It's not what you say it's what you do: School diversity ideologies and adolescent mental health and academic engagement.

This study examined the relation between schools' color-evasive versus multicultural diversity ideologies, school characteristics, and adolescent development. Across two datasets linking individual-level survey data (N = 1692) and administrative records (N = 300,063; Mage = 12.4, 52% female, 48% male), schools' stated support for diversity (via a pro-diversity mission statement) was related to adolescent mental health and academic achievement, but in nuanced ways depending on individual racial/ethnic backgrounds, the racial/ethnic diversity of the student body and teachers, and the extent of racial disparities in discipline and gifted education. Findings suggest that communicating support for diversity without redressing systemic inequities in school discipline and academic tracking will not reduce racism-related achievement gaps and may instead exacerbate mental health disparities.

Healthcare delivery to patients from culturally and linguistically diverse backgrounds in emergency care: a scoping review protocol.

BACKGROUND: Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery. METHODS: The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature. DISCUSSION: Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care. SYSTEMATIC REVIEW REGISTRATION: This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ.

The influence of culture on the health beliefs and health behaviours of older Vietnam-born Australians living with chronic disease.

AIM: To explore the health beliefs and health behaviours of older Vietnam-born people living with chronic disease in Western Australia. DESIGN: This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. METHODS: Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. RESULTS: This study included 12 participants. The health perspectives and practices of older Vietnam-born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self-blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese-oriented and Westernized-orientated practices. Individual factors were also identified as contributing to chronic disease self-care among participants. CONCLUSION: This study emphasizes culture played a significant role in shaping the way that older Vietnam-born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. IMPLICATIONS: A better understanding of the health beliefs and practices of older Vietnam-born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. PATIENT AND PUBLIC CONTRIBUTION: This study encompassed the contribution of 12 older Vietnam-born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants.

Cultural humility among nursing students in a multicultural setting.

BACKGROUND: Given the importance of cultural diversity in healthcare, the shift from "cultural competence" to "cultural humility" has become crucial. This transition is particularly relevant for nursing students in multiethnic regions, such as Southeastern Anatolia, Turkey, where diverse cultural interactions can significantly impact their professional development and practice. OBJECTIVE: This study was conducted to determine the cultural humility levels of nursing students. METHODS: This descriptive study was carried out with nursing students in two universities in the Southeastern Anatolia region, where the immigrant population is dense, in Turkey. RESULTS: In this study, the total mean score of the Cultural Humility Scale of the students participating in the research was 70.03±16.01. A significant difference was found between the Cultural Humility scale mean scores of the students and their gender, nationality, native language, experience of going abroad, desire to live in another country, and enjoying spending time with people from different cultures (p < 0.05). Significant positive correlations were determined between the average scores provided by the students on a 0-10 scale, indicating the importance they placed on cultural diversity in nursing education, and both the total score of the Cultural Humility Scale and the mean score of its sub-dimensions (p < 0.01, r = 0.273). CONCLUSION: This study found that the cultural humility level of nursing students living and studying with people from various cultures is sometimes exhibited.

Factors influencing intercultural competences of hospital workers for multicultural patients in South Korea.

Objectives: This study aims to assess the intercultural competence of general hospital workers in South Korea by examining their understanding of cultural diversity in healthcare and to identify factors influencing their intercultural competence. Methods: A cross-institutional survey was conducted with 439 participants from four South Korean general hospitals, employing inferential statistics such as one-way Analysis of Variance, Mann-Whitney U, and Kruskal-Wallis test followed by post-hoc, and multiple linear regression analyses. Results: While 85% (n = 362) of participants acknowledged the significance of multiculturalism in Korean society, only 11% (n = 49) felt competent in treating multicultural patients. Additionally, 72% (n = 315) experienced significant linguistic difficulties in medical communication. Multiple regression analysis identified advanced English competency, multicultural training experiences, and peer support with organizational awareness of multicultural importance as significant positive contributors to intercultural competence. Conclusions: Despite recognizing the importance of multiculturalism, general hospital workers face significant language barriers and low self-efficacy in providing care to multicultural patients. To address these challenges, hospitals should designate resident translators for culturally appropriate communication. Furthermore, a tri-tiered training approach is proposed to enhance the five domains of intercultural competence among general hospital workers in Korea, including overarching multicultural training, occupation-specific courses, and long-term managerial programs aimed at managing cultural diversity effectively in healthcare settings.

