Cultural competence in the prevention of sexually transmitted diseases.Abstract: Generally, programs and interventions that integrate culture into the context of their prevention strategies are thought to be very effective in curtailing disease than those designed for the general population. Subsequently, we reviewed the application of cultural competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
2. in preventing sexually transmitted diseases Sexually transmitted diseases
Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely . Essentials of cultural competence cultural competence Social medicine The ability to understand, appreciate, and interact with persons from cultures and/or belief systems other than one's own were incorporated into the research studies (n=19). Eighty percent of the studies reported success in achieving desired outcomes. However, no single method of cultural competence was found to produce a successful outcome. Therefore, defining the construct measures of cultural competence may improve our understanding of this concept and its effect on health outcome(s).
There is a considerable amount of current interest in cultural competency among academicians, healthcare providers, public health practitioners, community program planners and policy makers. This interest is stimulated, in part, by the growing racial and ethnic diversity of the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. (U.S.) population. Between, 1995 and 2050 the U.S. population will increase by 50%. Ninety percent of this growth is attributed to the projected increase in ethnic minority groups (The Emerging Minority Marketplace, 1999). As a result, many health professionals are attempting to design culturally competent programs that successfully address the health needs of B\blacks, Latinos/Hispanics, Asian/Pacific Islanders Islanders may refer to:
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. that describe how health professionals can effectively and consistently apply cultural competence to prevention efforts to improve health outcomes. The lack of consensus to define cultural competence, and consequently, the difficulties associated with assessing and measuring this concept has stymied progress in this area.
Nevertheless, health promotion strategies and interventions that infuse in·fuse
1. To steep or soak without boiling in order to extract soluble elements or active principles.
2. To introduce a solution into the body through a vein for therapeutic purposes. elements and techniques of cultural competence can potentially accelerate the reduction of well-known health disparities
Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. among racial and ethnic Americans (Brach & Fraser, 2000). The Office of Minority Health, for example, has made recommendations for national standards on culturally and linguistically appropriate services in health care (Houkje, 2001). These standards were organized into three themes: (1) culturally competent care, (2) language access services, and (3) organizational supports. The recommendations were put in place to ensure the availability of respectful re·spect·ful
Showing or marked by proper respect.
re·spectful·ly adv. care that takes into consideration the cultural beliefs, practices, and the preferred language of the individual.
Building on the concept of respect and the provision of culturally compatible services, a literature review on cultural competence and the prevention of sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, (STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country. ) was conducted to assess: (a) the incorporation of cultural competence in prevention strategies, and (b) the potential impact of cultural competence on the outcomes of STD prevention programs among racial and ethnic groups. The research findings were summarized to make the information easily accessible to planners and evaluators of STD prevention programs. General recommendations were also provided for the use of cultural competence in prevention strategies, based on the review of the STD literature. In addition, broader implications were included for planning and implementing programs aimed at reducing health disparities and improving the health of racial and ethnic populations.
WHAT IS CULTURAL COMPETENCE?
There are various definitions of cultural competence (Table 1). According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Brach and Fraser (2000), cultural competence extends beyond cultural awareness or sensitivity to include possession of cultural knowledge and respect for different cultural perspectives including the effective use of knowledge and skills in cross-cultural situations. Cultural competence reflects the ability to acquire and use knowledge of health-related beliefs, attitudes, practices, and communication patterns of individuals and their families to improve services, strengthen programs, increase community participation and close gaps in health status among diverse population groups.
Several implicit domains are helpful in understanding the broader concept of cultural competence. They include multiculturalism multiculturalism or cultural pluralism, a term describing the coexistence of many cultures in a locality, without any one culture dominating the region. , cultural sensitivity, cultural assessment, and diversity awareness (Resnicow, Baranowski, Ahluwalia, & Braithwaite, 1999). Mental health professionals in the 1960s and 1970s were among the first to conceptualize con·cep·tu·al·ize
v. con·cep·tu·al·ized, con·cep·tu·al·iz·ing, con·cep·tu·al·iz·es
To form a concept or concepts of, and especially to interpret in a conceptual way: "multicultural mul·ti·cul·tur·al
1. Of, relating to, or including several cultures.
2. Of or relating to a social or educational theory that encourages interest in many cultures within a society rather than in only a mainstream culture. " care. Multiculturalism is defined as incorporating and appreciating perspectives of varied racial and ethnic groups without assumptions of superiority or inferiority (Resnicow et al.). In the 1980s, "multiculturalism" evolved into "cultural sensitivity" in response to the changing cultural diversity of the population. Cultural sensitivity is defined as "the extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns In software engineering, behavioral design patterns are design patterns that identify common communication patterns between objects and realize these patterns. By doing so, these patterns increase flexibility in carrying out this communication. and beliefs of a target population, as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of particular health promotion materials and programs." (Resnicow et al.).
There was a shift from population health to a focus on the individual in the 1980s. At that time the goals of treatment and prevention became more personalized per·son·al·ize
tr.v. per·son·al·ized, per·son·al·iz·ing, per·son·al·iz·es
1. To take (a general remark or characterization) in a personal manner.
2. To attribute human or personal qualities to; personify. and addressed the specific concerns of the individual with respect to culture, race or ethnicity, and experiences and provided one with the necessary tools to make informed decisions about health care (Table 2). As an overlay (1) A preprinted, precut form placed over a screen, key or tablet for identification purposes. See keyboard template.
