cognitive validation of a social capital measurement tool in Peru and Vietnam.

Social capital is a relatively new concept which has attracted significant attention in recent years. No consensus has yet been reached on how to measure social capital, resulting in a large number of different tools available. While psychometric validation methods such as factor analysis have been used by a few studies to assess the internal validity of some tools, these techniques rely on data already collected by the tool and are therefore not capable of eliciting what the questions are actually measuring. The Young Lives (YL) study includes quantitative measures of caregiver's social capital in four countries (Vietnam, Peru, Ethiopia, and India) using a short version of the Adapted Social Capital Assessment Tool (SASCAT). A range of different psychometric methods including factor analysis were used to evaluate the construct validity of SASCAT in Peru and Vietnam. In addition, qualitative cognitive interviews with 20 respondents from Peru and 24 respondents from Vietnam were conducted to explore what each question is actually measuring. We argue that psychometric validation techniques alone are not sufficient to adequately validate multi-faceted social capital tools for use in different cultural settings. Psychometric techniques show SASCAT to be a valid tool reflecting known constructs and displaying postulated links with other variables. However, results from the cognitive interviews present a more mixed picture with some questions being appropriately interpreted by respondents, and others displaying significant differences between what the researchers intended them to measure and what they actually do. Using evidence from a range of methods of assessing validity has enabled the modification of an existing instrument into a valid and low cost tool designed to measure social capital within larger surveys in Peru and Vietnam, with the potential for use in other developing countries following local piloting and cultural adaptation of the tool.

Adult↗
PubMed2005

Couples' experiences of postnatal depression: a framing analysis of cultural identity, gender and communication.

Difficulties in communication have been associated with fathers' perceived lack of support for mothers suffering postnatal depression (PND). This paper investigates why the communication of the experience of PND is so difficult and considers how these difficulties might be linked, in part, to the diagnostic process. The study explores, through in-depth interviews, how six Australian couples talked about the new mothers' experience of mild to moderate PND. Framing analysis revealed discrepancies in the couples' explanations of the mothers' PND. The application of the concept of 'framing' has come to the study of mental health by way of Goffman's work on how experience becomes organised. Goffman used the technique of 'frame analysis' to identify and describe the taken-for-granted sociocultural elements that give meaning to a situation. This study identified that mothers and fathers used different frames, with mothers understanding their postnatal experience primarily from within an 'identity' frame and fathers understanding the mothers' experience primarily through a 'psychological' or 'physical hardship' frame. Implications for health service providers are considered.

Adult↗
PubMedDate not supplied

Incorporating political socialization theory into baccalaureate nursing education.

Political socialization theory explains how an individual develops a political belief system. As the health care system undergoes dramatic changes, nursing faculty should use political socialization theory to enhance the education of student nurses. A political thread can be woven through the nursing curricula, and students can be socialized to the political role. The new generation of nurses must incorporate a political component into their professional role identity. Political socialization theory can guide nursing faculty as knowledge of the political system and political skills are incorporated into nursing curricula.

Curriculum↗
PubMed2003

Applying ethnic equivalence and cultural values models to African-American teens' perceptions of parents.

This study evaluated both the parenting styles and family ecologies models with interview responses from 93 14- and 15-year-old African-American adolescents. The parenting styles model was more strongly represented in both open-ended and structured interview responses. Using variables from the structured interview as independent variables, regression analyses contrasted each model with a joint model for predicting self-esteem, self-reliance, work orientation, and ethnic identity. Overall, the findings suggest that a joint model that combines elements from both models provides a richer understanding of African-American families.

Adaptation, Psychological↗
PubMed2003

Peer and adult relationships of adolescents with disabilities.

The purpose of this study was to enhance our knowledge of what it is like to grow up with a disability, specifically, with focus on how adolescents with restricted mobility perceive social roles and relationships to peers and adults. The group investigated consisted of 12 adolescents with restricted mobility from northern Sweden, aged from 15 to 19 years. The adolescents were individually interviewed. The analysis resulted in a core category (Who am I), which describes how the adolescents perceive themselves. The core category was related to three subcategories: Relationships to friends--describes the adolescents' experiences of peer relationships, Relationships to adults--describes adolescents' relationships to adults, Thoughts about relationships in the future--comprises wishes for future relationships. The results indicated that the 12 disabled adolescents saw themselves as regular members of the adolescent peer group but that the members of the adolescent group saw them as being different. The relationships to friends of the same age were either markedly defective or did not exist at all, while relationships to adults were often characterized as ambivalent or asymmetric, i.e. the adults were simultaneously helpful and supportive while over protective and dominant. The study revealed that despite the many hindrances, the adolescents had a comparatively positive view of their future.

