Globally, children and youth are more vulnerable to experiencing mental health challenges; early intervention is key to preventing ongoing mental health difficulties into adolescence and adulthood. School-based mental health interventions have proven to be effective but require a significant amount of collaboration between teachers, parents, mental health specialists and other important stakeholders. Equally noteworthy are the significant treatment, resource and capacity gaps between high and low to middle income countries when it comes to child mental health; the SHINE research group seeks to implement a school-based mental health program in countries in the Eastern Mediterranean region. They also intend to scale-up the prevention and intervention capabilities of said countries to improve overall child mental health. This study investigated the role of collaborative care in SHINE’s program development and implementation processes, while examining the cultural and societal challenges associated with implementing a school mental health program developed primarily in high-income countries to specific non-Western contexts. Individual and small-group indepth interviews were conducted with ten key stakeholders from the SHINE team and partner countries (specifically Iran, Jordan and Egypt). Findings identified the potential for the collaborative care approach within the SHINE school mental health program to greatly ameliorate child mental health outcomes. Additionally, participants noted the necessity for clearer stakeholder role definition and differentiation of general vs specific program elements between countries. Challenges associated with implementing the intervention in the Eastern Mediterranean region included the dominant role of the family, challenging societal norms and stigmatization and structural barriers to applying SHINE’s specific program resources. In summary, the role of collaborative care is increasingly important to SHINE’s current efforts in improving child mental health, however, individual cultural and country characteristics should be an area of emphasis moving forward. / Thesis / Master of Science (MSc) / The SHINE research group are implementing a school-based mental health intervention in the Eastern Mediterranean region, alongside a facilitated collaborative learning group involving key local and global stakeholders. This study focuses on the collaborative care element of the school-based mental health program and its impact on the overall functioning of the intervention, in different country contexts. Collaborative care involves the interactions between parents, teachers, mental health professionals and researchers to ensure the sustainability of the program as well as its scalability to different country contexts. This is an exploratory qualitative study with a case study design; data has been collected with ten participants through individual and small group in-depth interviews. Interviews were transcribed, coded and then cross-compared using thematic analysis to identify overarching patterns. The primary goals of the study are to examine the role of collaboration as well as to consider some of the challenges of applying Western psychological interventions to diverse country and cultural contexts.

Bakgrund: En god kommunikation mellan sjuksköterska och patient är en grundförutsättning för god omvårdnad. För att uppnå en jämlik och personcentrerad vård är det viktigt att göra sig förstådd och blir förstådd. I olika kulturer har människor olika värderingar och normer gällande synen på hälsa vilket kan innebära att språkbarriärer kan vara ett hinder för denna förståelse.  Syfte: Syftet var att belysa sjuksköterskors erfarenheter av språkbarriärer vid omvårdnad av patienter med annan kulturell bakgrund. Metod: En allmän litteraturöversikt genomfördes med en systematisk sökstrategi av artiklar och endast artiklar med kvalitativ data inkluderades. Analysen genomfördes med en tematisk, manifest analys enligt Braun och Clarke.  Resultat: Vid analysen har tre teman arbetats fram. Utmaningar med språkbarriärer och kommunikation med tolk samt patientens integritet- och säkerhet.  Slutsats: Språkbarriären och bristen på tid innebar att sjuksköterskorna fick använda sig av informella tolkar. Detta innebar sänkt patientenssäkerhet och ökad arbetsbörda för sjuksköterskorna. Brist på att förstå och bli förstådd resulterade i en sämre delaktighet i sin vård och avsaknad av person centrerad vård. Det krävs mer utbildning för sjuksköterskor när det finns språkbarriärer och bättre tolktillgängligheter samt ökad vilja för sjuksköterskorna att finna strategier för att arbeta när det finns språkbarriärer. / Background: Good communication between nurse and patient is a basic prerequisite for caring for patient. In order to achieve equal and person-centred care, it is important to make yourself understood and to be understood. In different cultures, people have different values ​​and norms regarding health, which can mean that language barriers can be an obstacle to this understanding. Aim: The aim of this study was to shed light on nurses´ experiences of language barriers when nursing for patients with a different cultural background. Method: A general literature review was conducted with a systematic search of articles and only articles with a qualitative approach was included. The analysis was carried out with a thematic, manifest analysis according to Braun and Clarke. Results: In the analysis, three themes have been developed. Challenges with language barriers and communication with an interpreter as well as patient privacy and security. Conclusions: Language barrier and lack of time were the reason why the nurses used informal interpreters. This has been shown to mean reduced patient safety and increased workload for the nurses. Deficiencies in understanding each other and being understood led to patients' poorer participation in their care and poorer person-centred care. More training is required for nurses when there is a language barrier and better availability of interpreters as well as increased willingness to overcome language barriers.

