A community-based program evaluation of community competency trainings.

Transgender and gender-nonconforming individuals encounter a multitude of barriers to accessing clinically and culturally competent health care. One strategy to increase the quality and competence of care delivery is workplace trainings. This study describes a community-based program for the evaluation of this type of training. Using a mixed-methods approach, the research team assessed the effectiveness of three competency trainings administered by a local nonprofit organization in the Northwest United States. Quantitative data indicated a significant shift in self-assessed knowledge associated with completion of the training. Qualitative data confirmed this result and revealed a number of important themes about the effect of the trainings on providers and their ability to implement knowledge and skills in practice. Clinical considerations are proposed for providers who seek similar trainings and who aim to increase clinical and cultural competency in delivering care to transgender and gender-nonconforming patients and clients.

How do communities want their information? Designing educational outreach on organ donation for Asian Americans.

CONTEXT: Support of organ donation among Asian Americans has been limited, but lack of access to information and prevalence of misinformation are 2 barriers that might be counteracted by public education. OBJECTIVE: To solicit advice from 4 Asian American communities on the design of a culturally appropriate educational campaign on organ donation and transplantation. DESIGN AND SETTING: Cross-sectional, multilingual survey administered at community festivals and supermarkets. PARTICIPANTS: 201 Asian American respondents. MAIN OUTCOME MEASURES: The components of an effective public education outreach campaign on organ donation were defined for 4 Asian American communities. RESULTS: Media venues ranked highest for information dissemination on organ donation/transplantation were, in descending order, mainstream television, ethnic newspapers, mainstream newspapers, and ethnic television. Most respondents preferred a spokesperson of Asian American descent, but opinions differed by ethnicity as to whether an effective spokesperson needed to be of the same Asian ethnicity as the respondents. Respondents were further divided by ethnicity on their preference for a locally or nationally well-known spokesperson. The most compelling scenario to promote organ donation was an Asian American waiting for a transplant, followed by an organ donor family or individual, and, last, a transplant recipient. Different advertisements for organ donation appealed to different Asian ethnic groups. CONCLUSIONS: Community-based research gives communities the opportunity to collaborate with health professionals in designing health education programs that target their own populations. Because key aspects influencing campaign efficacy can vary by ethnicity, these important differences need to be taken into account in outreach planning.

Disaster preparedness for limited English proficient communities: medical interpreters as cultural brokers and gatekeepers.

Current disaster and emergency response planning does not adequately address the needs of limited English proficient (LEP) communities. The complexities of language and cultural differences pose serious barriers to first responders and emergency providers in reaching LEP communities. Medical interpreters are potential key cultural and linguistic linkages to LEP communities. This project established a collaborative partnership with the Interpreter Services department of Harborview Medical Center in Seattle, Washington. In summer 2004, a pilot assessment of the training background and work experiences of medical interpreters was conducted that focused on training needs for disaster/emergency situations. Overall, medical interpreters identified a need for disaster preparedness training and education. Medical interpreters further reported that LEP communities are not prepared for disasters and that there is a need for culturally appropriate information and education.

Understanding the experiences of lesbian, bisexual and trans survivors of domestic violence: a qualitative study.

OBJECTIVES: Using a participatory approach, our objectives were to understand community perspectives on domestic violence (DV) in lesbian, bisexual and trans (LBT) communities, and to assess access to and cultural appropriateness ofDVservices for LBT survivors. METHODS: We used qualitative methods and conducted focus groups and semi-structured interviews with LBT survivors of DV. RESULTS: Nearly all participants reported that the level of awareness regarding DV in their communities was limited. Survivors reported difficulty identifying their partners' behavior as abusive. Isolation was described as central to experiences of abuse, and respondents discussed a variety of isolation tactics specific to LBT communities. Isolation also contributed to difficulty seeking help. Respondents reported that they often did not access mainstream DV services due to concerns about homophobia and transphobia. To address DV in LBT communities respondents pointed to the importance of friendship and community networks, sharing information about queer DV, and holding batterers accountable for their behavior. CONCLUSIONS: LBT people face challenges identifying and responding to DV that are specific to their cultural context. Services for LBT DV survivors must be culturally appropriate and accessible. Community based solutions for addressing and preventing DV should be encouraged.

"Women must endure according to their karma": Cambodian immigrant women talk about domestic violence.

Asian populations living in the United States share similar cultural values that influence their experiences with domestic violence. However, it is critical to recognize how differential cultural beliefs in the context of immigration and adjustment to life in the United States affect attitudes, interpretations, and response to domestic violence. This article discusses findings from community-based participatory action research that explores how Cambodian immigrant women talk about domestic violence, what forms of abuse contribute to domestic violence, and what strategies they use to cope with and respond to abuse in their lives. The richness of this research lies in the stories that immigrant women tell about their struggle and their strength in addressing domestic violence.

"For us it is like living in the dark": Ethiopian women's experiences with domestic violence.

This article discusses the experiences of domestic violence among Ethiopian refugees and immigrants in the United States. A subset (n=18) of the larger study sample (N=254) participated in three focus groups with Amharic-speaking survivors of domestic violence who were currently in or had left abusive relationships. The research was conducted through a public health department, University, and community agency partnership. Findings show domestic violence as taking place within a context of immigration, acculturation, and rapid changes in family and social structure. Participants expressed a need for language and culture-specific domestic violence support and advocacy as well as education programs regarding U.S. laws and resources.

"No way out": Russian-speaking women's experiences with domestic violence.

This article explores the experience of domestic violence and utilization of domestic violence resources among immigrant women who were Russian speaking. Participants, many of whom came to the United States as so-called mail-order brides, reported diverse forms of abuse, including isolation and financial restrictions, and were reluctant to get outside help because of embarrassment about their circumstances. Survivors stressed the importance of language- and culture-appropriate outreach and services and urged that women receive information about domestic violence services and laws on immigration. Assistance with housing, child care, and job searches is integral to safe transitions out of abusive relationships.

"Like a bird in a cage": Vietnamese women survivors talk about domestic violence.

In recent years, a growing literature has emerged that explores the role of culture in domestic violence for ethnic minority populations, including immigrants and refugees. This article presents qualitative data collected from Vietnamese refugee women through a research project in partnership with the Refugee Women's Alliance in Seattle, Washington. Through the women's stories, their own self-awareness of domestic violence as Vietnamese women residing in the United States is available for reflection and review. Issues of acculturation, changing gender roles, examples of strength, and cultural persistence constitute the thematic structure within which these women articulate their needs for creating and sustaining a life free of abuse for themselves and their children.

Participatory action research in practice: a case study in addressing domestic violence in nine cultural communities.

Participatory action research (PAR) is increasingly recognized as a viable approach to developing relationships with communities and working closely with them to address complex public health problems. In the case of domestic violence research, where ensuring the safety of women participants who are battered is paramount, participatory approaches to research that include advocates and women who are battered in research design, implementation, analysis, and dissemination are critical to successful and mutually beneficial projects. This article presents a case study of a PAR project that conducted formative qualitative research on domestic violence in nine ethnic and sexual minority communities. The article describes the specific ways in which a PAR approach was operationalized and discusses in detail how community participation shaped various stages of the research. Furthermore, specific actions that resulted from the research project are reported.

Older adult perspectives on physical activity and exercise: voices from multiple cultures.

INTRODUCTION: Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. METHODS: Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7-13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD +/- 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. RESULTS: Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. CONCLUSION: Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.