A culturally competent approach to cancer news and education in an inner city community: focus group findings

Ethnic minorities who live in socioeconomically disenfranchised communities suffer disproportionately from many health problems including cancer. In an effort to reduce these disparities, many health-care practitioners and scholars have promoted "culturally competent" health education efforts. One component of culturally competent education is a grounded knowledge base. To obtain knowledge about the cancer-related ideas of members of one African American community, researchers conducted focus groups with public housing residents and used the findings to develop a five-part television news series about breast, prostate, and cervix cancers. We found that participants gathered information from the folk, popular, and professional health sectors and constructed their cancer-related ideas from this information. Furthermore, experiences of racism, sexism, and classism colored their beliefs and behaviors regarding the prevention, detection, and treatment of common cancers. For this community "cancer" represents a giant screen upon which individual fears and societal ethnic, political, and economic tensions are projected.     

Fatalistic Cancer Beliefs and Information Seeking in Formerly Incarcerated African-American and Hispanic Men: Implications for Cancer Health Communication and Research

African-American and Hispanic men are disproportionately affected by cancer experiencing higher rates of cancer-related morbidity and mortality for many cancers (but not all). These challenges may be magnified for a subpopulation of African-American and Hispanic men who have been incarcerated. A survey assessing demographics, incarceration experience, psychosocial, behavioral, and cancer health information seeking was administered to 230 previously incarcerated men aged 35 years and older. Data analysis was performed to assess the association between fatalism, perceived susceptibility, and health information seeking in this population. This study revealed the following: the majority of the participants (68.7%) held the fatalistic belief: “When I think of cancer, I automatically think of death.” Second, the fatalistic belief, “There’s not much you can do to lower your chances of getting cancer,” is more prevalent among those who perceived a higher risk of developing cancer. Third, older participants (those between 55 and 70 years old) and widowed are less likely to think of death when they think of cancer. In addition, those who use the Internet to look for health or medical information (i.e., engaging in health information seeking) are less likely to agree with the fatalistic belief: “It seems like everything causes cancer.” Given the high incidence of certain cancers among African-American and Hispanic men and the vulnerability of those involved in the criminal justice system, our findings highlight the importance of understanding perceived susceptibility to cancer, fatalistic beliefs about cancer, and information seeking in formerly incarcerated men.     

Meeting the needs of Somali patients at the end of life

Given the large number of Somali refugees living in Minnesota, it is likely that Minnesota physicians will encounter Somali patients, some of whom will have serious illnesses. Although our knowledge of Somali expectations about health care is growing, little has been written about the Somali people's views of treatment for life-threatening illnesses or their ideas about end-of-life care. After encountering a Somali man with advanced cancer in our practice, we attempted to learn about the Somali view of death and dying and the kind of treatment Somali patients might want during their final days. We share what we learned so that others might provide more culturally competent end-of-life care for Somali patients in the future.     

Cancer Information-Seeking Behaviors and Information Needs Among Korean Americans in the Online Community

Korean Americans tend to have less access to health service and cancer screening tests than all US population. It is necessary to understand their current cancer information-seeking behaviors and information needs to more effectively provide adequate cancer information. However, there is little known about their cancer information seeking behaviors and needs. The purpose of the study was to understand cancer information seeking behaviors and information needs among Korean Americans. Data were collected from MissyUSA, which is one of the biggest websites for the Korean community in the USA. A total of 393 free-texts from January to June 2013 were reviewed; 120 were deleted because the messages were not related to cancer health information. A total of 273 posted free-texts were analyzed for this study, using an open source text-mining software program called AntConc 3.2.4. The extracted terms were categorized based on coding systems, after linguistic variations were handled. Terms such as “surgery,” “breast cancer,” “examination,” “cancer” (unspecified), “Korea,” and “pain” were most frequently identified. Medical topics accounted for 71.4 % of the main topics of the postings. Treatment was the most frequently discussed in the medical topics while in the non-medical category, the most frequently discussed topic was recommendations for hospitals or doctors. In relation to types of cancer, breast cancer was the greatest concern, followed by cervical and liver cancer. The findings from this study can help in establishing more effective strategies to provide better cancer information among Korean Americans by assessing their cancer information seeking trends and information needs.     