Bakgrund: Sverige är mångkulturellt. En kultur är något som utvecklats över tid och påverkar alla aspekter i det dagliga livet. Döden väcker många gånger existentiella frågor och i ett mångkulturellt land som Sverige förekommer flertalet olika traditioner och livsåskådningar. Detta ställer höga krav på att sjuksköterskan är lyhörd och har kunskap om olika kulturella bakgrunder. Forskning tyder på att mer kunskap och utbildning i transkulturell omvårdnad behövs för att kunna ge en individuellt anpassad palliativ vård. Syfte: Syftet var att studera sjuksköterskors erfarenheter av att möta patienter från annan kulturell bakgrund inom palliativ vård. Metod: Studien genomfördes som en litteraturöversikt med induktiv ansats baserad på 15 vetenskapliga artiklar, hämtade från CINAHL och PubMed. Artiklarnas kvalitet granskades enligt Sophiahemmets tolkning av Caldwell´s ramverk. Utifrån utvalda artiklar gjordes en tematisk analys med inspiration av Braun och Clark. Resultat: Resultatet visade att sjuksköterskorna många gånger ansåg familjens delaktighet var större hos personer med transkulturell bakgrund och att det var viktigt att involvera flera familjemedlemmar i vården. Det var ofta speciellt framträdande i läkemedelsbehandling med opioider. Sjuksköterskorna ansåg sig behöva ökad kulturell medvetenhet i form av formell och informell kunskap och utbildning för att kunna bemöta svårt sjuka personer med annan kulturell bakgrund inom palliativ vård. Kommunikationen kunde vara begränsad genom språksvårigheter, språkbarriärer eller genom att sjuksköterskorna och patienterna med familjer inte hade samma syn på vad som skulle pratas om kring döden. Genom relation med patienten och dennes närstående skapades respekt för kulturella olikheter. En ökad kunskap och förståelse kring traditioner och ritualer i samband med döden underlättade för sjuksköterskorna i arbetet. Slutsats: För att sjuksköterskan ska kunna tillgodose behoven hos svårt sjuka personer med palliativa vårdbehov och annan kulturell bakgrund behövs ökad kulturell medvetenhet, utbildning och kunskap. Att kunna samtala och förstå varandra utan språkbarriärer är viktigt.

Bakgrund: I dagens samhälle med globalisering och en ökad invandring från andra länder så interagerar olika individer och grupper som inte har samma livsåskådning, tro ellervärderingar. Detta skapar ett ökat behov för en palliativ vård som är betydligt mer kulturkänslig, där sjuksköterskan och det multidisciplinära teamet kan bemöta både patienter från en annan kulturell etnicitet i ett palliativt skede och deras närstående på ett icke-dömande sätt. Konflikter och etiska svårigheter i omvårdnaden av dessa patienter kan riskera att påverka livets sista tid negativt. Syfte: Syftet är att belysa sjuksköterskan och det multidisciplinära teamets utmaningar i mötet med patienter från en annan kulturell etnicitet i palliativt skede. Metod: Studien är genomförd som en induktiv litteraturöversikt. Femton artiklar inkluderades och en tematisk innehållsanalysen utfördes enligt Bettany-Saltikov och McSherry. Resultat: Fyra huvudteman utformades i resultatet. Resultatet visade på utmaningar i det palliativa mötet, i kommunikationen, kulturell kompetens och kulturella utmaningar med patienter från en annan kulturell etnicitet. I det palliativa mötet framkom det att ordet palliativ inte har någon tydlig översättning inom flera olika språk och kulturer, vilket försvårade för sjuksköterskan och teamets i deras arbete. Kommunikation visade att det var svårt att göra ett bra arbete när man multidisciplinärt team varken kunde förmedla eller få korrekt tolkad information gällande sjukdomen, symtom eller förlopp till patienten. En kulturell medvetenhet var av stor betydelse samt vikten av att en god kulturell kompetens inom hela teamet var av stor vikt för att kunna bemöta och ge dessa patienter från en annan kulturell etnicitet i palliativt skede och deras närstående en god vård. Slutsats: Det framkom att både sjuksköterskan och teamet upplevde svårigheter med att möta och vårda patienter från en annan kulturell etnicitet och deras närstående på grund av kommunikationshinder och kulturella skillnaderna. Resultatet påvisade också att det fanns stora brister i kommunikationen både gällande den språkliga delen och uttrycksdelen men att även den kulturella delen brister. Kunskaper gällande religion och kultur hos personalen samt teamet runt omkring patienten är otillräcklig. / Background: In society today with the globalization and increased immigration from other countries, different individuals and groups who do not have the same outlook on life, beliefs or values interact. This creates an increased need for palliative care that is significantly more culturally sensitive, where the nurse and the multidisciplinary team can respond to both patients from another cultural ethnicity at a palliative stage and their relatives in a nonjudgmental way. Conflicts and ethical difficulties in the care of these patients may have a negative effect on the last days of life. Aim: The purpose is to shed light on the nurse and the multidisciplinary team's challenges in the meeting with patients from another cultural ethnicity in a palliative phase. Method: The study is conducted as an inductive literature review. Fifteen articles were included, and a thematic content analysis was performed according to Bettany-Saltikov and McSherry. Results: Four main themes were formulated in the result. The result showed challenges in the palliative encounter, in communication, cultural competence and cultural challenges with patients from another cultural ethnicity. In the palliative meeting, it emerged that the word palliative doesn`t have a clear translation in several different languages and cultures, which made it difficult for the nurse and the team in their work. Communication showed that it was difficult to do a good job when a multidisciplinary team could neither convey nor get correctly interpreted information regarding the disease, symptoms or course to the patient. A cultural awareness was of great importance and the importance of good cultural competence within the entire team was of great importance to be able to meet and give these patients from another cultural ethnicity in the palliative care stage and their relatives a good care. Conclusion: It emerged that both the nurse and the team experienced difficulties in meeting and caring for patients from another cultural ethnicity and their relatives due to communication barriers and cultural differences. The results also showed that there were major shortcomings in the communication, in terms of the linguistic part and the expressive part, but that the cultural part was also short. Knowledge regarding religion and culture of the staff and the team around the patient is insufficient.

