Research has shown that African-Americans are least likely to receive adequate palliative interventions leading to concerns about the quality of health care in general and palliative care in particular for this population. Acknowledging patient preferences are essential in administering quality health care especially when a patient's condition is terminal. But when African-Americans are least likely to complete living wills or durable power of attorneys for health care and more likely to continue to request life sustaining treatments when near death, conflicts between patients and medical professionals can result.<br> Recognizing patient spirituality and addressing their spiritual needs can help the patient, family or surrogate decision-maker come to terms with, if not make sense of, their life-threatening illness and eventual mortality. This may be especially salient for African-Americans because of their history of victimization of racial discrimination and ensuing overwhelming challenges with sometimes tragic consequences. Models and approaches used to assess the spirituality of African-American patients must be culturally appropriate and performed by professionals with interpersonal communications skills and an awareness of how their implicit bias can impede the integrity of the clinician-patient interaction. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Life expectancy and overall health have improved in recent years for most Americans, thanks in part to an increased focus on preventive medicine and dynamic new advances in medical technology. However, not all Americans are benefiting equally. This suggests a level of urgency for need to assist our public health professionals in obtaining specific skills sets that will assist them in working better with ethnic and racial minority populations. The overall goal of the research was to assess cultural competence knowledge and programmatic skill sets of individuals employed by an urban department of health located in the southwest region of the US. The Theory of Planned Behavior (TPB) guided the research design to effectively evaluate the correlation between behavior and beliefs, attitudes and intention, of an individual, as well as their level of perceived control. Within the program design, 90 participants were identified using convenience sampling. In order to effectively evaluate these constructs, a quantitative research approach was employed to assess attitudes, beliefs, knowledge and competencies of the subject matter. Participants completed the Cultural Competence Assessment (CCA), which is designed to explore individual knowledge, feelings and actions of respondents when interacting with others in health service environments (Schim, 2009). The instrument is based on the cultural competence model, and measures cultural awareness and sensitivity; cultural competence behaviors and cultural diversity experience on a 49 item scale. It seeks to assess actual behaviors through a self report, rather than self-efficacy of performing behaviors. In addition, information was obtained to assess participant perception of organizational promotion of culturally competent care and; availability of opportunities to participate in professional development training. The analysis suggested healthcare professionals who are more knowledgeable and possess attitudes which reflect increased cultural sensitivity, are more likely to engage in culturally competent behaviors. In addition, positive attitudes and increased knowledge were associated with diversity training participation. Respondents reported high levels of interaction with patients from ethnic and racial minorities. Observing the clinical and non-clinical respondents, approximately 47% and 57% respectively, stated their cultural diversity training was an employer sponsored program.

The population demographics of the greater Toronto Area are rapidly changing, with visible minorities comprising 43% of the GTA, and 10% of the total adult population of Canada. It is incumbent upon the health care sector to accommodate these changes in a culturally competent manner. Health care and culture intersect in the most delicate of ways during the last stages of life. The health care system must ensure that minorities have an equal access to end-of-life health care services and that their individual cultural beliefs and values are respected by culturally competent health care providers. Hence, this thesis examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area. This study will show the strengths and limitations of the current hospice care in terms of providing culturally competent care. To explore this topic in greater detail, my research is guided by the following questions: 1) What is the current state of culturally competent care in a hospice setting? 2) What are the challenges to providing culturally competent care in a hospice in the Greater Toronto Area? 3) What are some possible strategies for increasing competency within a hospice setting? To explore my research questions fully, I provide a critical analysis of six cultural competency theories, while integrating a social determinants of health framework, focusing on the theory of social exclusion and minority health care. This case study analysis is enhanced by the 14 in-depth interviews of hospice volunteer participants and 1 administrator. There are six major findings in this research. First, volunteer participants encountered cultural clashes when their levels of cultural competency were weak. Second, volunteer participants revealed there was a lack of adequate cultural competency training with the hospice. Third, volunteer participants gave abundant suggestions for improving cultural competency training. Fourth, volunteer participants perceived the hospice to be unsupportive of some of their needs. Fifth, the lack of ethnic, cultural and linguistic diversity of the hospice volunteer participants was noted. Last, the lack of religiosity amongst the volunteer participants was surprising. This research is significant for its Canadian hospice volunteer focus and the findings will be beneficial in practice for patients, their families, volunteers, and other health care providers, by providing the knowledge and tools necessary to enhance their level of cultural competency.

