The purpose of this study was two-fold. The first was to determine the degree of culturally responsive teaching practices and level of cultural competence of participants who teach upper elementary (grades three through six) STEM educators of predominantly Native Hawaiian students. The second purpose was to identify differences in cultural competence and culturally responsive teaching practices of those same participants identified above. These two participant groups were from the State of Hawaiʻi Department of Education’s Keonepoko and Pāhoa Elementary Schools. Both schools are from the Keaʻau-Kaʻu-Pāhoa Complex Area. The educators from Keonepoko were afforded knowledge and experiences from a culture-based professional development program known as the Moenahā School Program, while the educators from Pāhoa were not afforded these same knowledge and experiences. Using a quantitative, quasi-experimental design, data were collected via an online survey using three instruments: the Culturally Responsive Teaching Self-Efficacy Inventory (CRTSE), the Cultural Competence Self-Assessment Questionnaire (CCSAQ), and the Cultural Competence Self-Assessment Scale Demographic Information (CCSASDI). The data were analyzed using mean scores and those mean scores were compared for differences using a Mann-Whitney U test. The findings indicated the Moenahā participants had a statistically significantly higher level of cultural competence and higher degree of culturally responsive teaching practices than the non-Moenahā participants suggesting the importance of cultural competence professional development iii opportunities. These findings are applicable for teachers in schools with an higher Native Hawaiian student population. / Ph. D.

As the state of the world continues to evolve through means of social justice and technology, the discussion of cultural humility as the evolution of cultural competence is a growing topic in the field of mental health and the art therapy community. The following mixed- method research explores the impact of art materials, group processes, and creative practices in the development of cultural humility. Six graduate students from the Marital and Family Art Therapy Program at Loyola Marymount University (LMU) designed the following collaborative ethnography. Utilizing both quantitative and qualitative data to answer the question: How can group art-based practices (e.g., materials, group processes) develop cultural humility among art therapists? The data collected include pre and post-survey statistics in addition to art responses and dialogue reflection. The data revealed that art-based group processes and the intentional choice of material may facilitate the growth surrounding the four principles of cultural humility. Critical self-reflection was achieved through a deep exploration of individual experiences surrounding socioeconomic status, race, colonialism, gender, family, and spirituality. Participants were able to readdress the power imbalance by taking on the role of participant and facilitator taking into consideration how information and materials are both presented and received. Through group art-making, sharing, and discussing systemic changes, participants developed partnerships with communities and maintained institutional accountability. In order to build upon our findings, we propose future research on group-based art practices with mental health professionals and trainees that focus on the development of cultural humility in different social and environmental contexts.

Background: The implementation of the Care Matters: Transforming the Lives of Children and Young People in Care Green Paper (Department for Education and Skills, (DfES) 2006) and the subsequent Care Matters: Time for Change White Paper (DfES, 2007), witnessed the consolidation of a universal ambition to improve the opportunities for all children living in care. Arguably, the most important recommendation in this pursuit is reflected in the need to provide people who have lived in care as children with independent support, which enables them to discuss their experiences, and suggest ways in which the care system might be improved. However, whilst this recommendation has been implemented with a diverse range of care leavers, the impact of the experience of living in care and the associated disadvantage experienced by Travellers and Gypsies remains under researched, understated, and unacknowledged (Cemlyn et al., 2009). Methodology: Guided by the philosophical assumptions of interpretative phenomenological analysis (IPA), this study represents and constructs the experience of living in public care by focusing on the voices 10 Travellers and Gypsies who lived in care as children. Testimonies were collected through a wide variety of methods that included face-to-face interviews, focus groups, telephone interviews, blogs, emails, letters, song lyrics, and poems. Findings: Following a considered application of IPA, six main themes emerged from the analysis. These were social intervention; an emotional rollercoaster of separation, transition, and reincorporation; a war against becoming settled; leaving care and the changing relationship with the self and others; inclusion and strength; and, messages for children living in care. In line with the tenets of phenomenology, these findings are presented in such a way to as to invite the reader to move away from their own personal understanding of the world in order to enter the ‘lifeworld’ (Husserl, 1970, 1982) of Travellers and Gypsies who lived in care as children. However, to assist in this sense making activity, this study also provides a discrete interpretation of the findings before developing this knowledge to form a more detailed theoretical construct entitled ‘the model of reflective self-concepts’. Taken together with the testimonies of each person who took part in the study, the thesis enables an understanding of how the experience of living in care is inextricably linked to a process of social and psychological acculturation. By staying close to the experiences provided, it reveals how a process of change is determined, more often than not, by a sense of personal resilience directly related towards a Traveller or Gypsy self-concept. In attempt to move towards service improvement, this thesis offers a series of recommendations and conclusions which aim to support social workers and carers empower Traveller and Gypsy children to develop a secure Traveller and Gypsy self-concept thus enabling them experience improved outcomes including those opportunities set out in Care Matters social policy agenda (DfES, 2006; 2007).

