Cultural Competency

The current P-12 educational landscape is riddled with inequities, especially for historically underserved students. As such, greater efforts are needed from educational stakeholders (i.e. counselors and principals) who center social justice and advocacy practices that eliminate systemic barriers to rigorous educational experiences for all students. This paper proposes an alignment of advocacy and social justice professional standards and competencies for school counselors and principals. This alignment, which consists of three contextual dimensions including social justice identity, human resources, and advocacy actions, serves as the foundational framework for principal-counselor collaboration around social justice advocacy. Implications for practice and research are discussed.

Author
Buonanno, Thomas  Anthony
Title
School Leadership for a Diverse Society
Year Degree Awarded
2020
Department
Educational Leadership
Degree
Ed.D.
Abstract
Given the increase of language minority students in school districts across Pennsylvania, school leaders are faced with the demand to address the unique needs of students learning English. Previous research suggests that state initiatives to simply assimilate students may not have been successful in meeting their needs. Furthermore, research and theory also suggest that leaders demonstrating cultural proficiency may be more effective in meeting the needs of English learners who are also ethnic minorities. The approach leaders take may be a function of the ethical paradigm that informs their decision-making. In order to understand the extent to which elementary school principals in one school district display cultural proficiency and to investigate the ethical paradigms that inform their decision-making, I conducted interviews with five principals in one large diverse school district in Pennsylvania. Drawing on a framework of Cultural Proficiency, I found in general there to be an over-appreciation of diversity and under-appreciation of cultural proficiency at the conclusion of this study. Additionally, there was an observed tendency for these school principals to view their leadership role as one that functions primarily within the confines of executing district policies at the building-level. Though each participant expressed the importance of advocacy for their students, they did not pursue policy creation or change within a broader political context. Despite the similarities among participants, my analysis suggested variations in the participants’ concepts of their role as school leaders to support English Language Learners and language minority students.
Advisor
McGinley, Christopher W.

Committee Members
Laurence, Janice H.
Haviland, Joseph
Smith, Michael W.

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Multicultural professional psychologists routinely assert that psychotherapeutic interventions require culturally competent delivery for ethnoracial minority clients to protect the distinctive cultural orientations of these clients. Dominant disciplinary conceptualizations of cultural competence are "kind of person" models that emphasize specialized awareness, knowledge, and skills on the part of the practitioner. Even within psychology, this approach to cultural competence is controversial owing to professional misgivings concerning its culturally essentialist assumptions. Unfortunately, alternative "process-oriented" models of cultural competence emphasize such generic aspects of therapeutic interaction that they remain in danger of losing sight of culture altogether. Thus, for cultural competence to persist as a meaningful construct, an alternative approach that avoids both essentialism and generalism must be recovered. One means to capture this alternative is...

HE HEALTH BURDENS OF OBESITY ARE SEVERE, especially among African-American women who experience lower life expectancy and higher rates of chronic diseases than the general population. Furthermore, losing weight continues to be a major challenge for African-American women, who are less likely to participate in weight-loss programs and tend to have a low success rate when they do (1,2). The reason for lack of success is largely unknown, but many believe that most weight-loss programs are very generic and ignore culturally influenced factors, such as body image, beauty, and traditions (3-5). In addition, they do not consider the stigma, prejudice, and discrimination that obese individuals experience because of their weight (6). Perceptions about weight and knowledge, attitudes, and beliefs about obesity and weight management cannot be effectively measured and quantified solely with surveys (7-9). Therefore, this qualitative study used focus groups to explore these issues. Focus groups allow participants to critique, comment, explain, and share their experiences, opinions, and attitudes on the issues in question. The results from focus groups can be used to plan, develop, and implement specific messages and programs (10). The Health Belief Model (HBM) was used as the theoretical framework for this study. The framework is often used to explain why individuals change or maintain specific health behaviors. It also can be used to guide development of culturally appropriate weight-loss materials and intervention strategies for weight loss (11-14). HBM contains the following constructs: perceived susceptibility, perceived severity/seriousness, perceived benefits, perceived barriers, cues to action, and self-efficacy (14-17). Figure 1 depicts the HBM framework using the example of obesity and weight management. Few studies have applied all of the HBM constructs in studying weight management. The goal of this project was to explore the use of the HBM in developing culturally appropriate weight-management programs for African-American women. METHODS The project was approved by the Institutional Review Board at the researchers' institution. Seven focus groups were conducted with a convenience sample of African-American women who were overweight or obese and who were interested in losing weight. Fifty women were recruited from beauty salons, churches, sororities, a college campus, and a low-income housing community. Three community liaisons recruited participants and located convenient venues for the focus groups. The liaisons asked each woman her height and weight and used a body mass index (BMI; calculated as kg/m 2

