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The recognition of the importance of addressing cultural issues in psychotherapy and counseling has been increasing. The present paper seeks to contribute to the specification of multicultural competencies in the fields of counseling and clinical psychology, based on clients’ perspectives. In particular, its objectives were to explore the experiences of individuals of ethnic minority groups regarding their access to the Portuguese healthcare system and to identify the multicultural competencies of the clinicians (as perceived by the clients) which would be required to improve culturally sensitive treatments.

The sample included 40 adults from different ethnic minority groups in Portugal – a total of 30 women and ten men – with a mean age of 34. Participants took part in one of eight focus groups, which were conducted using a semi‐structured interview plan.

Content analysis revealed that, generally, participants had experienced discrimination in the healthcare system, and that mental healthcare was perceived as mixed (both positive and negative). Furthermore, participants identified specific aspects of multicultural awareness, knowledge, and skills required of clinicians to provide culturally sensitive treatments, providing support for the tridimensional model of multicultural competencies.

Implications are discussed for ethical guidelines and clinical training of counselors, clinical psychologists, and other social and health professionals in Europe.

The purpose of this study is to explore social barriers affecting participation in chosen instrumental activities of daily living (IADL) among community-dwelling persons with schizophrenia in Rwanda.

A qualitative study used an embedded single case study design and constructivist epistemology paradigm. Purposive sampling and semistructured interviews of 10 persons with schizophrenia and their 10 caregivers were conducted. Data analysis was done thematically using an inductive analysis approach, following within-case and cross-case analysis.

The hindrances to participation and community negative attitudes were explored as the two themes. This study focuses on the community negative attitudes including family exclusion and stigmatization, which hinder the participation of persons with schizophrenia in their chosen IADLs.

This study highlights the need for psychoeducation about mental illness for the caregivers of the persons with schizophrenia, community outreach activities for sensitizing about mental illness to address stigma toward persons with mental illness and strengthening the activities which promote the social interaction and sense of belonging of persons with mental illness.

Persons with schizophrenia are facing maltreatment and stigma from the community members while participating in their chosen IADLs. Awareness raising of the support needs of persons living with schizophrenia will contribute to relevant stakeholders advocating for inclusion into families and communities.

The purpose of this paper is to update the assessment of national data on law enforcement worker suicide based on the National Occupational Mortality Surveillance database (NOMS, Centers for Disease Control and Prevention).

Death certificate data for 4,441,814 decedents, age 18–90 who died in one of the 26 reporting states were the source of NOMS data. Utilizing proportionate mortality ratios (PMRs), the ratio of suicides in law enforcement occupations in those who are 18–90 years old with a designated usual occupation was calculated.

Findings indicate a significantly higher proportion of deaths from suicide for law enforcement officers (PMR = 154, 95% CI = 147–162), compared to all the US decedents in the study population who were employed during their lifetime. Law enforcement personnel are 54% more likely to die of suicide than all decedents with a usual occupation. PMRs were highest for African-Americans, Hispanic males and for females. PMRs were similar for detectives, corrections officers and all law enforcement jobs, when not stratified by race, ethnicity and sex.

Bias may arise because a PMR can be affected by disproportionate increased or decreased mortality from causes of death other than suicide.

A better understanding of the scope of law enforcement suicide can inform policy focused on the planning and initiation of prevention programs.

The use of a national database to study law enforcement worker suicide adds to other information available on law enforcement worker suicide in specific geographic areas. The discussion on prevention in this paper presents ideas for policy.

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues.

In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated.

Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated.

Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare.

This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.

This study examined 46 articles in total, which yielded 5 recurring themes: perceived discrimination, language barriers, socioeconomic barriers, cultural barriers and educational/knowledge barriers. The two most dominant themes found were the inability to speak the country's primary language and belonging to a culture with different practices and values from the host country. The review provides vital insights into the numerous challenges that immigrants and refugees encounter as they navigate through the primary care systems of English-speaking (E-S) countries and potential solutions to overcome these barriers.

Access to adequate healthcare plays a central part in ensuring the physical and mental wellbeing of society. However, vulnerable groups such as immigrants and refugees, face numerous challenges when utilizing these healthcare services. To shed further light on the barriers impacting healthcare quality, the authors’ team performed a scoping thematic review of the available literature on immigrant and refugees' experiences in primary healthcare systems across E-S countries. Articles were systematically reviewed while focusing on healthcare perceptions by immigrants, potential barriers and suggestions to improve the quality of primary care.

This work looked at qualitative and quantitative information, attempting to combine both paradigms to give a rich and robust platform with which to devise a further study through focus groups. Qualitative inquiry accounted for 28/46, or 61%, of studies, and quantitative inquiry made up 9/46, or 20%, while 9/46 or 20% combined both qualitative and qualitative. Emerging themes are -perceived ethnic discrimination faced by immigrants accessing primary care, language barriers, socioeconomic barriers, cultural barriers and educational barriers.

Most medical journals rely on quantitative data to relate “results” and cases. The authors set out to change ways in which medical reports can be done. Most of the authors were solely trained in quantitative research; consequently, they had to learn to isolate themes and to use a narrative approach in the article.