This thesis examines the shifting relationship between the state and its subjects with regard to responsibility for and entitlement to care. Using Malaysia as a case study the research engages with international medical travel (IMT) as an outcome of the neoliberal retrenchment of the welfare state. I offer a critical reading of postcolonial development strategies that negotiate the benefits and challenges of extending care to non-national subjects. The research draws from relevant media, private-sector and governmental documents and 49 semi-structured, in-depth interviews with IMT proponents and critics representing federal, state and urban governmental authorities, professional associations, civil society, private medical facilities and medical travel agencies in Malaysia’s principal IMT regions (Klang Valley, Penang and Malacca). Across four empirical chapters, the thesis demonstrates how ‘Malaysia’ gets positioned as a destination within a range of imagined geographies of care through a strategic-relational logic of care and hospitality. I argue that this positioning places ‘Malaysian’ subjects and spaces into lucrative global networks in ways that underscore particular narratives of postcolonial hybridity that draw from Malaysia’s ‘developing country’, ‘progressive, moderate Islamic’ and ‘multiethnic’ credentials. In considering the political logics of care-giving, I explore how the extension of care can serve as a place-making technology to re-imagine the state as a provider and protector within a globalising marketplace in which care, increasingly commodified, is tied to the production of new political, social, cultural and economic geographies.

Dans un contexte de mondialisation, les frontières géographiques et politiques se font de plus en plus diffuses et donnent lieu à un mélange des cultures tant au niveau local qu'international. Ce pluralisme culturel observé dans la population se transpose dans les milieux de soins, amenant son lot d'enjeux et de défis pour la pratique et la formation infirmière. Le développement de la compétence culturelle chez les professionnels de la santé est considéré comme l'une des solutions favorisant la qualité et l'équité dans les soins en contexte de diversité culturelle. La compétence culturelle fait l'objet de nombreux articles scientifiques en sciences infirmières, mais bon nombre d'entre eux sont issus d'une perspective essentialiste. À notre connaissance, aucune étude ne permet de représenter la trajectoire de développement de cette compétence sur un continuum intégrant des apprentissages réalisés à la fois chez des étudiantes et des infirmières selon une perspective constructiviste. Cette étude vise donc à formuler une proposition théorique constructiviste du développement de la compétence culturelle infirmière. L'approche de théorisation ancrée de Corbin et Strauss (2008) a permis de documenter le processus de développement de la compétence culturelle chez des infirmières et des étudiantes dans un Centre de santé et de services sociaux desservant une population qui présente une grande diversité culturelle. Une stratégie d'échantillonnage intentionnel a permis de recruter des infirmières identifiées par leurs pairs comme étant expertes du domaine des soins en contexte de diversité culturelle, des infirmières se disant intéressées par une pratique culturellement compétente et des étudiantes en dernière année d'un programme de baccalauréat en sciences infirmières. Un total de 24 participantes, dont 13 infirmières et 11 étudiantes ont pris part à cette étude. Un questionnaire sociodémographique, des périodes d'observation participante et des entrevues semi-structurées ont servi d'outils de collecte des données. La catégorie centrale « apprendre à réunir les différentes réalités afin d'offrir des soins efficaces en contexte de diversité culturelle » a été construite à partir d'une analyse inductive des données. Cette catégorie centrale se divise en trois sous-catégories : « construire la relation avec l'autre », « sortir du cadre habituel de pratique » et « réinventer sa pratique dans l'action ». La proposition théorique formulée présente l'évolution concomitante de ces trois