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Journal of Bioethical Inquiry Sep 2019Decision-making capacity in children and adolescents in healthcare requires thorough assessment: the minor's maturity, understanding of the decision, risk of the...
Decision-making capacity in children and adolescents in healthcare requires thorough assessment: the minor's maturity, understanding of the decision, risk of the situation and contextual factors needs to be explored. The intention was to design and validate a test-the Maturtest-to assess the maturity of minors in decision-making processes in healthcare. A reasoning test on moral conflicts for adolescents was designed to infer the degree of maturity of minors applied to decision-making regarding their own health. The test was completed by a sample of 441 adolescents aged from twelve to sixteen, with a corresponding analysis of their psychometric skills to measure feasibility, viability, reliability, validity, and sensitivity to change. Psychometric test results showed viability, reliability, validity, and sensitivity to change. High correlation (correlation index = 0.74) between the test score and the reference method were notable. A high stability was obtained with an intraclass correlation coefficient (r = 0.77). The average response time of the test was twenty-three minutes. This test measures the moral maturity of adolescents. It is presented as an objective, useful, valid, reliable tool, easy to fill out, edit and apply in a healthcare context. It helps to assess the maturity of minors faced with a decision.
Topics: Adolescent; Child; Decision Making; Female; Humans; Informed Consent By Minors; Male; Minors; Moral Development; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 31372885
DOI: 10.1007/s11673-019-09930-4 -
BMJ Open Jun 2023This review examined the factors influencing communication and engagement with ethnic and racial minority groups in Australia during the COVID-19 pandemic. It aimed to... (Review)
Review
OBJECTIVES
This review examined the factors influencing communication and engagement with ethnic and racial minority groups in Australia during the COVID-19 pandemic. It aimed to answer two main questions: (1) what communication problems people from these communities typically faced during the pandemic? and (2) what strategies and recommendations were suggested to enhance communication and engagement for ethnic and racial minorities during the current COVID-19 pandemic and any similar events in the future?
DESIGN
Scoping review.
DATA SOURCES
PubMed, EMBASE, Cochrane Library, PsychINFO and CINAHL. Grey literature was searched within organisations' websites and a Google search of key terms.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included original research, case studies, reports (including government and charity reports), systematic and scoping articles and literature reviews in English, published from January 2020 to August 2022.
DATA EXTRACTION AND SYNTHESIS
Two researchers independently assessed the literature for eligibility and extracted data from the included literature. The selected papers were analysed and summarised into themes relevant to the research questions. The final review included 38 studies combining published academic papers and grey literature.
RESULTS
Key themes relating to communication and engagement issues included a lack of trust in authority, a lack of access to information and ineffective communication channels and a lack of timely and culturally responsive materials. To reduce the issues, the papers spoke about the key role of community organisations to provide local support and community leaders as trusted spokespersons. Lastly, key recommendations to reduce inequity and strengthen future pandemic responses focused on the need for collaborations and consultations, increasing the number of bilingual workers and supporting community-led communication efforts.
CONCLUSIONS
The insights gained from the activities and experiences documented in this review during the COVID-19 pandemic should be incorporated into future decision-making and interventions to enhance communication and engagement strategies.
Topics: Humans; COVID-19; Ethnic and Racial Minorities; Pandemics; Minority Groups; Communication
PubMed: 37344110
DOI: 10.1136/bmjopen-2022-069552 -
The Journal of Clinical Psychiatry Oct 2005Because of the poor quality of mental health care received by minorities, analyses documenting comparable response to and tolerability of medications for anxiety and... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Because of the poor quality of mental health care received by minorities, analyses documenting comparable response to and tolerability of medications for anxiety and depression in large samples of minority and majority populations could increase the willingness of providers and patients to use medications in minority populations.
METHOD
A pooled analysis of 14,875 adults who participated in 104 double-blind, placebo-controlled paroxetine clinical trials investigating major depression, panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, or premenstrual dysphoric disorder from March 1984 through March 2002. An intent-to-treat analysis with last observation carried forward used the Clinical Global Impressions (CGI) scale to measure dichotomous outcome, classified as either response (CGI score of 1 or 2) or more complete response (CGI score of 1) ("full response"). Minority group differences were examined using logistic regression for the entire sample and repeated for those with major depression. Adverse events greater than 5% and twice the rate of placebo were descriptively tabulated. Finally, a survival analysis examined group differences in speed of onset of response.
RESULTS
Hispanic and Asian subjects had a slightly lower response rate, while Asians had the highest rates and Hispanics had the lowest rates of "full response." The more consistent Hispanic outcome differences appeared to be due to a higher placebo response rate. There was no treatment by minority group interaction for depressed patients. Speed of response and adverse effects were similar across groups.
