The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators

SpringerPlus - Tập 5 - Trang 1-13 - 2016
Neil Krishan Aggarwal1,2, Kryst Cedeño2, Peter Guarnaccia3, Arthur Kleinman4, Roberto Lewis-Fernández5,6
1Columbia University, New York, USA
2New York State Psychiatric Institute, New York, USA
3Department of Human Ecology, Rutgers, The State University of New Jersey, Newark, USA
4Department of Social Medicine, Harvard University, Cambridge, USA
5Columbia University Medical Center, New York, USA
6NYS Center of Excellence for Cultural Competence, and Hispanic Treatment Program, New York State Psychiatric Institute, New York, USA

Tóm tắt

Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches. Administrators and clinicians named clinician techniques for psycho-education whereas patients named these techniques for enlistment in treatment planning as equals. All groups named patient cultural views and institutional challenges as barriers to care, but only patients and administrators additionally named clinician biases as possible barriers. We discuss these discrepant perceptions and possible solutions to improve research, practice, and policy on cultural competence in mental health.

Tài liệu tham khảo

Aggarwal NK (2011) Intersubjectivity, transference, and the cultural third. Contemp Psychoanal 47:204–223 Aggarwal NK (2012) The psychiatric cultural formulation: translating medical anthropology into clinical practice. J Psychiatr Pract 18:73–85 Aggarwal NK, Nicasio AV, DeSilva R, Boiler M, Lewis-Fernández R (2013) Barriers to implementing the DSM-5 Cultural Formulation Interview: a qualitative study. Cult Med Psychiatry 37:505–533 Aggarwal NK, DeSilva R, Nicasio AV, Boiler M, Lewis-Fernández R (2015) Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. Ethn Health 20:1–28 Ambrose AJH, Lin SY, Chun MB (2013) Cultural competency training requirements in graduate medical education. J Grad Med Educ 5:227–231 American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington American Psychological Association (2002) Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychological Association, Washington, DC Association of American Medical Colleges (2015) Assessing change: evaluating cultural competence education and training. Association of American Medical Colleges, Washington, DC Bassiri KG, Soriano AT (2016) Administrative perspectives on the implementation and use of the Cultural Formulation Interview. In: Lewis-Fernández R, Aggarwal NK, Hinton L, Hinton DE, Kirmayer LJ (eds) DSM-5 handbook on the cultural formulation interview. American Psychiatric Association, Arlington, pp 224–236 Bullon A (2013) Learning by teaching an unsuccessful “Cultural Sensitivity” course. Cult Med Psychiatry 37:280–287 Burkard AW, Knox S, Groen M, Perez M, Hess SA (2006) European American therapist self-disclosure in cross-cultural counseling. J Couns Psychol 53:15–25 Carlsen B, Glenton C (2011) What about N? A methodological study of sample-size reporting in focus group studies. BMC Med Res Methodol 11:26 Carpenter-Song EA, Nordquest Schwallie MA, Longhofer J (2007) Cultural competence reexamined: critique and directions for the future. Psychiatr Serv 58:1362–1365 Constantine MG, Kwan KLK (2003) Cross-cultural considerations of therapist self-disclosure. J Clin Psychol 59:581–588 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 4:50 Donald A (2001) The Wal-Marting of American psychiatry: an ethnography of psychiatric practice in the late 20th century. Cult Med Psychiatry 25:467–472 Durkheim E (2013) The rules of sociological method: and selected texts on sociology and its method. In: Lukes S (ed) Palgrave Macmillan, Hampshire Gaines AD (1994) From DSM-I to III-R; voices of self, mastery and the other: a cultural constructivist reading of U.S. psychiatric classification. Soc Sci Med 35:3–24 Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P (2004) The future of health behavior change research: what is needed to improve translation of research into health promotion practice. Ann Behav Med 27:3–12 Good MJD, Hannah SD (2015) “Shattering culture”: perspectives on cultural competence and evidence-based practice in mental health services. Transcult Psychiatry 52:198–221 Guarnaccia PJ, Rodriguez O (1996) Concepts of culture and their role in the development of culturally competent mental health services. Hisp J Behav Sci 18:419–443 Huey SJ Jr, Tilley JL, Jones EO, Smith CA (2014) The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annu Rev Clin Psychol 10:305–338 Institute of Medicine (2003) Unequal treatment: confronting racial and ethnic disparities in health care. National Academies, Washington, DC Jenks AC (2011) From ‘lists of traits’ to ‘openmindedness’: emerging issues in cultural competence