Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health ...disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.
A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong.
Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes.
This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Race/ethnicity and socioeconomic status (SES) are social categories that capture differential exposure to conditions of life that have health consequences. Race/ethnicity and SES are linked to each ...other, but race matters for health even after SES is considered. This commentary considers the complex ways in which race combines with SES to affect health. There is a need for greater attention to understanding how risks and resources in the social environment are systematically patterned by race, ethnicity and SES, and how they combine to influence cardiovascular disease and other health outcomes. Future research needs to examine how the levels, timing and accumulation of institutional and interpersonal racism combine with other toxic exposures, over the life-course, to influence the onset and course of illness. There is also an urgent need for research that seeks to build the science base that will identify the multilevel interventions that are likely to enhance the health of all, even while they improve the health of disadvantaged groups more rapidly than the rest of the population so that inequities in health can be reduced and ultimately eliminated. We also need sustained research attention to identifying how to build the political support to reduce the large shortfalls in health.
Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis ...focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI -.24,-.21, k = 227; positive mental health: r = -.13, 95% CI -.16,-.10, k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI -.18,-.09, k = 30), and poorer physical health (r = -.09, 95% CI -.12,-.06, k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health ...outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12–18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health.
► A global systematic review of relationships between reported racial discrimination and child and youth health was conducted. ► Among 121 studies, results were significant in 76% of associations between racial discrimination and negative mental health. ► Over 50% of associations with each of positive mental health; behaviour; and birth outcomes; were also significant. ► Future research requires longitudinal designs, valid exposure instruments and improved definition of racial discrimination. ► Investigation of pathways by which racial discrimination affects child and youth health is also needed.
Socioeconomic, racial/ethnic, and gender inequalities in academic achievement have been widely reported in the US, but how these three axes of inequality intersect to determine academic and ...non-academic outcomes among school-aged children is not well understood. Using data from the US Early Childhood Longitudinal Study-Kindergarten (ECLS-K; N = 10,115), we apply an intersectionality approach to examine inequalities across eighth-grade outcomes at the intersection of six racial/ethnic and gender groups (Latino girls and boys, Black girls and boys, and White girls and boys) and four classes of socioeconomic advantage/disadvantage. Results of mixture models show large inequalities in socioemotional outcomes (internalizing behavior, locus of control, and self-concept) across classes of advantage/disadvantage. Within classes of advantage/disadvantage, racial/ethnic and gender inequalities are predominantly found in the most advantaged class, where Black boys and girls, and Latina girls, underperform White boys in academic assessments, but not in socioemotional outcomes. In these latter outcomes, Black boys and girls perform better than White boys. Latino boys show small differences as compared to White boys, mainly in science assessments. The contrasting outcomes between racial/ethnic and gender minorities in self-assessment and socioemotional outcomes, as compared to standardized assessments, highlight the detrimental effect that intersecting racial/ethnic and gender discrimination have in patterning academic outcomes that predict success in adult life. Interventions to eliminate achievement gaps cannot fully succeed as long as social stratification caused by gender and racial discrimination is not addressed.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: To explore the associations between self‐reported racism and health and wellbeing outcomes for young Aboriginal Australian people.
Design, setting and participants: A cross‐sectional study ...of 345 Aboriginal Australians aged 16–20 years who, as participants in the prospective Aboriginal Birth Cohort Study, were recruited at birth between 1987 and 1990 and followed up between 2006 and 2008.
Main outcome measures: Self‐reported social and emotional wellbeing using a questionnaire validated as culturally appropriate for the study's participants; recorded body mass index and waist‐to‐hip ratio.
Results: Self‐reported racism was reported by 32% of study participants. Racism was significantly associated with anxiety (odds ratio OR, 2.18 95% CI, 1.37–3.46); depression (OR, 2.16 95% CI, 1.33–3.53); suicide risk (OR, 2.32 95% CI, 1.25–4.00); and poor overall mental health (OR, 3.35 95% CI, 2.04–5.51). No significant associations were found between self‐reported racism and resilience or any anthropometric measures.
Conclusions: Self‐reported racism was associated with poor social and emotional wellbeing outcomes, including anxiety, depression, suicide risk and poor overall mental health.
Abstract
Background
Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally, with children and adolescents particularly vulnerable. Racial ...discrimination is a common stressor in the lives of many children and adolescents, with growing evidence of negative associations between racial discrimination and multiple domains of child and adolescent health. Addressing racism and racial discrimination must be core public health priorities, even more so among children and young people.
Schools are key settings in the lives of children and adolescents and become increasingly more important to identity formation. School communities, teachers and peers greatly influence children and adolescents’ beliefs about race and difference. Schools are therefore key sites for the delivery of population-based programs to reduce racism and promote proactive bystander behaviour and healthy resistance to racism among all children and adolescents as well as among the adults.
