Acculturative stress, stigma, and mental health challenges: emic perspectives from Somali young adults in San Diego county's 'Little Mogadishu'.

OBJECTIVES: The purpose of this study was to explore the social factors that contribute to the mental health challenges that Somali young adults endure. DESIGN: In a two-phase qualitative approach carried-out in the San Diego area, in phase-I, we conducted exploratory interviews with key-informants including clinicians and local Somali leaders (n = 7) who are familiar with the challenges of young Somalis. This information was then augmented through a focus group discussion with Somali young adults (n = 4) to gain further contextual knowledge and for access to the larger community of young people for phase-II. In this second phase, we carried-out individual interviews with 21 Somali young adults. Interviews covered topics including the social factors influencing their mental health, typical strategies for coping with psychological distress, barriers to seeking professional mental health services, and suggestions for combating mental health problems affecting young Somalis. RESULTS: Participant narratives indicate that psychological distress (depression and posttraumatic stress disorder) are highly pervasive, and that shame, acculturative stress and ethnic discrimination as well as parents' dismissive reactions to their children's emotional problems perpetuate mental health problems. Coping strategies included support from friends, religious activities, and playing soccer. Suggestions for addressing their challenges centered on engagement from their own community to advocate for mental health. CONCLUSIONS: Implications of this study are discussed in the context of bridging intergenerational and acculturation divides to deliver culturally competent interventions that improve the mental health and well-being of Somali young adults and aid them in their adjustment to the U.S.

Colorectal cancer screening among Mexican Americans at a community clinic.

BACKGROUND: Mexican Americans tend to under-utilize colorectal cancer (CRC) prevention. Yet little is known about sociocultural factors associated with CRC screening. This study assessed predictors of three primary CRC tests among low-income Mexican Americans. METHODS: From May to December 2003, an availability sample of 287 patients, aged 50 to 89 years, who presented for routine care at a community health center near the U.S.-Mexico border completed surveys on CRC knowledge, awareness, attitudes toward screening, logistic barriers, perceptions of health, locus of control, acculturation, whether their doctor discussed CRC screening, and sociodemographics. Participants also reported whether they had ever had a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy. Logistic regression identified predictors of having had these tests. RESULTS: Overall, 41% reported having ever had any of the three tests; 34.1% had a fecal occult blood test; 6.6%, flexible sigmoidoscopy; and 11.8%, colonoscopy. Few respondents reported any clear knowledge about CRC, and only 41% said their doctor had ever discussed screening with them. Yet "doctor discussed screening" was the only consistent screening predictor across tests. CRC knowledge (p=0.006) and insurance coverage (p=0.009) predicted having had a flexible sigmoidoscopy. Perceptions of general poor health also predicted having had a flexible sigmoidoscopy or a colonoscopy (p=0.04). Being employed marginally predicted whether patient had ever had any of the three tests (p=0.05). CONCLUSIONS: Results show that even those in contact with community medical services exhibit low CRC screening rates. They further suggest that interventions focused on clinical settings are an important first step toward CRC prevention in this community.

Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model.

Latinos, who constitute the fastest growing ethnically distinct US group, experience disproportionately high rates of type 2 diabetes. At the same time, linguistic and economic barriers, differing cultural expectations between patients and physicians, provider reactions based on stereotypes, and managed healthcare shortfalls limit diabetes care. Such trends highlight physicians' need to consider culture in the delivery of effective services. To address these issues we investigated predictors of culturally competent actions among a sample of 134 practicing San Diego County physicians. They provided demographic information and completed questions assessing their cultural knowledge, cultural awareness, and culturally competent actions specific to Mexican Americans with diabetes. We then developed a structural cultural competence model. Results indicated that participation in diverse medical education settings and experience in community clinics predicted cultural knowledge. Participation in diverse educational settings, Latino ethnicity, bilingual skills, and cultural knowledge predicted cultural awareness. An internal medicine specialty predicted less cultural awareness. Culturally competent actions were only predicted by cultural awareness. Goodness-of-fit statistics supported the overall model's acceptability. The number of Mexican Americans physicians see in practice did not predict any tested cultural competence dimension. Our model supports a number of conclusions. First, knowledge of cultural factors per se and simple exposure to Mexican Americans in practice do not directly facilitate culturally competent care. Rather, such care is most strongly predicted by recognition that cultural factors and awareness of personal biases are important. Results further support medical education that does not solely focus on basic information about Mexican Americans but also explores provider biases and preconceptions. Diverse educational experiences appear particularly helpful in this process. Community clinic settings also help practitioners gain cultural knowledge. While Latino ethnicity predicted cultural awareness, results also suggest that all physicians can take steps towards increasing their cultural competence.

Acculturation and health beliefs of Mexican Americans regarding tuberculosis prevention.

Mexican Americans are at particular risk of contracting tuberculosis. Yet too little is known about perceptions influencing their health. This study investigated gender and acculturation differences in TB-specific Health Belief Model (HBM) constructs, and the applicability of the HBM's traditional configuration to Mexican Americans. Acculturation and gender substantially influenced the findings. Traditional Mexican Americans reported higher perceived susceptibility and seriousness, more barriers, and greater attention to cues regarding TB prevention than Highly Integrated Biculturals. Women reported greater benefits, attention to cues, and intent to engage in TB prevention behaviors than men. Highly Integrated Bicultural men reported less attention to cues and less intent to engage in health behaviors than other groups. The traditional HBM configuration did not fit this sample. Reconfiguration did, however, result in adequate fit. Overall, higher perceived susceptibility, action benefits, attention to media cues, and female gender predicted greater intent to engage in TB health behaviors.

Improvement in diabetes care of underinsured patients enrolled in project dulce: a community-based, culturally appropriate, nurse case management and peer education diabetes care model.

OBJECTIVE: To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes. RESEARCH DESIGN AND METHODS: A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA(1c), lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce. RESULTS: After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA(1c) (12.0-8.3%, P < 0.0001), total cholesterol (5.82-4.86 mmol/l, P < 0.0001), LDL cholesterol (3.39-2.79 mmol/l, P < 0.0001), and diastolic blood pressure (80-76 mmHg, P < 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P = 0.024), treatment satisfaction (P = 0.001), and culture-based beliefs (P = 0.001) were also improved. CONCLUSIONS: A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations.