This project entails a critical examination of the race/culture divide in human services from the vantage point of middle women non-professional grassroots advocates who emerged in the 1990s to address inequities that minoritized immigrants experience with main stream human services in Canada. The race/culture divide denotes critical race theorists' critique of a focus on cultural difference that obscures racism. Shaped by critical race theory and critical research methods, and drawing on interviews and participant observation involving 25 middle women, my findings reveal that the middle women's articulations of barriers and gaps as systemic inequities are at odds with main stream services' tendencies to focus on cultural challenges. This tension results in the discursive production of a cultural niche, a gendered space of exploitation of a culturally defined Middle Woman, who is thus rendered perpetually immigrant. The study illuminates how the Middle Woman navigates a complex and perilous tension between jeopardizing relationships with main stream organizations and simultaneously resisting what she experiences as disrespectful, unacceptable, unethical and overtly racist interfaces with human services. Although the middle women recounted numerous, visceral and detailed culturalist-racist interfaces in systemically racialized human service systems, they were equivocal about naming racism until I raised it directly. They gave meaning to "in Canada" experiences through their particular pre-migration realities in a process of continuous comparison between "back home" and "here," positioning them differentially in relation to Canada, and therefore also to the possibility of naming racism in Canada. The middle women engage in a continuous process of discerning racism, always weighing it against other explanations for inequitable treatment. The project thus draws attention to the toll that navigating the race/culture divide takes in embodying the sensed and draining the spirit. It draws attention to the process through which I, as a white researcher, came to see the workings of our racialized society. My research contributes to the literature on the race/culture divide and whiteness studies, and has implications for research on racism, dialogue about cultural competence and anti-racist practice, and conceptualizing settlement and responsive human services.

The aim of the current project was to improve the cross-cultural clinical competence of mental health staff in Victoria’s Crisis Assessment and Treatment Teams (CATTs) by developing, delivering and evaluating a training program in Cross-Cultural Psychiatric Assessment (CPA). The project was guided by a program logic framework. A literature review demonstrated cross-cultural differences in manifestations of mental disorders and disparities in mental health service provision to racial and ethnic groups, suggesting clinician bias, unfamiliarity with cross-cultural manifestations, or delayed help-seeking by ethnic groups. No research has been identified into crisis service provision to ethnic communities. (For complete abstract open document)

"A dissertation submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Doctor of Education." Title from PDF of title page (Georgia Southern University, viewed on May 6, 2010). Delores D. Liston, major professor; Grigory Dmitriyev, Hsiu-Lien Lu, David Alley, committee members. Electronic version approved: December 2009. Includes bibliographical references (p.167-181).

Bakgrund: År 2017 var nästan 1,9 miljoner av Sveriges befolkning födda utomlands. För patienter med språksvårigheter och som vårdas inom den svenska hälso- och sjukvården finns säkerhetsrisker, vilket kan hota patientsäkerheten och då är kommunikationen av stor vikt. Personcentrerad vård men även kulturell kompetens ger möjlighet för vårdpersonalen att se hela människan och ge individuell omvårdnad.Syfte: Att beskriva invandrares erfarenheter av den svenska hälso-och sjukvården.Metod: En litteraturöversikt baserad på 15 artiklar, varav 13 kvalitativa, en kvantitativ och en mixed method. Databaserna PubMed och Cinahl användes för artikelsökning.Resultat: Resultatet visade på både positiva och negativa erfarenheter från den svenska hälso- och sjukvården. Olika former av kommunikation var det största hindret för patienter med invandrarbakgrund, men även kulturella skillnader påverkade deras upplevelser. Patienterna uttryckte både känslor av tacksamhet och att bli bemött med respekt men även känslor av osäkerhet, rädsla och oro.Slutsats: Kommunikationssvårigheter och kulturella skillnader är hinder som både patienter med invandrarbakgrund och sjukvårdspersonal måste hantera i den svenska hälso- och sjukvården. Kulturell kompetens hos hälso- och sjukvårdspersonalen kan hjälpa patienter med invandrarbakgrund att få förståelse för det svenska hälso-och sjukvårdssystemet. / Background: In 2017, nearly 1.9 million of Sweden's population were born abroad. For patients with language difficulties there are safety risks in the Swedish healthcare system, which can threaten the patient safety, and therefore are the communication of great importance. Person-centred but also cultural competence care provides the opportunity for health professionals to see the whole person and provide individual care.Aim: To describe immigrants’ experiences of the Swedish healthcare system.Method: A literature review based on 15 articles, including 13 qualitative, a quantitative and a mixed method. Databases PubMed and Cinahl were used for article search.Results: The results revealed both positive and negative experiences from the Swedish healthcare system. Different forms of communication were the main obstacle for patients with immigrant backgrounds, but also cultural differences affected their experiences. The patients expressed both feelings of gratitude and being treated with respect but also feelings of uncertainty, fear and anxiety.Conclusion: Communication difficulties, but also cultural differences are barriers that both patients with immigrant backgrounds and healthcare professionals must manage In the Swedish healthcare system. The cultural competence of health professionals can help patients with immigrant backgrounds gain an understanding of the Swedish healthcare system.