sous-catégories en trois niveaux de développement de la compétence culturelle infirmière : « s'ouvrir aux différentes réalités entourant la pratique en contexte de diversité culturelle », « mettre à l'épreuve sa pratique » et « réunir les différentes réalités de la pratique en contexte de diversité culturelle de façon intégrée ». La proposition théorique constructiviste est ancrée dans les données empiriques, circonscrit des étapes de développement interreliées et met en contexte les apprentissages du début du développement de la compétence culturelle à l'expertise. Les éléments contextuels précisés suggèrent l'ajout des dimensions sociales et politiques dans la définition du concept de compétence culturelle. Les deux principales contributions théoriques de cette étude soulignent que l'interaction entre l'infirmière et l'environnement de même que l'expérience clinique sont constitutifs du développement de cette compétence. Les retombées de cette recherche se situent non seulement en formation, mais aussi dans la pratique, la gestion et la recherche en sciences infirmières. / In a context of globalization, political and geographical barriers are more diffuse and involve a blend of cultures both locally and internationally. This cultural pluralism, also observed in health care settings, creates issues and challenges for nursing practice and education. The development of cultural competence among health care professionals is considered an essential condition to promote quality and equity in health care. In nursing science, cultural competence is generally treated from an essentialist perspective. To our knowledge, there have been no published studies to date of the processes involved in the development of cultural competence among nurses and students nurses that are embedded in a constructivist approach. The purpose of this study is to develop a constructivist theoretical proposition pertaining to the development of cultural competence in nursing from a constructivist perspective. A grounded theory design (Corbin & Strauss 2008) was implemented to study the developmental process of cultural competence among nurses and student nurses in a health care and social service center situated in a culturally diverse setting. A purposive sampling strategy allowed to recruit nurses recognized by their peers as having a high level of proficiency in cultural competence, as well as nurses that were preoccupied by culturally competent practice and senior undergraduate level students. A total of 24 study participants includes 13 nurses and 11 students. Data collection proceeded via a sociodemographic questionnaire, participant observation and semi-structured interviews. The central category dlearning to combine different realities to provide effective care in a context of cultural diversitye was constructed using an inductive qualitative data analysis process. This central category is divided in three subcategories : dbuilding the relation with the othere, dgoing beyond the usual course of practicee and dreinventing its practice through actione. The resulting theoretical proposition describes the concomitant evolution of these three categories into three developmental levels of cultural competence: "opening to different realities of practice in the context of cultural diversity", "challenging one's practice" and "bringing together different realities of practice in the context of cultural diversity in an integrated mannere. The resulting theoretical proposition reflects a constructivist perspective, is grounded in empirical data, delineates inter-related developmental stages of cultural competence, from initiation to expertise, and situates learning in context. These contextual elements suggest the addition of social and political dimensions to the conceptual definition of cultural competence. The main theoretical contributions of this study are two fold. First, the interaction between nurses and their environment and, second, clinical experience, both contribute significantly to the development of cultural competence. The outcomes of this study are relevant not only for nursing education but also for nursing practice, management, and research.