Maternal Involvement in Education, Bicultural Acceptance, and School Adjustment: An Autoregressive Cross-Lagged Modeling Study among Adolescents from Multicultural Families.

This study examined the associations between maternal involvement in education and bicultural acceptance and school adjustment during the first year of middle school among adolescents from Korean multicultural families as well as the reciprocal relationships between bicultural acceptance and school adjustment during the three years of middle school. The present study used three-wave longitudinal data of 1185 dyads of adolescents (50.8% girls; mean age = 12.96 ± 0.35 years at the first wave) and their immigrant mothers (mean age = 43.54 ± 5.19 years at the first wave), who participated in the Multicultural Adolescents Panel Study. An autoregressive cross-lagged modeling analysis revealed that maternal involvement in education was significantly and positively associated with adolescents' bicultural acceptance and school adjustment in the first year of middle school. Individual levels of bicultural acceptance and school adjustment among adolescents remained moderately stable over the three years. Whereas the positive effects of school adjustment on bicultural acceptance were significant over time, the effects of bicultural acceptance on school adjustment were not. Finally, this study highlights the roles of intervention programs (e.g., parent and multicultural education) in facilitating maternal involvement in education and school adjustment as well as in increasing bicultural acceptance among minority youths.

Structuralizing Culture: Multicultural Neoliberalism, Migration, and Mental Health in Santiago, Chile.

The arrival of Afro-descendant migrants, mainly from Haiti and the Dominican Republic, has led to the emergence of new discourses on migration, multiculturalism, and mental health in health services in Chile since 2010. In this article, I explore how mental health institutions, experts, and practitioners have taken a cultural turn in working with migrant communities in this new multicultural scenario. Based on a multisited ethnography conducted over 14 months in a neighbourhood of northern Santiago, I focus on the Migrant Program-a primary health care initiative implemented since 2013. I argue that health practitioners have tended to redefine cultural approaches in structural terms focusing mainly on class aspects such poverty, social stratification, and socioeconomic inequalities. I affirm that this structural-based approach finds its historical roots in a political and ideological context that provided the conditions for the development of community psychiatry experiences during the 1960s and 1970s, as well as in multicultural and gender policies promoted by the state since the 1990s. This case reveals how health institutions and practitioners have recently engaged in debates on migration and intersectionality from a structural approach in Chile.

The changes in biethnic acceptance across daily settings and biethnic adolescents' psychological well-being during middle school transition.

INTRODUCTION: Patterns of biethnic adolescents' perceived biethnic acceptance across families, peers, and school contexts were examined during the transition from elementary to middle school in South Korea. We also examined how the transition patterns were related to their psychological outcomes during this period. METHODS: Utilizing 2-wave data (2017 and 2019) from the Panel Survey of Korean Multicultural Youth Adjustment, a latent transition analysis was conducted. Participants were biethnic adolescents who were in 5th or 6th grade at Wave 1 (N = 245; 51.02% female; Mage = 11.38). Their fathers were Korean, and mothers were immigrants from neighboring countries. Familial ethnic socialization, peer discrimination, and school multicultural climate scores were used as indicators of biethnic acceptance. Outcomes of self-esteem, depression, and biethnic affirmation were also examined. RESULTS: Latent profile and transition analyses yielded two groups (i.e., high acceptance and low acceptance) at each wave and four transition patterns (i.e., high-high, low-high, low-low, and high-low). Compared to high-high group, which was the most prevalent group, low-low and high-low groups reported lower self-esteem and ethnic affirmation, and greater depression at Wave 3. CONCLUSIONS: While for the majority of participants, their daily settings continued to be high in biethnic acceptance across the transition period, most at risk were those who perceived a decrease in biethnic acceptance in their daily settings. Results shed light on the need for support to maintain the context of high biethnic acceptance surrounding biethnic adolescents for their psychological well-being in school transitions.