Various policies, plans, and initiatives have been implemented to provide safe, quality, and culturally competent care to patients within Queensland's healthcare system. A series of models of maternity care are available in Queensland that range from standard public care to private midwifery care. The current study aimed to determine whether identifying as Culturally or Linguistically Diverse (CALD) was associated with the perceived safety, quality, and cultural competency of maternity care from a consumer perspective, and to identify specific needs and preferences of CALD maternity care consumers. Secondary analysis of data collected in the Having a Baby in Queensland Survey 2012 was used to compare the experiences of 655 CALD women to those of 4049 non-CALD women in Queensland, Australia, across three stages of maternity care: pregnancy, labour and birth, and after birth. After adjustment for model of maternity care received and socio-demographic characteristics, CALD women were significantly more likely than non-CALD women to experience suboptimal staff technical competence in pregnancy, overall perceived safety in pregnancy and labour/birth, and interpersonal sensitivity in pregnancy and labour/birth. Approximately 50% of CALD women did not have the choice to use a translator or interpreter, or the gender of their care provider, during labour and birth. Thirteen themes of preferences and needs of CALD maternity care consumers based on ethnicity, cultural beliefs, or traditions were identified, however, these were rarely met. Findings imply that CALD women in Queensland experience disadvantageous maternity care with regards to perceived staff technical competence, safety, and interpersonal sensitivity, and receive care that lacks cultural competence. Improved access to support persons, continuity and choice of carer, and staff availability and training is recommended.

The issue of cultural competency in health care continues to be a priority in Australia for health and human services professionals. Cultural competence in caring for Aboriginal and Torres Strait Islander peoples is of increasing interest, and is a priority in closing the gap in health disparities between Indigenous and non-Indigenous Australians. Through a collaborative conversation, the authors draw on a case study, personal experience and the literature to highlight some of the issues associated with employing culturally appropriate, culturally safe and culturally competent approaches when caring for Aboriginal and Torres Strait Islander peoples. The intent of this article is to encourage discussion on the topic of cultural competency, and to challenge health professionals and academics to think and act on racism, colonialism, historical circumstances and the political, social, economic, and geographical realms in which we live and work, and which all impact on cultural competency.

The prevalence of smoking among the adult Aboriginal population is almost double that of the non-Aboriginal population. Research shows smoking cessation brief interventions have a positive impact on quit attempts. However, examples of statewide, Aboriginal-led initiatives that ensure health service delivery of brief intervention to all Aboriginal clients are limited. Guidance from an Aboriginal chief investigator and key health stakeholders supported the development of the NSW SmokeCheck Program. One component of the program was the establishment of a state-wide network of Aboriginal Health Workers (AHWs) and other health professional participants. Another was a culturally specific training program to strengthen the knowledge, skills, and confidence of participants to provide an evidence-based brief smoking-cessation intervention to Aboriginal clients. The brief intervention was based on the transtheoretical model of behaviour change, adapted for use in Aboriginal communities. Smoke...

Cultural competence education is relatively new in the United States, particularly in the area of graduate and post-graduate medical education. There is, however, wide acceptance that an understanding of the role culture plays in the treatment and care of patients is critical. Numerous studies and a variety of commentaries document this importance, but valid, uniform evaluation methods for assessing the efficacy of these efforts is lacking. This review discusses existing evaluation efforts and makes suggestions regarding future development of such tools.

Background: Boundary issues, which regularly arise in therapy, can present dilemmas for most clinicians. There has been substantial literature on boundary excursions in clinician-patient relationships, however, very little empirical research exists and is documented. As mental health researchers, we need to investigate a wide range of sensitive topics to enhance our understanding of the many issues that arise in the psychotherapeutic frame. Aims: We set out to empirically explore perceptions of what may constitute a boundary violation among the mental health staff in the State of Qatar and their views on the subject. Results: A total of 50 participants (24 psychiatrists, 2 doctorate level psychologists, 24 psychiatric nurses) responded with a response rate of 80%. Participants rated each possible boundary violation according to its degree of harm and professional unacceptability. Three distinct groupings of boundary violations were obtained: (1) core, consisting of the most serious violations; (2) disclosure and greeting behaviour, involving disclosure of information about the therapist and greeting behaviour; and (3) separation of therapist and client lives, involving encounters between therapists and clients outside of therapy. Conclusions: It is important to ascertain these dilemmas so that these theoretical models can be integrated in clinical practice.

Over the past two decades, the United States has attracted large South Asian populations, who have imported tobacco products previously unique to the native subcontinent. South Asian cigarette use prevalence is consistently lower than other U.S. Asian subgroups; however, most surveys fail to capture smokeless products accurately. In part because of the pervasive use of popular smokeless cultural products resulting in greater population attributable risk of oral malignancies, many countries outside the United States have developed surveillance systems to capture these products and implemented effective population-level or community-based intervention strategies. This minority population in the United States continues to be "at risk" of suffering from a disproportionate burden of diseases, which are plausibly linked to the use of these products. The primary focus of this article is to provide an exhaustive literature review of tobacco use patterns and existing tobacco control strategies among South Asians in the United States. Framed within the social ecological model, the article suggests that there needs to be more detailed assessment of cultural tobacco products, a concurrent increase in cultural competencies of health care providers and provision of cessation resources outside the clinical setting. At the policy level, future efforts should adequately regulate these products and oversight must include such products in efforts to reduce rates of use. Concurrently, communitybased efforts are needed to change social norms related to perceived health benefit and lack of stigma. This will help ensure that appropriately framed messages around use rates and burden of disease are addressed through culturally valued institutions and leaders.

CONTEXT Non-conscious stereotyping and prejudice contribute to racial and ethnic disparities in health care. Contemporary training in cultural competence is insufficient to reduce these problems because even educated, culturally sensitive, egalitarian individuals can activate and use their biases without being aware they are doing so. However, these problems can be reduced by workshops and learning modules that focus on the psychology of non-conscious bias.

The University of South Florida (USF) ranks as one of the top 50 public universities in the nation. As of Spring 2022, 14% of the student population identify as military-connected students (MCS). MCS comprises Active Duty, National Guard, Reserve, veteran or military dependents. Many student veterans choose not to embrace their veteran identity due to feeling unaccepted or viewed from a deficit mindset by faculty, staff, and other students. Veteran studies research identifies the significant influence faculty and staff possess when addressing MCS retention and graduation rates (Lim et al., 2018; Vacchi, 2012; Vacchi, 2018). USF’s Office of Veteran Success (OVS) developed the Got Your Six (GY6) Workshop addressing cultural awareness as professional development for faculty and staff. This explanatory sequential mixed-methods study evaluates a redesigned military-connected student cultural competency workshop. The newly revised GY6 Workshop operated over the last year using the continuous improvement model of improvement science to elicit feedback from workshop participants to improve the GY6 Workshop.

As a Scholarly Practitioner who attempts to solve problems in their practice (Perry, 2016), I chose to embrace an issue I faced during my academic journey and a problem the students I serve face daily. I also decided to write an alternative dissertation in a digital magazine format, providing greater accessibility to veteran studies, veteran research, and veteran affairs practitioners. Although my study is not generalizable and the program evaluation intends to inform USF and their OVS, others might find the alternative dissertation as inspiration to rethink dissertation formats to one with more significant applicability. 

Objective: The aim of this study is to investigate to which extent diversity is part of current healthcare practices and to explore opportunities and barriers in the implementation of diversity dimensions in healthcare practices. Methods: Nine in-depth, semi-structured interviews and three focus groups were conducted in three healthcare settings (mental health, hospital, nursing home care). Results: Results demonstrate that (the potential of) diversity is an ambiguous issue; diversity is said to be important, but this has not led to adjustments of the neutral, disease-oriented approach of patients. If recognized at all, diversity is reduced to one dimension (sex). Barriers in the implementation of diversity relate to: (a) lacking awareness and knowledge of diversity, (b) poor information and communication, and (c) organizational constraints. Opportunities to implement diversity in healthcare include: (d) an emerging sense of urgency to attend to diversity, (e) the development of good practices, and (f) the political climate. Conclusion: Various barriers and some opportunities for the implementation of diversity in healthcare practices have been identified. There is an ambiguity in how professionals deal with diversity. As a result, the neutral approach remains dominant in practice and policy. Practice implications: In order to raise the awareness and enhance the competence of professionals, educational programmes and learning networks are required.

