Narratives of Ugandan Women Adhering to HIV/AIDS Medication

Adherence to highly active antiretroviral therapy (HAART) is essential to improving the quality of life of people living with HIV/AIDS; however, it still remains a challenge especially for young African women. The purpose of the study was to explore how young women with HIV/AIDS in Uganda experience the influence of their everyday life occupations on adherence to HAART after more than 1 year on the medication. Narratives of six participants were elicited using two semistructured interviews within a period of 1 month. Narrative analysis was used to develop themes reflecting the participants' stories of coping with everyday activities. The participants described their adherence to HAART in relation to everyday life occupations as a “tug of war”, which describes the struggles they had taking medication because they were afraid of being discriminated by peers and the general society. They also expressed fear of not being included in many activities if people knew they have HIV/AIDS because there are many beliefs associated with the illness especially for young women in which they are branded promiscuous. However, in the Ugandan culture, women are considered to be home makers, which restricted their activities mostly around domestic work making it hard for them to prioritize their medication, and when they young women prioritized, it was all about fun activities that seemed to consume much time, hence contributing to the poor adherence. It is therefore important to assess the everyday occupations of young women before they start taking medication, so that HAART is scheduled in accordance with their everyday life occupation to reduce poor adherence. The implications of the study on practice is that it will enable occupational therapists working with persons with HIV/AIDS develop age‐specific activities taking into consideration HAART as an everyday life activity rather than one that needs to be incorporated into their already existing activities, hence improving their adherence and reducing on stigma associated to the medication. Copyright © 2012 John Wiley & Sons, Ltd.     

Occupational therapy in oman: the impact of cultural dissonance

Occupational therapy theory and philosophy are broadly considered to be based on Western cultural values. In contrast, the application of theory and practice in the Sultanate of Oman, historically based on traditional Middle Eastern and Islamic cultural values, provides a case exemplar, which highlights both paradigmatic differences and cultural dissonance. Drawing on the experiences of occupational therapists working in Oman, this study found that the application of therapeutic goals aimed at patient independence and autonomy were difficult to achieve in an environment where family duty and responsibility for care were highly prized. Dressing and cooking assessments were challenging, and issues related to gender proved problematic. Therapists found the need to adapt practice to acknowledge these differences, and to adopt pragmatic problem‐solving strategies, without resolving the underpinning philosophical contradictions. Occupational therapy in Oman is under‐researched; further work is needed to confirm the cross‐cultural validity of specific assessments and practice models. Copyright © 2012 John Wiley & Sons, Ltd.     

Nazi indoctrination and anti-Semitic beliefs in Germany

Attempts at modifying public opinions, attitudes, and beliefs range from advertising and schooling to “brainwashing.” Their effectiveness is highly controversial. In this paper, we use survey data on anti-Semitic beliefs and attitudes in a representative sample of Germans surveyed in 1996 and 2006 to show that Nazi indoctrination––with its singular focus on fostering racial hatred––was highly effective. Between 1933 and 1945, young Germans were exposed to anti-Semitic ideology in schools, in the (extracurricular) Hitler Youth, and through radio, print, and film. As a result, Germans who grew up under the Nazi regime are much more anti-Semitic than those born before or after that period: the share of committed anti-Semites, who answer a host of questions about attitudes toward Jews in an extreme fashion, is 2–3 times higher than in the population as a whole. Results also hold for average beliefs, and not just the share of extremists; average views of Jews are much more negative among those born in the 1920s and 1930s. Nazi indoctrination was most effective where it could tap into preexisting prejudices; those born in districts that supported anti-Semitic parties before 1914 show the greatest increases in anti-Jewish attitudes. These findings demonstrate the extent to which beliefs can be modified through policy intervention. We also identify parameters amplifying the effectiveness of such measures, such as preexisting prejudices.Schools, parents, and the media not only communicate information and teach skills, they transmit values and beliefs as well (1). Dictatorships and democracies alike use schooling in particular to influence the outlook of children and young adults––the period of their lives during which humans are most susceptible to outside influences. The efficiency of such interventions, ranging from mild attempts to modify attitudes to “brainwashing,” is highly controversial (2–6). In particular, the effect of schooling has remained doubtful (5–7). Whereas many historians believe that Nazi propaganda and schooling prepared the ground for the Third Reich’s excesses, scientific studies of indoctrination have typically found few systematic effects (8, 9).In this paper, we use modern-day data on anti-Semitic beliefs in Germany to examine the effectiveness of indoctrination. Nazi schooling and extracurricular activities sought to inculcate racial hatred to an extraordinary extent. The entire curriculum––not only biology classes––was used to convince the young of the importance of race and the inferiority of Jews, blacks, etc. In addition to compulsory school attendance, young Germans had to join the Hitler Youth, where indoctrination continued; the official handbook for schooling the Hitler Youth devoted fully 45 out of 105 pages to racial ideology (10). Further, propaganda messages embedded in books and films reinforced indoctrination (11).Germans who grew up under the Nazi regime were therefore exposed to a wide range of indoctrination methods. Using data from the German General Social Survey (ALLBUS), we show that these individuals are still markedly more anti-Semitic today than cohorts born either before or after. They are more inclined to deny Jews equal rights, to resent having them as neighbors or family members, and they believe more often that Jews have too much influence in the world. The creation of additional racial bias varies by location. Where anti-Semitism was already prevalent before World War I (WWI), the Nazi message of racial hatred produced many more zealots than elsewhere. This suggests that indoctrination is particularly effective where it can exploit preexisting stereotypes and beliefs (12), leading to a “magnification effect.”     