Multicultural Efficacy Beliefs in Higher Education: Examining University Instructors' Burnout and Mental Well-Being.

Canadian universities are experiencing a dramatic increase in enrollment of students from diverse backgrounds. Evidence suggests many educators are not prepared to teach in multicultural contexts. Educators' lack of preparedness to teach in such contexts may lead them to develop burnout, which can negatively impact their mental and professional well-being. However, self-efficacy beliefs may buffer against job burnout and promote mental well-being. Hence, multicultural efficacy is an important factor for teaching in multicultural settings. In this study, we examined the relationships of multicultural efficacy with university instructors' burnout and mental well-being. A total of 158 faculty and sessional instructors were recruited from four prominent higher education institutions in Canada. The results revealed that multicultural efficacy was significantly related to the Personal Accomplishment facet of burnout and mental well-being, even after controlling variance accounted for by demographics, job-related characteristics, teaching self-efficacy, and colour-blind racial attitudes. These findings indicate that domain specific multicultural efficacy and general teaching self-efficacy are distinct constructs. Further, findings may inform the development of training opportunities and diversity-related workshops to enhance university instructors' awareness of diversity, social justice issues, and multicultural efficacy to better equip them for instruction in multicultural classrooms.

'The Relentless Nature of Whiteness': Black Psychologists' Experiences of Racial Microaggressions in Cross-Cultural Supervision.

OBJECTIVES: Research suggests that cross-cultural supervision can be prone to microaggressions with deleterious effects for ethno-racial minorities. There are currently no known studies examining the impact of racial microaggressions in supervision on qualified psychologists. This study aimed to explore Black psychologists' experiences of microaggressions in supervision with a White supervisor and their impact. METHODS: Semi-structured interviews were conducted with 10 individuals who had completed clinical or counselling psychology doctoral training. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS: Three superordinate themes and 12 subthemes were derived from the analysis. The superordinate themes were: 'It's the subtle things', 'It's an ordeal' and 'Surviving Whiteness in psychology'. The findings illustrate the complex nature of racial microaggressions and their profound and lasting impact on individuals. The cumulative impact of these experiences resulted in significant negative psychological outcomes. CONCLUSIONS: The results suggest that there are common microaggressions that recur in supervision. Encountering microaggressions impeded the supervisory relationship, supervision and professional development. Clinical implications include recommendations for including multicultural competency in psychology trainings and ongoing professional development plans.

Swimming and water safety delivery for newly arrived Australians.

In Victoria, Australia, culturally and linguistically diverse communities are more than twice as likely to drown than their Australian-born counterparts. One explanation is the lack of feasible, community-led approaches to water safety and swimming education. A community engagement framework was used to develop and implement a 5-day pool program to teach swimming and water safety to newly arrived migrant children attending an English language school in Victoria. Socio-cultural needs of the predominantly Afghan cohort were incorporated through in-language consultation with parents who requested males and females be educated separately. Participants were assessed against Victorian aquatic competency benchmark standards at pre- and post-program, however, there was no expectation to achieve these competencies within the 5 days due to a lack of prior aquatic exposure. Independent and paired samples t-tests determined changes in skills, including by sex and number of lessons attended. Forty-one participants completed all assessments. Excluding lifesaving skills, there was a significant increase in total competency attainment overall from pre- to post-program (p < 0.001), and for each competency (p's ≤ 0.002)-predominantly knowledge and rescue skills. Improvements were mostly recorded among males, demonstrating that females may require more specialized support to achieve similar outcomes. Improvements in rescue skills and knowledge indicate the program's effectiveness in increasing newly arrived migrant children's awareness of, and exposure to, foundations of safe aquatic behaviours. Future programs tailored to newly arrived migrant communities should consider implementing water familiarization activities as a stepping stone to engagement with structured swimming and water safety education.

Insecure attachment and eating disorder symptoms: Intolerance of uncertainty and emotion regulation as mediators.