Il existe une grande diversité dans les programmes de formation en sciences infirmières concernant l’organisation de stages d’immersion clinique à l’international et le soutien offert aux étudiantes (Kokko, 2011). Cette étude de cas qualitative explore, selon la perspective d’étudiantes infirmières, les éléments de l’environnement d’apprentissage de la pratique en contexte de diversité culturelle dans le cadre d’une immersion clinique à l’international. Le modèle constructiviste de développement de la compétence culturelle de Blanchet Garneau (2013 ; Blanchet Garneau et Pepin, 2015a) a servi de cadre de référence à cette étude. Dix étudiantes ayant participé à l’immersion clinique ont pris part à une entrevue individuelle en profondeur. Suite à une analyse qualitative thématique des données inspirée de Miles, Huberman et Saldana (2014), trois thèmes inter reliés ressortent : accompagnement par de multiples collaborations, trouver sa place dans le milieu d’accueil et écart entre les attentes des étudiantes et l’expérience vécue. Ces thèmes permettent de comprendre l’environnement d’apprentissage des étudiantes dans le développement de leur compétence culturelle, notamment leur capacité de s’ouvrir aux différentes réalités en contexte de diversité culturelle. Puisque peu d’écrits abordent spécifiquement les éléments de l’environnement d’apprentissage liés à la capacité de s’ouvrir aux différentes réalités de la pratique en contexte de diversité culturelle à l’étranger, cette étude contribue à l’approfondissement des éléments de l’environnement d’apprentissage présenté dans le modèle de Blanchet Garneau (2013 ; Blanchet Garneau et Pepin, 2015) et constitue un ajout aux connaissances actuelles liées au développement de la compétence culturelle. / There is a wide diversity in nursing education programs concerning the organization of international clinical immersion curricula and the support offered to students (Kokko, 2011). Guided by the constructivist cultural competence development model designed by Blanchet Garneau (2013 ; Blanchet Garneau et Pepin, 2015a), this qualitative case study explored the learning environment that promotes the development of nursing practice in culturally diverse contexts through an international clinical immersion. Ten students who had recently undergone international clinical immersion participated in an individual in depth interview. Thematic qualitative data analysis was inspired by Miles, Huberman and Saldana (2014). Results of this study yield three interrelated themes: support through multiple collaborations, finding one’s place in the host environment and gap between the expectations of the students and the lived experience. These themes develop our understanding of learning environments in students’ cultural competence development, particularly with respect to their capacity to open up to different realities of practice in a culturally diverse context. In summary, this study adds to current knowledge related to cultural competence development and contributes to Blanchet Garneau’s model (2013 ; Blanchet Garneau et Pepin, 2015b).

Global student mobility has become a dynamic force in American higher education. Integrating international students into diverse campus environments provides domestic as well as foreign students with enriched learning opportunities. However, a diverse campus climate itself will not make college students interculturally competent. Intentional curricular design is critical for overcoming issues such as resistance and reinforcement of stereotypes, but the research literature is extremely limited on effective pedagogical strategies for cultivating college students' intercultural sensitivity. This paper explicates a research study to investigate college students' development of intercultural sensitivity through an intentional course design utilizing Kolb's (1984) learning styles cycle and Hammer's (2009) Intercultural Development Continuum (IDC). Quantitative and qualitative data were collected to explore domestic and international students' intercultural learning experiences and to potentially identify pedagogical approaches that facilitate students' intercultural competence. These findings show that the four pedagogical strategies associated with Kolb's learning cycle were effective and crucial when designing an intercultural course in order to develop college students' intercultural competence. This study also revealed a gap in intercultural development through the intentional intercultural course between American students and Japanese exchange students due to their vastly different intercultural experiences.