The population demographics of the greater Toronto Area are rapidly changing, with visible minorities comprising 43% of the GTA, and 10% of the total adult population of Canada. It is incumbent upon the health care sector to accommodate these changes in a culturally competent manner. Health care and culture intersect in the most delicate of ways during the last stages of life. The health care system must ensure that minorities have an equal access to end-of-life health care services and that their individual cultural beliefs and values are respected by culturally competent health care providers. Hence, this thesis examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area. This study will show the strengths and limitations of the current hospice care in terms of providing culturally competent care. To explore this topic in greater detail, my research is guided by the following questions: 1) What is the current state of culturally competent care in a hospice setting? 2) What are the challenges to providing culturally competent care in a hospice in the Greater Toronto Area? 3) What are some possible strategies for increasing competency within a hospice setting? To explore my research questions fully, I provide a critical analysis of six cultural competency theories, while integrating a social determinants of health framework, focusing on the theory of social exclusion and minority health care. This case study analysis is enhanced by the 14 in-depth interviews of hospice volunteer participants and 1 administrator. There are six major findings in this research. First, volunteer participants encountered cultural clashes when their levels of cultural competency were weak. Second, volunteer participants revealed there was a lack of adequate cultural competency training with the hospice. Third, volunteer participants gave abundant suggestions for improving cultural competency training. Fourth, volunteer participants perceived the hospice to be unsupportive of some of their needs. Fifth, the lack of ethnic, cultural and linguistic diversity of the hospice volunteer participants was noted. Last, the lack of religiosity amongst the volunteer participants was surprising. This research is significant for its Canadian hospice volunteer focus and the findings will be beneficial in practice for patients, their families, volunteers, and other health care providers, by providing the knowledge and tools necessary to enhance their level of cultural competency.

No description available.

Class of 2012 Abstract / Specific Aims: To identify and assess cultural competency courses for healthcare professionals that are available to pharmacy students. Methods: A literature review was performed to identify research articles discussing pharmacy courses in health care disparities. Additionally, a systematic review of all curricula for ACPE accredited schools of pharmacy was conducted and these syllabi were subsequently evaluated. Main Results: The search identified XXX articles focusing on specific health disparities curricula in schools of pharmacy and XXX syllabi about specific courses. Out of those articles and syllabi XXX were included in the analysis. Results are pending. Conclusions: Anticipated results will be utilized to design effective health disparities curricula at the University of Arizona College of Pharmacy.

Significant health care disparities exist in the United States. Nurses can play an important role eliminating these disparities. International immersion experiences for undergraduate nursing students may provide long-lasting enhancements in cultural competency and improvements in professional practice. The purpose of this descriptive qualitative study is to explore how a faculty-led international immersion experience for undergraduate nursing students in public health nursing has influenced cultural competency and how this is perceived to have impacted the individuals' current professional practice. Campinha-Bacote's (2002) Process of Cultural Competence in the Delivery of Health Care Services served as a theoretical framework for the study. Participants were sampled based on their experiences in either Bangladesh or Uganda from 2011 to 2013 as part of an international immersion program for undergraduate nursing students. Participants were asked to provide a written response to three prompts. Analysis was guided by the method developed by Colaizzi (Polit & Beck, 2012). Seven individuals agreed to participate. The data collected was somewhat limited in terms of depth, but it did reveal the themes of positive personal and professional development as well as the self-perceived enhancement of one's cultural competency. These findings are discussed within the context of the literature reviewed. Finally, the methodology of this study is reflected upon and recommendations are made for a follow-up study. This study supports the idea that an international immersion experience for undergraduate nursing students is an overall positive experience and can benefit professional practice as well as enhance one's cultural competency. However, more research is still needed to assess specifically how professional practice is benefited and to what extent these benefits are maintained overtime.