Adaptation, Psychological↗
PubMed1979

Friendship patterns.

Explore the source record for details and available documents.

Adaptation, Psychological↗
PubMed1995

Students' evolving beliefs about nursing: from entry to graduation in a four-year baccalaureate programme.

Students become socialised into nursing during an educational programme through interaction with faculty members, classes and seminars, and by the experience of practicing nursing. In this paper, some results from a qualitative study that examined the socialisation of nursing students from one four-year baccalaureate programme are described. The changes in the students' attitudes and values are presented. Davis' (1975) theory of doctrinal conversion is used to examine progress in the process of socialisation. There is evidence that students moved from a lay to a professional image of nursing over the course of their four-year programme. While they tended to remain idealistic, elements of realism were evident in the final year as they looked toward their role as a registered nurse and recognised the constraints inherent in the hospital system.

Adult↗
PubMed1998

An examination of the role of learning environments in the construction of nursing identity.

The interplay between the development of a nurse's identity within the world of nursing, and the construction of relevant nursing concepts is by necessity a difficult and complex one. It is in part grounded in the theories of social interaction, concept formation, and relevant peripheral participation in the workplace, all of which can be related to the nursing role. These issues are considered here primarily from the sociocultural viewpoint of Vygotsky, bringing together the important role of significant participants in the nurse's learning experiences, predominantly peers, and examining briefly the effects of such a viewpoint in relation to nursing education. How best nursing knowledge may be structured to optimize the learner's educational experiences, and how best the learning environment of the student may be utilized to maximum educational benefit still remain complex questions. With moves towards more competence-based learning such interactions may be crucial to our understanding of the complexities of learning in what are essentially very practical-based environments, and at the same time allow us to acknowledge the important mechanisms involved in concept acquisition and transferability, a notion central to lifelong learning.

Education, Nursing, Baccalaureate↗
PubMed2000

How much does social capital add to individual health? A survey study of Russians.

Some Russians are healthier than others. To what extent does their health vary with involvement or exclusion from social capital networks? The first section reviews alternative theories: human capital as the primary determinant; social capital, whether generic, situation-specific or simply a new label for old measures of social integration; or a composite theory--both human and social capital are major determinants of health. The evidence to test hypotheses consists of individual-level data about self-assessed physical and emotional health from the special-purpose social capital questionnaire used in the 1998 New Russia Barometer survey, a nationwide representative sample of the adult Russian population. Multiple regression analysis shows that on their own human capital and social capital each account for a notable amount of variance in health. When both forms of capital are combined in a composite model, each retains major influence, demonstrating that social capital does make an independent contribution to health. Significant social capital influences include involvement or exclusion from formal and informal networks; friends to rely on when ill; control over one's own life; and trust. Significant human capital influences besides age include subjective social status, gender and income. Regression-based estimates of impact show that social capital increases physical and emotional health more than human capital; together they can easily raise an individual's self-reported health from just below average on a five-point scale to approaching good health.

Adolescent↗
PubMed2002

Sister cities and easy passage: HIV, mobility and economies of desire in a Thai/Lao border zone.

It is recognised that people movement can increase potential risk of HIV transmission. In recent years, mobile populations moving across national borders have become a focus for HIV/AIDS prevention campaigns. These programs generally target border "hot zones" that produce high levels of HIV vulnerability due to the degree of mobility and the risk behaviours fostered by these marginal environments. However, high degrees of movement and social exploitation need not be the only criteria for borders to exacerbate HIV vulnerability. The types of social interactions promoted by mobility take many forms. In this paper we consider a border zone between Thailand and Laos to show that the links between movement and HIV vulnerability are not confined to stereotypical instances of coercion and exploitation. Rather we demonstrate that HIV risk in this area is a product of both a sense of community and a sense of difference that together foster a range of interactions based on mobility back and forth across the border. As HIV/AIDS prevention programs increasingly control forms of sexual interaction, the border provides a practical and symbolic opportunity to establish new forms of sexual relationship falling outside these constraints. This tendency to move outside bounds is not limited to border areas but has implications for prevention programs everywhere.