Increasing diversity among community college students and the rising demand for a culturally competent workforce necessitate community college faculty across all disciplines to adjust their pedagogical choices to effectively serve diverse students while preparing all students for the new global era. The purpose of this narrative study was to explore what culturally competent pedagogies effective community college instructors use and reasons behind their choices. The study was conducted at a large community college in the Pacific Northwest. Data was collected through in-depth interviews with ten instructors teaching in different disciplines. In addition, the Intercultural Development Inventory (IDI) was used to measure participants' intercultural competency. The findings revealed that the participants were cognizant of the growing diversity in their classes and made a number of pedagogical choices to accommodate their students' needs. The findings also revealed that the participants' teaching in the Humanities and the Adult Basic Skills departments had more latitude in engaging diversity and choosing materials to fit the needs of their students compared to science and vocational field instructors.

Dans un contexte de mondialisation, les frontières géographiques et politiques se font de plus en plus diffuses et donnent lieu à un mélange des cultures tant au niveau local qu'international. Ce pluralisme culturel observé dans la population se transpose dans les milieux de soins, amenant son lot d'enjeux et de défis pour la pratique et la formation infirmière. Le développement de la compétence culturelle chez les professionnels de la santé est considéré comme l'une des solutions favorisant la qualité et l'équité dans les soins en contexte de diversité culturelle. La compétence culturelle fait l'objet de nombreux articles scientifiques en sciences infirmières, mais bon nombre d'entre eux sont issus d'une perspective essentialiste. À notre connaissance, aucune étude ne permet de représenter la trajectoire de développement de cette compétence sur un continuum intégrant des apprentissages réalisés à la fois chez des étudiantes et des infirmières selon une perspective constructiviste. Cette étude vise donc à formuler une proposition théorique constructiviste du développement de la compétence culturelle infirmière. L'approche de théorisation ancrée de Corbin et Strauss (2008) a permis de documenter le processus de développement de la compétence culturelle chez des infirmières et des étudiantes dans un Centre de santé et de services sociaux desservant une population qui présente une grande diversité culturelle. Une stratégie d'échantillonnage intentionnel a permis de recruter des infirmières identifiées par leurs pairs comme étant expertes du domaine des soins en contexte de diversité culturelle, des infirmières se disant intéressées par une pratique culturellement compétente et des étudiantes en dernière année d'un programme de baccalauréat en sciences infirmières. Un total de 24 participantes, dont 13 infirmières et 11 étudiantes ont pris part à cette étude. Un questionnaire sociodémographique, des périodes d'observation participante et des entrevues semi-structurées ont servi d'outils de collecte des données. La catégorie centrale « apprendre à réunir les différentes réalités afin d'offrir des soins efficaces en contexte de diversité culturelle » a été construite à partir d'une analyse inductive des données. Cette catégorie centrale se divise en trois sous-catégories : « construire la relation avec l'autre », « sortir du cadre habituel de pratique » et « réinventer sa pratique dans l'action ». La proposition théorique formulée présente l'évolution concomitante de ces trois sous-catégories en trois niveaux de développement de la compétence culturelle infirmière : « s'ouvrir aux différentes réalités entourant la pratique en contexte de diversité culturelle », « mettre à l'épreuve sa pratique » et « réunir les différentes réalités de la pratique en contexte de diversité culturelle de façon intégrée ». La proposition théorique constructiviste est ancrée dans les données empiriques, circonscrit des étapes de développement interreliées et met en contexte les apprentissages du début du développement de la compétence culturelle à l'expertise. Les éléments contextuels précisés suggèrent l'ajout des dimensions sociales et politiques dans la définition du concept de compétence culturelle. Les deux principales contributions théoriques de cette étude soulignent que l'interaction entre l'infirmière et l'environnement de même que l'expérience clinique sont constitutifs du développement de cette compétence. Les retombées de cette recherche se situent non seulement en formation, mais aussi dans la pratique, la gestion et la recherche en sciences infirmières. / In a context of globalization, political and geographical barriers are more diffuse and involve a blend of cultures both locally and internationally. This cultural pluralism, also observed in health care settings, creates issues and challenges for nursing practice and education. The development of cultural competence among health care professionals is considered an essential condition to promote quality and equity in health care. In nursing science, cultural competence is generally treated