OBJECTIVE: Literature on eating disorder (ED) symptoms of Black, Indigenous, and People of Color (BIPOC) group is extremely scarce. This study aimed to understand the mechanisms underlying the associations between insecure attachment and ED symptoms and examine whether these mechanisms differed between White and BIPOC groups. METHOD: The study investigated direct and indirect relationship between attachment anxiety/avoidance and ED symptoms via intolerance of uncertainty (IU) and emotion regulation strategies of suppression and reappraisal. Further, we examined whether the proposed mechanisms equally represented White versus BIPOC using Multigroup Structural Equation Model (MG-SEM). A total of 1227 college students (48.50% BIPOC and 51.50% White) completed research questionnaires. RESULTS: Results showed that IU and suppression mediated the relations between insecure attachment and ED symptoms for both White and BIPOC groups. Uniquely, reappraisal mediated the relations between insecure attachment and ED symptoms for the White group, but not for the BIPOC group. DISCUSSION: The implications of the findings for culturally informed practice are discussed, including targeting increasing tolerability of uncertainties and improving emotion regulation to mitigate ED symptoms for those with insecure attachment.

Assessing the impact of an online dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking communities: A case study.

BACKGROUND: Awareness and understanding of dementia remain limited in ethnically diverse populations in multicultural societies due to culturally inappropriate and inaccessible information. OBJECTIVE: To establish the impact, helpers and hinderers of an online multilingual dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking people. DESIGN: A case study using mixed methods to assess the impact and implementation of an information session on dementia knowledge. SETTING AND PARTICIPANTS: The study was conducted with English, Arabic and Vietnamese speaking individuals in Canterbury-Bankstown, Australia. INTERVENTION STUDIED: A dementia alliance co-created an online multilingual dementia information session, which was delivered synchronously in English, Arabic and Vietnamese by trained facilitators. MAIN OUTCOME MEASURES: In-session group discussions, quizzes and a postsession survey assessed the impact on dementia knowledge. A postimplementation focus group explored the factors that helped and hindered the initiative. RESULTS: The online dementia information session successfully supported participants understanding of dementia causes, impacts and care strategies. The initiative was hindered by competing priorities and limited accessibility to target audiences, while it was helped by the support of an established organisation and feedback mechanisms. DISCUSSION: Ongoing dementia education and awareness-raising campaigns that are culturally sensitive are needed in communities to promote dementia literacy and help-seeking. CONCLUSIONS: An online multilingual dementia information session can be an effective way to improve dementia literacy and advocate for change in multicultural communities. PATIENT OR PUBLIC CONTRIBUTION: English, Arabic and Vietnamese speaking members of the Canterbury Bankstown Dementia Alliance participated in the co-creation and evaluation of this initiative.

Social acceptance and adjustment of spouses in multicultural families to reduce violent behavioral conflicts in the Mueang district, Yala province.

Currently, there is an increasing number of intercultural marriages in Thailand. Many Thai citizens, especially in various regions, tend to marry foreigners. In the southern region, particularly in the three southern border provinces, intercultural marriages mostly occur between Thai Muslim women and Thai Buddhist men. In these cases, the men usually convert to their wives' religion, Islam, which can lead to significant differences in beliefs and practices between the spouses. These differences often result in conflicts within the family and ultimately contribute to domestic violence issues. This situation has serious repercussions for both adults and children involved. This qualitative research examined the acceptance and adjustment of spouses in multicultural families to reduce violent behavioral conflicts in Muang District, Yala Province, Thailand. This study was the first research conducted in the region. To this end, data were collected through in-depth interviews, focus group discussions, and both participant and non-participant observations. Interview questions and group discussion topics were determined according to research objectives. Further, study samples were collected from multicultural Buddhist-Islamic families using the purposive sampling method. Thematic analysis was employed to analyze data. Results revealed that individuals' intolerance of each other's beliefs and attitudes was the major cause of violence in multicultural families. The values, beliefs, concepts, and attitudes of married couples are shaped by their primary and secondary socialization based on their cultural foundations. Therefore, spouses in multicultural families accept and adjust themselves holistically to reduce violent behavioral conflicts in their family life. Their acceptance includes: (1) physical acceptance and adjustment; (2) mental acceptance and adjustment; (3) social acceptance and adjustment; and (4) spiritual acceptance and adjustment. The findings have implications for intercultural marriages.