CONCLUSIONS
There were few consistent differences in medication response and tolerability. These findings may serve to counteract the greater rate of negative attitudes toward medication use among minorities and reinforce the value of medications used to treat anxiety and depression in minorities.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anxiety Disorders; Cohort Studies; Depressive Disorder; Ethnicity; Female; Humans; Male; Middle Aged; Minority Groups; Nausea; Paroxetine; Placebos; Selective Serotonin Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders; Survival Analysis; Treatment Outcome
PubMed: 16259535
DOI: 10.4088/jcp.v66n1004 -
Nursing Inquiry Jul 2022A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident... (Review)
Review
A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno-specific nursing homes create the ideal social condition for residents to express their care needs and preferences in a language of choice. In nonethno-specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences.
Topics: Communication; Ethnic and Racial Minorities; Ethnicity; Humans; Minority Groups; Nursing Homes; Qualitative Research; Social Conditions
PubMed: 34647382
DOI: 10.1111/nin.12469 -
Chronic Illness Mar 2016The health of people from Indigenous and ethnic minorities is poorer than the remainder of the population. Frequently, Westernized health systems respond by introducing... (Review)
Review
OBJECTIVES
The health of people from Indigenous and ethnic minorities is poorer than the remainder of the population. Frequently, Westernized health systems respond by introducing self-management interventions to improve chronic illness health outcomes. The aim of this study was to answer the research question: "Can self-management programs that have been adapted or modified still be effective for ethnic minority and Indigenous populations?"
METHODS
A systematic review across four databases was conducted.
RESULTS
Twenty-three publications met the inclusion criteria. As the studies were heterogeneous, meta-analysis was not possible. Overall, interventions resulted in more positive health outcomes than usual care, but findings were inconsistent.
DISCUSSION
We argue that rather than focusing on individual skills, knowledge, self-efficacy, and attitudes toward self-management, it may be more important to explore the structures and processes that underpin the sharing of information and skills within clinical or education encounters. Given that self-management is a Western cultural construct, creating empathic and responsive systems might be more effective for improving health of Indigenous and ethnic minority groups rather than relying predominantly on individual skill development.
Topics: Chronic Disease; Culturally Competent Care; Health Education; Humans; Minority Groups; Outcome Assessment, Health Care; Population Groups; Self Care
PubMed: 26026156
DOI: 10.1177/1742395315587764 -
Journal of Immigrant and Minority Health Dec 2023Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among... (Review)
Review
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
Topics: Humans; Ethnicity; Minority Groups; Ethnic and Racial Minorities; Transients and Migrants; Qualitative Research
PubMed: 36976449
DOI: 10.1007/s10903-023-01468-3 -
Annals of Family Medicine 2022As a psychiatry residency program director of Asian descent at a historically Black institution, I provided forums for my majority-Black residents to process their...
As a psychiatry residency program director of Asian descent at a historically Black institution, I provided forums for my majority-Black residents to process their feelings about the racial turmoil of the past couple of years. At the same time, I was downplaying anti-Asian racism. This tendency slowed my response to the recent rise of anti-Asian violence and how it affected my Asian residents and others. It comes in part from the flawed stereotype that Asians are model minorities, which influences both Asians and non-Asians alike. I was aware of this stereotype and educated others on it years ago, but it still led to me suppress my own feelings about the violence. Reviewing my past experiences with racism and discussing these issues in my various communities helped me acknowledge my feelings and learn to speak up about this significant issue. Taking anti-Asian racism seriously will validate the experience of a significant proportion of the American population and the medical workforce, and it is one of multiple steps necessary to address it.
Topics: Humans; Learning; Minority Groups; Racism; United States
PubMed: 35879070
DOI: 10.1370/afm.2819 -
Medical Teacher Sep 2004The aim of the study was to obtain information regarding the prevalence, structure, student characteristics and outcomes of formal decelerated medical education...