education. Cult Med Psychiatry 35:209–235 Kagawa-Singer M, Dressler WW, George SM, Elwood WN (2014) The cultural framework for health: an integrative approach for research and program design and evaluation. National Institute of Health, Bethesda Kirmayer LJ (2012) Cultural competence and evidence-based practice in mental health: epistemic communities and the politics of pluralism. Soc Sci Med 75:249–256 Kitzinger J (1994) The methodology of focus groups: the importance of interaction between research participants. Sociol Health Illn 16:103–121 Kitzinger J (1995) Qualitative research. Introducing focus groups. Br Med J 311:299 Kleinman A, Benson P (2006) Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med 3:294 Kronenfeld JJ (2001) New trends in the doctor-patient relationship: impacts of managed care on the growth of a consumer protections model. Sociol Spectr 21:293–317 Krueger RA (1998) Moderating focus groups. Sage, Thousand Oaks Lambert H, McKevitt C (2012) Anthropology in health research: from qualitative methods to multidisciplinarity. Br Med J 325:210–213 Lewis-Fernández R, Aggarwal NK, Bäärnhielm S, Rohlof H, Kirmayer LJ, Weiss MG, Jadhav S, Hinton L, Alarcón RD, Bhugra D, Groen S, van Dijk R, Qureshi A, Collazos F, Rousseau C, Caballero L, Ramos M, Lu F (2014) Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5. Psychiatry 77:130–154 Llerena-Quinn R (2013) A safe space to speak above the silences. Cult Med Psychiatry 37:340–346 Mays N, Pope C (2000) Assessing quality in qualitative research. Br Med J 320:50–52 Morgan DL (1996) Focus groups. Annu Rev Clin Psychol 22:129–152 Morgan DL, Krueger RA (1998) Developing questions for focus groups. Sage, Thousand Oaks Morrison-Beedy D, Cȏté-Arsenault D, Feinstein NF (2001) Maximizing results with focus groups: moderator and analysis issues. Appl Nurs Res 14:48–53 Morse JM (1995) The significance of saturation. Qual Health Res 5:147–149 Mulvaney-Day NE, Alegría M, Earl T, Diaz-Linhart Y (2011) Preferences for relational style with mental health clinicians: a qualitative comparison of African American, Latino, and non-Latino White patients. J Clin Psychol 67:31–44 Napier AD, Ancarno C, Butler B, Calabrese J, Chater A, Chatterjee H, Guesnet F, Horne R, Jacyna S, Jadhav S, Macdonald A, Neuendorf U, Parkhurst A, Reynolds R, Scambler G, Shamdasani S, Smith SZ, Stougaard-Nielsen J, Thomson L, Tyler N, Volkmann AM, Walker T, Watson J, Williams AC, Willott C, Wilson J, Woolf K (2014) Culture and health. Lancet 384:1607–1639 National Association of Social Workers (2001) NASW standards for cultural competence in social work practice. National Association of Social Workers, Washington, DC Office of the Surgeon General (US), Center for Mental Health Services (US), National Institute of Mental Health (US) (2001) Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the surgeon general. Substance Abuse and Mental Health Services Administration, Rockville Reed J, Payton VR (1997) Focus groups: issues of analysis and interpretation. J Adv Nurs 26:765–771 Renzaho AMN, Romios P, Crock C, Sønderlund AL (2013) The effectiveness of cultural competence programs in ethnic minority patient-centered health care—a systematic review of the literature. Int J Qual Health Care 25:261–269 Saha S, Beach MC, Cooper LA (2008) Patient centeredness, cultural competence, and healthcare quality. J Natl Med Assoc 100:1275–1285 Shaw SJ, Armin J (2011) The ethical self-fashioning of physicians and health care systems in culturally appropriate health care. Cult Med Psychiatry 35:236–261 Strauss AL, Corbin J (1998) Basics of qualitative research: techniques and procedures for developing grounded theory, 2nd edn. Sage, Thousand Oaks Tervalon M, Murray-García J (1998) Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved 9:117–125 United States Census Bureau (2015) Queens County QuickFacts from the US Census Bureau. U.S. Department of Commerce, Washington, D.C. http://quickfacts.census.gov/qfd/states/36/36081.html. (Accessed 21 Jan 2016) van der Geest S, Finkler K (2004) Hospital ethnography: introduction. Soc Sci Med 59:1995–2001 Vargas SM, Cabassa LJ, Nicasio AV, De La Cruz AA, Jackson E, Rosario M, Guarnaccia PJ, Lewis-Fernández R (2015) Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy. Transcult Psychiatry 52:244–273 Willen SS (2013) Confronting a “big huge gaping wound”: emotion and anxiety in a cultural sensitivity course for psychiatry residents. Cult Med Psychiatry 37:253–279 Willen SS, Carpenter-Song E (2013) Cultural competence in action: “Lifting the hood” on four case studies in medical education. Cult Med Psychiatry 37:241–252 Yanos PT, Roe D, Lysaker PH (2010) The impact of illness identity on recovery from severe mental illness. Psychiatr Rehabil J 13:73–93