Bridging cultural differences in medical practice. The case of discussing negative information with Navajo patients.
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BACKGROUND: Cultural differences between doctors and their patients are common and may have important implications for the clinical encounter. For example, some Navajo patients may regard advance care planning discussions to be a violation of their traditional values. OBJECTIVE: To learn from Navajo informants a culturally competent approach for discussing negative information. DESIGN: Focused ethnography. SETTING: Navajo Indian reservation, northeast Arizona. PARTICIPANTS: Thirty-four Navajo informants, including patients, traditional healers, and biomedical health care providers. MEASUREMENT: In-depth interviews. MAIN RESULTS: Strategies for discussing negative information were identified and organized into four stages. Assessment of patients is important because some Navajo patients may be troubled by discussing negative information, and others may be unwilling to have such discussions at all. Preparation entails cultivating a trusting relationship with patients, involving family members, warning patients about the nature of the discussion as well as communicating that no harm is intended, and facilitating the involvement of traditional healers. Communication should proceed in a caring, kind, and respectful manner, consistent with the Navajo concept k'e. Reference to a third party is suggested when discussing negative information, as is respecting the power of language in Navajo culture by framing discussions in a positive way. Follow-through involves continuing to care for patients and fostering hope. CONCLUSIONS: In-depth interviews identified many strategies for discussing negative information with Navajo patients. Future research could evaluate these recommendations. The approach described could be used to facilitate the bridging of cultural differences in other settings. (+info)
The notion of health: a conceptual analysis.
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The notion of health used in medicine may have important implications, such as guiding the allocation of medical resources. This paper explores the notion of health through an overview and conceptual analysis of various notions of health found in modern medical and philosophical literature. It argues that health is characterized either positively or negatively (per exclusion), and either mechanistically (as the set of common or ideal states of a species) or holistically (as unimpaired self-organization of organisms). The paper concludes that a sound notion of health characterizes health negatively and holistically, assimilating mechanism as a good approximation in simple cases. (+info)
The concept of noise sensitivity: implications for noise control.
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The term "noise sensitivity" is frequently used in many areas of noise research. However, it can be used to describe several different effects and it can be measured in different ways. In noise surveys, noise sensitivity refers to the fact that individuals differ in the annoyance produced by different sources of noise. Noise sensitivity can be viewed as an independent variable, which may be directly related to outcomes such as health status, or it can be conceptualized as a factor that modifies or mediates the effects of noise exposure on the outcome measure. Noise sensitivity is highly correlated with the general trait negative affectivity, a measure of the extent to which individuals perceive or report negative features of their environment or self. Indeed, few studies have demonstrated effects of noise sensitivity that are independent of negative affectivity. This implies that it is most appropriate to examine general indicators of reported sensitivity rather than a noise-specific measure. Noise sensitivity can also be considered in terms of physiological reactivity to noise sources. Such effects are often only weakly associated with self-reports of noise sensitivity. Habituation to noise is also an important topic to consider and again this appears to be largely independent of self-reported noise sensitivity. Overall, it would appear that it is important to distinguish between subjective reports of noise sensitivity and objective indicators. Different factors will modify these two aspects of noise sensitivity and this implies that different strategies are needed to influence them. Such effects must be taken into consideration when one considers whether control should be targeted at the community in general, or whether it should also cover the most sensitive individuals. (+info)
Negative impact of clinical misdiagnosis of measles on health workers' confidence in measles vaccine.
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We conducted a survey to determine the accuracy of the clinical diagnosis of measles in Zimbabwe. Between December 1996 and February 1997, we collected blood samples and clinical and demographic information from a sample of 105 children with a clinical diagnosis of measles. A clinical case of measles was defined as a person with a history of fever, rash for three or more days, and either cough, coryza, or conjunctivitis. A laboratory-confirmed case of measles or rubella had IgM antibodies against measles virus or rubella virus respectively. A total of 91% of children met the clinical case definition. Among those who met the clinical case definition for measles, 72% were IgM-positive for measles virus only, 23% were IgM-positive for rubella virus only, 3% were IgM-positive for both measles and rubella viruses, and 2% were IgM-negative for both viruses. This study demonstrates the importance of considering selective laboratory confirmation of measles in periods of high disease incidence when the effectiveness of the vaccine is questioned. (+info)
Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers.
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OBJECTIVES: We assessed the impact of graphic Canadian cigarette warning labels. METHODS: We used a longitudinal telephone survey of 616 adult smokers. RESULTS: Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up. CONCLUSIONS: Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes. (+info)
Attitudes toward transplantation in U.K. Muslim Indo-Asians in west London.
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The worldwide shortage of organs for transplantation makes it important to understand why some oppose donation. Attitudes vary with religion and ethnicity. Accordingly, we undertook a qualitative study of the attitudes of 141 U.K. Muslim Indo-Asians to organ donation. Participants were observed, focus group discussions held and in-depth individual interviews conducted. We identified a high level of alienation from the health care system in general. With respect to organ donation in particular, its importance was generally discounted, often in deference to authority figures within the community who appeared negatively disposed. The culture-specific issues arguing against donation included a sense of the sacredness of the body, a fatalistic approach to illness, a belief that organs took on an independent role as 'witnesses' to an individual's life on Judgement Day and an anxiety that the donor would have no control of the probity of the recipient of an organ. We believe these data suggest a need to improve in a culturally sensitive fashion the provision of health information provided to this community. (+info)
The association between negative self-descriptions and depressive symptomology: does culture make a difference?
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Research findings that depressed Americans endorse more negative self-related adjectives than controls may be related to a shared self-enhancement cultural frame. This study examines the relationship between negative core self-descriptors and depressive symptoms in 79 Japanese and 50 American women. Americans had more positive self-descriptions and core self-descriptors; however, there were no cultural group differences in number of negative self-descriptors or core self-descriptors. There was a significant correlation between negative core self-descriptor and Beck Depression Inventory (BDI) for Americans only, explaining 10.6% of the BDI variance. Analysis of variance revealed that there was significant BDI group differences for American negative core self-descriptor only. Theoretical possibilities are discussed. (+info)
Investigation of staff and patients' opinions of a proposed trial of elective single embryo transfer.
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BACKGROUND: In the context of mounting concern about the risks of twin pregnancies resulting from IVF, this study aimed to assess staff and patients' attitudes towards a proposed randomized controlled trial (RCT) of elective single embryo transfer (SET) in a Scottish fertility centre. METHODS: The views of 10 members of IVF clinic staff were assessed by means of a focus group and those of 12 couples by semi-structured interviews. RESULTS: Staff were aware of the risks of twin pregnancies to mothers and babies and the need for evidence of success in SET, but had reservations about the proposed RCT. The need to subject patients to unpopular scientific procedures such as randomization and blinding conflicted with their perceived caring role. They felt it would be hard to recruit and onerous to patients but nevertheless discussed how it could be successfully mounted if necessary. They debated how to ensure that consent was fully informed, and when, and how, to randomize. Patients accepted the possibility of twins but were largely unaware of risks inherent in twin pregnancies. They saw no need for a trial and found the idea of randomization unacceptable except in younger women. They would accept SET if it became unit policy and appeared unaffected by financial considerations. CONCLUSIONS: Involving affected staff at the design stage may make it easier to conduct a SET trial in their clinics. IVF patients whose ultimate goal is pregnancy are less likely to support a trial which aims to minimize twin pregnancies. (+info)