The aim of the study was to obtain information regarding the prevalence, structure, student characteristics and outcomes of formal decelerated medical education programs. A 13-item survey was mailed to all US medical schools examining characteristics of decelerated curricular programs. Responses were received from 77 schools (62% response). Some 24 (31%) indicated a formal decelerated option; 13 (57%) decelerate the first year while four (17%) decelerate year 1 or year 2. Participants may be selected before matriculation or after difficulty in 14 (61%) programs while four (17%) select only after encountering difficulty. Students may unilaterally choose deceleration in 10 (43%); 4.3% (0.1-12) of total matriculants were decelerated. The proportion of decelerated students identified as underrepresented minority (URM) was 37% (0-100), representing 10.5% (0-43) of total URM enrollment. Twelve (52%) programs do not provide unique support beyond deceleration. Standards for advancement are identical for decelerated and regular students in 17 schools (81%). In total, 10% (0-100) of decelerated students were dismissed within the last five years, representing 24% (0-90) of all dismissals. Few schools provided grade point average (GPA) or Medical College Admissions Test (MCAT) data but the limited responses indicate that many decelerated students are at risk for academic difficulty. It is concluded that decelerated curricular options are available at a significant number of US medical schools. Decelerated students comprise a small proportion of total enrollment but URM matriculants represent a disproportionate share of participants. Decelerated programs appear to be successful as measured by dismissal rates if one accepts attrition which exceeds that for regular MD students. Variation in dismissal rates is difficult to interpret given the lack of GPA and MCAT data. One half of all programs offer no additional support activities beyond deceleration. More data are needed to determine the relative contribution of deceleration vs. other support measures to the advancement of students at academic risk.
Topics: Curriculum; Education, Medical, Undergraduate; Female; Humans; Male; Minority Groups; School Admission Criteria; Student Dropouts; Surveys and Questionnaires; United States
PubMed: 15763826
DOI: 10.1080/01421590410001696407 -
Suicide & Life-threatening Behavior Jun 2008Despite evidence of considerable racial/ethnic variation in adolescent suicidal behavior in the United States, research on youth of European American descent accounts... (Review)
Review
Despite evidence of considerable racial/ethnic variation in adolescent suicidal behavior in the United States, research on youth of European American descent accounts for much of what is know about preventing adolescent suicide. In response to the need to advance research on the phenomenology and prevention of suicidal behavior among ethnic minority populations, NIMH co-sponsored the "Pragmatic Considerations of Culture in Preventing Suicide" workshop to elicit through interdisciplinary dialogue how culture can be considered in the design, development, and implementation of suicidal behavior prevention programs. In this discussion paper we consider the three ethnic minority suicide prevention efforts described in the articles appearing in this issue, along with workshop participants' comments, and propose six major areas where issues of culture need to be better integrated into suicidal behavior research.
Topics: Acculturation; Adolescent; Culture; Ethnicity; Health Promotion; Health Services Research; Humans; Minority Groups; Models, Psychological; Prejudice; Preventive Health Services; Psychology, Adolescent; Research Design; Risk Factors; Stereotyping; Suicide; United States; Suicide Prevention
PubMed: 18611134
DOI: 10.1521/suli.2008.38.3.354 -
Contemporary Clinical Trials Feb 2023Engaging communities in research planning and implementation can enhance recruitment and retention (R&R) of racial and ethnic groups historically excluded and... (Review)
Review
INTRODUCTION
Engaging communities in research planning and implementation can enhance recruitment and retention (R&R) of racial and ethnic groups historically excluded and underrepresented in clinical research; however, most studies do not use community-informed approaches. This paper describes the formative research process used to design a Community-Informed Recruitment Plan Template for racial and ethnic groups historically excluded and underrepresented in clinical research.
METHODS
Using an existing R&R template as a starting point, we iteratively developed and refined the community-informed template through a 3-phase process to achieve cultural-appropriateness. Phase 1 included a literature review, 34 community engagement (CE) studios to review recommendations, community advisory board (CAB) review, and survey data from minority recruitment experts. Phase 2 involved integration of content into existing R&R template. Phase 3 was a final review and revision using input of the CAB and researchers' panel. Survey data collected in Phase 1 were analyzed using descriptives (i.e., frequencies and percentages). Open-ended survey responses were analyzed using inductive, qualitative thematic analysis.
RESULTS
The final 8-section template can help develop effective grant or proposal language where study R&R plans are requested. They include: 1) Recruitment Strategy; 2) A Stakeholder Communication Plan; 3) Evidence of Recruitment Feasibility; 4) Recruitment and Retention Team; 5) Recruitment and Retention Methods; 6) Recruitment and Retention Timeline; 7) Evaluation; and 8) Budget.
CONCLUSIONS
Incorporating multiple perspectives into this formative research process enhances the cultural appropriateness of this community-informed R&R template to help research teams achieve R&R goals for individuals historically excluded and underrepresented in clinical research.
Topics: Humans; Ethnicity; Minority Groups; Pilot Projects; Research Design; Patient Selection
PubMed: 36572240
DOI: 10.1016/j.cct.2022.107064