Praying to win this battle: Cancer Metaphors in Latina and Spanish Women’s Narratives

ABSTRACT

This study closely examines 51 breast cancer narratives Latina and Spanish women wrote for other patients to illuminate how they conceptualize their health, with insights for addressing health disparities. Using discourse analysis of the role of language and culture in health care communication, this study focuses on the use of metaphors in the narratives. This provides revelations about the cultural and linguistic aspects of how the writers conceptualize their disease. Building on past research on metaphor use in cancer discourse in the English language, this study reveals the prevalence of metaphors comparing cancer to combat, or more generally, violence (e.g., “my battle against cancer”), or a journey (e.g., “my path with cancer”). Writers used this metaphorical language to offer advice to others with cancer and to mark their membership in a larger community of people with cancer. We also find that Spanish women use metaphors more frequently than Latinas and that they differed in their metaphorical portrayals of cancer. This research uncovers culturally embedded themes that are central to how women with cancer think about the disease, such as the prominence of spirituality in Latinas’ metaphorical constructions, a pattern not evident in Spanish women’s narratives.     

Knowledge of and Adherence to Fruit and Vegetable Recommendations and Intakes: Results of the 2003 Health Information National Trends Survey

Attention to cancer-relevant communication (e.g., fruit/vegetable intake recommendations) through various media has been shown to be a pivotal step in reduction of the cancer burden, thus underscoring the importance of examining associations between exposure to health media and knowledge of and adherence to fruit/vegetable intake recommendations. The purpose of the present study was to assess factors associated with fruit/vegetable intake knowledge and behavior. The authors analyzed data collected from the 2003 Health Information National Trends Survey to evaluate the effect of fruit/vegetable intake knowledge on behavior, and the relationship of this effect with biobehavioral, sociodemographic, and communication characteristics. Participants who were knowledgeable of fruit/vegetable intake recommendations and consumed at least 5 fruit/vegetable servings per day were classified as informed compliers. Associations were observed for being an informed complier and paying “a lot” of attention to health media on the radio, in the newspaper, and in magazines and “a little” or “some” attention to health media in magazines or on the Internet. The recent explosion of available cancer-related information through various media underscores the importance of examining associations between exposure to health media and knowledge of and adherence to fruit/vegetable intake recommendations.     

Social determinants of health: Social forces that shape women and men's knowledge of reproductive health in a resource-limited setting

Social forces shape people's reproductive health in many ways. We examined people's knowledge about reproductive health using focus group data collected from 93 participants in rural districts of Malawi. Participants' perspectives were contextualized by explaining the socioeconomic, cultural, and gender factors that determine reproductive health for rural Malawians. Strategies to improve reproductive health care in environments lacking in health infrastructure, staff, and economic resources are then provided. We call for a reproductive health agenda to target preventive care by providing information about anatomy and biology, communicating information in culturally competent ways, and educating men and women over the life course.     

Improving Health Promotion to American Indians in the Midwest United States: Preferred Sources of Health Information and Its Use for the Medical Encounter

American Indians and Alaska Natives suffer significant health disparities for many infectious and chronic diseases as compared to the general population. Providing accurate and culturally tailored health information to underserved groups has been shown to influence health behaviors and health outcomes. Little prior research has explored American Indians health information use and preferences. National representative sample surveys such as the Health Information National Trends Survey provide some data on minority groups but are underpowered to provide useful information on American Indians. The present study analyzes data from a survey of over 900 American Indians from the Midwest United States and explores their sources of health information, their preferences for information presentation, and their use of health information prior to and during medical encounters. We conclude that campaigns targeting Natives should be narrowly focused and be community driven or employing community resources. American Indians use a diversity of media sources to obtain health information, with the Internet being underutilized compared to the general population. Partnership with Indian Health Service providers and pharmacists, as well as traditional healers, in the development and dissemination of new health information for Natives may provide the “expert” tone needed to promote health improvements in American Indians.     