Objetivos: Desenvolver um novo instrumento para avaliar espiritualidade e realizar análises psicométricas de validade e confiabilidade. Métodos: O instrumento foi elaborado através de quatro etapas: fundamentação teórica, investigação sobre definições de espiritualidade na população geral, elaboração da primeira versão por um comitê de especialistas e teste de compreensibilidade. Nas análises psicométricas, o instrumento foi submetido à avaliação de juízes e posteriormente, foi testado em estudantes de medicina (N=85) e em uma população de religiosos (N=85), para cálculo de consistência interna, análise fatorial exploratória e confiabilidade teste-reteste. Resultados: O instrumento desenvolvido, a Escala de Atitudes Relacionadas à Espiritualidade (ARES), apóia-se na compreensão sobre espiritualidade no contexto brasileiro e em bases teóricas. Apresentou análises psicométricas apropriadas: a análise fatorial exploratória apontou uma estrututura unidimensional, o alfa de Cronbach encontrado em cada item foi >= 0,98 e o Coeficiente de Correlação Intraclasse (CCI=0,98) apontou boa reprodutibilidade da escala. Conclusão: ARES é um instrumento unidimensional, desenvolvido em idioma português, que apresentou consistência interna excelente e indicou ser reprodutível na população avaliada. São necessários mais estudos para verificar se ARES é aplicável em amostra com baixa escolaridade e em outros contextos culturais e religiosos. A escala ARES permite operacionalizar o construto espiritualidade em pesquisas quantitativas / Objectives: Develop a new instrument devised to measure spirituality, able to perform psychometric analysis of validity and reliability. Methods: The instrument was elaborated through four processes: theoretical foundation, a population based investigation about possible definitions of spirituality, a first version was achieved by a committee of experts in Spirituality along with a comprehension test. In psychometric analysis, the analysis was evaluated by judges, then tested in a population of medical students (N = 85) and in a religious population (N = 85), in order to calculate internal consistency, exploratory factor analysis (EFA) and reliability, through test-retest. Results: The instrument, ARES, a Spirituality-Related Attitudes Scale, was based on theoretical understandings of spirituality in the Brazilian context. It presented an appropriate psychometric analysis: the EFA indicated a one-dimensional structure, the Cronbach\'s Alpha found each item at >= 0.98 and the Intraclass Correlation Coefficient (ICC = 0.98) indicated good reproducibility of the scale. Conclusion: ARES is a one-dimensional instrument, developed in the Portuguese language, which presented an excellent internal consistency and indicated to be reproducible in the evaluated population. Further studies are needed to verify if ARES is applicable to other population samples, for example, a low SES and other cultural/religious contexts. The ARES scale allows for operationalization of the construct of spirituality in quantitative researches