from an essentialist perspective. To our knowledge, there have been no published studies to date of the processes involved in the development of cultural competence among nurses and students nurses that are embedded in a constructivist approach. The purpose of this study is to develop a constructivist theoretical proposition pertaining to the development of cultural competence in nursing from a constructivist perspective. A grounded theory design (Corbin & Strauss 2008) was implemented to study the developmental process of cultural competence among nurses and student nurses in a health care and social service center situated in a culturally diverse setting. A purposive sampling strategy allowed to recruit nurses recognized by their peers as having a high level of proficiency in cultural competence, as well as nurses that were preoccupied by culturally competent practice and senior undergraduate level students. A total of 24 study participants includes 13 nurses and 11 students. Data collection proceeded via a sociodemographic questionnaire, participant observation and semi-structured interviews. The central category dlearning to combine different realities to provide effective care in a context of cultural diversitye was constructed using an inductive qualitative data analysis process. This central category is divided in three subcategories : dbuilding the relation with the othere, dgoing beyond the usual course of practicee and dreinventing its practice through actione. The resulting theoretical proposition describes the concomitant evolution of these three categories into three developmental levels of cultural competence: "opening to different realities of practice in the context of cultural diversity", "challenging one's practice" and "bringing together different realities of practice in the context of cultural diversity in an integrated mannere. The resulting theoretical proposition reflects a constructivist perspective, is grounded in empirical data, delineates inter-related developmental stages of cultural competence, from initiation to expertise, and situates learning in context. These contextual elements suggest the addition of social and political dimensions to the conceptual definition of cultural competence. The main theoretical contributions of this study are two fold. First, the interaction between nurses and their environment and, second, clinical experience, both contribute significantly to the development of cultural competence. The outcomes of this study are relevant not only for nursing education but also for nursing practice, management, and research.

Cultural competence is widely recognized as an essential strategy for reducing health disparities. As the United States' population becomes increasingly ethno-culturally diverse, these disparities are becoming even more pronounced. One particular challenge in this regard concerns overweight/obesity prevalence among American adults, as a disproportionately high number of racial and ethnic minority adults are classified as overweight or obese. Dietary behavior assessments are often utilized by health and human services professionals to obtain the data necessary to promote goals such as the reduction and elimination of overweight/obesity across all ethno-cultural groups. The primary objective of this research study was to develop, test, and evaluate a culturally-competent dietary behavior assessment instrument by effectively synthesizing qualitative methods from Cognitive Anthropology with appropriate survey research and quantitative statistical methods. Specifically, a quantitative methods triangle of hierarchical cluster analysis, binary logistic regression, and Poisson regression in conjunction with the free listing qualitative research technique from Cognitive Anthropology was explored as a possible combined methodological approach for researchers and public health professionals wishing to develop a comprehensive understanding of dietary behaviors at the local community level. Binary logistic regression and Poisson regression enabled the relationship between selected food categories and certain demographic/cultural indicators to be modeled, while hierarchical cluster analyses enabled modeling of the distinct patterns of food category groupings that comprise individuals' regular diet. Additionally, initial qualitative analyses of the raw data promoted an understanding of the influence that the local fast food and dine-in restaurant environment has on the dietary behaviors of the target population. The results of this study suggest that a quantitative methods triangle of hierarchical cluster analysis, binary logistic regression analysis, and Poisson regression analysis founded upon qualitative research principles has potential for use as a combined methodological approach for researchers and public health professionals wishing to develop a comprehensive understanding of dietary behaviors at the local community level. By employing these techniques, researchers can analyze individual dietary behaviors and eating patterns from a multifaceted perspective. In turn, public health professionals can develop community-based, cross-culturally relevant programs and interventions that are equally effective across all ethno-cultural groups in their target population.