Suicide and mortality following self-harm in Culturally and Linguistically Diverse communities in Victoria, Australia: insights from a data linkage study.

Background: While cultural backgrounds are well-documented to be relevant to intentional self-harm, little is known about how cultural and linguistically diverse (CALD) backgrounds affect mortality outcomes following self-harm. Aim: This study aimed to compare the risk of all-cause mortality and suicide after intentional hospital admissions for self-harm among people from CALD (vs. non-CALD) backgrounds. Method: Linked hospital and mortality data in Victoria, Australia, was used to assess suicide and all-cause death after hospital admissions for self-harm among patients aged 15+ years. All-cause death was identified by following up on 42,122 self-harm patients (hospitalized between 01 July 2007 and 30 June 2019) until death or 15 February 2021. Suicide death was evaluated in 16,928 self-harm inpatients (01 January 2013 and 31 December 2017) until death or 28 March 2018. Cox regression models were fitted to compare mortality outcomes in self-harm patients from CALD vs. non-CALD backgrounds. Outcomes: During the follow-up periods, 3,716 of 42,122 (8.8%) participants died by any cause (by 15 February 2021), and 304 of 16,928 (1.8%) people died by suicide (by 28 March 2018). Compared to the non-CALD group, CALD intentional self-harm inpatients had a 20% lower risk of all-cause mortality (HR: 0.8, 95% CI: 0.7-0.9) and a 30% lower risk of suicide (HR: 0.7, 95% CI: 049-0.97). Specifically, being from North Africa/Middle East and Asian backgrounds lowered the all-cause mortality risk; however, the suicide risk in Asians was as high as in non-CALD people. Conclusion: Overall, people from CALD backgrounds exhibited lower risks of all-cause mortality and suicide following hospital admission for self-harm compared to the non-CALD group. However, when comparing risks based on regions of birth, significant variations were observed. These findings underscore the importance of implementing culturally tailored background-specific suicide preventive actions. The study focussed on outcomes following hospital admission for self-harm and did not capture outcomes for cases of self-harm that did not result in hospital admission. This limits generalisability, as some CALD people might avoid accessing healthcare after self-harm due to cultural factors. Future research that not limited to hospital data is suggested to build on the results.

Nursing roles in disaster zones: Experiences and lessons from Turkey's 2023 earthquakes.

BACKGROUND: Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment. AIM: This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission. METHODS: Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research. FINDINGS: The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission. CONCLUSION: Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation. NURSING AND HEALTH POLICY IMPLICATIONS: Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.

Chronic bullying victimization and life satisfaction among children from multicultural families in South Korea: Heterogeneity by immigrant mothers' country of origin.

BACKGROUND: Despite existing literature on the link between bullying victimization and psychological well-being, little is known about the potential lasting negative effects of chronic bullying victimization, especially among children from multicultural families (CMF). OBJECTIVE: This study examined the longitudinal association between chronic bullying victimization and life satisfaction among CMF in Korea, and further investigated whether this association differs by immigrant mothers' country of origin. PARTICIPANTS AND SETTING: This study utilized data from the Multicultural Adolescents Panel Study (MAPS) 2011-2019, a nationally representative longitudinal study of CMF in Korea who were between the ages of 9 and 12 at baseline (N = 1375). METHODS: Fixed effects models were employed to address potential bias resulting from unobserved time-invariant confounders. Three theoretical models were proposed to examine the trajectory patterns of change in life satisfaction among chronically bullied children: cumulative effects, immediate-sustained effects, and short-lived effects models. RESULTS: The longitudinal trajectories of change in life satisfaction associated with chronic bullying victimization were consistent with an immediate-sustained effects model. Heterogeneous patterns in the association by mothers' country of origin were observed. A cumulative effects model was supported for children with Southeast Asian mothers, indicating that chronic bullying victimization leads to a cumulative decrease in life satisfaction. For children with Chinese and Japanese mothers, the results supported either immediate-sustained or short-lived effects models. CONCLUSIONS: Efforts to improve the psychological well-being of CMF should consider the potential long-term risk of chronic bullying victimization, particularly among youth with mothers from Southeast Asia.