To explore causal explanations of obesity among African-American women of diverse weight across the life spectrum. Methods: In-depth interviews were conducted with adult African-American women of healthy weight (N = 10), overweight (N = 10), and obese weight (N = 20) to evaluate the relationship between causal explanations of obesity and weight. Results: Generally overlooked dimensions of health definitions were discovered. Differences in weight definitions were detected between women of different weights. Terminology, symptoms, and solutions to obesity were detected between the women of different weights and public health recommendations. Conclusion: Identified causal discrepancies will help bridge the disconnection between public health recommendations and African-American women's perceptions with tailored interventions.

The limited access to oral health care in developing countries can be greatly improved by integrating oral health into the Primary Health Care (PHC) system. This study was designed to assess the views of PHC workers on integrating oral health care into the PHC system. A self-administered questionnaire survey was conducted in two selected local government areas of Lagos State. The instrument contained three sections assessing sociodemographic features, knowledge of common oral diseases and views on integration of oral health into PHC respectively. The mean knowledge score was 7.75 (SD=±1.81), while 60.4% of the respondents had average knowledge scores. Educational status (P=0.018) and designation (P=0.033) were significantly related to the mean knowledge scores. There was no significant difference in the oral health knowledge of the various cadres (P=0.393). Majority (85.4%) of the respondents were willing to include oral health education in their job schedule and 82% believed they n...

The challenge in the field of sexual medicine is to develop evidence-based principles for clinical evaluation and create a uniform, widely accepted diagnostic and treatment approach for all sexual problems and dysfunctions, for both genders. Aim. To provide recommendations for the broad approach for assessing sexual problems in a medical practice setting; to develop an evidence-based diagnostic and treatment algorithm for men and women with sexual dysfunctions. Methods. The PubMed literature was reviewed. Expert opinion was based on the grading of evidence-based medical literature and the Delphi consensus process. Results. The Committee determined three principles for clinical evaluation and management: (i) adoption of a patient-centered framework, with emphasis on cultural competence in clinical practice; (ii) application of evidencebased medicine in diagnostic and treatment planning; (iii) use of a unified management approach in evaluating and treating sexual problems in both men and women. The International Consultation in Sexual Medicine-5 stepwise diagnostic and treatment algorithm was developed for that purpose. According to this algorithm, sexual, medical, and psychosocial history is mandatory, whereas physical examination and laboratory tests are highly recommended in most cases. Furthermore, the Brief Sexual Symptom Checklist (BSSC) for Men and BSSC for Women, and more recently the Sexual Complaints Screener (SCS) for Men and SCS for Women, were all endorsed for screening purposes. A classification system was also defined; clinically, sexual dysfunctions are categorized in three types according to their etiology (Type I: psychogenic; Type II: organic; Type III: mixed). Final recommendations on specialized diagnostic tests were based on level of evidence.

A key component of the 2011 Australian National Health Reform, via the Access and Equity Policy, is to improve access to quality health services for all Australians including CALD communities. Awareness has been raised that certain CALD communities in Australia experience limited access to health care and services, resulting in poor health outcomes. To address this issue, the Community Navigator Model was developed and implemented in four CALD communities in Logan, Queensland, through a partnership between government and non-government organisations. The model draws on local natural leaders selected by community members who then act as a conduit between the community and health service providers. Nine 'navigators' were selected from communities with low service access including the Sudanese, Burmese, Afghan and Pacific Islander communities. The navigators were trained and employed at one of two local nongovernment organisations. The navigators' role included assessing client needs, facilitating health promotion, supporting community members to access health services, supporting general practitioners (GPs) to use interpreters and making referrals to health services. This paper explores the 'lived experience' of the navigators using a phenomenological approach. The findings revealed three common themes, namely: (1) commitment to an altruistic attitude of servility allowing limitless community access to their services; (2) becoming knowledge brokers, with a focus on the social determinants of health; and (3) 'walking the walk' to build capacity and achieving health outcomes for the community. These themes revealed the extent to which the role of CALD community navigators has the potential to make a difference to health equity in these communities, thus contributing to the Australian National Health Reform.

The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can i...

