Randomized control trial of a culturally adapted behavioral activation therapy for Muslim patients with depression in Pakistan

BACKGROUND Behavioral activation therapy(BA)is as effective as cognitive behavior therapy(CBT)in treating depression and can be delivered by practitioners with much less psychological training,making it particularly suitable for low resource settings.BA that is culturally adapted for Muslims(BA-M)is a culturally adapted form of BA that has been found acceptable and feasible for Muslims with depression in the United Kingdom and Turkey;however,this is the first time that its efficacy has been determined through a definitive randomized controlled trial.AIM To compare the effectiveness of BA-M with CBT for Muslim patients with depression in Pakistan.METHODS One hundred and eight patients were randomized 1:1 to treatment arms in a parallel-group randomized controlled trial in hospital or community sites in Lahore,Pakistan.Recruitment followed self-referral or referrals from clinicians,consultants or relevant professionals at each site.Four measures were recorded by blinded assessors:The patient health questionnaire-9(PHQ-9);the BA for depression scale short form(BADS-SF);symptom checklist-revised and the World Health Organization Quality-of-Life Brief Scale.All measures were recorded at baseline and post treatment;PHQ-9 and BADS-SF were also recorded at each session and at three month follow up.The primary analysis was to regress the PHQ-9 score after therapy upon the PHQ-9 score before therapy(baseline)and the type of therapy given,that is,analysis of covariance.In addition,analysis using PHQ-9 scores collected at each therapy session was employed in a 2-level regression model.RESULTS Patients in the BA-M arm experienced greater improvement in PHQ-9 score of 1.95 units compared to the CBT arm after adjusting for baseline values(P=0.006)The key reason behind this improvement was that patients were retained in therapy longer under BA-M,in which patients were retained for an average 0.75 sessions more than CBT patients(P=0.013).Patients also showed significant differences on physical(P<0.001),psychological(P=0.004)and social(P=0.047)domains of Quality of Life(QoL)at post treatment level,indicating an increased QoL in the BA-M group as compared to the treatment as usual group.Some baseline differences were noted in both groups for BA scores and two domains of QoL scale:Physical and environment,which might have influenced the results,though the BA-M group showed more improvement at completion of therapy.CONCLUSION Results proved the efficacy of BA-M in reducing symptoms for depressed patients in Pakistan,indicating BA-M is a promising treatment modality for depression in future,particularly in low resource settings.

Evaluation of a culturally adapted cognitive behavior therapy-based,third-wave therapy manual

BACKGROUND Recommendations for psychotherapy have evolved over the years,with cognitive behavioral therapy(CBT)taking precedence since its inception within clinical guidelines in the United Kingdom and United States.The use of CBT for severe mental illness is now more common globally.AIM To investigate the feasibility and acceptability of a culturally adapted,CBT-based,third-wave therapy manual using the Comprehend,Cope,and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.METHODS A pilot study was used to assess the feasibility and acceptability of the manualised intervention.Outcome measures were evaluated at baseline,post-intervention and 12 wk-follow up.32 participants with mental health conditions aged 20-53 years were recruited.Assessments were completed at three time points,using Clinical Outcomes in Routine Evaluation(CORE),Hospital Anxiety and Depression Scale(HADS),Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0(WHODAS).The Patient Experience Questionnaire was completed post-treatment.RESULTS Repeated measures of analysis of variance associated with HADS depression,F(2,36)=12.81,P<0.001,partialη^(2)=0.42 and HADS anxiety scores,F(2,26)=9.93,P<0.001,partialη^(2)=0.36;CORE total score and WHODAS both showed significant effect F(1.25,18.72)=14.98,P<0.001,partialη^(2)=0.5.and F(1.29,14.18)=6.73,P<0.001,partialη^(2)=0.38 respectively.CONCLUSION These results indicate the effectiveness and acceptability of the culturally adapted,CBT-based,third-wave therapy manual intervention among minoritized groups with moderate effect sizes.Satisfaction levels and acceptability were highly rated.The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.

Can an evidence-based fall prevention program be translated for use in culturally diverse communities?