Abstract Through a two-phase process an instrument was created to measure the cognitive domain as proposed by King and Baxter Magolda in their Developmental Model of Intercultural Maturity (2005). The first phase involved expert panels who identified the competencies which exist in the cognitive domain, identified situations which might exist between individuals from different cultures, validated scenarios created from the identified situations, and created responses which corresponded to the three developmental levels (Initial, Intermediate, and Mature) defined in the Developmental Theory of Intercultural Maturity. Within the second phase, the created instrument was administered to 371 individuals representing eight geocultural world divisions (Asia, Caribbean, Europe, Middle East, North America, South/Latin America, South Pacific/Polynesia, and Sub-Saharan Africa). The initial instrument contained 8-12 interactive demographic questions and 20 scenario-based questions which were created to measure the four identified competencies (Ability to Shift Cognitive Perspectives, Flexibility in Thinking, Willingness to Seek Knowledge about Other Cultures, and Willingness to Consider Others' Viewpoints as Valid). Through exploratory factor analysis (EFA), the instrument was analyzed and a final 12-item instrument was identified which corresponded to three competencies: Ambiguity, Acclimation, and Acceptance. Overall, the final instrument functioned with minimal gender bias. Some differences in world regions were noted. The Caribbean was the only region who had consistently different scores from the other regions. While some significant differences were noted in scores of those who had lived abroad and those who had not, time spent outside one's home region was not correlated to scores on the instrument. Low reliability scores, factor pattern coefficients, and communality estimates indicated that opportunities to improve the instrument exist. Additional opportunities for further research include the creation of additional instruments to measure all three domains (Cognitive, Interpersonal, and Intrapersonal) and thus measure Intercultural Maturity in full. Recommended uses for the instrument are in the creation of intercultural curriculum to prompt discussion or to create metacognitive opportunities within intercultural training and classrooms.

Métis people in Canada experience Type 2 Diabetes Mellitus (T2DM) at a rate that is substantially higher than the general Canadian population, and therefore require medical and public healthcare for diabetes complications. Despite a growing literature examining Aboriginal health, little is known about how diabetes healthcare interventions are being delivered to the Métis in Canada. Culturally competent medical and public health interventions, those that are sensitive to the culture, history and the beliefs people hold, are known to produce better patient outcomes. These interventions are also known to deliver greater patient satisfaction, and may reduce existing health inequities. This thesis explores the extent to which community-level diabetes healthcare interventions in Saskatoon are being delivered to the Métis people in a manner that is appropriate and sensitive to their culture. Data were collected using semi-structured in-depth interviews with seven Métis participants living with diabetes. Structured in-depth interviews were conducted with one key informant from Central Urban Métis Federation Inc. (CUMFI), and five healthcare practitioners tasked with providing T2DM interventions. Observations and documentary materials were used to supplement the interview data for the study. The study identified two main community-level diabetes healthcare interventions in Saskatoon with a series of activities organized under them. Although the study found no Métis specific T2DM healthcare intervention, participants identified that Métis cultural activities such as jigging and community gardening were incorporated into some of the interventions. However, language, Métis traditional foods, and traditional approaches to teaching were not incorporated into these programs. These omissions, coupled with barriers such as limited spatial accessibility, lack of funding and community poverty have repercussions on participation levels, participant retention and health outcomes for participants living with diabetes. Respondents are less inclined to participate if interventions are generic (non-Métis specific), which are considered less satisfactory. In turn, this may affect the sustainability of the healthcare program resulting in poor health outcomes. In this way the Métis continue to struggle with these community-level diabetes healthcare intervention programs. This study supports the need for Métis-specific community-level diabetes healthcare interventions as a means of improving health outcomes for the fight against T2DM among Métis people.

With growing cultural diversity in the United States (U.S.), health disparities continue to exist among many ethnic minority populations impacting the U.S. economy. Health disparities are health differences that are noted in a particular cultural group in respect to higher rates of diseases and deaths in comparison to others. These cultural groups have common attributes and can be based on race, ethnicity, disability, sexual orientation, income, residential location and many others. One such example is individuals of Puerto Rican heritage, the second largest Hispanic group living in the U.S. mainland. Puerto Ricans are identified to have multiple health disparities in comparison to other Hispanic and non-Hispanic population groups living in the U.S. Among other factors, common cultural health care beliefs and practices of individuals impact health outcomes. Healthcare professionals like nurses are expected to provide culturally competent care to vulnerable populations with known health disparities. Culturally competent care refers to delivering care congruent with patients' cultural beliefs and practices. Therefore, it is important to educate health professionals regarding caring for vulnerable populations. The purpose of this community-based participatory research (CBPR) study was to develop content for an educational tool, an online virtual interactive simulation (OVIS) case for developing cultural competency of nursing students in caring for the Puerto Rican population of New York City (NYC). The content development for OVIS was guided by the framework for Cultural Competency Simulation Experiences (CCSE), which was developed as a part of this dissertation. The CCSE framework guided the content development of OVIS using a CBPR approach. A community advisory board was developed which consisted of cultural, clinical and educational experts, residing in New York and Puerto Rico.