(2) A program segment called into memory when required. to the shifting paradigm, there was a distinct need in the 1990s for an appropriate response to the growing diversity of the population and the persistence of health disparities between people belonging to racial and ethnic groups and those of European ancestry an·ces·try
n. pl. an·ces·tries
1. Ancestral descent or lineage.
2. Ancestors considered as a group.
[Middle English auncestrie, alteration (influenced by .
To reflect this paradigm shift A dramatic change in methodology or practice. It often refers to a major change in thinking and planning, which ultimately changes the way projects are implemented. For example, accessing applications and data from the Web instead of from local servers is a paradigm shift. See paradigm. , Coggins and Yancey (2000) defined cultural competence as a habit of exhibiting the appropriate behavior with respect to the diverse cultural, ethnic, and racial patient population (Table 2). The Coggins and Yancey definition emphasized that cultural competence should become a habitual Regular or customary; usual.
A habitual drunkard, for example, is an individual who regularly becomes intoxicated as opposed to a person who drinks infrequently. exhibit of appropriate behavior with respect to individual cultural backgrounds.
In light of this paradigm shift, some arenas within preventive health care were struggling to meet the needs of specific populations. In particular, researchers and practitioners within the field of sexually transmitted disease routinely express the desire to create programs and services that are informed by empirical evidence. These practitioners understand that the incidence and prevalence of sexually transmitted disease is a consistent public health concern. An estimated 19 million new sexually transmitted infections are contracted a year in the United States (Weinstock, 2004). Clearly, the number of sexually transmitted infections is staggering for the population at large but even more so for racial and ethnic minority groups.
One of the most recognized sexually transmitted diseases is the human immunodeficiency virus human immunodeficiency virus
Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans. (HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. ) that causes acquired immunodeficiency syndrome acquired immunodeficiency syndrome, see AIDS. (AIDS). African Americans African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. have been disproportionately dis·pro·por·tion·ate
Out of proportion, as in size, shape, or amount.
dispro·por affected by HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome since the epidemic's beginning, and that disparity dis·par·i·ty
n. pl. dis·par·i·ties
1. The condition or fact of being unequal, as in age, rank, or degree; difference: "narrow the economic disparities among regions and industries" has only deepened over time (CDC See Control Data, century date change and Back Orifice.
CDC - Control Data Corporation , 2006). Among black men, AIDS is not only a medical problem, but also represents a social-cultural dilemma characterized by issues that center on and around racism, poverty, and gender ideologies (Bowleg bowleg /bow·leg/ (bo´leg) genu varum; an outward curvature of one or both legs near the knee.
A leg having an outward curvature in the region of the knee. , 2004). Race and ethnicity are not, by themselves, risk factors for HIV infection. However, African Americans are more likely to face challenges associated with risk for infection, including at risk partners, substance use, and denial (CDC, 2003).
Interventions that can reduce HIV risk behaviors typically target demographically similar persons who are especially vulnerable for contracting HIV. Targeting relatively homogeneous groups allows for tailoring activities to address specific needs and risk behaviors that are common among group members (Braithwaite, Hammett & Mayberry, 1996). The demographically similar groups that have been frequently targeted in behavioral change interventions include men who have sex with men Men who have sex with men (MSM) is a term used mostly in the United States to classify men who engage in sex with other men, regardless of whether they self-identify as gay, bisexual, or heterosexual. , intravenous drug users (IDUs), young heterosexual heterosexual /het·ero·sex·u·al/ (-sek´shoo-al)
1. pertaining to, characteristic of, or directed toward the opposite sex.
2. one who is sexually attracted to persons of the opposite sex. women, and adolescents (Kalichman, Carey & Johnson 1996). Although researchers and practitioners desire to create programs and services that are informed by culture, these efforts are rarely guided by theory or informed by empirical evidence. It is useful to acknowledge, however, that the extant literature Extant literature refers to texts that have survived from the past to the present time. Extant literature can be divided into extant original manuscripts, copies of original manuscripts, quotations and paraphrases of passages of non-extant texts contained in other works, offers little direction in the way of providing effective HIV prevention interventions to racial and ethnic populations.
Also, the personal and invasive nature of a sexually transmitted disease, including HIV/AIDS and the presumptions regarding disease transmission makes it difficult for individuals to talk to about sexual practices with health care providers and health professionals who may not understand the cultural dynamics of disease transmission, individual practices or the linguistics linguistics, scientific study of language, covering the structure (morphology and syntax; see grammar), sounds (phonology), and meaning (semantics), as well as the history of the relations of languages to each other and the cultural place of language in human used to describe symptoms and health behaviors. In fact it has been noted in a survey on health care quality that African Americans, Latinos and Asian Americans This page is a list of Asian Americans. Politics
An advisory committee consisting of three consultants with expertise in cross-cultural education provided guidance for the framework of this review. The intention of the search method was to identify articles describing STD prevention strategies that incorporated elements and techniques of cultural competency. The research team used MEDLINE The online medical database of the U.S. National Library of Medicine (NLM) whose parent is the National Institutes of Health, Bethesda, MD. MEDLINE contains millions of articles from thousands of medical journals and publications. The consumer section of the site (http://medlineplus. , OVID, and ERIC databases, searched relevant bibliographies and references for original research articles written between 1980 and 2006. The year 1980 was determined as the starting point Noun 1. starting point - earliest limiting point
terminus a quo
commencement, get-go, offset, outset, showtime, starting time, beginning, start, kickoff, first - the time at which something is supposed to begin; "they got an early start"; "she knew from the for three reasons: (1) a shift in sensitivity toward other cultures, (2) the beginning of the AIDS epidemic, and (3) the changing demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. the U.S. population. The following keywords were used in the literature search: cultural competence (ies), cultural sensitivity, cultural diversity, cross-cultural interventions, transcultural, culturally diverse, multicultural populations and special populations. The following racial and ethnic groups also were specified in the literature search: African Americans or blacks, Hispanics or Latinos, Native Americans, and Asian/Pacific Islanders. Within the literature review, phrases such as African American or black were often interchangeable in·ter·change·a·ble
That can be interchanged: interchangeable items of clothing; interchangeable automotive parts.
