In recent years the terms diversity and inclusion have become major buzzwords across industries and fields of study. Within the field of education broadly, and higher education in particular, a shifting student demographic can be seen across the country. Issues of equity and inclusion have become central complexities for present day educational strategists, and organizations committed to cultivating a culture of inclusion must do so with intentionality. In the context of higher education, this often requires the intentional development of professionals within a particular college or university. There has been a great deal of research concerning the development of cultural competence in traditional aged college students, but far fewer studies address development in higher education professionals. This project seeks to fill that gap. This study explores how higher education professionals develop and demonstrate cultural competence in their professional roles. Through a mixed methods case-study approach (Jupp, 2006), the current study generally addresses how perceived levels of cultural competence in higher education professionals is shaped by participation in an extended diversity training program. Additionally, this study addressed implications for individual career trajectories as a result of program completion and implementation of new learning. In-depth interviews were conducted to explore how participants of an extended diversity training program at a large urban institution conceive of their development of cultural competence. The objective of the program was to prepare participants to facilitate diversity education workshops across campus for their peers. One-on-one interviews explored ways in which participants’ individual development and application of cultural competence skills fits into the context of Social Cognitive Career Theory (Creswell, 2007; Lent, Brown, & Hackett, 2002). Additionally, secondary data analysis was conducted to assess participants’ perceived levels of cultural competence throughout the training experience. Study findings indicate that participants anticipate lasting effects from the training experience. The training introduced and ignited a reconfiguration of what it means to engage and work in spaces where institutional and organizational commitments are aligned with personal commitments. Following training, all participants expressed deep commitment to intentionally and actively cultivating a sense of belonging and inclusion in the workplace through shared language, shifts in policy, and more thoughtful interpersonal interactions with colleagues and peers.

According to the Centers for Disease Control and Prevention, 29.1 million people in the United States have diabetes. Among those 29.1 million people, 21 million have been diagnosed, but 8.1 million have not. Changing demographics in the United States and the prevalence of diabetes are projected to be burdens on the health care system through 2050. Guided by the social cognitive theory, the purpose of this qualitative case study was to understand the importance of culturally appropriate patient-provider communication to the self-management of Type 2 diabetes by patients who are African immigrants. Culturally based health care has unique challenges when delivering culturally appropriate diabetes care, so a focus on cultural knowledge, intercultural patient-provider communication skills, and cultural assessment were key to this case study. One pilot study was conducted to test the focus group questions with 3 diabetes providers (i.e., certified nurse diabetes educator [CDE], registered nutritionist, and dietitian) who help patients to self-manage their diabetes. The second pilot study was conducted with 5 African immigrant patients who had been diagnosed with Type 2 diabetes. The primary focus groups were conducted with 5 CDEs and 10 patients. The transcribed responses were analyzed and categorized to identify the 17 themes that emerged (9 from the CDEs and 8 from the patients). One implication for social change is that a patient-centered approach to patient-provider communication will mean better health outcomes. To ensure culturally appropriate patient-provider communication, a change in health care delivery is required to incorporate cultural constructs as part of diabetes care and education to accommodate various ethnic and racial groups.

Military cultural competence has gained attention due to the past 15 years of military conflict and ongoing deployment of troops around the globe. Returning veterans, particularly those who go on to experience homelessness, have reported negative experiences and adverse treatment from programs that were designed to support them. Those experiences have resulted in perceived barriers to access or use of such services. Researchers have established the need for increased levels of military cultural competence to develop rapport with veterans and their families when delivering community-based social and healthcare services. Bandura's self-efficacy theory was the theoretical framework of this study. This study examined the relationship between military cultural competence, socialization tactics, and perceived self-efficacy of service providers employed with Continuum of Care Program member organizations that served veterans experiencing homelessness. Data were collected utilizing a cross-sectional web-based survey. After conducting a bivariate correlation, a statistically significant relationship was found between military cultural competence levels, socialization tactics, and self-efficacy levels. After conducting multiple linear regression, it was found that socialization tactics did not moderate the relationship between military cultural competence levels on self-efficacy levels. Though moderation was not found, leadership of organizations that support veterans may want to consider these factors to inform onboarding and training decisions. Addressing behaviors and attitudes of service providers may support social change by reducing adverse treatment that creates barriers to access and use of programs and services.

The growing number of minority populations living in the United States makes it mandatory that all health care organizations seek to be culturally sensitive. There is no consensus on the definition of the term cultural sensitivity. The goal of this thesis is to define what cultural sensitivity means in a rural health center, from the perspective of the staff as well as the Hispanic patient. Anthropological methods, such as participant observation, semi-structured interviews, and archival data analysis, show that the qualities that Hispanic patients value in a clinic are 1) attention, 2) availability of Spanish language, 3) financial assistance, 4) solution to their health problems, 5) presence of Hispanics around the clinic, and 6) clinic services. Furthermore, 90% of staff responses indicate acceptance and respect of patients health beliefs and practices. Results demonstrate that while the clinic is culturally sensitive, there are a few recommendations that would improve the quality of care that Hispanics receive. Based on the results of the data collection, a practical model for other rural health centers to build upon a culturally sensitive health care system is developed.

