Development and testing of a bespoke cultural intervention to support healthcare professionals with patients from a diverse background.

OBJECTIVE: Development and test of a culturally sensitive intervention for rheumatology healthcare professionals (HCPs). METHODS: Using a before and after study design, fifteen HCPs were recruited to undertake the bespoke intervention from four NHS sites across England, in areas serving a diverse population. The intervention was evaluated using the validated outcomes: [1] Patient Reported Physician Cultural Competency (PRPCC); and [2] Patient Enablement Instrument (PEI), measuring patients' perceptions of their overall healthcare delivery. Additionally, HCPs completed the Capability COM-B questionnaire (C), Opportunity (O) and Motivation (M) to perform Behaviour (B), measuring behaviour change. RESULTS: 200 patients were recruited before HCPs undertook the intervention (cohort 1), and 200 were recruited after (cohort 2) from fifteen HCPs, after exclusions 178 patients remained in cohort 1 and 186 in cohort 2. Patients identifying as White in both recruited cohorts were 60% compared with 29% and 33% of patients (cohorts 1 and 2 respectively) who identified as of South Asian origin. After the intervention, the COM-B scores indicated HCPs felt more skilled and equipped for consultations. No significant differences were noted in the average overall cultural competency score between the two cohorts in White patients (57.3 vs 56.8, p= 0.8), however, in the South Asian cohort, there was a statistically significant improvement in mean scores (64.1 vs 56.7, p= 0.014). Overall, the enablement score also showed a statistically significant improvement following intervention (7.3 vs 4.3, p< 0.001) in the White patients; and in the South Asian patients (8.0 vs 2.2, p< 0.001). CONCLUSION: This novel study provides evidence for improving cultural competency and patient enablement in rheumatology settings.

Exploring the potentially positive interaction between social media and mental health; the perspectives of adolescents.

Adolescents are spending significant time online. Consequently, concerns are consistently raised about potential negative impacts on their mental health. Potentially, these concerns minimise their autonomy and reify the construction of the vulnerable adolescent. Using template analysis, we explored adolescents' perspectives (N = 54) of the relationship between social media and mental health. We centrally considered the wide array of uses made of different social media by the participants, focusing on their understandings of the potentially positive effects these might have. Focus group discussions showed social media could be used to reduce stress, have value for social connectivity, were an important source of information about mental health, and provided a platform for peer-to-peer support. Our conclusion indicated adolescents are generally socially competent online and are often experimenting with their emergent sense of agency.

A discourse analysis of General Medical Council (GMC) guidelines for the inclusion of cultural diversity issues in medical education and practice.

BACKGROUND: Several studies have highlighted the insufficient inclusion of cultural diversity in medical schools' curricula and the extent of health inequalities highlighted by the COVID-19 pandemic. This study aimed to critically review a range of GMC publications to identify the inclusion of cultural diversity topics in their guidelines, as according to recent studies, doctors are inadequately prepared to serve a diverse population. METHODS: Twenty-four relevant GMC publications were analysed. An inductive thematic analysis was conducted to review the content of the guidelines; and discourse analysis was used to critically understand the linguistics used whilst also considering the cultural and social context. RESULTS: The GMC publications primarily focused on discouraging discrimination and promoting equality. Themes around diversity in medical practice were less commonly covered. There was considerable internal inconsistency across the guidelines. Guidelines aimed at medical schools and medical students were more likely to consider cultural diversity issues compared to those intended for doctors. CONCLUSIONS: Cultural diversity teaching can only be as effective as the policy that drives it. Despite the inclusion of cultural diversity issues in GMC guidelines, this study suggests considerable ambiguity in how these issues are represented and understood. The guidelines require careful revision and should be written to reduce the likelihood of variable interpretation, thereby promoting better cultural diversity inclusion in medical schools' curricula, and consequently better patient care.

A collaboration on teaching and assessing triadic consultation skills.

Introduction: Teaching triadic consultation skills is becoming increasingly prevalent at medical schools but is included by few schools in summative assessments. We describe a collaboration between Leicester and Cambridge Medical Schools to share teaching practice and the development of an objective structure clinical examination (OSCE) station to assess these important skills. Methods: We agreed on the broad components of the process skills of a triadic consultation and wrote a framework. We used the framework to develop OSCE criteria and suitable case scenarios. The triadic consultation OSCEs were used in our summative assessments at Leicester and Cambridge. Results: Student feedback on teaching was largely positive. The OSCEs at both institutions performed effectively provided a fair and reliable test and had good face validity. Student performance was similar in both schools. Discussion and conclusion: Our collaboration provided peer support and enabled the production of a framework for teaching and assessing triadic consultations that is likely to be generalisable to other medical schools. We were able to reach a consensus on what skills should be included in the teaching of triadic consultations and to co-design an OSCE station to effectively assess those skills. Innovation: Collaboration between two medical schools using a constructive alignment principle allowed the efficient development of effective teaching and assessment of triadic consultations.

A valid and reliable scale to assess cultural sensibility in nursing.