in . However, for the purposes of this review we referred to each population in the way that it was described within the study. Furthermore, these terms were coupled with words and phrases Words and Phrases®
A multivolume set of law books published by West Group containing thousands of judicial definitions of words and phrases, arranged alphabetically, from 1658 to the present. such as STD or sexually transmitted diseases and/or HIV or AIDS/acquired immuno-deficiency syndrome and prevention strategies.
Studies selected for inclusion in the review were those that: (a) reported original findings in peer reviewed journals (b) were conducted in the United States, and (c) specifically reported prevention strategies for sexually transmitted disease among racial and ethnic groups. These studies included quantitative and qualitative findings and a description of the efforts to incorporate elements and techniques of cultural competence in program planning and implementation, including training models. We identified elements or implied constructs of cultural competence, including cultural values, linguistic compatibility, cross-cultural training, racial and ethnic concordant staff, interpreter or translation services, community workers and training. We also applied the nine techniques of cultural competence (Brach & Fraser, 2000) in order to illustrate the way cultural competency may be promoted within prevention programs. The techniques are as follows:
* Interpreter Services--the provision of sign language or translation services to improve communication between people who speak different languages.
* Recruitment and Retention--the practice of hiring and retaining staff members who are from the community.
* Training--the inclusion of training programs that help to educate practitioners and others regarding effective communication methods that increase cultural awareness and produce changes in attitudes about cross-cultural interactions.
* Coordinating with Traditional Healers--coordination of care with traditional healers to avoid incompatible therapies (producing an atmosphere of cultural awareness and sensitivity to the patient's needs).
* Use of Community Health Workers--liaison(s) to the community who provide ways to overcome barriers associated with prevention messages and who are able to serve as mediators and endorsers of the health care system.
* Culturally Competent Health Promotion--a process that encourages healthy behaviors that decrease risk, increases knowledge and changes attitudes by incorporating culturally specific and sensitive messages into health promotion efforts (i.e., screening tools and health literature).
* Including Family and/or Community Members--the inclusion of family members in health care decisions to encourage compliance and treatment decisions.
* Immersion immersion /im·mer·sion/ (i-mer´zhun)
1. the plunging of a body into a liquid.
2. the use of the microscope with the object and object glass both covered with a liquid. into Another Culture--a decision to become deeply engaged in the practices of a culture other than one's own.
* Administrative and Organizational Accommodations--the change of physical environments and assessment procedures to enhance sensitivity to the unique languages, cultures and environmental constraints of the population (e.g., directions or procedures written in appropriate languages).
The articles were then organized into tables that followed a structured format that included the above elements and techniques of cultural competence as well a description of the study population, study objectives, and an assessment of key outcome variables (e.g., drug use, self -efficacy, risk perception, sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. , attitude toward HIV/AIDS and AIDS related knowledge). Many of these variables were also evaluation measures for some behavioral theories.
The literature search identified 18 studies specifically addressing cultural competence and the prevention of sexually transmitted diseases. The majority of the studies were published in the mid-to-late 1990s. Ethnic distribution of the populations studied included African Americans-only (n=8), Asian/Pacific Islanders (n=3), Latinos/Hispanics-only (n=2), and multiple race groups (n=5; i.e., African American, Latino/Hispanic and European American A European American (Euro-American) is a person who resides in the United States and is either the descendant of European immigrants or from Europe him/herself.
Overall, as the largest group, European Americans have the lowest poverty rate  ; Table 3). Fourteen studies reported quantitative findings, two studies collected qualitative data, and two studies described the incorporation of cultural competence in training models for HIV prevention. HIV/AIDS was the primary focus in all but two studies. Thirteen of the 18 studies were based in community settings and five were located in local heath care clinics.
ELEMENTS OF CULTURAL COMPETENCE
Each study integrated one or more elements of cultural competence, which included employing lay health workers or community health workers, translated materials or interpreters, culturally relevant videotapes, and racial and ethnic concordance concordance /con·cor·dance/ (-kord´ins) in genetics, the occurrence of a given trait in both members of a twin pair.concor´dant
n. to identify with study participants.
The most commonly used element of cultural competence was racial and ethnic concordance. Fourteen studies matched the race or ethnicity of the presenter, videotaped subjects or project staff to the race and/or ethnicity of the target audience (Delamater, Wagstaff & Havens, 2000; Dushay, Singer, Weeks, Rohena, & Gruber, 2001; Flaskerud & Nyamathi, 1988; Herek et al., 1998; Kalichman, Kelly, Hunter, Murphy & Tyler, 1993; Loue, Lloyd & Loh, 1996; McQuiston & Flaskerud, 2000; Nyamathi, Leake, Flaskerud, Lewis & Bennett, 1993; Nyamathi, Flaskerud, Bennett Leake & Lewis, 1994; Nyamathi & Stein, 1997; Nyamathi et al., 1999; Shain et al., 1999; Stevenson, Gay, & Josar, 1995; Weeks, Schensul, Singer & Grier, 1995).
