Development and validation of a scale for measuring cultural beliefs about psychotherapy patients in southern Chile

Abstract Purpose: Negative cultural beliefs about psychotherapy patients represent one of the barriers in the psychological help-seeking and treatment adherence. In Chile today, there is little research about specific beliefs towards this group, and therefore measuring them represents a challenge. The aim of the present study was to develop and validate an instrument to measure cultural beliefs about psychotherapy patients. Methods: A mixed method design conducted in four stages was implemented. First, 32 semi-structured interviews were carried out to identify beliefs about psychotherapy patients in southern Chile. Then, a scale of beliefs about psychotherapy patients (SBPP) was developed and piloted in an adult sample (n = 109). Subsequently, the factorial structure of the new scale was explored in patients of primary health centres in La Araucanía Region of Chile (n = 201). Finally, the validity of the construct was assessed in adults who were not undergoing psychotherapy (n = 361). Results: The results showed the existence of negative cultural beliefs about psychotherapy patients which were included in the construction of the SBPP. The scale had a bifactorial structure (αtransitory situations = 0.81 and αstable characteristics = 0.79), consisting of 15 items with a Likert-type response format, and showed good indicators of validity and reliability on the samples in which were applied. Conclusions: The present study shows the importance of using mixed methods for the examination of socially shared beliefs by the cultural group under study, in order to construct instruments that are psychometrically robust and culturally pertinent.

Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención / Health care effects of cultural beliefs about physicians and perceived discrimination

Background: Healthcare inequities may hamper physical and mental health. Aim: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. Material and Methods: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. Results: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. Conclusions: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Healthcare Mistreatment and Cultural Beliefs Impact HbA1c in Patients with Type 2 Diabetes Mellitus / La Negligencia Médica y las Creencias Culturales impactan BhA1C en Pacientes con Diabetes Mellitus tipo 2

Abstract The aim of this research was to examine the effects of healthcare mistreatment and cultural beliefs on psychological, behavioral, and biological phenomena relevant to treatment adherence and health outcome among patients with Type 2 Diabetes Mellitus (T2DM). The study was conducted in Chile, where the prevalence of T2DM is one of the highest in Latin America and is increasing at an accelerated rate. The research was guided by Betancourt's Integrative Model and bottom-up mixed-method cultural research approach. Consistent with the hypotheses of the study, the test of a structural equation model based on the Integrative Model, including exposure to healthcare mistreatment, diabetes-related cultural beliefs, psychological distress, and medical avoidance as determinants of HbA1c, a biological measure of diabetes control, fit the data. The fact that the analysis of structural equations accounted for significant variance in HbA1c provides supporting evidence for extending the Integrative Model, to explain biological phenomena based on cultural and psychological factors.

Resumen El propósito de este trabajo fue evaluar los efectos de la negligencia médica y las creencias culturales sobre fenómenos biológicos, conductuales y psicológicos relevantes para la adherencia al tratamiento y consecuencias de salud en pacientes con diabetes mellitus tipo 2 (DMT2). El estudio se llevó a cabo en Chile, donde la prevalencia de DMT2 es una de las más altas de América Latina y sigue en aumento de manera acelerada. La investigación se basó en el Modelo Integrativo de Betancourt y en el enfoque mixto-abajo-arriba de investigación cultural. Congruente con las hipótesis del estudio, el modelo de ecuaciones estructurales basado en el modelo integrativo, que incluyó la exposición a negligencia médica, creencias culturales vinculadas a la diabetes, estrés psicológico, y evitación médica como determinantes del HbA1c, una medición biológica de control diabético, mostró buen ajuste. El hecho de que el modelo de ecuaciones estructurales explique gran parte de la varianza del HbA1c aporta suficiente evidencia para ampliar el modelo integrativo en la explicación del fenómeno biológico con base en factores culturales y psicológicos.

Identificación y medición de creencias culturales sobre los médicos: construcción y validación de un instrumento / Development of an instrument to assess cultural beliefs about physicians

Background: Beliefs about professionals' healthcare may influence healthcare behaviors. Such beliefs are in part the result of the interactions that professionals have with their patients. Recent studies highlight the importance of beliefs about physicians, their effect on health-care behaviors, and the requirement of culturally appropriate tools to measure such beliefs. Aim: To develop and validate a culturally appropriate instrument to measure beliefs about physicians. Material and Methods: Based on a "bottom-up" methodology, a culturally pertinent scale of beliefs about physicians was developed and then validated by expert judges. The resulting scale, with 26 items, was applied to 337 participants aged 31 ± 7 years (85% women). Results: Two factors, grouping 24 items, emerged from the exploratory factor analysis. The first was called negative beliefs about doctors (Cronbach's α = 0.96) and the second was called positive beliefs about doctors (Cronbach's α = 0.95). Both factors explain 70 % of the scale variance. Conclusions: The devised instrument has adequate psychometric properties and is also culturally relevant. It allows the assessment of cultural beliefs about physicians.

