Increasing awareness and implementation of cultural competence principles in health professions education

Even as the importance of improved communication between health professionals and patients grows, the factors making it more difficult continue unabated--everything from expanding medical technology and increased subspecialization to America's ever-increasing cultural diversity. This article looks at some of the ways health care professionals, administrators, accreditors, and educators across the continuum of medical and health-related professions are seeking to increase the cultural competence skills of current and future practitioners. Many of these efforts, however, are still too recent and limited to produce measurable results. Data on the implementation of educational standards and curricula need to be collected, analyzed, and disseminated to begin to identify the degree to which standards and educational materials are being developed and implemented and what, if any, impact they are having on the delivery of culturally effective care.     

Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study

Background

Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children’s school snacks.

Methods

Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n?=?645 children from N?=?99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks.

Results

On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR?=?1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR?=?3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased.

Conclusions

Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

     

Bank accounts for public primary health care facilities: Reflections on implementation from three districts in Tanzania

Health care financing reforms are gaining popularity in a number of African countries to increase financial resources and promote financial autonomy, particularly at peripheral health care facilities. The paper explores the establishment of facility bank accounts at public primary facilities in Tanzania, with the intention of informing other countries embarking on such reform of the lessons learned from its implementation process. A case study approach was used, in which three district councils were purposively sampled. A total of 34 focus group discussions and 14 in‐depth interviews were conducted. Thematic content analysis was used during analysis. The study revealed that the main use of bank account revenue was for the purchase of drugs, medical supplies, and minor facility needs. To ensure accountability for funds, health care facilities had to submit monthly reports of expenditures incurred. District managers also undertook quality control of facility infrastructure, which had been renovated using facility resources and purchases of facility needs. Facility autonomy in the use of revenue retained in their accounts would improve the availability of drugs and service delivery. The experienced process of opening facility bank accounts, managing, and using the funds highlights the need to strengthen the capacity of staff and health‐governing committees.     

Scanning the horizon: development and implementation of an early awareness system for anticancer drugs in Austria

Background

Due to increasing expenditures for cancer therapies, an instrument was needed in Austria to facilitate the evidence-based use of new anticancer drugs and to pre-estimate their financial implications.

Objectives

To describe and analyse the development and implementation of a Horizon Scanning System (HSS) in Austria that allows for the evaluation of new anticancer drugs before their routine introduction into clinical practice in order to inform decision-makers.

Methods

Common stages involved in HSSs were identified by a literature review and in cooperation with experts. A first concept for an HSS in Oncology was developed and piloted, and further adjustments were made after several feedback rounds with experts in oncology.

Results

To specifically tailor the five common stages of HSSs to the needs of our HSS, a continually evolving process was required. Now, 21 information sources are regularly scanned, the information is retrieved and extracted in a standardised format, and only anticancer drugs in phase III are included and prioritised by a team of eight experts. Since the HSS in Oncology was implemented as a standard practice, 19 assessments on novel cancer therapies with likely therapeutic and/or financial impacts have been published.

Conclusions

The successful implementation of an HSS necessitates a repetitive cycle of adjustments in order to meet the objectives set by the individual HSS.     

Occupational safety and health education in the public schools: rationale, goals, and implementation

Occupational safety and health education deserve major attention in the elementary and secondary school curriculum. The astonishing severity and widespread prevalence of job-related injuries and diseases warrants the addition of this topic to the school syllabus. In addition, the years before high school graduation are the time when (a) attitudes toward safety and health are formed, (b) youngsters are readily accessible, and (c) youngsters can be motivated to consider the safety and health hazards of various occupations before they pursue a career. Six goals for occupational safety and health education at the elementary and secondary school levels are offered, and several instructional approaches designed to enable instructors and students to achieve these goals are recommended.     

The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.     

Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand,India: implications for ACSM

Setting: Forty hard-to-reach villages in the East and West Singhbhum Districts of Jharkhand State, India.Objectives: To document knowledge and awareness of tuberculosis (TB) among the general population, understand gender differences and inform intervention activities for the improvement of TB control programmes in tribal-dominant hard-to-reach areas in India.Design: A cross-sectional community-based survey was carried out among 825 respondents using population proportionate sampling.Results: Most of the respondents were in the 18–35 years age group, tribal and married; 44% were illiterate. The study shows poor knowledge about TB symptoms, causes, modes of transmission and moderate awareness about government TB services. Correct knowledge about the cause of TB was negligible: half of the respondents reported local liquor as the cause, 61% considered TB as transmissible and one third considered sharing of food as the mode of transmission. Awareness about the availability of free treatment services at government health facilities was high, but awareness about DOTS was low. Significant gender differences were observed in knowledge and awareness levels.Conclusion: Study findings point to the importance of urgent intensification of culturally congruent and gender-sensitive advocacy, communication and social mobilisation activities.     

Marketing as a tool to increase the effectiveness of public health plans. 2008 SESPAS Report

Recent years have seen a steady increase in social marketing applied to health with the aim of increasing public awareness and changing people's behavior. Programs or actions based on the principles of social marketing have been shown to be effective in improving public health. However, that is not the general rule in Spain, where health policies have been based on health plans directed more to economic efficiency than to citizens' needs. For a health marketing program to be effective, the following factors are necessary: 1) the program has a long-term temporal horizon for action; 2) the objectives are established in terms of behavioral changes; 3) market research is used as a source of information; 4) different actions are established according to the segments identified as targets; 5) the program is operationalized in the four variables of the marketing mix, namely, product, price, distribution and communication, and is not only based on advertising campaigns; 6) the core of the program is exchange, understood as the factors that motivate people to change in return for the promise of something beneficial to them; 7) the factors or forces that compete with the desired behavioral changes are neutralized, and 8) businesses' social responsibility is used as a mechanism to reinforce health improvement programs. The design of health marketing programs should include definition of strategic and operational actions aimed not only at potential adopters of the desired behavior but also at all agents who may help or hinder behavioral change (health professionals, the pharmaceutical industry, politicians, the advertising industry, and products and services with health-challenging objectives).     

The role of the Government in public health: a national perspective

The main challenges today are complex systems problems, with equally complex solutions; there are problems that have the potential to affect all individuals at different levels, affecting health, the sustainability of health services, and potentially the long-term economic prosperity of the country. The evidence shows that unless people themselves are engaged, releasing their potential for action, supporting a cultural shift towards a health promoting society, it is unlikely that the necessary sustainable impact on obesity, diabetes and other chronic diseases will be achieved. By reflecting on experience in England, this article will provide an insight into the potential for change that can be generated by rebalancing the relationship between the state, the individual and civil society.