The broken mirror. A self psychological treatment perspective for relationship violence.
Clinicians face formidable challenges in working with male perpetrators of domestic violence. Many treatment programs use a confrontational approach that emphasizes male entitlement and patriarchal societal attitudes, without honoring the genuine psychological pain of the abusive male. Although some men with strong psychopathic tendencies are almost impossible to treat, the majority of spouse-abusing males respond best to an empathic, client-centered, self psychological approach that also includes education about sociocultural issues and specific skill building. Understanding the deprivations in mirroring selfobject functions from which these men typically suffer facilitates clinical treatment response. While insisting that men take full responsibility for their abusive behavior, treatment approaches can still be most effective by addressing inherent psychological issues. Group leaders who can offer respect for perpetrators' history, their experience of powerlessness, and their emotional injuries in primary relationships are more likely to make an impact. (+info)
Childbirth customs in Orthodox Jewish traditions.
OBJECTIVE: To describe cultural beliefs of Orthodox Jewish families regarding childbirth in order to help family physicians enhance the quality and sensitivity of their care. QUALITY OF EVIDENCE: These findings were based on a review of the literature searched in MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Science Abstracts (1984 to present). Interviews with several members of the Orthodox Jewish community in Edmonton, Alta, and Vancouver, BC, were conducted to determine the accuracy of the information presented and the relevance of the paper to the current state of health care delivery from the recipients' point of view. MAIN MESSAGE: Customs and practices surrounding childbirth in the Orthodox Jewish tradition differ in several practical respects from expectations and practices within the Canadian health care system. The information presented was deemed relevant and accurate by those interviewed, and the subject matter was considered to be important for improving communication between patients and physicians. Improved communication and recognition of these differences can improve the quality of health care provided to these patients. CONCLUSIONS: Misunderstandings rooted in different cultural views of childbirth and the events surrounding it can adversely affect health care provided to women in the Orthodox Jewish community in Canada. A basic understanding of the cultural foundations of potential misunderstandings will help Canadian physicians provide effective health care to Orthodox Jewish women. (+info)
Childbirth customs in Vietnamese traditions.
OBJECTIVE: To examine and understand how differences in the cultural backgrounds of Canadian physicians and their Vietnamese patients can affect the quality and efficacy of prenatal and postnatal treatment. QUALITY OF EVIDENCE: The information in this paper is based on a review of the literature, supplemented by interviews with members of the Vietnamese community in Edmonton, Alta. The literature was searched with MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Sciences Abstracts (1984 to present). Emphasis was placed on articles and other texts that dealt with Vietnamese customs surrounding childbirth, but information on health and health care customs was also considered. Interviews focused on the accuracy of information obtained from the research and the correlation of those data with personal experiences of Vietnamese community members. MAIN MESSAGE: Information in the texts used to research this paper suggests that traditional Vietnamese beliefs and practices surrounding birth are very different from the biomedical view of the Canadian medical system. The experiences and beliefs of the members of the Vietnamese community support this finding. Such cultural differences could contribute to misunderstandings between physicians and patients and could affect the quality and efficacy of health care provided. CONCLUSIONS: A sensitive and open approach to the patient's belief system and open and frank communication are necessary to ensure effective prenatal and postnatal treatment for recent Vietnamese immigrants and refugees. Education and awareness of cultural differences are necessary for physicians to provide the best and most effective health care possible. (+info)
Gender, work and illness: the influence of a research unit on an agricultural community in The Gambia.
Changes in employment opportunities and medical services are exploited by men and women in different ways. This paper examines gender-based variation in the selective use of employment and health opportunities in a Gambian village which has been the subject of medical and nutritional research by the Medical Research Council (MRC) for 43 years. The seasonal workloads of 105 men and women in Keneba were compared during one calendar year. Women carried a heavier burden of agricultural labour, while men had a higher rate of waged employment. The impact of the MRC field station on the local economy was assessed and evidence of associated male dependence on MRC employment found. Illness reporting patterns and the treatment choices of men and women were examined. Women made greater use of the MRC medical service, while men resorted more frequently to local remedies and healers. Female dependence on the MRC medical services is suggested by the data, and may be linked to the greater attention paid to them by researchers and medical practitioners. (+info)
Choice and accountability in health promotion: the role of health economics.
Choices need to be made between competing uses of health care resources. There is debate about how these choices should be made, who should make them and the criteria upon which they should be made. Evaluation of health care is an important part of this debate. It has been suggested that the contribution of health economics to the evaluation of health promotion is limited, both because the methods and principles underlying economic evaluation are unsuited to health promotion, and because the political and cultural processes governing the health care system are more appropriate mechanisms for allocating health care resources than systematic economic analysis of the costs and benefits of different health care choices. This view misrepresents and misunderstands the contribution of health economics to the evaluation of health promotion. It overstates the undoubted methodological difficulties of evaluating health promotion. It also argues, mistakenly, that economists see economic evaluation as a substitute for the political and cultural processes governing health care, rather than an input to them. This paper argues for an economics input on grounds of efficiency, accountability and ethics, and challenges the critics of the economic approach to judge alternative mechanisms for allocating resources by the same criteria. (+info)
Health seeking behaviour and the control of sexually transmitted disease.
What people do when they have symptoms or suspicion of a sexually transmitted disease (STD) has major implications for transmission and, consequently, for disease control. Delays in seeking and obtaining diagnosis and treatment can allow for continued transmission and the greater probability of adverse sequelae. An understanding of health seeking behaviour is therefore important if STD control programmes are to be effective. However, taboos and stigma related to sex and STD in most cultures mean that gaining a true picture is difficult and requires considerable cultural sensitivity. At the moment relatively little is known about who people turn to for advice, or about how symptoms are perceived, recognized or related to decisions to seek help. It is argued that such knowledge would assist programme planners in the development of more accessible and effective services, that studies of health seeking behaviour need to include a combination of qualitative and quantitative methods, and that studies should include data collection about people who do not present to health care facilities as well as those who do. A pilot protocol for studying STD-related health seeking behaviour in developing countries is briefly presented. (+info)
Planning with PRA: HIV and STD in a Nepalese mountain community.
The application of Participatory Rural Appraisal methods (PRA) to the topic of sexual health enabled us to explore key factors concerning local people's perceptions regarding HIV/AIDS and STDs and to plan collectively to address the emerging issues. Conducting the process in a gender sensitive way enabled people to feel safe enough to express their own opinions, and having gained confidence in their peer groups, to share ideas later with the whole community in a joint planning exercise. Nevertheless one group was identified as difficult to reach and whose needs could not be met in a group for reasons of confidentiality. While the methodology itself clearly has great potential in planning around specific health issues, there are, nevertheless, limitations. Although the approach and the tools used are simple and accessible, the skills needed to analyze the information are more complex and demanding. The training given did not manage to equip facilitators adequately with these analytical skills and in the future will be more experience based and geared towards developing analysis and the ability to formulate questions. In addition, since the project is not permanently resident in the area, intensive support within the District is necessary to increase the chances of sustainability. (+info)
Practicing participatory research in American Indian communities.
The purpose of this article is to explore the historical issues that affect research in American Indian communities and examine the implications of these issues as they relate to culturally sensitive, respectful, and appropriate research with this population. Methods include review and analysis of the literature and examination of our collective experience and that of our colleagues. Recommendations are given for conducting culturally sensitive, participatory research. We conclude that research efforts must build on the establishment of partnerships between investigators and American Indian communities to ensure accurate findings and analyses and to implement culturally relevant benefits. (+info)