Teaching and learning interventions designed to improve cultural competence in health profession students : a systematic review

Purpose: Developing healthcare profession students’ cultural competency knowledge, skills and attributes is critical to meet the needs of culturally and linguistically diverse healthcare service consumers. The purpose of this systematic review was to identify effective cultural competence interventions for healthcare profession students. Methods: A systematic review of peer reviewed articles published from 2010-2021 using PRISMA guidelines was conducted by searching CINAHL, EMBASE, ERIC, PubMed, and Psych INFO databases. Article quality was assessed using the Evaluation Tool for Quantitative Research and Mixed Method Appraisal Tool. Results: The initial search identified 2,261 potentially relevant studies, 41 studies met the inclusion criteria in which intervention effectiveness was evaluated using a validated outcome measure pre- and post- intervention. Only one study used a non-self-report outcome measure. Out of the 41 studies, only eight studies employed randomisation in the method. Conclusion/Recommendations: This review evaluated effectiveness of cultural competence interventions and evaluation of the intervention using either self-report or non-self-report validated outcome measures at pre- and post-intervention exposure. Combining cultural competence teaching methods such as lectures with simulations, role-playing and community engagement with diverse populations enhanced cultural competence. Further studies are required to compare effective cultural competence teaching models and identify reliable non-self-report outcome measures to assess the effectiveness of interventions post-exposure. Comparing effective cultural competence teaching models that utilise reliable non-self-report outcome measures will be valuable for guiding the design of teaching and learning interventions directed towards cultural competence. Further research is also required to examine the duration of intervention efficacy and how to maintain efficacy post-intervention exposure. Findings from this review are important for designing and structuring of cultural competence curriculum for healthcare profession students and informing future research on cultural competence teaching. This review has identified that most evaluation tools and studies have been designed for the nursing discipline. There is need to design more cultural competence evaluation tools and studies for other healthcare disciplines such as pharmacy and physical therapy

Reducing health inequities for asylum seekers with chronic non-communicable diseases : Australian context

Asylum seekers are susceptible to chronic non-communicable diseases pre- and post-arrival due to poor living conditions, unhealthy lifestyles and restrictive and poor access to health services. Despite their need for constant and continuous health care access due to poor health, they face healthcare services access restrictions dependent on their visa conditions in Australia. Some visas only allow access to hospital services with restrictions on primary health services access such as GPs and free or discounted pharmaceutical products. In comparison, disadvantaged host populations have access to free/discounted pharmaceutical products and unrestricted access to primary and secondary health care. Ten professionals who constantly engage with asylum seekers in three large asylum seeker centres in Melbourne were interviewed either face-to-face or over the phone. The interviews were essential to understand how health inequities may be addressed for asylum seekers. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic analysis framework. Their recommendations, based mainly on their experience and evaluation of programs, were: (1) cultural competence training (2) use of interpreters (3) free access to health services and medications (4) use of English learning to promote health literacy and community integration (5) robust chronic non-communicable diseases screening and (6) health promotion and accessible food programs. © 2021 La Trobe University

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

BackgroundTeenage pregnancies and childbearing are important health concerns in low-and middleincome countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.MethodsThe study used the 2004, 2010 and 2015–16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.Results The teenage pregnancy and childbearing rate averaged 29% (

Different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis: the SIRJIA mixed-methods feasibility study.

BACKGROUND:In the UK, juvenile idiopathic arthritis is the most common inflammatory disorder in childhood, affecting 10 : 100,000 children and young people aged < 16 years each year, with a population prevalence of around 1 : 1000. Corticosteroids are commonly used to treat juvenile idiopathic arthritis; however, there is currently a lack of consensus as to which corticosteroid induction regimen should be used with various disease subtypes and severities of juvenile idiopathic arthritis. OBJECTIVE:The main study objective was to determine the feasibility of conducting a randomised controlled trial to compare the different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis. DESIGN:This was a mixed-methods study. Work packages included a literature review; qualitative interviews with children and young people with juvenile idiopathic arthritis and their families; a questionnaire survey and screening log to establish current UK practice; a consensus meeting with health-care professionals, children and young people with juvenile idiopathic arthritis, and their families to establish the primary outcome; a feasibility study to pilot data capture and to collect data for future sample size calculations; and a final consensus meeting to establish the final protocol. SETTING:The setting was rheumatology clinics across the UK. PARTICIPANTS:Children, young people and their families who attended clinics and health-care professionals took part in this mixed-methods study. INTERVENTIONS:This study observed methods of prescribing corticosteroids across the UK. MAIN OUTCOME MEASURES:The main study outcomes were the acceptability of a future trial for children, young people, their families and health-care professionals, and the feasibility of delivering such a trial. RESULTS:Qualitative interviews identified differences in the views of children, young people and their families on a randomised controlled trial and potential barriers to recruitment. A total of 297 participants were screened from 13 centres in just less than 6 months. In practice, all routes of corticosteroid administration were used, and in all subtypes of juvenile idiopathic arthritis. Intra-articular corticosteroid injection was the most common treatment. The questionnaire surveys showed the varying clinical practice across the UK, but established intra-articular corticosteroids as the treatment control for a future trial. The primary outcome of choice for children, young people, their families and health-care professionals was the Juvenile Arthritis Disease Activity Score, 71-joint count. However, results from the feasibility study showed that, owing to missing blood test data, the clinical Juvenile Arthritis Disease Activity Score should be used. The Juvenile Arthritis Disease Activity Score, 71-joint count, and the clinical Juvenile Arthritis Disease Activity Score are composite disease activity scoring systems for juvenile arthritis. Two final trial protocols were established for a future randomised controlled trial. LIMITATIONS:Fewer clinics were included in this feasibility study than originally planned, limiting the ability to draw strong conclusions about these units to take part in future research. CONCLUSIONS:A definitive randomised controlled trial is likely to be feasible based on the findings from this study; however, important recommendations should be taken into account when planning such a trial. FUTURE WORK:This mixed-methods study has laid down the foundations to develop the evidence base in this area and conducting a randomised control trial to compare different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis is likely to be feasible. STUDY REGISTRATION:Current Controlled Trials ISRCTN16649996. FUNDING:This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 36. See the NIHR Journals Library website for further project information