Older adult falls are a significant public health problem,but one that is amenable to preventive interventions.1,2 Despite the progress made in identifying risk factors,developing efficacious health-related interventions,and promoting evidencebased programs in the community,much work remains before these strategies are broadly available and effectively used to reduce fall-related injuries.3 As Newton and ScottFindlay4 have pointed out,the translation of basic scientific knowledge into clinical studies,and the transformation of clinical studies into improvements in health services and public health practices,remain major obstacles to widespread adoption.

Culturally Relevant Pedagogy in Teaching Proficiency through Reading and Storytelling

When the demographics in American public schools became more diverse,educators have faced the challenge of working with diverse student learners.In the education field,culturally relevant pedagogy has been widely recognized as an effective practice for teaching about diversity and is used across different school subject areas.This article discusses the four aspects in which teachers can implement culturally relevant pedagogy in TPRS language classrooms:a caring learning community,establishing meaning,story asking,and story reading.Teachers can include and empower students by validating them as learning subjects and engaging them in knowledge creation and representation in curriculum and instruction.The goal is to develop academic success,culture and identity,equity,and excellence for all student learners in a multicultural and global society.

Childhood Development Cross Culturally:Implications for Designing Childhood Obesity Interventions and Providing Culturally Competent Care

United States is experiencing significant growth in its foreign-born population,especially Chinese American population comprising of 1.2%of the U.S.population.Many healthcare providers are challenged in their efforts to provide culturally competent healthcare to this population.To provide culturally competent healthcare,healthcare providers should understand variations in cultural attributes that impact health.One group in which cultural variation holds great influence is that of children.Culture influences a child's behavior,development and health.This article provides a cross-cultural,comparative examination of important cultural influences on child behaviors development and health in China and the U.S.Using the findings about these two populations,interventions for childhood obesity cross culturally are addressed through the analysis of a U.S.based Children's Obesity Program.The author suggests that uniquely different approaches to childhood obesity intervention research are needed based upon the cultural differences identified within this paper.

The Culturally Responsive Teacher in Class-teaching

Successfully teaching students from culturally and linguistically diverse backgrounds requires a new way of looking at teaching that is grounded in an understanding of the role of culture and language in learning.Teachers need to be familiar with constructivist views of learning,develop socio-cultural consciousnessuse instructional strategies.

Politeness, Culturally-Bound

The present attempts to probe into the cultural difference underlying the different ways of expressing politeness in USA, and Chi na so as to arouse people's awareness in politeness expressing.

Culturally tailored DSMES:A new key for South Asian patients with Type 2 Diabetes Mellitus

South Asians have an exceptionally high risk for developing Type 2 diabetes mellitus.It is very challenging for healthcare providers to successfully manage diabetes and control glucose levels at target due to the unique lifestyle of the South Asian population.Culturally tailored diabetes self-management education and support(DSMES)can be more effective in guiding South Asian patients with Type 2 diabetes.Unique considerations to address lifestyle modification for South Asians include a diet that typically consists of a high carbohydrate to lipids/proteins ratio,preference for high glucose index fruits,regular intake of traditional sweets or desserts,late afternoon tea break followed by late dinner,lack of vigorous exercise(yoga or walking being the preferred activity),lack of DSMES knowledge and skills,and poor access to culturally appropriate resources for diabetes care.We present a 38-year-old male diagnosed with diabetes four years ago who showed poor glucose control before our intervention.Our interventions included education on the importance of blood glucose monitoring,exercise,and diet.Based on our experience with this case,we propose the following recommendations for a tailored approach to DSMES for South Asian patients with Type 2 diabetes:make appropriate dietary changes(decrease total daily caloric intake,decrease the percentage of carbohydrates,add low glucose index fruits and vegetables,avoid late afternoon tea breaks,eat dinner before 8 PM);incorporate appropriate daily physical activity;and monitor blood glucose daily for prompt feedback.