Bakgrund: Barnhälsovården spelar en betydelsefull roll i det svenska folkhälsoarbetet. En femtedel av de inskrivna barnen har minst en förälder som är född utanför Sverige. Majoriteten av BVC-sköterskorna upplever arbetet med invandrarfamiljerna som stimulerande men anger också att svårigheter förekommer. Syftet: var att belysa faktorer som påverkar BVC-sköterskans transkulturella vårdrelationer med invandrarfamiljer i Barnhälsovården. Metod: Studien genomfördes som en allmän litteraturstudie och baserades på elva vetenskapliga artiklar som kvalitetsgranskades och analyserades. Resultatet redovisades i olika tre teman. Resultat: Faktorer som påverkade den transkulturella vårdrelationen i Barnhälsovården var BVC-sköterskans förmåga att kommunicera, bemötandet och förhållningssättet samt den kulturella kompetensen. Diskussion: Kommunikationssvårigheterna påverkade möjligheterna att skapa trygghet och förtroende i den transkulturella vårdrelationen. BVC-sköterskans bemötande och förhållningssätt hade betydelse inte bara för utgången av hälsovårdsarbetet utan även för invandrarfamiljens inställning till integration. Kulturell kompetens påverkade BVC-sköterskans möjligheter att se varje invandrarfamilj individuellt snarare än som en representant för sin kulturgrupp. Slutsats: För att möjliggöra en förtroendefull och trygg transkulturell vårdrelation i Barnhälsovården ställs inte bara krav på BVC-sköterskans skicklighet i att finna bra vägar för kommunikation, utan även på förmågan att praktiskt kunna omsätta sin kulturella kompetens samt insikt om betydelsen av att ge ett vänligt, empatiskt och individuellt bemötande åt invandrarfamiljen. / Background: The primary child health care services (PCHC services) plays an important part in the Swedish public health work. One fifth of the enrolled children have at least one parent born outside of Sweden. The majority of the PCHC nurses finds the interaction with the immigrant families stimulating but also recognizes difficulties. The aim: was to illuminate factors that influence the PCHC nurse's transcultural caring relationship with immigrant families in PCHC services. Method: The study was conducted as a literature review and based upon eleven scientific articles which were quality assessed and analyzed. The result was reported in three different themes. Result: Factors affecting the transcultural caring relationship in the PCHC services were the PCHC nurse's ability to communicate, the reception and approach and the cultural competence. Discussion: Communication difficulties affected the possibilities to create trust and confidence in the transcultural caring relationship. The PCHC nurse's reception and approach had implications not only for the outcome of the health care work but also for the immigrant family's attitude towards integration. Cultural competence affected the PCHC nurse's possibilities to see each immigrant family individually rather than as a representative of their cultural group. Conclusion: To enable a safe and trusting transcultural caring relationship in the PCHC services it’s necessary that the PCHC nurse has good communication skills, is able to use and incorporate cultural competence and understands the importance of providing a friendly, empathetic and individual approach to the immigrant family.