Research implications clearly indicated that using a qualitative (phenomenological) approach with quantitative data created a human and reachable discourse around patient comfort and the realities of immigrants and refugees to E-S countries. The use of this research opens medical practitioners (and patients) to a richer understanding within a usually difficult arena.

By understanding the qualitative nature of medical research, practitioners, students and mentors are able to bridge medical quantitivity to the human, widening doors to social science and medical collaboratory research.

As stated above, this work is important as it understands the human/patient element and de-emphasizes the medical obsession with quantifying the lives of patients through hard data. This is a unique collaboration that relies on the qualitative to pinpoint and define the difficulties of newcomers to E-S countries.

The purpose of the scoping study was to understand the experiences of refugees with disabilities and their families in the US from expert service-provider perspectives, including gaps in resources and services. The authors also investigated challenges and opportunities for technology intervention in this space.

The authors conducted semi-structured interviews with six experts who serve refugees in the United States. The authors asked them about the experiences of refugees with disabilities and their families and inquired into challenges and opportunities for technology access for this population.

The authors found that refugees and their families are significantly impacted by disabilities and mental health challenges. Additionally, while refugees have access to resources and services, they face a number of structural barriers, including the need to navigate a complex healthcare system, geographic placements that sometimes make it difficult to access employment or healthcare services, and issues with accessing public transit.

The main limitation of the current study is that the authors did not collect data directly from refugees with disabilities.

The authors offer several directions for practical improvements based on the findings, including improving structural support for refugees with disabilities and incentivizing health care providers utilizing more culturally aware language services.

While the number of refugees worldwide has doubled in the past decade and there is consensus that a significant number of refugees experience disabilities and mental health challenges, few projects have looked into the technology needs of refugees with disabilities. The exploratory study provides population-level insights on the experiences and accessibility barriers of refugees with disabilities in the United States.

Recent models of care incorporate service user involvement within the development and sustainability of a quality improvement project. The purpose of this paper is to demonstrate the significance of working with patients and members of the public for the integration of psychosocial care into long-term condition (LTC) management.

Research shows that mental health difficulties are more prevalent in people with LTC. The three Dimensions for Long-term Conditions (3DLC) is a patient-centred multidisciplinary service which integrates psychological and social care into the usual physical care. Thematic analysis was conducted on the discussions of the two patient and public involvement workshops that were facilitated by the service. The workshops included healthcare professionals, patients with LTC and their carers.

Several themes and subthemes emerged which highlighted the importance of discussing and treating mental health in a physical health setting, the challenges that both the patients and healthcare professionals encounter and the ways in which an integrated care service may address these barriers. The findings show that there was an emphasis on patient-centeredness, accessibility of services and the need for better communication.

People with LTC can be empowered to better self-manage their condition, whilst having access to all types of care, physical, social and psychological. By involving service users in the implementation process of the 3DLC service, the components of an effective integrated service are delineated.

The service users have identified barriers and facilitators of integrating a biopsychosocial model in care pathways. This has helped the 3DLC team to further develop the model to ensure improvements in condition-specific outcomes, quality of life and healthcare utilisation.

The role of implicit provider bias in mental health care is an important issue that continues to be of concern in the twenty-first century for the Black/African American community. Access to mental health and quality care remains elusive as members of this social group lack access to mental health screening, diagnosis, and attention due to institutional and cultural barriers. Supporting the position that implicit and explicit provider bias exists in the mental health profession, this chapter will explore how implicit provider bias is an intractable institutional barrier that prevents Black/African Americans from accessing mental health and quality care. A review of the implications related to mental health outcomes with Black/African American clients will also be explored.

A brief overview of the Black/African American cultural responses to implicit provider bias will be discussed later in this chapter. There will be an exploration of the ways to help identify, address, and eliminate implicit provider bias using evidence-based personal and community engagement strategies that promote mental health wellness within the Black/African American community. Implications for best practices in Black/African American mental health will also be addressed to eradicate the risk of unethical or medical malpractice with Black/African American clients, reduce the mental health disparity experienced by Blacks/African Americans, and create mental health equity for this population.

The purpose of this paper is to synthesise data from the existent literature on the experiences of non-western older migrants in Europe in accessing and using healthcare services.

In total, 1,606 records were reviewed and 12 studies were selected. A thematic synthesis using Thomas and Harden’s approach was conducted.

The findings resulted in the three overarching themes: traditional discourses under new circumstances; predisposed vulnerabilities of older migrants and the healthcare system; and the conceptualization of health and the roles of healthcare professionals. The authors found that older migrants’ experience of accessing healthcare is influenced by many factors, such as health literacy, differences in healthcare beliefs and language barriers, and is not limited to cultural and traditional discourses of care. Findings reveal that there is a limited body of knowledge on barriers experienced by older migrant women.

The geographical scope of the study and subsequent type of healthcare systems should be taken into account while understanding barriers to care. Another limitation is that although we studied different migrant groups, the authors synthesised barriers experienced by all. Future research could study migrants as separate groups to better understand how previous experiences with healthcare in their home country and specific social, cultural and economic circumstances shape them.

This paper provides a synthesis of the experiences of migrants from non-western countries who moved to a host country with a very different language, culture and healthcare system.