The Benchmarking Strategy Has a Role to Play Across Cultures

This article responds to the commentary by Cardemil ( 2015 ) on our original article (Spilka & Dobson, 2015 ), in which we proposed the use of a benchmarking strategy to evaluate culturally adapted and transported treatments. We address Cardemil's assertion that a culturally embedded or bottom‐up approach to the development of models of psychopathology and treatment of disorders is optimal and argue that benchmarking provides an alternative model in which treatments may also be developed in one culture and exported, with appropriate adaptation and evaluation, to another. We discuss the circumstances in which benchmarking is likely to have enhanced benefit and argue that this issue should be addressed with research and evidence as part of the global efforts toward evidence‐based practice.     

Recognizing the True Norm: Commentary on “Toward Defining,Measuring, and Evaluating LGBT Cultural Competence for Psychologists”

In this commentary, the author discusses the difference between aspirational guidelines and enforceable standards of professional practice and argues that the 28 recommendations proposed by Boroughs, Bedoya, O’Cleirigh, and Safren (Clinical Psychology: Science and Practice, 22, 2015) contain both. The ultimate goal of developing cultural competence training and evaluating cultural competence is to create a professional psychology workforce of people committed to the lifelong practice of self‐evaluation when it comes to the inevitable biases engrained through learning and development within the limitations of our own cultures. The damage of decades of marginalization of sexual and gender minority communities can be ameliorated by improvements in multicultural training and by establishing an expectation that adequate representation of sexual and gender minority participants be included in research on therapeutic practices that will be recognized as treatments with empirical support. The development of criteria for instruction in cultural competence at all levels of psychological training will improve our research and clinical training to be inclusive of sexual minority and gender identity minority individuals, rather than continuing considerations of this population as an out‐group.     

‘It was caused by the carelessness of the parents’: cultural models of child malnutrition in southern Malawi

Parents’ conceptions of child growth, health and malnutrition are culturally bound, making information about local understandings of malnutrition and its causes necessary for designing effective nutrition programmes. This study used ethnographic methods to elucidate cultural models of child care and malnutrition among the Yao of southern Malawi. Data were collected in six rural villages from 28 key informant interviews with village chiefs and traditional healers among others and 18 focus group discussions with parents and grandmothers of young children. For the Yao, lack of parental care is a key cause of poor child health and can lead to thinness (kunyililika) or swelling (kuimbangana). Parents are said to be careless if they are not attentive to the child's needs, are unable to provide adequate quality or quantity of food, or fail to follow sexual abstinence rules. Maintaining abstinence protects the family and failure to do so causes the transfer of ‘heat’ from a sexually active parent to a ‘cold’ child and results in child health problems, including signs and symptoms of malnutrition. These findings indicate that the Yao understanding of care is much broader than the concept of care during feeding described in the nutrition literature. In addition, the Yao note the importance of several key feeding practices supported by international agencies and understand the influence of illness on child nutritional status. These congruencies with the public health frame should be used together with information about the cultural context to design more socially and emotionally relevant care and nutrition programmes among the Yao.     

Cultural safety,diversity and the servicer user and carer movement in mental health research

This study will be of interest to anyone concerned with a critical appraisal of mental health service users’ and carers’ participation in research collaboration and with the potential of the postcolonial paradigm of cultural safety to contribute to the service user research (SUR) movement. The history and nature of the mental health field and its relationship to colonial processes provokes a consideration of whether cultural safety could focus attention on diversity, power imbalance, cultural dominance and structural inequality, identified as barriers and tensions in SUR. We consider these issues in the context of state‐driven approaches towards SUR in planning and evaluation and the concurrent rise of the SUR movement in the UK and Australia, societies with an intimate involvement in processes of colonisation. We consider the principles and motivations underlying cultural safety and SUR in the context of the policy agenda informing SUR. We conclude that while both cultural safety and SUR are underpinned by social constructionism constituting similarities in principles and intent, cultural safety has additional dimensions. Hence, we call on researchers to use the explicitly political and self‐reflective process of cultural safety to think about and address issues of diversity, power and social justice in research collaboration.     

Almutairi's Critical Cultural Competence model for a multicultural healthcare environment

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairi's critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross‐cultural interactions. CCC has addressed the limitations of many other cultural competence approaches that have been discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC.     

The Pain Self‐Efficacy Questionnaire: Cross‐Cultural Adaptation into Italian and Assessment of Its Measurement Properties

The Pain Self‐Efficacy Questionnaire (PSEQ) is a patient self‐reported measurement instrument that evaluates pain self‐efficacy beliefs in patients with chronic pain. The measurement properties of the PSEQ have been tested in its original and translated versions, showing satisfactory results for validity and reliability. The aims of this study were 2 fold as follows: (1) to translate the PSEQ into Italian through a process of cross‐cultural adaptation, (2) to test the measurement properties of the Italian PSEQ (PSEQ‐I). The cross‐cultural adaptation was completed in 5 months without omitting any item of the original PSEQ. Measurement properties were tested in 165 patients with chronic low back pain (CLBP) (65% women, mean age 49.9 years). Factor analysis confirmed the one‐factor structure of the questionnaire. Internal consistency (Cronbach's α = 0.94) and test–retest reliability (ICC_agreement = 0.82) of the PSEQ‐I showed good results. The smallest detectable change was equal to 15.69 scale points. The PSEQ‐I displayed a high construct validity by meeting more than 75% of a priori hypotheses on correlations with measurement instruments assessing pain intensity, disability, anxiety, depression, pain catastrophizing, fear of movement, and coping strategies. Additionally, the PSEQ‐I differentiated patients taking pain medication or not. The results of this study suggest that the PSEQ‐I can be used as a valid and reliable tool in Italian patients with CLBP.