A Culturally Appropriate Cancer Education Program for African-American Adolescents in an Urban Middle School

ABSTRACT: This article describes an innovative transfer of cancer prevention information from a Comprehensive Cancer Center to the community and school setting. A cancer control curriculum, developmentally and culturally appropriate for middle school, African-American children, was taught to seventh grade students in a public middle school in a large, northeastern city. By building partnerships among a university, an academic medical center, a public school district, and a non-profit arts organization, students learned cancer control concepts in the context of their daily lives. Students increased their knowledge of cancer risk and demonstrated a positive attitude about their ability to affect their own health. Experience with this project enabled staff to identify additional education and support needs that exist among students who have family members with cancer.     

Association of culturally competent care with influenza vaccination coverage in the United States

BackgroundCultural minority groups in the United States have lower vaccination rates or worse influenza-related outcomes. Culturally competent care, which aims to engage the social, cultural, and linguistic needs of all patients, may address some of these disparities.ObjectiveWe investigate how self-reported measures of culturally competent care is associated with influenza vaccination rates in the United States.MethodsThe National Health Interview Survey (NHIS) 2017 was queried for respondents asked a set of questions which assessed respondents’ access to culturally competent care in the past year. The outcome of interest was self-reported receipt of the annual influenza vaccine. Sample-weighted multivariable logistic regressions estimated the adjusted odds ratios and 95 % confidence intervals (95 %CI) of influenza vaccination with response to the cultural competency survey questions as the dependent variable of interest. Subsequent marginal modeling predicted the adjusted vaccination rates among cultural minorities (racial/ethnic minorities, LGBTQ + adults, foreign-born individuals, and non-English speakers) and respondents with high-risk comorbidities for worse influenza outcomes. Models were adjusted for other known determinants of vaccination coverage.Results20,303 sample adults were included in the analyses. There were significantly higher odds of influenza vaccination among respondents who were “always” or “most of the time” treated with respect by their providers (aOR 1.53, 95 %CI [1.23–1.90], P < 0.001), given easy-to-understand information (aOR 1.37, 95 %CI [1.19–1.58], P < 0.001), asked about their opinions or beliefs about their care (aOR 1.29, 95 %CI [1.19–1.39], P < 0.001), and seen by providers who shared or understood their culture (aOR 1.15 95 %CI [1.01–1.30], P = 0.03), compared to their counterparts who responded with “some” or “none of the time” to the same survey questions. Higher adjusted influenza vaccination rates were seen among multiple racial/ethnic groups, LGBTQ + adults, foreign-born individuals, non-English speakers, and individuals with high-risk comorbidities who reported positive responses to the cultural competency survey questions.ConclusionsWe demonstrate a positive association between self-reported frequency of access to culturally competent care and receipt of the annual influenza vaccine. These findings support future efforts to evaluate vaccination outcomes among patients who receive components of culturally competent care, such as linguistically appropriate services, race-concordant healthcare workforce, and community engagement.     