Denna studie syftar till att undersöka hur socialarbetare upplever kulturella skillnader i kommunikation med sina kollegor. Studiens deltagare är socialarbetare som arbetat minst 6 månader inom samma arbetsgrupp. Datainsamlingen är gjord utifrån en kvalitativ metod där empirin samlats in genom semistrukturerade intervjuer. Resultaten framställs genom en tematisk analys där vi lyfter olika områden. Utifrån vår studie kan vi utläsa att våra respondenter upplever att det finns en upplevd kulturell skillnad i kommunikationen med kollegor samt att dessa yttrar sig på olika vis. Respondenterna berättade om olika kommunikationssituationer där både språk och handling varit de områden som visat de kulturella skillnaderna mest. Respondenterna berättade även om upplevda för- och nackdelar med kulturella skillnader och hur dessa kunde påverka kommunikationen med kollegorna på arbetsplatsen. / This study aims at investigating how social workers experience cultural differences in communication with their colleagues. The students of the study are social workers who have worked for at least 6 months in the same working group. The data collection is based on a qualitative method where the data was gathered through semi-structured interviews. The results are then produced through a thematic analysis where we highlight different areas. Based on our study, we can state that our respondents feel that there is an experienced cultural difference in communication with colleagues and that they express themselves differently. Respondents talked about different communication situations where both language and action were the areas that showed the most cultural differences. Respondents also told about the pros and cons of cultural differences and how these could affect communication with colleagues in the workplace

Cultural competence is critical to public service, yet it is often ignored and underutilized, especially in post-disaster response and recovery. The current literature on cultural competence and frameworks developed by the private sector do not fully consider the complexities of a post-disaster public service context. This project explores the importance of cultural competence in post-disaster response and recovery, identifies effective training methods and organizational policies which may present barriers to competence acquisition, and proposes a new theoretical framework by which to assess cultural competence in international response and recovery work. This study used focus groups with Haitian beneficiaries (n=7), in-depth interviews with response and recovery workers (n=50), close ended surveys with both groups (n=226), observation, and a review of secondary sources (e.g. job announcements, training manuals) to explore cultural competence from the perspectives of international response and recovery workers, their agencies, and Haitian beneficiaries after the January 2010 Haitian earthquake. The analysis revealed that although 88% of participating aid workers identified cultural competence (CC) as critical to program effectiveness, 42% had no training before or during deployment. An analysis of the job announcements revealed that only 37% of agencies required cultural competencies. While aid workers and beneficiaries identified experiential strategies (e.g. immersion, mentoring) as critical to cultural competence acquisition, organizational policies (e.g. curfews, restrictions on travel) were often found to be at odds with these methods and more than 1/3 of participating aid workers felt that these policies were a barrier to cultural competency. Findings from this study may help aid workers better understand the importance of cultural competence and how it can improve the effectiveness of aid programs, and provide ways in which aid agencies can enhance cultural competence acquisition by their employees.