Methods
This study examines the feasibility and acceptability of the ‘Speak Out Against Racism (SOAR)’ program, a whole of school, multi-level, multi-strategy program that aimed to promote effective bystander responses to racism and racial discrimination in primary schools. A mixed-methods, quasi-experimental design was used. Students in Years 5 and 6 (10–12 years) across six schools completed surveys pre- and post- intervention (
N
= 645; 52% female; 6% Indigenous, 10% Middle Eastern, African, Latinx or Pacific Islander, 21% Asian, 52% Anglo/European). Focus groups with students and interviews with staff collected qualitative data about their experiences of the program and their views about the program’s perceived need, implementation, impacts and suggested improvements.
Results
Quantitative data showed student prosocial skills and teacher inter-racial climate improved in intervention schools compared to comparison schools. Qualitative data highlighted teacher attitudinal and behaviour change regarding racism, and student reduced interpersonal racial discrimination, improved peer prosocial norms, commitment to anti-racism, knowledge of proactive bystander responses and confidence and self-efficacy to intervene to address racism.
Conclusions
This study provides quantitative evidence of the potential of the SOAR program to improve the prosocial skills of students and their perceptions of the inter-racial school climate provided by their teachers. This program also provided qualitative evidence of the potential to promote teacher and student attitudinal and behavioural change. Further refinement and testing of the program in a large scale implementation trial is recommended.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Child mental health problems are now recognised as a key public health concern. Parenting programs have been developed as one solution to reduce children's risk of developing mental health problems. ...However, their potential for widespread dissemination is hindered by low parental engagement, which includes intent to enrol, enrolment, and attendance. To increase parental engagement in preventive parenting programs, we need a better understanding of the predictors of engagement, and the strategies that can be used to enhance engagement.
Employing a PRISMA method, we conducted a systematic review of the predictors of parent engagement and engagement enhancement strategies in preventive parenting programs. Key inclusion criteria included: (1) the intervention is directed primarily at the parent, (2) parent age >18 years, the article is (3) written in English and (4) published between 2004-2016. Stouffer's method of combining
-values was used to determine whether associations between variables were reliable.
Twenty-three articles reported a variety of predictors of parental engagement and engagement enhancement strategies. Only one of eleven predictors (child mental health symptoms) demonstrated a reliable association with enrolment (
< .01).
There was a lack of consistent evidence for predictors of parental engagement. Nonetheless, preliminary evidence suggests that engagement enhancement strategies modelled on theories, such as the Health Belief Model and Theory of Planned Behaviour, may increase parents' engagement.
PROSPERO CRD42014013664.
Among working‐age Australian adults with a disability, we assess the association between disability‐based discrimination and both overall health and psychological distress.
Using data from the 2015 ...Australian Bureau of Statistics Survey of Disability, Ageing and Carers we estimated the proportion of working‐age women and men (15–64 years) with disability who report disability‐based discrimination by socio‐demographic characteristics and assessed the association between disability‐based discrimination and self‐reported health and psychological distress.
Nearly 14% of Australians with disability reported disability‐based discrimination in the previous year. Disability‐based discrimination was more common among people living in more disadvantaged circumstances (unemployed, low income, lower‐status occupations), younger people and people born in English‐speaking countries. Disability‐based discrimination was associated with higher levels of psychological distress (OR: 2.53, 95%CI: 2.11, 3.02) and poorer self‐reported health (OR: 1.63, 95%CI: 1.37, 1.95).
Disability‐based discrimination is a prevalent, important determinant of health for Australians with disability.
Disability‐based discrimination is an under‐recognised public health problem that is likely to contribute to disability‐based health inequities. Public health policy, research and practice needs to concentrate efforts on developing policy and programs that reduce discrimination experienced by Australians with disability.
Racism has been identified as an important determinant of health but few studies have explored associations between racism and health outcomes for Australian Aboriginal young people in urban areas.
...Cross sectional data from participants aged 12-26 years in Wave 1 of the Victorian Aboriginal Health Service's Young People's Project were included in hierarchical logistic regression models. Overall mental health, depression and general health were all considered as outcomes with self-reported racism as the exposure, adjusting for a range of relevant confounders.
Racism was reported by a high proportion (52.3%) of participants in this study. Self-reported racism was significantly associated with poor overall mental health (OR 2.67, 95% CI 1.25-5.70, p = 0.01) and poor general health (OR 2.17, 95% CI 1.03-4.57, p = 0.04), and marginally associated with increased depression (OR 2.0; 95% CI 0.97-4.09, p = 0.06) in the multivariate models. Number of worries and number of friends were both found to be effect modifiers for the association between self-reported racism and overall mental health. Getting angry at racist remarks was found to mediate the relationship between self-reported racism and general health.
This study highlights the need to acknowledge and address racism as an important determinant of health and wellbeing for Aboriginal young people in urban areas of Australia.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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