Cities↗
PubMed2002

Ethnic identities, social capital and health inequalities: factors shaping African-Caribbean participation in local community networks in the UK.

This paper examines the impact of ethnic identity on the likelihood of peoples' participation in local community networks, in the context of recent policy emphasis on the participation of marginalised communities in such networks as a means of reducing health inequalities. Conceptually, the paper is located against the background of debates about possible links between health and social capital--defined in terms of grassroots participation in local community networks--and an interest in the way in which social exclusion impacts on social capital. The paper draws on lengthy semi-structured, open-ended interviews with 25 African-Caribbean residents of a deprived multi-ethnic area of a south England town. While African-Caribbean identity played a central role in peoples' participation in inter-personal networks, this inter-personal solidarity did not serve to unite people at the local community level beyond particular face-to-face networks. Levels of participation in voluntary organisations and community activist networks were low. Informants regarded this lack of African-Caribbean unity within the local community as a problem, saying that it placed African-Caribbean people at a distinct disadvantage--furthering their social exclusion through limiting their access to various local community resources. The paper examines the way in which the construction of ethnic identities--within a context of institutionalised racism at both the material and symbolic levels--makes it unlikely that people will view local community organisations or networks as representative of their interests or needs, or be motivated to participate in them. Our findings highlight the limitations of policies which simply call for increased community participation by socially excluded groups, in the absence of specific measures to address the obstacles that stand in the way of such participation.

Adolescent↗
PubMed2003

Disability and a sense of community belonging. A study among tetraplegic spinal-cord-injured persons in France.

This article presents a study of the identity of persons with motor impairments with regard to the community of disabled persons. The authors used the Tetrafigap survey on the long-term outcome of Tetraplegic Spinal-cord-injured (TSCI) persons, in France, to study the sense of belonging to the community of disabled persons among 1356 TSCI persons in relation to factors of social participation (both sociological and disability-related) and subjective factors (subjective well-being, social perception of disability, perceived disability). The results show that 44% of TSCI persons felt that disabled persons do not constitute a community (the "no-community" group). Of those who recognised the existence of such a community, 34% said they belonged to it (the "in-community" group) and 22% declared they did not (the "out-community" group). People in the "no-community" group tended to be more socially integrated, whilst those in the "in-community" group tended to have greater social and clinical difficulties. The "out-community" group was more diverse, being made up of both autonomous persons and dependent persons suffering from complications. Factors related to the sense of community belonging were identified using bivariate analysis and multiple logistic regression. Subjective well-being appeared to be independent of any sense of community belonging. However, the authors found a gender difference: women in the "in-community" group described themselves as having a poorer level of well-being than women in the other two groups. The results are discussed in terms of two views on the social treatment of disabilities: universalism and assimilation vs. particularism and positive identity and the growth of the disability movement.

Activities of Daily Living↗
PubMed2003

"Love thy neighbour"-it's good for your health: a study of racial homogeneity, mortality and social cohesion in the United States.

This paper explores the idea that in societies that experience racial tension, increasing racial heterogeneity will be associated with poorer health outcomes, and this effect will be observable in the health of both the minority and the majority group. Here, the association between mortality and racial homogeneity in the United States is examined. The level of racial homogeneity, indexed by the proportion of blacks in each state of the 50 states in the US, was examined in relation to all-cause mortality, adjusted for age and disaggregated by race and sex. The level of poverty in each state was controlled for in ordinary least squares regression models. The level of racial homogeneity was significantly associated with age adjusted mortality rates for both blacks and whites, accounting for around 30% of the variance in mortality rates in the total population and the white population. Every 1% increase in the percentage of the state population who were black was associated with an increase in the total mortality rate of 5.06 per 100000 and an increase in the white mortality rate of 3.58 per 100000. Based on the data, this suggests, for example, that racial heterogeneity in Mississippi accounts for around 14% of the white mortality rate and in New York and Delaware it accounts for around 7%. These results appear to support the social cohesion thesis that in societies that are intolerant, mortality rates will increase as the proportion of racial or ethnic minorities increase in population. Limitations and explanations for the findings are discussed.

Black or African American↗