Six studies identified cultural values as a means to engage participants in the intervention (Dushay et al., 2001; Kalichman et al., 1993; Nyamathi et al., 1994; Nyamathi et al., 1999; Weeks et al., 1995; Foster et al., 1993). Cultural values delineate characteristics that are important to a particular culture (e.g., emphasizing ethnic pride or respect within the design and implementation of the prevention program).
An important element described in the literature reviewed was cross-culturally trained staff (n=4). Cross-culturally trained staff members were those qualified to effectively communicate and relate to people of diverse ethnic backgrounds. In a number of studies, staff underwent training to understand cultural differences in order to reduce communication gaps between cultures (Nyamathi & Stein, 1997; Weeks et al., 1995; Harris, Kavanagh, Hetherington, & Scott, 1992; Jemmott, Maula & Bush, 1999).
Six studies used culturally competent videotapes in their interventions. In most instances, the videotapes were filmed in familiar settings, and matched the ethnicity and language of the audience (Delamater et al., 2000; Herek et al, 1998; Kalichman et al., 1993; Nyamathi et al., 1993; Stevenson et al., 1995; O'Donnell et al., 1995).
Two studies used linguistic compatibility as an element of cultural competence (Weeks et al., 1995; Stevenson et al., 1995). Linguistic compatibility refers to the use of idioms or familiar language (e.g., slang) in the planning or implementation of the intervention.
Other elements of cultural competence noted in the literature were interpreter or translation services and the use of community health workers. Eight studies employed interpreters or translators This is primarily a list of notable Western translators. Please feel free to add translators from other languages, cultures and areas of specialization. Large sublists have been split off to separate articles. (Dushay et al., 2001; Flaskerud & Nyamathi, 1988; Loue et al., 1996; McQuiston & Flaskerud, 2000; Nyamathi et al., 1993; Nyamathi et al., 1994; Jemmott et al., 1999; O'Donnell et al., 1995). In these studies, speakers or staff members of the same ethnicity provided translation or interpreter services to Asian/ Pacific Islanders Pacific Islander
1. A native or inhabitant of any of the Polynesian, Micronesian, or Melanesian islands of Oceania.
2. A person of Polynesian, Micronesian, or Melanesian descent. See Usage Note at Asian. and Latino/Hispanic populations in their native language or dialect dialect, variety of a language used by a group of speakers within a particular speech community. Every individual speaks a variety of his language, termed an idiolect. .
Four studies used community workers throughout the implementation of the project. Community workers were typically lay health workers who were from the community or liaisons to the community (Nyamathi et al., 1993; Nyamathi et al., 1994; Nyamathi & Stein, 1997; Nyamathi et al., 1999). The community workers distributed information, gathered valuable input on how to structure information for the community and mobilized the community to action. The lay health staff helped to facilitate the intervention through recruitment efforts or to helped participants understand the nature of the study.
TECHNIQUES OF CULTURAL COMPETENCE
Four techniques of cultural competence were identified using Brach and Fraser's (2000) model. Those techniques were: (1) culturally competent health promotion, (2) cultural competence training, (3) interpreter services, and (4) employment of community workers. There was some overlap between the elements of cultural competence and the culturally competent techniques. Techniques were used to classify and distinguish pathways of cultural competence, whereas elements represented discrete intervention components or actions.
The most frequently adopted technique was culturally competent health promotion (n=16) which included, but was not limited to, using culturally relevant videotapes or racial and ethnic concordant staff to educate the public or encourage certain practices, such as increased condom 1. condom - The protective plastic bag that accompanies 3.5-inch microfloppy diskettes. Rarely, also used of (paper) disk envelopes. Unlike the write protect tab, the condom (when left on) not only impedes the practice of SEX but has also been shown to have a high failure use (Delamater et al., 2000; Dushay et al., 2001; Flaskerud & Nyamathi, 1988; Herek et al., 1998; Kalichman et al., 1993; Loue et al., 1996; McQuiston & Flaskerud, 2000; Nyamathi et al., 1993; Nyamathi et al., 1994; Nyamathi & Stein, 1997; Nyamathi et al., 1999; Shain et al., 1999; Stevenson et al., 1995; Weeks et al., 1995; Jemmott et al., 1999; O'Donnell et al., 1995).
The second most common technique was interpreter and translation services (n=8), which were necessary to ensure that there was a two-way communication Two-way communication is a form of transmission in which both parties involved transmit information. Common forms of two-way communication are:
The third most commonly used technique was employing community workers (n=4), who were often the liaisons between health care agencies and the community they served. Some community workers served as advocates for the community (Nyamathi et al., 1993; Nyamathi et al., 1994; Nyamathi & Stein, 1997; Nyamathi et al., 1999). In this review, community workers were primarily employed in the recruitment and implementation of the intervention or program.
The fourth technique identified in the literature was cultural competence training (n=2). Training activities included practices that increased cultural knowledge and understanding, developed skills in bicultural bi·cul·tur·al
Of or relating to two distinct cultures in one nation or geographic region: bicultural education.
bi·cul and bilingual interviewing, taught methods to increase sensitivity and awareness, and provided multicultural health and demographic information to service area populations (Foster et al., 1993; Harris et al., 1992). Two models attempted to develop cultural competence training. The focus of the first model was to train African American women in a drug treatment program to be peer leaders. The second model incorporated Afrocentric principles of Nguzo Saba and NTU NTU - Network Termination Unit (a central African Central African may mean:
This review also examined the primary outcomes of interventions that incorporated cultural competence in the design and implementation. Key outcomes were the reduction in drug use, increase in AIDS knowledge and positive attitude, reduction in sexual risk, increase in self-efficacy (primary reliance on self to effect changes in behavior), and increase in perception of risk.