Understanding the philosophy of a different culture and integrating this understanding into the provision of pharmaceutical care is challenging and complex. This thesis argues the importance for community pharmacists to acknowledge that culture, religion, family and community dynamics can impact on patients' health, health seeking behaviour and medicines adherence. The perceptions of members of the South Asian population, general practitioners, and community pharmacists about how these factors are viewed in relation to community pharmacy services were explored in this study. It was conducted in Leicester City, which has a South Asian minority ethnic population of more than 25%. Participants' views of the role of extended community pharmacy services in the wider government agenda were explored. South Asians attitudes to healthcare, self care and the management of minor ailments were discussed. A qualitative methodology approach was adopted, which used constructivist and interpretive principles. Data collection for the study was conducted in two phases. In Phase 1, one to one semi-structured interviews were conducted separately with six local GPs and five community pharmacists from both 'white' (European) and South Asian backgrounds. In Phase 2, six gender specific focus groups were convened comprising of fifty five participants in total from the Sikh, Moslem and Hindu communities. Bi-lingual community workers were used in this study which allowed a more 'sensitive' exploration of the sociological aspects of health seeking behaviour and the impact of 'cultural' influences on medicines adherence. The need for 'cultural competence' of community pharmacists is discussed as one of the major contributions to the evidence base for pharmacy practice. Such initiatives would require pharmacists to acquire more effective consultation skills in the first instance. South Asians expressed views that community pharmacists need to be more knowledgeable, responsive and flexible in their professional practice by assessing their pharmaceutical needs and being aware of particular cultural sensitivities when planning their services in line with the new pharmaceutical contract. More specifically, South Asian participants illustrated the need for community pharmacists and their staff to be more 'culturally knowledgeable' about the communities in which they practice. It is argued that the provision of a more culturally sensitive and pro-active service is needed to develop a better patient-practitioner professional relationship that promotes trust. South Asians illustrated how certain behavioural, religious and cultural beliefs impact on medicines adherence, such as compliance issues whilst on holiday to their homeland, the impact of religious pilgrimage and fasts. Many South Asian participants had limited understanding about 'generic' medicines and considered these to be 'inferior' or 'less effective' than 'branded' medication. Participants' views of 'sharing' of medicines and medicines waste were also illustrated. Factors such as 'stress', 'fate' and 'karma' and their impact on health of the participants were discussed. Many of these factors could not be solely attributable to a South Asian 'culture'. However, the findings illustrate a need for a Medicines Use Review (MUR) service to include more 'targeted' exploration of medicines adherence and medicines optimisation for this population. The findings also highlighted why South Asians rarely consult the community pharmacist about sensitive or stigmatised issues such as depression, and how some conditions and symptoms were perceived to have negative impact on the 'social acceptance' of South Asian individuals within their own communities. South Asians suggested that community pharmacists needed to be more pro-active and 'responsive' to their pharmaceutical needs and respect confidentiality through use of private consultation areas for routine counselling, health promotion and medicines information. All participants endorsed a need for more 'professional' recognition of the pharmacist not only as an autonomous health care professional, but as one integral to providing NHS services relating to medicines and public health. The findings illustrated a lack of professional collaboration between community pharmacists and GPs, confounded by community pharmacists being 'subordinate' to GPs and portraying more of a 'shopkeeper' image. South Asians were well informed about the lack of shared medical records and relied heavily on a doctor's definitive 'diagnosis' for somatic symptoms related common ailments. South Asians pro-actively engaged with 'community action' based approaches in health education and health promotion, and an opportunity for community pharmacists to become more involved with social initiatives was inferred from the findings. Candid and animated discussions explored their understanding of exercise as part of weight management and their interpretation of effects of the use of herbal products, alternative practitioners and the importance of collaboration with religious and community leaders in promoting medicines adherence. Participants desired alternative communication methods other than leaflets (translated or otherwise), including the use of audio-visual means and use of media. Communication difficulties were still prevalent, and trained interpreters were rarely used. By embracing some of these challenges, community pharmacists could enhance the value of their services and provide a more meaningful, 'culturally' competent and responsive services based on the needs of their local populations and nurture a better trusting and professional relationship with their service users and healthcare colleagues.