BACKGROUND: Cultural sensibility is an important concept linked to the achievement of cultural competence. Health professionals must first improve their cultural sensibility to become culturally competent and to be able to offer competent care to culturally diverse populations. Aim To develop and psychometrically test the Cultural Sensibility Scale for Nursing (CUSNUR), a cultural sensibility scale that can be used in nursing for the achievement of competencies needed to care for culturally diverse populations. DESIGN AND METHODS: The cross-sectional survey was conducted over two stages. The first stage involved the cross-cultural and discipline-specific adaptation of an existing scale addressing this concept in the field of law using the reverse translation method. Second, validation of the scale was carried out from October 2016-June 2017 by studying the psychometric properties of the questionnaire through an analysis of content acceptability and reliability and through exploratory factor analysis (EFA). RESULTS: The questionnaire was designed to be clear, easy to understand, and of adequate length, and experts involved in content validation agreed that the scale meets these criteria. A total of 253 nursing students participated in the validation stage. Four factors were identified from the EFA: (1) patient and health professional behaviours, (2) self-assessments, (3) self-awareness, and (4) cultural influence. Two items were excluded. Factorial saturation is adequate for all factors (>0.30). The Cronbach alpha was measured as 0.75. CONCLUSIONS: This study presents the first version of the CUSNUR and demonstrates that the scale is valid and reliable.

Encounters between children's nurses and culturally diverse parents in primary health care.

The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e-records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.

The challenge of conducting qualitative research to understand the factors that influence equity in medical education: A scoping review.

This article was migrated. The article was marked as recommended. Introduction There are national and international concerns about equity in basic and postgraduate medical education, especially about differential rates of access and attainment across groups of learners. Qualitative research has been increasingly used to understand the factors that influence equity but there are potential limitations to this understanding related to how the research has been conducted. The aim of the scoping review was to identify how qualitative research exploring the factors that influence equity in basic and postgraduate medical education has been conducted. The intention was to inform future research. Methods The electronic databases British Education Index, Campbell Library, CINAHL, Cochrane Library, EMBASE, ERIC, Google Scholar, Health Management Information Consortium (HMIC), MEDLINE, PsycINFO, Web of Science and medical education journals were searched to identify relevant published articles between 2008 and April 2019. Results Among 19,523 articles identified from the literature search, 72 full text articles were included in the review. Most studies had a focus on only one background characteristic and only two studies had a strengths-based focus on individuals. Recommendations for change was at the 'policy level' in ten studies and four studies had learner recommendations for change. No studies with a participatory approach were identified. Conclusion The approach to conducting previous qualitative research appears to limit greater understanding of the complexity of factors that influence equity. In response to this challenge, we recommend that future research widen the focus to consider the experiences and strengths of individual learners in addition to those identified by background characteristics. Future qualitative research is recommended to have a broad focus on both the 'policy level' and 'local level', especially from multiple perspectives. We also recommend greater collaboration of participants with researchers throughout the research process.

Perspectives of Patients With Mental Illness on How to Better Teach and Evaluate Diversity Education in the National Health Service.

INTRODUCTION: Diversity education is a mandatory requirement for all mental-health practitioners and health care professionals in the UK National Health Service. Wide variability exists in the development, delivery, and evaluation of diversity education across health care settings, with limited evidence to suggest the optimal approach for teaching this subject. This study aimed to explore the perspectives of patients with mental illness on how to better teach and evaluate diversity education in the National Health Service. METHODS: A participatory research approach was used with five mental-health patient organizations. Forty-two patients with mental illness took part in three participatory workshops. Data were analyzed through template analysis. RESULTS: The findings indicated that a focus on the nuances and dynamics of clinical relationships would be beneficial. Specifically, the relationship considered most important to examine with respect to diversity education was the "practitioner-self" relationship. DISCUSSION: Reconstructing the relationship-centered care model with the addition of the practitioner-self relationship may be better suited to theoretically informing future developments in diversity education. Further research is needed to understand what educational approaches contribute toward a relationship-centered care outlook and how relationship building behaviors, particularly those relevant to the practitioner-self relationship are best developed in diverse settings.

Culturally Competent in Medical Education - European Medical Teachers' Self-Reported Preparedness and Training Needs to Teach Cultural Competence Topics and to Teach a Diverse Class.

This article was migrated. The article was marked as recommended. Background Health inequalities related to culture and ethnicity may be reduced by training future health care providers.Medical teachers therefore also need to be culturally competent. The aim of this study was to assess medical teachers' preparedness and their training needs to teach cultural competence topics and to teach a diverse class. Methods A link to an online survey was sent to medical teachers of eleven European institutions. Results were analysed through descriptive analysis and answers to open-ended questions were analysed using qualitative analysis. Results 968 respondents were included. The majority of respondents felt it was important that cultural competence topics should be incorporated into the medical curriculum. Assessment of skills in cultural competence was found important as well. Over 60% of all respondents reported to be somewhat or very prepared to teach cultural competence topics like migrant health and disparities. Most respondents felt somewhat or very prepared to teach a diverse class. A high interest in training was expressed on teaching cultural competence topics, specifically on communication-related topics. Conclusion This study emphasizes the importance of incorporating cultural issues into the medical curriculum and to train medical teachers according to their needs.