BackgroundThe design of a cultural competency curriculum can be challenging. The 2002 Institute of Medicine report, Unequal Treatment, challenged medical schools to integrate cross-cultural education into the training of all current and future health professionals. However, there is no current consensus on how to do this. The Department of Native Hawaiian Health at the John A. Burns School of Medicine formed a Cultural Competency Curriculum Development team that was charged with developing a curriculum for the medical school to address Native Hawaiian health disparities. By addressing cultural competency training of physicians, the team is hoping to help decrease the health disparities found in Native Hawaiians. Prior attempts to address culture at the time consisted of conferences sponsored by the Native Hawaiian Center of Excellence for faculty and clinicians and Problem Based Learning cases that have imbedded cultural issues.ObjectiveGather ideas from focus groups of Native Hawaiian stakeholders. The stakeholders consisted of Native Hawaiian medical students, patients and physicians. Information from the focus groups would be incorporated into a medical school curriculum addressing Native Hawaiian health and cultural competency training.MethodologyFocus groups were held with Native Hawaiian medical students, patients and physicians in the summer and fall of 2006. Institutional Review Board approval was obtained from the University of Hawaii as well as the Native Hawaiian Health Care Systems. Qualitative analysis of tape recorded data was performed by looking for recurrent themes. Primary themes and secondary themes were ascertained based on the number of participants mentioning the topic.ResultsAmongst all three groups, cultural sensitivity training was either a primary theme or secondary theme. Primary themes were mentioned by all students, by 80% of the physicians and were mentioned in all 4 patient groups. Secondary themes were mentioned by 75% of students, 50% of the physicians and by 75% of patient group. All groups wanted medical students to receive cultural sensitivity training, and all wanted traditional healing to be included in the training. The content of the training differed slightly between groups. Students wanted a diversity of teaching modalities as well as cultural issues in exams in order to emphasize their importance. They also felt that faculty needed cultural competency training. Patients wanted students to learn about the host culture and its values. Physicians felt that personal transformation was an important and effective tool in cultural sensitivity training. Cultural immersion is a potential teaching tool but physicians were concerned about student stages of readiness and adequate preparation for cultural competency training modalities such as cultural immersion.ConclusionsCultural competency or sensitivity training was important to patients, students and physicians. The focus group data is being used to help guide the development of the Department of Native Hawaiian Health's cultural competency curriculum.

This study aimed to explore the practical experience of child welfare caseworkers and professionalism in child case management in Malaysia. This paper discussed the specific social work practice competency and the challenges faced by child caseworkers in the fieldwork. This research was qualitative with grounded theory approach. Four sessions of focused group discussion (FGD) were conducted involving a total of 27 caseworkers (child protector and probation officers) in the Klang Valley. The study found that the four basic principles of knowledge in child case management namely: 1. knowledge in child case management; 2. professional values of caseworkers towards children; 3. skills in managing cases; and 4. culturally competent practice in child case management. In addition, major challenges faced by the child case manager are the capacity and commitment of the family in children's rehabilitation program, the credibility of caseworkers are being challenged, and the challenges of ...

Authors: Bhui K, Aslam RW, Palinski A, McCabe R, Johnson MR, Weich S, Singh SP, Knapp M, Ardino V, Szczepura A Abstract BACKGROUND: Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. OBJECTIVES: To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research. PARTICIPANTS: Black African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people. INTERVENTIONS: Any that improve TCs between BME patients and staff in psychiatric services. DATA SOURCES: The publis...

Research has shown that experiences of military sexual assault and harassment can have a negative impact on veterans' health and functioning, even years or decades later, thus clearly identifying this as an important area of concern for social workers. In addition to understanding the scope and general impact of military sexual assault and harassment, social workers also must thoroughly understand how different cultural factors may intersect with veterans' experiences. To this end, this article reviews the current knowledge base on how veterans' life experiences related to gender can affect their experience of and recovery from military sexual assault and harassment, highlights common gender-specific issues, and discusses implications for practice.

a b s t r a c t This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep medical professionals from seeing the social determinants of suffering of their unauthorized migrant patients.

The Escola Superior d’Infermeria del Mar proposed to incorporate the skills acquisition of cultural competence in the curricula design of the new Nursing Degree; to get it, an optional course was created (Cultural Competence) within the 3rd quarter of 3rd year. The aim of this study is to evaluate the effectiveness of training for the acquisition of Cultural Competence in nursing students. Is a quasi-experimental pretest-postest design with a single group in two consecutive courses (2011-12/2012-13). Data were collected through an ad-hoc 16 items Likert questionnaire at the beginning (pre-test) and the end of the course (post-test). A total of 43 students participated in the study. Statistically significant differences were observed in two items of the pretest results and no difference in post-test results. To confirm pretest and posttest hypothesis, results were compared after the educational intervention, finding significant differences in all survey items. The design of the course, in which knowledge and skills were worked, appears to be effective in acquiring cultural competence.