Bakgrund: Transpersoner tillhör en av de grupper i samhället som rapporterar om bristfälligt bemötande inom den svenska hälso- och sjukvården. De senaste åren har transpersoners synlighet i samhället förändrats. Allt fler personer önskar att genomgå utredningar, behandlingar och juridiskt könsbyte för att leva mer i enlighet med sin könsidentitet. Ett antal studier visar att det finns en kunskapsbrist bland sjuksköterskor gällande transpersoner. Syfte: Syftet med litteraturstudien var att sammanställa transpersoners erfarenheter av interaktioner med vårdpersonal samt hur de ser på bemötande inom hälso- och sjukvården. Metod: Genom strukturerade databassökningar i CINAHL, PubMed och PsychInfo identifierades 15 artiklar som var relevanta i förhållande till studiens syfte. Kvalitativ latent innehållsanalys användes för att identifiera samband och mönster mellan de 15 artiklarna. Resultat: Transpersonerna upplevde att vårdpersonal hade varierande och bristande kunskaper kring trans och könsidentitet. Kunskapsnivån kunde kopplas till hur vårdpersonal agerade mot transpersoner. Både negativa och positiva erfarenheter av interaktion med vårdpersonal identifierades. Vårdpersonalens agerande påverkade hur transpersonerna reagerade och agerade i interaktionen med vårdpersonal. Konklusion: En förvriden maktbalans mellan vårdpersonal och patient uppstår när transpersoner upplever sig maktlösa gällande sin vård samtidigt som de upplever att de måste vara ihärdiga och kräva makt för att få vård. Genom att tillämpa kulturkompetent omvårdnad kan vårdpersonal förbättra sättet de interagerar med transpersoner. / Background: Transgender people in Sweden report of having inadequate experiences of interactions with healthcare professionals. Visibility of transgender people in Sweden has changed over recent years. A growing number of people desire to pursue investigations, treatments and juridical gender change in order to live in accordance with their gender identity. A number of studies conclude that there is a lack of knowledge among nurses concerning trans issues. Aim: The aim of the literature study was to compile the experiences of transgender people concerning interactions with healthcare professionals, and how they experienced being approached in healthcare settings. Method: Through structured database searches in CINAHL, PubMed and PsychInfo, 15 articles relevant to the aim of the study were identified. Qualitative latent content analysis was used to identify patterns across the 15 articles. Result: Transgender people perceived that healthcare professionals had insufficient knowledge regarding trans. The level of knowledge affected the way healthcare professionals acted towards transgender people. These behaviors affected the reactions and actions of transgender people when engaging with healthcare professionals. Conclusion: A distorted power balance between patient and healthcare professionals is created when trans people feel both powerless concerning their healthcare while also experiencing the need to be persistent in their healthcare process. By acquiring cultural competence, healthcare professionals can improve the way they interact with transgender people.

When therapists engage with clients from a culture other than their own, narrative therapy can be applied to overcome the linguistic and cultural challenges that result. Accordingly, this type of therapy allows for collective interactional problem solving. Hence, a qualitative narrative approach to therapy is advocated as being more culturally sensitive in diverse settings, because it should enable therapists to determine their clients' worldviews. This is a critical aspect of cross-cultural assessment and intervention when establishing an effective therapeutic relationship. The purpose of this study was to explore and describe (Babbie&Mouton, 2001) the utility of narrative therapy in order to enable a therapeutic alliance in a cross-cultural psychological assessment and intervention in a remote school. For this purpose, a qualitative research approach was adopted together with a constructivist paradigm. In addition, a content analysis design was employed by analysing existing documents comprising field notes (those of the student therapist, the supervisor and two peer supervisors), a reflection journal and visual data generated during cross-cultural psychological assessment and intervention sessions at the school. After reviewing the relevant literature, a priori categories (deductive analysis) were identified and the data sources were searched for instances of therapeutic alliance. This study found that the therapist's counselling skills and, more specifically, displaying coordinated acts of concern to benefit the client, namely actions such as thorough planning with a rationale for change; clear, logical communication; giving opportunities for re-learning; giving time; cooperation; being involved (responsive and taking part); paying attention (awareness and insight); benevolence; giving advice; being respectful; and instilling/communicating a sense of hope, may prove to have potential value in establishing a therapeutic alliance with these clients. In addition, the study found that the use of a narrative therapy technique, the clients, positive affect and the interaction between the therapist and the clients (therapeutic relationship) contributed marginally to the established alliance. The findings of the study suggest, therefore, that cultural competence did not contribute meaningfully to the development of a therapeutic alliance in this specific case, as cultural competence skills were not observed in the actions of the therapist. The findings further suggest that common factors, such as those of the therapist, client, relationship, and technique, are interactive and dynamic, and are all necessary factors in establishing a therapeutic alliance in cross-cultural assessment and intervention at a remote school. Copyright / Dissertation (MEd)--University of Pretoria, 2011. / Educational Psychology / unrestricted