En réponse à la disproportion des familles de minorités visibles dans le système montréalais de la protection de la jeunesse, cette recherche explore, du point de vue de l'intervenant, le rôle de ses compétences culturelles et du soutien informel parental dans l’élaboration d'une relation de collaboration. L’analyse porte sur 24 entrevues individuelles, où 48 interventions sont racontées par des intervenants. Les résultats proposent une typologie, élaborée à partir de la collaboration des parents et de l’engagement de leur réseau informel dans l’intervention. Ils présentent ensuite une description des compétences culturelles et de leur utilisation auprès des dynamiques familiales comprises dans la typologie. La discussion aborde la résilience sociale, les stratégies d’intervention et le constructionnisme social. Trois principales idées sont évoquées : une conception de la collaboration qui inclut le réseau informel, une réflexion sur la notion de « compétences culturelles » et le développement d’une pratique réflexive. / This research is in response to the overrepresentation of visible minority families in the Montreal child welfare system. It explores, from the perspective of the practitioner, the role of the practitioner's cultural competencies and of informal parental support in developing collaborative relationships. The analysis looks at data from 24 individual interviews, during which practitioners described 48 different interventions. The results propose a typology based on the collaboration of parents and the involvement of their informal network in the intervention. The practitioners provide a description of the competencies and how they are used with typology profiles. The discussion evokes the concept of social resilience, intervention strategies and social constructionism. Three outcomes result from this research : a view of collaboration that expands on the informal network, a questioning of cultural competencies, and the development of a reflective practice.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Background: Migration is a global phenomenon that characterize today’s globalized world. Although, the relationship between migration and health in the host countries is not always negative, many countries, including Sweden are concerned about possible spread of infectious diseases of public health significance such as HIV/AIDS and tuberculosis (TB). Moreover, apart from disease profiles, migrants also have different socio-cultural backgrounds, which may challenge health care access and provision. Objectives: To investigate, identify, and delineate potential challenges of relevance in the care and prevention of communicable diseases of public health significance in general and particularly HIV/AIDS and TB among migrants from countries where these infections are endemic, and eventually generate knowledge that could inform policies and practice. Methods: Data for this thesis were collected in four of the five counties of the Northern region in Sweden. Quantitative and qualitative methods were used including a survey of 268 migrant students in two language schools (I & II); an interview study with 10 care providers caring for patients with migrant backgrounds and observations of care encounters (III) and an interview study with 15 care providers experienced in screening migrants (IV). Descriptive and logistic regression analyses were used to summarize survey data whereas a thematic analysis approach was applied to the qualitative data within the interpretive description framework. Results: The students scored on average low on both HIV/AIDS and TB knowledge and displayed misconceptions and negative attitudes towards the two diseases and infected/sick persons. Knowledge level and attitude could be predicted by prior knowledge, years of previous education and geographic origin. In contrast, no association was found between being screened and the level of TB knowledge or attitude towards TB and infected/sick persons. However, fear of being deported appeared to be the main predictor of reluctance to seek HIV/AIDS care after controlling for socio-demographic factors, knowledge level, stigmatizing attitudes and fear of disclosure. Health care providers described complex and intertwined challenges that influenced both care delivery and receipt. The challenges described included language, the socio-cultural diversity within migrant groups and between migrants and the caregivers. These often resulted in divergent perceptions and expectations about care and caring. The participants highlighted the complexities of caring for diverse patients within different institutions with conflicting policies and frameworks. They also described the difficulties the migrants face in navigating the Swedish care system. Conclusions: This thesis illuminates complex challenges in the care of migrants. The findings emphasize the need for multilevel strategies in order to remove identified barriers. This requires accommodating diversity by improving care providers’ cultural competence and migrants’ health literacy. It further requires policies and practices that emphasize health services responsiveness in order to provide equal access and equitable care. Finally, it entails revisiting existing policies and legislative frameworks to promote a change in ways of thinking about and approaching migration, HIV/AIDS and TB issues, to address the specific vulnerabilities of mobile populations in a world on the move.

INTRODUKTION Sverige tar emot en stor andel flyktingar och flera kommer till glesbygd. Ett bra mottagande är avgörande för flyktingarnas hälsa. De har rätt till hälsoundersökning, akut sjukvård samt sjukvård som inte kan vänta. Kulturella skillnader innebär utmaningar för vården och distriktssköterskorna som möter flyktingarna. SYFTE Syftet med studien var att undersöka distriktssköterskors upplevelser av faktorer som påverkar mötet med flyktingar på hälsocentraler utan specifik flyktingmottagning i glesbygd. METOD Studien genomfördes med kvalitativ design. Åtta distriktssköterskor med erfarenhet av flyktingmottagande i glesbygd valdes ut och intervjuades. Semistrukturerade intervjuer genomfördes och insamlad data analyserades med kvalitativ innehållsanalys. RESULTAT Ett bra bemötande är viktigt när flyktingar söker vård samt tilltro till flyktingarna när de söker vård som inte kan anstå. Bedömningar av vad som är vård som inte kan vänta har beskrivits som svåra. Kännedom om kulturer har beskrivits som önskvärt. Att prioritera hälsosamtalen har betonats som viktigt. Uppdraget kring flyktingmottagning är tydligt, men resurser saknas och kunskapsutveckling var önskvärd. Positiv utveckling i arbetet med flyktingar i glesbygd har setts och tron är att antalet kommer att öka. Relationerna upplevs mer personliga i glesbygd. KONKLUSION I glesbygd upplevs mötet mer personligt och distriktssköterskorna vill utvecklas och arbeta gränsöverskridande. Flyktingarna har förtroende för vårdpersonalen vilket möjliggör att integration främjas om distriktssköterskan ser det som sitt ansvar och ges resurser. Behovet av kunskap i transkulturell omvårdnad är högst aktuellt och för att tillgodose detta efterfrågas möjligheter till eftertanke och utbyte av erfarenheter. / INTRODUCION Sweden receives a large number of refugees and many of them come to the rural area. A good reception is crucial for the health of the refugees who are entitled to a health assessment, emergency care and care that cannot wait. Cultural differences imply challenges for the health care and primary health care nurses who meet the refugees. OBJECTIVE The aim of this study was to investigate the factors that affect the experience of primary health care nurses meeting with refugees at community health centers without specific care refugee centers in rural areas. METHOD The study was performed with a qualitative design. Eight primary health care nurses with experiences working with refugees in rural areas were sampled and interviewed. Data was collected from semi structured interviews and analyzed using qualitative content analysis. RESULTS A good attitude is important when refugees seek care, and to credence the refugees when they seek health care that cannot wait. Assessments to characterize 'what is care that cannot wait' described as difficult. The knowledge of cultures was expressed as desirable. Prioritizing health assessments were emphasized as important. The assignment in refugee reception is clear, but there is a lack of resources and the wish for knowledge was expressed. Positive development in working with refugees exists and the number of refugees is believed to increase in rural areas. The relationships are perceived more personal in rural areas. CONCLUSION In rural areas, the meeting felt more personal and primary health care nurses wish to develop and operate transboundary. The refugees have confidence in the nursing staff which enables integration and could be promoted by the primary health care nurses if they saw this as their responsibility and were provided proper resources. Knowledge of trans-cultural nursing is needed today in health care and to develop that it demands the opportunity for reflection and exchange of experiences.