Eight of the 16 interventions focused solely on African American populations (Delamater et al.,2000; Herek et al., 1998; Kalichman et al., 1993; Nyamathi & Stein, 1997; Nyamathi et al., 1999; Stevenson et al., 1995; Foster et al., 1993; Harris et al., 1992). The major findings from three of these eight interventions were that African Americans responded more favorably fa·vor·a·ble
1. Advantageous; helpful: favorable winds.
2. Encouraging; propitious: a favorable diagnosis.
3. to an ethnically matched presenter and culturally-specific message, as opposed to a presenter that was not matched to the audience's ethnicity. Participants in these studies retained more AIDS-related knowledge, were more sensitive to their personal risk factor for HIV infection or expressed more intent to use condoms with steady partners (Delamater et al., 2000; Herek et al., 1998; Kalichman et al., 1993).
Interventions with Asian/Pacific Islanders noted expected changes in AIDS-related knowledge and attitude toward intended practices such as condom use or reduction in partners. Few prevention programs reviewed devoted attention to the specific needs of Asian/Pacific Islander populations (Flaskerud & Nyamathi, 1988; Loue et al., 1996; Jemmott et al., 1999). Studies targeting racial or ethnic populations that were homeless or intravenous drug users (IDUs) showed improvement in behavioral (IV drug use and multiple partners), cognitive (knowledge score) or psychological (depression, distress, and coping scores) outcomes, as compared with baseline assessments. Nyamathi et al. (1994) recruited homeless and Latina IDUs for a culturally sensitive intervention. The women were randomized ran·dom·ize
tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es
To make random in arrangement, especially in order to control the variables in an experiment. into either a two-hour gender and culturally sensitive program or a traditional program that included a basic AIDS education program and community resources. Participants in this intervention did not experience significant differences in expected behavioral, psychological, or cognitive outcome variables. Women in the specialized group and the traditional group showed a decrease in distress, depression and high-risk behavior high-risk behavior Public health A lifestyle activity that places a person at ↑ risk of suffering a particular condition. See Safe sex practices. , such as multiple sex partners and IV drug use. Both groups also increased their knowledge of AIDS, as well as the optimism in their attitude towards AIDS. In addition, Weeks et al.(1995) reported that out-of-treatment African American and Puerto Ricans It may never be fully completed or, depending on its its nature, it may be that it can never be completed. However, new and revised entries in the list are always welcome.
This list of Puerto Ricans in a culturally targeted intervention found the culturally enhanced program to be more "attractive" as indicated by retention rates for the program. However, in second phase of the program, 5-10 months after the intervention, African American and Puerto Rican Puer·to Ri·co
Abbr. PR or P.R.
A self-governing island commonwealth of the United States in the Caribbean Sea east of Hispaniola. drug users out-of-treatment did not experience significant outcome differences between the enhanced condition and the standard condition at follow up.
Many factors influence sexual behavior. Some of these influences are psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.
Involving aspects of both social and psychological behavior. , gender based, or cultural. For some time, researchers have underscored the need for culturally appropriate STD prevention programs because of the influence of culture on sexual customs and practices (Wingood & DiClemente, 1992). Culture has a bearing on how we interact and relate to one another within the dynamics of a sexual relationship. That is why an understanding of the importance of cultural competence is important to successful prevention techniques.
Cultural competence is a broader and more complex concept than is referenced in the current literature on STD prevention. This literature review examined how the concept of cultural competence was operationalized as a part of STD prevention. Not surprisingly, the incorporation of cultural competency varied significantly throughout the literature. The studies that were reviewed all included some element or practice utilizing cultural competence in their prevention strategy. However, the explicit constructs of cultural competence were rarely defined or explained. Readers of the current literature would need to infer meaning and interpret aspects of cultural competence from the context in which related elements and techniques were used. These inferences were usually drawn from the design of the intervention. There are two basic approaches for integrating culture into an intervention; design the intervention to appeal to a specified cultural group, and to design the intervention so that it is embedded Inserted into. See embedded system. with cultural concepts (Wilson & Miller, 2003).
However, without distinct measurements for culture it is unlikely that any single element or technique of cultural competence would improve the outcomes of STD prevention among racial and ethnic populations. Key cultural components of an intervention will vary depending on the defined population, resources, and social context. The few studies which compared purported pur·port·ed
Assumed to be such; supposed: the purported author of the story.
pur·ported·ly adv. culturally competent interventions with standard interventions have shown relative improvement in outcomes such as risk perception, decreased high-risk sexual behavior, increased self-efficacy, and an increase in knowledge or an attitude change toward sexually transmitted diseases and/or HIV(Delamater et al., 2000; Flaskerud et al., 1998; Herek et al.,1998; Harris et al.,1992; Kalichman et al., 1993; Nyamathi et al., 1993; Nyamathi et al., 1999; Nyamathi & Stein, 1997; O'Donnell et al., 1995).
Besides the variance in the number and type of elements of cultural competence incorporated into the interventions, studies still showed that individuals were more responsive to positive behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. in prevention strategies presented by racial and ethnic concordant staff. Prevention strategies were also more readily accepted if they were presented in the native language of the population or incorporated cultural values into the intervention. In this regard, culturally relevant approaches are promising, but the broader concept of cultural competence still warrants considerable attention in the evaluation of program effectiveness, reliable measurements, and replication of potentially promising prevention strategies (Wilson & Miller, 2003).