To be used in some type of experiment and then be forgotten. Why are you interested in me now?" This is one of many sentiments felt by African Americans. In one of many surveys conducted by researchers, African Americans feared they would be used as guinea pigs for medical research. This survey also found that blacks were more likely than whites not to trust that their doctors would fully explain the significance of their participation in clinical research or other studies. Many scientists believe that bad feelings make it difficult for them to recruit minorities as participants in biomedical research studies in different areas. There continues to be an underlying element of mistrust hetween the poor populations and minority populations that may be subjects of research and the research establishment. The perception of mistrust from the African American community is in large caused by their previous experiences with the health care system. However, the mistrust is not only in perception, but has many other reasons. Mistrust of the health care system by African Americans is a major problem that has to be addressed and corrected. This paper is a historical perspective of the African Americans relating to their distrust of research and the traditional health care system.

This article describes the concept of disability as a culture, discusses key components of cross-cultural communication with people with disabilities, and identifies the key elements of providing culturally competent care to people with disabilities. To gain an understanding of cultural competence, it is important to understand the concepts and definitions of culture, disability, and competence. The World Health Organization classification of functioning, disability, and health will be used as the theoretical model in the discussion on disability. J. Campinha-Bacote's Cultural Competent Model of Care is used as the theoretical model for the discussion on cultural competence.

Purpose:  The purposes of this review were to provide an updated report of intervention studies designed to enhance mobility in older adults and discuss the strengths and limitations of existing intervention studies and their implications for practice.Data sources:  Medline, CINAHL, and PsychInfo were searched to identify original research articles reporting interventions for promoting mobility in community-dwelling older adults.Conclusion:  Effective interventions for enhancing mobility in older adults include walking, aerobic exercise, and resistance training focusing on strength, balance, and flexibility. Group-based interventions show significant beneficial effects in increasing mobility. To obtain significant effects of physical activity interventions, the patient should participate in the exercise programs for at least 12 weeks. Strengths of existing clinical trials for promoting mobility in older adults include testing of various types of physical activity and training interventions and the use of an experimental design with a control group. The major challenges of creating mobility enhancement recommendations for older adults include detailing a mobility enhancement program will delay disability, creating a specific program dose for different populations by gender and ethnicity, and developing culturally appropriate mobility enhancement programs to improve adherence over time.Implications for practice:  Prescribing regular physical activity including aerobic exercise and resistance training in a primary care setting can be a beneficial approach to minimize progression of impaired mobility in older adults. The typical dose of the physical activity prescription is 20–60 min of aerobic activity three times weekly. Adherence to mobility enhancement recommendations by older patients can be followed up by in-person interview or use of mobility monitoring tools such as exercise diary or log.

This study examined perceived satisfaction among Hispanic/Latino individuals who participated in a baseline examination for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large cohort study of 16,415 adults living in four selected communities. An estimated 22% (n= 3,584) of participants completed a questionnaire regarding satisfaction with staff attention, the overall experience during the study examination, and the influence of the informed consent digital video disc (DVD). The majority of participants who completed the questionnaire expressed overall satisfaction with the study. Most participants reported that staff were friendly, courteous and respectful and study test procedures were clearly explained. Participants who preferred to complete the interview in Spanish felt that the informed consent DVD positively influenced their ability to make an informed decision to enroll in the study. Participants who preferred to complete the interview in English tended to...

This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists' attitudes towards the culture of the patient and towards their own culture, patients' previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.

To be used in some type of experiment and then be forgotten. Why are you interested in me now?" This is one of many sentiments felt by African Americans. In one of many surveys conducted by researchers, African Americans feared they would be used as guinea pigs for medical research. This survey also found that blacks were more likely than whites not to trust that their doctors would fully explain the significance of their participation in clinical research or other studies. Many scientists believe that bad feelings make it difficult for them to recruit minorities as participants in biomedical research studies in different areas. There continues to be an underlying element of mistrust hetween the poor populations and minority populations that may be subjects of research and the research establishment. The perception of mistrust from the African American community is in large caused by their previous experiences with the health care system. However, the mistrust is not only in perception, but has many other reasons. Mistrust of the health care system by African Americans is a major problem that has to be addressed and corrected. This paper is a historical perspective of the African Americans relating to their distrust of research and the traditional health care system.

1. J Cult Divers. 2007 Summer;14(2):56-60. African Americans and their distrust of the health care system: healthcare for diverse populations. Kennedy BR, Mathis CC, Woods AK. BRK Healthcare Services, Inc. PO Box 25652, Columbia, SC 29224, USA. [email protected]. ...