Bakgrund: Den växande kulturella mångfalden i Sverige har lett till nya utmaningar för samhället och inte minst för sjukvården. Kultur är universellt för alla människor och speglas bland annat av faktorer som religion, värderingar, språk, miljö och kön. Den kulturella bakgrunden influerar våra uppfattningar av hälsa och sjukdom och hur vi ger uttryck för smärta och obehag. Det finns likheter och olikheter som leder till att vårdande kan förstås på olika sätt och kräver därför kulturellt kompetenta vårdgivare. Syfte: Syftet är att belysa hur vårdtagare med olika kulturella bakgrunder och vårdpersonal upplever transkulturella möten inom den svenska sjukvården. Metod: Litteraturöversikt där tolv kvalitativa studiers resultat har syntetiserats och sammanställts. Sex artiklar utgår från ett vårdtagarperspektiv och sex från ett vårdpersonalperspektiv. Gemensamt för studierna är att de belyser upplevelser av transkulturella möten i svensk sjukvård. Resultat: Tre teman framkom med två subteman vardera. Det första temat är ”Utmaningar relaterat till kommunikation”, med två subteman, ”Språket som hinder” och ”Användning av tolk”. Det andra temat är ”Utmaningar relaterat till kulturella olikheter”, med två subteman, ”Olikheter i synen på vård och vårdande” och ”Uppfattningar om könsskillnader”. Det tredje temat är ”Fördomar och kränkande bemötande”, med två subteman, ”Fördomar och misstro” och ”Upplevelser och tankar om kränkande bemötande”. Diskussion: Resultatet i denna studie ger en bild av att transkulturella möten i vården inte är helt okomplicerade. Det saknas verktyg att närma sig varandra i transkulturella möten och det handlar om att hitta nya vägar att kommunicera, både verbalt men också icke-verbalt. Vårdpersonal upplever känslor av frustration och osäkerhet när de vårdar människor med andra kulturella bakgrunder än den egna. Dessa känslor kan ses som exempel på ett etnocentriskt förhållningssätt. För att vårdpersonal ska kunna utveckla kulturell kompetens krävs utbildning och reflektion om transkulturell omvårdnad. / Background: The increasing cultural diversity in Sweden has led to new challenges for the society and the health care services. Culture is universal for all humans and is reflected by factors such as religion, values, language, environment and gender. The cultural background influence our perceptions about health and sickness and how we express pain and discomfort. There are similarities and differences which leads to different understandings about caring hence the importance of cultural competence among health care staff. Aim: To illuminate clients and health care staff´s experiences of transcultural meetings in the context of Swedish health care. Methods: A litterature overview. The results of twelve qualitative studys have been synthesized and summarized. Six articles are from a clients perspective and the other six from a health care staff perspective. All of the studys have in common that they illuminate experiences of transcultural meetings in Swedish health care. Results: Three themes emerged with two subthemes each. The first theme is ”Challenges related to communication” with two subthemes, ”Language as a barrier” and ”The use of interpreter”. The second theme is ”Challenges related to cultural differences” with two subthemes, ”Different views of care and caring” and ”Perceptions about gender-differences”. The third theme is ”Prejudices and offensive treatment” with two subthemes, ”Prejudices and disbeliefs” and ”Perceptions and thoughts about offensive treatments”. Discussion: The result in this study provides a picture that transcultural meetings are not entirely uncomplicated. There are lack of tools to approach one another in transcultural meetings and it is a matter of finding new ways to communicate, both verbally and non-verbally. Health care staff experience feelings of frustration and insecurity when they care for people with different cultural backgrounds than their own. These feelings can be understood as examples of an ethnocentric approach. In order to develope cultural competence the health care staff needs education and reflection of transcultural care.