Potential of social media in promoting mental health in adolescents.

The growing prevalence of adolescent mental disorders poses significant challenges for education and healthcare systems globally. Providers are therefore keen to identify effective ways of promoting positive mental health. This aim of this qualitative study was to explore perceptions that social media might be leveraged for the purposes of mental health promotion amongst adolescents aged between 11 and 18 years. Utilizing focus groups conducted with adolescents (N = 54), educational professionals (N = 16) and mental health practitioners (N = 8). We explored their views about the value of social media for this purpose. Three themes were identified. First, social media appears to have potential to promote positive mental health. Second, adolescents frequently utilize social media and the internet to seek information about mental health. Finally, there are benefits and challenges to using social media in this way. We conclude that despite challenges of using social media and the risks, social media does offer a useful way of educating and reaching adolescents to promote mental wellbeing.

Whose Responsibility is Adolescent's Mental Health in the UK? Perspectives of Key Stakeholders.

The mental health of adolescents is a salient contemporary issue attracting the attention of policy makers in the UK and other countries. It is important that the roles and responsibilities of agencies are clearly established, particularly those positioned at the forefront of implementing change. Arguably, this will be more effective if those agencies are actively engaged in the development of relevant policy. An exploratory study was conducted with 10 focus groups including 54 adolescents, 8 mental health practitioners and 16 educational professionals. Thematic analysis revealed four themes: (1) mental health promotion and prevention is not perceived to be a primary role of a teacher; (2) teachers have limited skills to manage complex mental health difficulties; (3) adolescents rely on teachers for mental health support and education about mental health; and (4) the responsibility of parents for their children's mental health. The research endorses the perspective that teachers can support and begin to tackle mental well-being in adolescents. However, it also recognises that mental health difficulties can be complex, requiring adequate funding and support beyond school. Without this support in place, teachers are vulnerable and can feel unsupported, lacking in skills and resources which in turn may present a threat to their own mental well-being.

Review of mental health promotion interventions in schools.

PURPOSE: The prevalence of mental disorders amongst children and adolescents is an increasing global problem. Schools have been positioned at the forefront of promoting positive mental health and well-being through implementing evidence-based interventions. The aim of this paper is to review current evidence-based research of mental health promotion interventions in schools and examine the reported effectiveness to identify those interventions that can support current policy and ensure that limited resources are appropriately used. METHODS: The authors reviewed the current state of knowledge on school mental health promotion interventions globally. Two major databases, SCOPUS and ERIC were utilised to capture the social science, health, arts and humanities, and education literature. RESULTS: Initial searches identified 25 articles reporting on mental health promotion interventions in schools. When mapped against the inclusion and exclusion criteria, 10 studies were included and explored. Three of these were qualitative and seven were quantitative. CONCLUSIONS: A range of interventions have been tested for mental health promotion in schools in the last decade with variable degrees of success. Our review demonstrates that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations.

Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents.

Despite growing evidence of the effects of social media on the mental health of adolescents, there is still a dearth of empirical research into how adolescents themselves perceive social media, especially as knowledge resource, or how they draw upon the wider social and media discourses to express a viewpoint. Accordingly, this article contributes to this scarce literature. Six focus groups took place over 3 months with 54 adolescents aged 11-18 years, recruited from schools in Leicester and London (UK). Thematic analysis suggested that adolescents perceived social media as a threat to mental wellbeing and three themes were identified: (1) it was believed to cause mood and anxiety disorders for some adolescents, (2) it was viewed as a platform for cyberbullying and (3) the use of social media itself was often framed as a kind of 'addiction'. Future research should focus on targeting and utilising social media for promoting mental wellbeing among adolescents and educating youth to manage the possible deleterious effects.

Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives.

BACKGROUND: Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. METHOD: The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. RESULTS: An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. CONCLUSIONS: No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.

The Foundation Programme in psychiatry: a qualitative study into the effects of a foundation placement.

Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry. Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects. Clinical implications Those developing foundation placements will need to ensure they are of high quality.

Research and partnerships with schools.

PURPOSE: Despite the quantity of research on child and adolescent mental health being done in schools, little output has focused on the practical aspects of recruiting schools and students into a study. Furthermore, there is limited knowledge on how to develop and sustain productive and mutually beneficial partnerships with schools after the project finishes. METHODS: A large study examining prevalence of mental health problems in young people involving nine schools is used as an example for the procedure of recruitment and carrying out a research project, while developing and sustaining partnerships with schools. RESULTS: While recruiting the schools, a three-stage model was developed that corresponded closely to the school's needs and existing demands. The suggested procedure for the study, thus, closely reflected the varying existing cultures of participating schools. Partnerships, developed as a result of the project, were used in developing further projects and interventions for promoting good mental health in schools. CONCLUSIONS: Rather than a blanket research recruitment and procedural approach with an end to school involvement at the end of the project, the paper advocates for a deeper understanding of the schools' internal culture for improved recruitment and study outcomes. Developed partnerships, when sustained past the completion of research, prove to be a useful tool in applying the findings in promoting good mental health in schools and continuing research further.