A health professional students' cultural competence and attitudes toward the poor: the influence of a clinical practicum supported by the National Health Service Corps

To provide quality health care today, practitioners must be culturally competent. Funding sources, such as the federal government, recognize the need to prepare culturally competent clinicians. The mission of the National Health Service Corps (NHSC), a federal program, is to increase access to primary care services and reduce health disparities by assisting in the preparation of community-responsive, culturally competent primary care clinicians. This study evaluated an NHSC program that funded, in part, health professional students' educational programs. Following their participation in an NHSC-supported clinical experience, students were assessed on their cultural competence, perceptions of the poor, and intention of serving in an underserved community. Health professional students completed a survey before and after the clinical practicum. Participants included students who were studying to be physicians, physician assistants, social workers, and nurse practitioners. Results of the study found no change in students' cultural competence after their clinical practicum. Although they remained in the "culturally aware" stage, they were not considered either "culturally proficient" or "culturally competent." However, their attitudes toward those in poverty were more positive than in previous studies of health professionals. The greatest impact from the students' clinical experience was their increased intention to practice in an underserved community following their practicum. They found their experience with the underserved to be rewarding, challenging, and humbling. Documenting the influence that government-funded programs have on health professional students is extremely important in studies such as this.     

Bolivian Mothers Clubs as Media: Building on Community-Based Networks*

ABSTRACT: Because of the high infant mortality rate in Bolivia, health officials sought an effective method of distributing information about oral-rehy-dration therapy (ORT). Capitalizing on the existence of a network of “mothers clubs” throughout the country, an attempt was made to transform these units from passive recipients of surplus food to active agents of health education. These efforts to disseminate information and supplies through the education of local community leaders were combined with mass media strategies to form a coordinated information and delivery system. Preliminary evaluations suggest that the effort was successful in increasing the awareness of the ORT therapy among participants, their knowledge about the consequences of ORT use, and the availability of ORT supplies. Moreover, informed club members were found to be sharing their knowledge with non-member mothers. The implications of this strategy for other health education efforts are discussed.     

Cervical Cancer Prevention in Malawi: A Qualitative Study of Women's Perspectives

Researchers posit that cervical cancer knowledge is central to participation in prevention behaviors. However, of the many barriers to cervical cancer prevention in low- and middle-income countries, cervical cancer knowledge remains severely limited among communities at great risk for the disease. Malawi is one such country where the burden of cervical cancer is considerably high. Formative research targeting cervical cancer prevention is needed, particularly research that explores ways to deliver cervical cancer information efficiently and effectively to Malawian women. In this study, the authors aimed to garner Malawian women's understanding of cervical cancer and to shed light on preferences for health information delivery, including community health advocacy. Qualitative, in-depth interviews were conducted with 30 Malawian women and analyzed for recurring themes. In general, women had limited cervical cancer knowledge, which supported misperceptions about the disease, including factors pertaining to risk and prevention. Nonetheless, women reported that receiving cervical cancer information from trusted sources would help promote preventive behaviors. Women noted that they received most of their health information from hospital personnel, but distance was a barrier. Women also expressed interest in community health advocacy. Perspectives from Malawian women may be vital toward informing efforts to increase cervical cancer knowledge and prevention.     

Exploring issues relating to disability cultural competence among practicing physicians

BackgroundMany factors contribute to the well-recognized health care disparities experienced by persons with disability, including failure of physicians to understand the lives of individuals with disability. Disability cultural competence considers physicians’ ability to meet the social, cultural, and linguistic needs of this population.ObjectivesTo assess physicians’ understanding of disability cultural competence and attitudes towards patients with disability.MethodsQualitative analyses of open-ended individual interviews averaging 41 min with 20 Massachusetts physicians from 5 different subspecialties, in practice for 8–51 years. Interview recordings were transcribed verbatim for conventional content analysis.ResultsMost participants defined disability using medically-focused concepts rather than concepts that recognize how social factors contribute to disability. All participants used disability culturally-competent language, such as “person-first language,” at some points throughout their interviews. However, most participants also employed language that is now considered unacceptable or archaic, such as variations on the word “handicap,” “wheelchair-bound,” describing persons with disability as “suffering,” and calling persons by their health condition (e.g., “COPDer”). Participants mentioned persons with mental illness and intellectual disability as particularly challenging, especially around communication and performing even routine tests or examinations. Recommendations for improving care included better listening to patients with disability and seeking their views about their care.ConclusionsIn this exploratory study, most participants used language that is considered disability culturally competent at times but also employed many terms and concepts that are considered outdated and may be troubling to some persons with disability.     