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The cultural productions of Katherine Anne Porter, Anita Brenner, Tina Modotti, Maria Izquierdo, and Juanita Guccione represent a distinctive interweaving of gender and class consciousness, national identification and political resistance, as represented in their artistic work. These five women became transnational carriers of a radical realist and modernist thought, culture, and ideology that became transported through their art when their gendered and classed bodies were left otherwise silenced and boundaried. These women, their cultural productions, and the ways in which their art generates a counter discourse to the dominant and institutionalized conceptions of transculturalism, aesthetics, and re-production, are vital to understanding the co-construction of nationhood as well as the self-determined creation of the individual self. From this overarching framework, I will explore how these women negotiated political conceptions of nationhood, artistic genres such as realism and modernism, and then created their own feminist, transcultural and working-class aesthetics to counter otherwise limited conceptions of individual agency.

Culture is critical to delivering effective mental health care, necessitating tailored approaches aligned with the respective cultural contexts. The rise of globalization and transcultural psychiatry highlights the importance of integrating culture comprehensively into mental health and psychosocial interventions within humanitarian contexts. Existing research underscores the significance of culture in mental health. However, a prevailing influence of Western perspectives on mental health is evident globally, leading to the widespread implementation of Euro-American viewpoints in humanitarian fieldwork. This approach negatively impacts individuals affected by crisis by sidelining culturally grounded understandings of illness. While several studies examine the impact of culture on mental health care, there is limited research on how humanitarian organizations perceive and incorporate culture in training materials. This study aims to examine how the Red Cross Red Crescent Movement conceptualizes and integrates culture within its mental health and psychosocial support (MHPSS) intervention. I collected data from nineteen Red Cross guidebooks to conduct a thematic analysis and extract insights into the organization’s approach. I found nine themes: understanding culture through self, culture as behaviour, culture as meanings, community-based approach, assessment, planning and implementation, training, monitoring and evaluation, and universality of mental illness. My findings indicate that the Red Cross conceptualizes culture holistically, and by doing so, they aim to produce culturally relevant care. While the Red Cross emphasizes cultural relativism in its MHPSS responses, encouraging cultural competency, it also tends towards universalism when discussing mental health, reflecting the nuanced nature of MHPSS interventions. This tension highlights the complex relationship between these two perspectives in creating the Movement’s MHPSS responses and speaks to broader challenges in delivering mental health and psychosocial care in humanitarian fields. Further avenues for research lie in exploring strategies to reconcile relativist and universalist frameworks, aiming to produce seamless MHPSSs. / Thesis / Master of Arts (MA) / Effective mental health care respects and incorporates the cultural beliefs and practices of the individuals receiving it. However, according to the literature, there is a pattern amongst international aid agencies of applying Westernized mental health ideas globally. In this study, I investigate how the Red Cross Red Crescent Movement understands and incorporates local culture in its mental health and psychosocial supports (MHPSS). The study reveals that the Movement recognizes culture holistically. The Movement closely works with communities, aiming to ensure that the support matches local ways of understanding well-being and distress. However, the Movement tends to apply a more universal understanding regarding specific mental disorders. This discrepancy highlights issues within the humanitarian field at large. My findings suggest that while the Red Cross does well to integrate cultural understandings of psychosocial distress, there is a need for better collaboration between universal and local perspectives in MHPSS.