Policies and initiatives/programs that promote health and self-care in asylum seekers living in high income countries : a narrative review

Purpose: This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace. Design/methodology/approach: Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives. Findings: Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research. Originality/value: This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace. © 2021, Emerald Publishing Limited

Teaching cultural competence to undergraduate pharmacy students using vignettes (case scenarios) as an innovative teaching intervention

Objective: Cultural competence is instrumental in reducing health equities. Addressing cultural competence at higher education level in healthcare students lays a solid cultural competence foundation for professional practice. The use of vignettes as a teaching intervention was effective because it allowed the use of role-modelling in real-life situations. The study aimed to enhance cultural competence in undergraduate pharmacy students using a self-directed online interactive cultural competence module embedded with three vignettes (case scenarios). Method: This study was an exploratory longitudinal mixed method (survey and written feedback) study and used a convenience sample of 90 pharmacy students at an Australian University. Students' self-perceived transcultural self-efficacy was evaluated pre-and post-intervention using Jeffreys' Transcultural Self-Efficacy Tool (TSET) which is a validated outcome measure. Key findings: Vignettes were effective in teaching cultural competence as shown by significant (P 0.90 in all domains confirmed the test's internal consistency and reliability. Conclusions: The findings were indicative of the students' positive receptivity to learning cultural competence and that they had a well-developed understanding of cultural competence. Further research is needed to determine why most cultural competence teaching methods produce little or no meaningful change in enhancing the affective domain. © 2023 The Author(s). Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved

Teaching and Learning Interventions Designed to Improve Cultural Competence in Health Profession Students: A Systematic Review

Purpose: Developing healthcare profession students’ cultural competency knowledge, skills and attributes is critical to meet the needs of culturally and linguistically diverse healthcare service consumers. The purpose of this systematic review was to identify effective cultural competence interventions for healthcare profession students. Methods: A systematic review of peer reviewed articles published from 2010-2021 using PRISMA guidelines was conducted by searching CINAHL, EMBASE, ERIC, PubMed, and Psych INFO databases. Article quality was assessed using the Evaluation Tool for Quantitative Research and Mixed Method Appraisal Tool. Results: The initial search identified 2,261 potentially relevant studies, 41 studies met the inclusion criteria in which intervention effectiveness was evaluated using a validated outcome measure pre- and post- intervention. Only one study used a non-self-report outcome measure. Out of the 41 studies, only eight studies employed randomisation in the method. Conclusion/Recommendations: This review evaluated effectiveness of cultural competence interventions and evaluation of the intervention using either self-report or non-self-report validated outcome measures at pre- and post-intervention exposure. Combining cultural competence teaching methods such as lectures with simulations, role-playing and community engagement with diverse populations enhanced cultural competence. Further studies are required to compare effective cultural competence teaching models and identify reliable non-self-report outcome measures to assess the effectiveness of interventions post-exposure. Comparing effective cultural competence teaching models that utilise reliable non-self-report outcome measures will be valuable for guiding the design of teaching and learning interventions directed towards cultural competence. Further research is also required to examine the duration of intervention efficacy and how to maintain efficacy post-intervention exposure. Findings from this review are important for designing and structuring of cultural competence curriculum for healthcare profession students and informing future research on cultural competence teaching. This review has identified that most evaluation tools and studies have been designed for the nursing discipline. There is need to design more cultural competence evaluation tools and studies for other healthcare disciplines such as pharmacy and physical therapy