Sexual experiences among multicultural adolescents in Korea: evidence from the Korean Youth's Risk Behavior Survey.

Several studies have examined adolescent sexual behaviors by family immigration status, but most of these failed to account for heterogeneity within youths' multicultural backgrounds. To fill this gap in the literature, this paper draws data from the 2011 to 2022 rounds of the Korean Youth's Risk Behavior Survey (N = 769,160) and compares the likelihood of sexual intercourse across four groups of adolescents. Results from logistic regression indicate that the odds of having sexual contact increased 2.8 times for youths with a non-Korean father and Korean mother, compared with those from families with two Korean parents. When both father and mother are foreign-born, the odds of being sexually active increased 4.7 times. In both cases, the discrepancies might be primarily associated with the foreign fathers' lack of socioeconomic resources. Therefore, the father's role deserves more examination, and sex education in schools should be tailored to reflect multicultural adolescents' needs.

Trends in diversity-related learning among secondary schools in 35 US states, 2014-2018.

Objective: School Health Profiles (Profiles) is a national surveillance system operated by the US Centers for Disease Control and Prevention. A school-based system of surveys, Profiles monitors school health policies and practices in US states and other jurisdictions through questionnaires completed by school principals and lead health education teachers. This study used the Profiles principal survey to identify trends in US schools' implementation of diversity-related learning opportunities (i.e., opportunities to learn about people who are different from them) in secondary classroom and extracurricular settings. Methods: Logistic regression models using data from three cycles of School Health Profiles from 35 US states examined trends in the percentages of secondary schools offering students diversity-related learning opportunities in the following settings, each measured by using dichotomous yes/no response options: a) clubs; b) lessons in class; and c) special events (e.g., multicultural week, family night) sponsored by the school or community organisations. Results: During 2014-2018, no states experienced decreases in opportunities for students to learn about people who are different from them; most states demonstrated no significant change. Conclusion: Findings suggest efforts are needed to strengthen capacity for and prioritisation of policies, programmes, and practices promoting diversity and culturally relevant education in schools, and in turn, promote positive health and educational outcomes for youth.

Evaluating the cross-cultural competence instrument for healthcare professionals (CCCHP) among nurses in Okinawa, Japan.

BACKGROUND: To provide better quality healthcare services to patients with different linguistic and cultural backgrounds, the cross-cultural competence of medical professionals is important. However, assessing and improving the cross-cultural competence of healthcare professionals is difficult in Japan, as there is no standardized scale to measure the competence. This study's purpose was to translate the Cross-Cultural Competence instrument for Healthcare Professionals (CCCHP), which was developed and used in Europe, and to examine its reliability and validity among Japanese nurses. METHODS: During June and July 2021, nursing staff were invited to take web- and paper-based surveys in Okinawa Japan. The CCCHP (five-factor model with 27 items across motivation, attitude, skills, emotion, and knowledge) was translated using a combination translation method, and a five-point Likert scale was used for responses. Exploratory and confirmatory factor analyses and known-group method were used to examine structural validity, while Cronbach's alpha coefficient was used to test reliability. RESULTS: A total of 294 responses were analyzed; 77.2% had more than five years of experience. Since the fit index indicated that the five-factor model was not a good fit, it was modified to a four-factor model (J-CCCHP24) by moving three variables, removing the knowledge factor, and using the error covariance of the variables. The fit index after the modification was improved to comparative fit index (CFI) = 0.92, Tucker-Lewis index (TLI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, and standardized root mean square residual (SRMR) = 0.06, and Cronbach's alpha was 0.85. The mean scores of J-CCCHP24 were significantly higher in the group with a history of overseas travel, higher foreign language skill, training in intercultural care, experience of foreign patient care, and intercultural interactions outside the workplace than in the group without these characteristics. CONCLUSION: This study confirmed the validity and reliability of the modified Japanese version of the CCCHP (four-factor model with 24 items). The results suggest that the exposure to different cultures on a personal level may help improve nurses' cross-cultural competence. Further refinement of this scale for practical use would encourage the implementation of necessary countermeasures to improve the cross-cultural competence of Japanese healthcare professionals.