The Health Information National Trends Survey (HINTS): Development,Design, and Dissemination

Little is known about access, sources, and trust of cancer-related information, or factors that facilitate or hinder communication on a populationwide basis. Through a careful developmental process involving extensive input from many individuals and organizations, the National Cancer Institute(NCI)developed the Health Information National Trends Survey(HINTS)to help fill this gap. This nationally representative telephone survey of 6,369 persons aged?≥?18 years among the general population was first conducted in 2002–2003, and will be repeated biennially depending on availability of funding. The purpose of creating a population survey to be repeated on a cyclical basis is to track trends in the public's rapidly changing use of newcommunication technologies while charting progress in meeting health communication goals in terms of the public's knowledge, attitudes, and behaviors. The HINTS survey instrument was built upon extant models of health communication and behavior change, taking into account the rapidly changing communication environment. Questions in the survey were drawn from an overall theoretical framework that juxtaposed the“push”aspects of traditional broadcast media against the“pull”aspects of new media. HINTS data will be made widely available for researchers and practitioners; it will help further research in health communication and health promotion and provide useful information for programs, policies, and practices in a variety of settings.     

Integrated Primary Care and Behavioral Health Services for Latinos: A Blueprint and Research Agenda

ABSTRACT

Disparities in Latino utilization of mental health services have been documented for some years. Factors such as stigma, low rates of health insurance, paucity of culturally competent providers, and linguistic inaccessibility have contributed to this underutilization. The documented tendency of many Latinos to experience the mind and body as a unified whole, often referred to as “non-dualism,” provides a unique opportunity to address these disparities in utilization. This article advocates a specific model of engagement of Latinos into a continuum of needed behavioral health services via the primary care clinic, and suggests a variety of clinical and administrative outcome measures for evaluating the effectiveness of the model. The model centers on the inclusion of a behavioral health specialist who is “nested” within the primary care team. The preparation and perspectives of clinically trained social workers make them ideal for this role.     

Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian,Alaska Native,and Native Hawaiian Communities

Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.

     

Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.     

Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model

Latinos, who constitute the fastest growing ethnically distinct US group, experience disproportionately high rates of type 2 diabetes. At the same time, linguistic and economic barriers, differing cultural expectations between patients and physicians, provider reactions based on stereotypes, and managed healthcare shortfalls limit diabetes care. Such trends highlight physicians' need to consider culture in the delivery of effective services. To address these issues we investigated predictors of culturally competent actions among a sample of 134 practicing San Diego County physicians. They provided demographic information and completed questions assessing their cultural knowledge, cultural awareness, and culturally competent actions specific to Mexican Americans with diabetes. We then developed a structural cultural competence model. Results indicated that participation in diverse medical education settings and experience in community clinics predicted cultural knowledge. Participation in diverse educational settings, Latino ethnicity, bilingual skills, and cultural knowledge predicted cultural awareness. An internal medicine specialty predicted less cultural awareness. Culturally competent actions were only predicted by cultural awareness. Goodness-of-fit statistics supported the overall model's acceptability. The number of Mexican Americans physicians see in practice did not predict any tested cultural competence dimension. Our model supports a number of conclusions. First, knowledge of cultural factors per se and simple exposure to Mexican Americans in practice do not directly facilitate culturally competent care. Rather, such care is most strongly predicted by recognition that cultural factors and awareness of personal biases are important. Results further support medical education that does not solely focus on basic information about Mexican Americans but also explores provider biases and preconceptions. Diverse educational experiences appear particularly helpful in this process. Community clinic settings also help practitioners gain cultural knowledge. While Latino ethnicity predicted cultural awareness, results also suggest that all physicians can take steps towards increasing their cultural competence.