Desarrollo de un instrumento culturalmente pertinente para medir creencias en psicoterapia / Development of a culturally relevant instrument to measure beliefs in psychotherapy

El estudio de cómo los factores culturales se relacionan con la adherencia a psicoterapia es altamente relevante y sin embargo, en Chile no existen instrumentos que tomen en consideración tales factores. El objetivo de este estudio es ilustrar la construcción de un instrumento para medir variables culturales que se asocian a la adherencia a psicoterapia. Se utilizó una metodología mixta de tres etapas. Primero, se realizaron 32 entrevistas semiestructuradas con el objetivo de identificar creencias socialmente compartidas respecto de la psicoterapia. Luego, se desarrolló la Escala de Creencias en Psicoterapia (ECPSI) y se piloteó en una muestra de 109 personas. Finalmente, se exploró la estructura factorial y propiedades psicométricas de la nueva escala en 201 usuarias de centros de salud primaria de la Región de La Araucanía. Los resultados indican que la ECPSI es un instrumento adecuado psicométricamente y culturalmente pertinente a la sociedad Chilena.

The study of how cultural factors are related to adherence to psychotherapy is highly relevant, however in Chile there are no available measures that addresses these factors. In order to develop an instrument culturally relevant for measuring cultural factors associated with adherence to psychotherapy, a three-stage mixed methodology was used. First, 32 semi-structured interviews were conducted aiming to identifying socially shared beliefs about psychotherapy. Second, the Psychotherapy Beliefs Scale was developed and piloted with a sample of109 participants. Finally, the factorial structure, and the scale reliability were tested with a sample of 201 women recruited from several primary care health centers. The results obtained suggest that this scale is psychometrically sound and culturally relevant for measuring cultural beliefs associated with adherence to psychotherapy.

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche / Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

Asociación entre obesidad infantil y trastornos del sueño en pacientes del Servicio de Endocrinología del INSN / Association between childhood obesity and sleep disorders in patients INSN Endocrinology Service

Introducción: Actualmente la obesidad se ha incrementado de forma considerable en países desarrollados e incluso en aquellos en vías de desarrollo, constituyéndose en el principal problema de malnutrición del adulto y una enfermedad que va en aumento en la población infantil. Es debido al alarmante aumento de la prevalencia de sobrepeso- obesidad infantil, que la identificación de factores de riesgo sobre los que se pueda intervenir se convierte en una necesidad prioritaria entre estos los trastornos del sueño. Objetivo: Establecer si existe asociación entre los trastornos del sueño (tamizaje con escala de BEARS) y la obesidad infantil en niños entre 6 a 17 años del servicio de endocrinología del INSN. entre los meses de setiembre a noviembre del 2009. Método: Es un estudio de tipo analítico - transversal, en el que se aplicó una encuesta a los padres y niños de la muestra la que incluía el cribaje de trastornos del sueño en el niño BEARS, así como también se les realizo las mediciones del peso y la talla. Fueron incluidos en el estudio niños entre 6 a 17 años, divididos en dos grupos etarios de 6 a 12 años y de 13 a 17 años, que acudían al consultorio externo del servicio de endocrinología del INSN, en las fechas en las que se realizaron la recolección de datos. Los datos fueron recogidos en una tabulación en Microsoft Excel y posteriormente procesados con el programa SPSS (Statistical Package for the Social Sciences), versión 15.0. Resultados: Del total de 156 pacientes entrevistados, encontramos que 96 de ellos (61.5 por ciento) presentaban Trastornos del Sueño, de los cuales 38 pacientes, el 39.6 por ciento, presentaban OBESIDAD, por otro lado el 60.4 por ciento NO la presentaban...

Background: Currently, obesity has increased substantially in developed countries and even in those developing, becoming the main problem of adult malnutrition and disease that is increasing in the pediatric population. It is due to the alarming increase in prevalence of overweight and obese children, the identification of risk factors on which to intervene becomes a priority need among these sleep disorders. Objectives: T o establish whether the association between sleep disorders (with scale screening BEARS) and childhood obesity in children aged 6 to 17 years of endocrinology service of INSN between the months of September to November 2009. Methods: An analytical study - cross, which surveyed parents and children in the sample which included the screening of sleep disorders in children (BEARS) as well as the measurements were conducted in weight and height. Included in the study were children aged 6 to 17 years, divided into two age groups 6 to 12 years and 13 to 17, who carne to the outpatient endocrinology service of INSN on the dates in which where performed data collection. Data were collected in a tab in Microsoft Excel and then processed using SPSS (Statistical Package for the Social Sciences) version 15.0. Results: Of the 156 patients interviewed, found that 96 of them (61.5 per cent) had sleep disorders, within this total, 38 patients where representing the 39.6 per cent, and the rest 60.4 per cent where not obese..