Cultural competence in STD prevention and other prevention strategies are a prerequisite for engaging participants in effective communication. Effective communication builds trust and conveys respect and understanding between individuals, as well as in group interactions. The expectation of a culturally competent intervention is that there will be an exchange between program planners and participants, including input and recommendations as to how best to affect mutually desirable behavioral changes. It is indeed the identifiable, describable, and measurable exchanges that pose the greatest challenge in achieving cultural competence in the every day practice of health promotion and disease prevention.
Therefore, we propose the following recommendations for the design and implementation of culturally competent interventions for the prevention of sexually transmitted disease. Primarily, the health care arena should continue to provide contextual meaning and operational definitions of the concept "cultural competence" in order to build consensus of the meaning and application. Secondly, cultural competence will not be attained without an ongoing assessment on how to better meet the cultural needs of the population and focus on specific cultural approaches that may work best for the participant group and the culture's view about the genesis of the disease. In addition, program planners should include culturally and linguistically appropriate survey methods and process outcome measures that reflect the needs of multicultural populations when preparing needs assessments and creating interventions for STD reduction. Within clinical settings, providers may choose to incorporate group approaches to health promotion and provision of services to better understand the differences in the ways each cultural group views health and disease. Providers may also choose to assess cultural and religious values and beliefs that influence the participant's perception of disease and care processes.
In some instances, program planners could seek the involvement of a culturally diverse advisory group to assist program planners in meeting the needs of the participants. Advisory groups may help plannersaddress issues of historic, contemporary, personal, and societal so·ci·e·tal
Of or relating to the structure, organization, or functioning of society.
Adj. prejudices that are directed toward each ethnic, racial, and gender group. These are some suggested recommendations on how to create and sustain a culturally competent prevention program.
Although the evidence base has yet to be fully developed, experts sense that cultural competence is one essential part of a portfolio of activities to reduce the incidence of STD and eliminate racial/ethnic disparities in health status. Our study supports the conclusion that elements and techniques of cultural competence implemented in a standardized standardized
pertaining to data that have been submitted to standardization procedures.
standardized morbidity rate
see morbidity rate.
standardized mortality rate
see mortality rate. fashion have an impact on the receptiveness of STD prevention.
Effectiveness Research, Clinical Research Center, Morehouse School of Medicine Morehouse School of Medicine is a medical school in Atlanta, Georgia, USA.
Originally part of African-American all-male Morehouse College, it was founded in 1975 during the tenure of college president Hugh M. The literature review was support by a grant from CDC to MHPF MHPF Minority Health Professions Foundation (see report) with addition support provided by grants number P01 HS10875 and R24 HS11617 from the Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality,
n.pr formerly known as the Agency for Health Care Policy and Research, this agency researches the quality of medical care and health services. to the Program for Healthcare.
Bowleg, L. (2004). Love, sex, and masculinity masculinity /mas·cu·lin·i·ty/ (mas?ku-lin´i-te) virility; the possession of masculine qualities.
1. The quality or condition of being masculine.
2. in sociocultural so·ci·o·cul·tur·al
Of or involving both social and cultural factors.
soci·o·cul context: HIV concerns and condom use among African American men in heterosexual relationships. Men & Masculinities. 7, 166-186.
Betancourt, J. R., Green, A. R., Carrillo, J. E. & Ananeh-Firempong, O., II. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118, 293-302.
Brach, C. & Fraser, I. (2000). Can cultural competency reduce racial and health disparities? A review and conceptual model [Supplement]. Medical Care Research and Review, 57, 181-217.
Braithwaite, R., Hammett, T., & Mayberry, R. (1996). Prisons and AIDS: A public health challenge. San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden : Jossey-Bass.
Campinha-Bacote, J. (1999). A model and instrument for addressing cultural competence in health care. Journal of Nursing Education, 38, 203-207.
Centers for Disease Control and Prevention. (1995). Glossary A term used by Microsoft Word and adopted by other word processors for the list of shorthand, keyboard macros created by a particular user. See glossaries in this publication and The Computer Glossary. of terms used in HIV/AIDS health education and risk reduction activities. Retrieved November 16, 2005, from http://www.cdc.gov/hiv/HERRG/glossary.htm
Centers for Disease and Prevention. (2003). HIV/AIDS Fact Sheet: HIV/AIDS among African Americans. Retrieved November 16, 2005, from http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm
Centers for Disease Control and Prevention. (2004). Chlamydia chlamydia (kləmĭd`ēə), genus of microorganisms that cause a variety of diseases in humans and other animals. Psittacosis, or parrot fever, caused by the species Chlamydia psittaci, screening among active young female enrollers of health. Morbidity and Mortality Weekly Report Morbidity and Mortality Weekly Report (MMWR) is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention. The 5 June 1981 issue of the MMWR published the cases of five men in what turned out to be the first report of AIDS. , 53, 983-985.
Centers for Disease Control and Prevention. (2005). Sexually transmitted disease surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS .
Centers for Disease Control and Prevention. (2004). Trends in reportable sexually transmitted diseases in the United States, 2004: National surveillance data for chlamydia, gonorrhea gonorrhea (gŏnərē`ə), common infectious disease caused by a bacterium (Neisseria gonorrhoeae), involving chiefly the mucous membranes of the genitourinary tract. , and syphilis syphilis (sĭf`əlĭs), contagious sexually transmitted disease caused by the spirochete Treponema pallidum (described by Fritz Schaudinn and Erich Hoffmann in 1905). . Retrieved November 16, 2005, from http://www.cdc.gov/std/stats/04pdf/trends2004.pdf
Centers for Disease Control and Prevention. (2006). Racial/ethnic disparities in diagnosis of HIV/AIDS--33 States, 2001-2004. Morbidity and Mortality Weekly Report, 55, 121-125. Retrieved June 3, 2006, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5505a1.htm
Coggins, P. C. & Yancey, E. (2000). Focus on cultural competence: A training manual for healthcare professionals. Atlanta, GA: Morehouse School of Medicine, Substance Abuse Prevention Faculty Development Program.
The Commonwealth Fund. (2002). Minority Americans lag behind whites on nearly every measure of health care quality. Retrieved July 6, 2006, from http://www.cmwf.org/newsroom/newsroom_show.htm?doc_id=223608
Cross, T. L., Barzon, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: A monograph mon·o·graph
A scholarly piece of writing of essay or book length on a specific, often limited subject.
tr.v. mon·o·graphed, mon·o·graph·ing, mon·o·graphs
To write a monograph on. on effective services for minority children who are severely emotionally disturbed. Washington, DC: CASSP CASSP Child and Adolescent Service System Program
CASSP California Archaeological Site Stewardship Program (Society of California Archaeology) Technical Assistance Center, Georgetown Child Development Center.
Delamater, J., Wagstaff, D. A., & Havens, K. K. (2000). The impact of a culturally appropriate STD/AIDS education intervention on black male adolescents' sexual and condom use behavior. Health Education & Behavior. 27, 454-470.
Dushay, R. A., Singer, M., Weeks, M. R., Rohena, L., & Gruber, R. (2001). Lowering HIV risk among ethnic minority drug users: Comparing a culturally targeted intervention to a standard intervention. American Journal of Drug and Alcohol Abuse. 27,501-524.
Flaskerud, J. H. & Nyamathi, A. M. (1988). An AIDS education program for vietnamese women. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of State Journal of Medicine, 88, 632-637.
Foster, P. M., Phillips, F., Belgrave, F. Z., Randolph, S. M., & Braithwaite, N. (1993). An Africentric model for AIDS education, prevention, and psychological services within the African American community. Journal of Black Psychology, 19, 123-141.
Harris, R. M., Kavanagh, K. H., Hetherington, S. E. & Scott, D. E. (1992). Strategies for AIDS prevention. Clinical Nursing Research, 1, 9-24.
He, W. & Hobbs, F. (1999, September). The emerging minority marketplace. Retrieved July 6, 2006, from http://permanent.access.gpo.gov/lps70698/mbdacolor.pdf
Herek, G. M., Gillis, J. R., Glunt, E. K., Lewis, J., Welton, D., & Capitanio, J. P. (1998). Culturally sensitive AIDS educational videos for African American audiences: Effects of source, message, receiver, and context. American Journal of Community Psychology, 26, 705-743.
Jemmott, L. S., Maula, E. C., & Bush, E. (1999). Hearing our voices: Assessing HIV prevention needs among Asian and Pacific Islander women. Journal of Transcultural Nursing Transcultural nursing is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice. See also
Kalichman, S. C., Kelly, J. A., Hunter, T. L., Murphy, D. A., & Tyler, R. (1993). Culturally tailored HIVAIDS risk reduction messages targeted to African-American urban women: Impact on risk sensitization sensitization /sen·si·ti·za·tion/ (sen?si-ti-za´shun)
1. administration of an antigen to induce a primary immune response.
2. exposure to allergen that results in the development of hypersensitivity. and risk reduction. Journal of Counseling and Clinical Psychology, 61, 291-295.
Loue, S., Lloyd, L., & Loh, L. (1996). HIV prevention in the U.S. Asian Pacific Islander communities: An innovative approach. Journal of Health Care for the Poor and Underserved The Journal of Health Care for the Poor and Underserved (JHCPU) is an academic journal founded in 1990 by David Satcher, MD, PhD then President of Meharry Medical College (later, U.S. Surgeon General). , 7, 364-375.
McQuiston, C. & Flaskerud, J. H. (2000). Sexual prevention of HIV: A model for Latinos. Journal of the Association of Nurses in AIDS Care, 11, 70-79.
Nyamathi, A. M. & Stein, J. A. (1997). Assessing the impact of HIV risk reduction counseling in impoverished im·pov·er·ished
1. Reduced to poverty; poverty-stricken. See Synonyms at poor.
2. Deprived of natural richness or strength; limited or depleted: African American women: A structural equations approach. AIDS Education and Prevention, 9, 253-273.
Nyamathi, A. M., et al. (1999). Two-year follow-up of AIDS education programs for impoverished women. Western Journal of Nursing Research, 21, 405-425.
Nyamathi, A. M., Flaskerud, J., Bennett, C., Leake, B., & Lewis C. (1994). Evaluation of two AIDS education programs for impoverished Latina women. AIDS Education and Prevention, 6, 296-309.
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O'Donnell, L., San Doval, A. Duran, R., & O'Donnell, C. R. (1995). The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients. Sexually Transmitted Disease 22, 97-103.
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Ross, H. (2001, February/March). Office of Minority Health publishes final standards for cultural and linguistic competence. Closing the Gap, (pp.1-3). Retrieved March 10, 2003, from http://www.omhrc.gov/assets/pdf/checked/Final%20Standards%20for% 20Cultural%20and%20Linguistic%20Competence.pdf
Shain, R. N., Piper, J. M., Newton, E. R., Perdue Perdue may refer to:
Stevenson, H. C., Gay, K. M., & Josar, L. (1995). Culturally sensitive AIDS education and perceived AIDS risk knowledge: Reaching the "Know-It-All" teenager. AIDS Education and Prevention, 7, 134-144.