Bakgrund: I vår globaliserade värld ökar antalet invånare födda utomlands i Sverige, vilket utmanar sjuksköterskor vid vården av patienter med annan kulturell bakgrund. Forskning visar att språkbarriärer kan leda till frustration hos både sjuksköterskor och patienter. Genom att öka förståelsen för sjuksköterskors upplevelser av att vårda mångkulturella patienter kan vi förbättra vården och skapa en tryggare miljö. Syfte: Att beskriva sjuksköterskans upplevelser av att vårda patienter avvikande från majoritetskulturen inom sjukvården. Metod: Kvalitativ litteraturöversikt. Sökningar i PubMed och Cinahl resulterade i 12 artiklar som granskades noga och sammanställdes i en tabell. Dessa analyserades med Fribergs (2022) fyra analyssteg. Resultat: Vid möten med patienter från olika kulturella bakgrunder låg det primära ansvaret hos sjuksköterskor att upprätthålla hälsa och vård på lika villkor. Respekt för individens värdighet och mångfald, samt anpassning av vården för den mångkulturella befolkningen, var avgörande. Sjuksköterskors kulturella kompetens var central för anpassad vård. Kommunikationsbarriärer, tolkstrategier, fördomshantering och andliga behov var viktiga fokusområden. Diskussion: Utmaningar uppstår vid transkulturella vårdmöten på grund av språkliga hinder, anhörigas deltagande samt kulturella skillnader. Kulturell kompetensbrist påverkar vården negativt vid möten med patienter från olika kulturella bakgrunder då sjuksköterskor inte upplever sig ha tillräckligt med kompetens för att vårda på ett transkulturellt sätt.  Slutsats: Fortsatta brister finns i att integrera kulturell kompetens i sjukvårdssystemet, vilket påverkar sjuksköterskors förmåga att möta olika kulturella behov. Det blir alltmer viktigt att skapa en miljö som främjar kulturell mångfald för att kunna erbjuda högkvalitativ vård till en varierad patientpopulation. / Background: In our globalized world, the number of foreign-born residents in Sweden is increasing, which challenges nurses when caring for patients with a different cultural background. Research shows that language barriers can lead to frustration for both nurses and patients. By increasing the understanding of nurses' experiences of caring for multicultural patients, we can improve care and create a safer environment. Purpose: To describe the nurse's experiences of caring for patients deviating from the majority culture in healthcare. Method: A qualitative literature review. Searches in PubMed and Cinahl resulted in 12 articles that were carefully reviewed and compiled in a table. These were analysed using Friberg's (2022) four analysis steps. Results: In encounters with patients from different cultural backgrounds, the primary responsibility of nurses was to maintain health and care on equal terms. Respect for the individual's dignity and diversity, as well as adaptation of care for the multicultural population, was crucial. Nurses' cultural competence was central to adapted care. Communication barriers, interpreting strategies, prejudice management and spiritual needs were important areas of focus. Discussion: Challenges arise in transcultural healthcare encounters due to linguistic barriers, participation of relatives and cultural differences. The lack of cultural competence negatively impacts care during interactions with patients from diverse cultural backgrounds, as nurses feel they lack the expertise to provide transcultural care. Conclusion: Continued shortcomings persist in integrating cultural competence into the healthcare system, affecting nurses' ability to address diverse cultural needs. It becomes increasingly crucial to foster an environment that promotes cultural diversity to deliver high-quality care to a varied patient population.

The purpose of this project was to create a rubric from which researchers and filmmakers can begin producing media different from the existing English language, jargon-laden, instructional videos currently in use in the United States. From this rubric, one video detailing a clinic visit was produced, screened for a diverse audience and evaluated for its efficacy. This video utilized only images to convey information in an attempt to circumvent the confusion that may result while viewing media in a foreign language. Communication theories and strategies such as the Sabido method of edutainment and social cognitive theory guided the filmmaking process. Although it is impossible to create a universally comprehensible text, the development of potentially transcultural media helped identify key issues that should be carefully considered. Effective intercultural communication strategies and an awareness of cultural concerns factored into decisions on representations of gender and nationality, shot composition and editing, as well as the use of positive, negative and transitional characters. This task resulted in both a rubric for media production as well as a reflection on transcultural communication in a broader context. Pre- and post-screening feedback sessions were used to evaluate the comprehensibility of the video and results across varying cultures showed an improvement in knowledge of clinic procedures and protocol. This study represented an important first step in participatory transcultural media creation in partnership with the increasingly diverse patient population of the United States. / Media & Communication