Cultural Competency

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.

The multicultural competence (MC) and evidence-based practice (EBP) initiatives have each generated healthy debates in the mental health field, with ample implications for clinical training and practice. Using two case illustrations, we highlight practical challenges and prospects in the intersection of MC and EBP. To facilitate complementary practice of MC and EBP, we offer strategies for the group therapist as a ''local clinical scientist'' to deliver culturally responsive treatments. We stress the importance of cultural adaptation of EBP models, namely, modifying evidence-based interventions that involve changes in service delivery, in the nature of the therapeutic relationship, or in components of the treatment itself to accommodate the cultural beliefs and behaviors of racialcultural minority clients. Cultural adaptation of EBP in group therapy needs to be grounded in developmental contextualism and social justice. We discuss the two cases with an eye toward advancing multicultural competence in group therapy.

Background: This paper explores how a group of Vietnamese Australian young women acquire knowledge of sexual issues, and the impact the traditional Vietnamese culture has on the acquisition of this knowledge. It is based on a qualitative study that examined the factors which shape the sexual behaviour of Vietnamese Australian young women living in Australia. Methods. A Grounded Theory methodology was employed in this investigation, and involved in-depth interviews with 15 Vietnamese Australian young women aged 18-25 years, who reside in Victoria, Australia. Results: The findings illustrated three key elements involved in the acquisition of knowledge of sexual issues: 'Accepting parental silence', 'Exploring sources of knowledge' and 'Needing culturally targeted information'. The young women desired discussion about sexual issues but accepted that cultural 'barriers' were formidable. Their desire conflicted with the traditional familial norm of 'silence' regarding sexual matters. Consequently, knowledge was sought outside the home, specifically from peers and the media. The importance of culturally appropriate and adequate sexual discussions for Vietnamese Australian young people was stressed, so that informed decisions could be made about their sexual lives. Conclusion. It is imperative for young people to have adequate and appropriate sexual education so that informed and safe sexual choices can be made. For young people from diverse cultural backgrounds, this education must be culturally appropriate and accessible, taking into consideration cultural mores regarding gender and sexual matters, as well as current beliefs in the 'mainstream' youth culture.

Building on recent theory stressing multicultural orientation, as well as the development of virtues and dispositions associated with multicultural values, we introduce the construct of cultural humility, defined as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual's cultural background and experience. In 4 studies, we provide evidence for the estimated reliability and construct validity of a client-rated measure of a therapist's cultural humility, and we demonstrate that client perceptions of their therapist's cultural humility are positively associated with developing a strong working alliance. Furthermore, client perceptions of their therapist's cultural humility were positively associated with improvement in therapy, and this relationship was mediated by a strong working alliance. We consider implications for research, practice, and training.

Scientific research occurs within a set of socio-political conditions, and in Canada research involving Indigenous communities has a historical association with colonialism. Consequently, Indigenous peoples have been justifiably sceptical and reluctant to become the subjects of academic research. Community-Based Participatory Research (CBPR) is an attempt to develop culturally relevant research models that address issues of injustice, inequality, and exploitation. The work reported here evaluates the use of Photovoice, a CBPR method that uses participant-employed photography and dialogue to create social change, which was employed in a research partnership with a First Nation in Western Canada. Content analysis of semi-structured interviews (n=45) evaluated participants' perspectives of the Photovoice process as part of a larger study on health and environment issues. The analysis revealed that Photovoice effectively balanced power, created a sense of ownership, fostered trust, ...

As a group, people who use illicit drugs and are affected by social disadvantages often experience health inequities and encounter barriers such as stigma and discrimination when accessing health care services. Cultural safety has been proposed as one approach to address health inequities and mitigate stigma in health care. Drawing on a qualitative ethnographic approach within an overarching collaborative framework, we sought to gain an understanding of what constitutes culturally safe care for people who use(d) illicit drugs. The findings illustrate that illicit substance use in hospitals is often negatively constructed as (1) an individual failing, (2) a criminal activity, and (3) a disease of "addiction" with negative impacts on access to care, management of pain, and provision of harm-reduction supplies and services. These constructions of illicit substance use impact patients' feelings of safety in hospital and nurses' capacity to provide culturally safe care. On the basis of these findings, we provide recommendations and guidance for the development of culturally safe nursing practice.

This study aimed to investigate (a) whether it is possible to increase emotional competence (EC) in adulthood; (b) whether this improvement results in better mental, physical, and social adjustment; (c) whether this improvement can be maintained 1 year later; and (d) whether these benefits are accompanied by a reduction in stress-hormone secretion (i.e., cortisol). One hundred and thirty-two participants were randomly assigned to an EC-enhancing intervention (in group format) or to a control group. Participants in the intervention group underwent a specifically designed 15-hr intervention targeting the 5 core emotional competencies, complemented with a 4-week e-mail follow-up. Results reveal that the level of emotional competencies increased significantly in the intervention group in contrast with the control group. This increase resulted in lower cortisol secretion, enhanced subjective and physical well-being, as well as improved quality of social and marital relationships in the intervention group. No significant change occurred in the control group. Peer reports on EC and quality of relationships confirmed these results. These data suggest that emotional competencies can be improved, with effective benefits on personal and interpersonal functioning lasting for at least 1 year. The theoretical implications of these results as well as their practical implications for the construction and the development of effective emotional competencies interventions are discussed.