Health Resources and Services Administrations' Bureau of Primary Health Care The Bureau of Primary Health Care is a sub program of the United States Department of Health and Human Services. Key areas of responsibility
Weeks, M. R., Schensul, J. J., Williams, S. S., Singer, M. & Grier, M. (1995). AIDS prevention for African American and Latina women: Building culturally and gender-appropriate intervention. AIDS Education and Prevention, 7, 251-263.
Weinstock, H., Berman, S., & Cates n. pl. 1. Provisions; food; viands; especially, luxurious food; delicacies; dainties.
Cates for which Apicius could not pay.
Choicest cates and the fiagon's best spilth.
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Wingood, G. M. & DiClemente, R. J. (1992). Cultural, gender, and psychosocial influences on HIV-related behavior of African American female adolescents: Implications for the development of tailored prevention programs. Ethnicity & Disease, 2, 381-388.
Zweifler, J. & Gonzalez, A. M. (1998). Teaching residents to care for culturally diverse populations. Academic Medicine, 73, 1056-1061.
RESPONSIBILITIES AND COMPETENCIES IN HEALTH EDUCATION
Responsibility II--Planning Effective Health Education Programs
Competency A: Recruit community organizations, resource people, and potential participants for support assistance in program planning
Sub-competency 1 (as related to the literature review): Communicate need for the cultural competence in health promotion and health behavior programs
Identify the principles of cultural competence in planning for STD programs
Demonstrate and evaluate how the principles of cultural competence have been incorporated into STD programs
Leslie R. Boone, MPH, is the Administrative Director of Research for Health Equity Research, Center for Health Care Research for the Institute for Health Care Research and Improvement at Baylor Health Care System, Dallas, Texas “Dallas” redirects here. For other uses, see Dallas (disambiguation).
The City of Dallas (pronounced [ˈdæl.əs] or [ˈdæl. . Robert M. Mayberry, MPH, PhD, is the Director for Health Equity Research, Center for Health Care Research for the Institute for Health Care Research and Improvement at Baylor Health Care System, Dallas, Texas. Joseph R. Betancourt, MD, MPH, is a Senior Scientist for the Institute for Health Policy and Program Director of Multicultural Education at Harvard Medical School Harvard Medical School (HMS) is one of the graduate schools of Harvard University. It is a prestigious American medical school located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts. , Boston, Massachusetts “Boston” redirects here. For other uses, see Boston (disambiguation).
Boston is the capital and most populous city of Massachusetts. The largest city in New England, Boston is considered the unofficial economic and cultural center of the entire New . Patrick C. Coggins, PhD, JD, is the Director for the Multicultural Education Institute at Stetson University Stetson University is a private, co-educational, liberal arts university that consistently earns high rankings in national college guides. In the 2007 U.S. News and World Report guide, Stetson ranks 2nd (tied with Elon) in the category of Southern Masters-granting institutions.. , Deland, Florida DeLand is the county seat of Volusia County, Florida. In 2006, the U.S. Census Bureau estimated DeLand's population to be 24,375. It is part of the Deltona-Daytona Beach-Ormond Beach, Florida Metropolitan Statistical Area, which had an estimated population of 436,575 . Elleen M. Yancey, PhD, is the Director for the Prevention Research Center at the Morehouse School of Medicine, Atlanta, Georgia. Please address all correspondence to Leslie R. Boone, MPH, Administrative Director of Research, Center for Health Care Research, Institute for Health Care Research and Improvement, 8080 North Central Expressway The following roads are named Central Expressway:
Table 1. Selected Definitions of Cultural Competence Cross,Barzon, Dennis & Isaacs, "... a set of congruent behaviors 1989 attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations." Zweifler & Gonzalez, 1998 "... capacity of providers to effectively identify the health practices and behaviors of diverse populations and thereby intervene and educate across cultural and language barriers." Campinha-Bacote, 1999 "... an ongoing process of seeking cultural awareness, cultural knowledge, cultural skills, and cultural encounters." Brach & Fraser, 2000 "... a step beyond cultural awareness or sensitivity ... possession and use of cultural knowledge and respect of different cultural perspectives in cross- cultural situations." Coggins & Yancey, 2000 "... habit of exhibiting the appropriate behaviors with respect to the diverse cultural, ethnic, and racial patient population." Bureau of Primary Health "... a set of attitudes, skills, Care (DHHS), 2001 behaviors, and policies that enables organizations and staff to work effectively in cross-cultural situations." Betancourt, Green, Carrillo & "... the ability of systems to Ananeh-Firempong, II, 2002 provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to meet patients' social, cultural and linguistic needs." Table 2. "Paradigm Shift in Treatment and Prevention Efforts" (Coggins and Yancey, 2000) OLD/PAST NEW/PRESENT/FUTURE Expect same patient behavior Expect client behavior to be different based on race, ethnicity, and culture Expect shared understanding and Expect difference in cross- interpretation of patient behavior cultural meanings and communication processes including styles Treat everyone the same Focus on divergent/cultural approaches to the diversity with clients/individuals Table 3. Studies on Cultural Competence and Sexually Transmitted Disease 1988-2006 Racial/Ethnic Groups Studied: Blacks 8 Asian/Pacific Islanders 3 Latinos/Hispanics 2 Multiple Groupings 5 Study Settings: Community 13 Clinic 5