Culturally-loaded Chinese Discourse of Gu-qin and Its Inspiration to Translation——Based on a Maxim from a Chinese Classics The Roots of Wisdom

Inspired by one of the maxims in a Chinese classics entitled The Roots of Wisdom,the present paper borrows the typical culturally-loaded Chinese discourses of Gu-qin — "stringed lute" and "non-stringed lute"—to add to the literary translation terminology and to enrich some Chinese literary translation theories.On the basis of analyzing some related theories in linguistics,pragmatics,aesthetics and communication which show different perspectives relevant with the study of translation,the present paper offers a new angle to illustrate how the Chinese discourses of Gu-qin,rich in cultural implications,can best describe translation and bring new vigor and vitality into the diversity and further expansion of the field of translation research.

Culturally Responsive Teaching:Understanding and Embracing Cultural Diversity in the Chinese Classroom

Schools and society have become more diverse.Culturally responsive teaching as an effective teaching method has been applied in different school subject areas.This article introduces the concept of culturally responsive teaching and discusses its implementation in the Chinese classroom.This article addresses the establishment of an inclusive,safe,and academically rigorous learning environment,diversification of curriculum content knowledge and instructional strategies,and incorporation of culturally responsive assessment.Culturally responsive teaching in the Chinese classroom provides an opportunity for teachers not only to develop students'language skills and cultural understanding,but also to cultivate students'attitudes and dispositions toward diversity for their attainment of effective intercultural communication.

On the Translation of Culturally-loaded Terms in The Last Emperor—from the Perspective of Susan Bassnett’s Theory

Film translation plays an essential role in cultural exchange.Telling a Chinese story,The Last Emperor is a film made by western crews and its dialogues were written in English.The translation of the film reflects the clashes between Chinese and Western cultures.As a prestigious theory of translation,Susan Bassnett’s cultural translation theory is widely used to analyze and evaluate translations of various works.This essay categorizes the translation methods applied and uses Bassnett’s cultural translation theory as its theoretical basis,analyzing and evaluating the translation of the culturally-loaded terms in the translation of The Last Emperor.

Culturally adapted pictorial screening tool for autism spectrum disorder:A new approach

AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD.Each item in text was paired with a photograph that illustrated the written content,which was in the 2 main local languages.The final product had 21 items and was named the pictorial autism assessment schedule(PAAS).Performance of PAAS was tested on a clinical sample of 18-48 mo old children,diagnosis na?ve,presenting with developmental deficits.Mothers completed PAAS checklist.Based on clinical diagnosis,which was taken as the gold standard,children were later grouped into ASD(Group 1) and non-ASD developmental disorders(Group 2).Mothers of a control sample of typically developing children also completed PAAS(Group 3).RESULTS A total of 105 children(Group 1-45,Group 2-30,Group 3-30) participated in the study.Mean age of Group 1 and Group 2 were 36 and 40 mo respectively.Majority were male in all 3 groups.Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%,specificity 60.7%,positive predictive value(PPV) 78.4%,negative predictive value(NPV) 77.2%,likelihood ratio(LR+) 2.26,and LR-0.18.Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%,specificity 93.3%,PPV 95.2%,NPV 84.0%,LR+ 13.3 and LR- 0.12.The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder.A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSION PAAS is an effective tool in screening for ASD.Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.

Culturally sanctioned suicide:Euthanasia,seppuku,and terrorist martyrdom

Suicide is one of the greatest concerns in psychiatric practice, with considerable efforts devoted to prevention. The psychiatric view of suicide tends to equate it with depression or other forms of mental illness. However, some forms of suicide occur independently of mental illness and within a framework of cultural sanctioning such that they aren't regarded as suicide at all. Despitepersistent taboos against suicide, euthanasia and physician-assisted suicide in the context of terminal illness is increasingly accepted as a way to preserve autonomy and dignity in the West. Seppuku, the ancient samurai ritual of suicide by self-stabbing, was long considered an honorable act of self-resolve such that despite the removal of cultural sanctioning, the rate of suicide in Japan remains high with suicide masquerading as seppuku still carried out both there and abroad. Suicide as an act of murder and terrorism is a practice currently popular with Islamic militants who regard it as martyrdom in the context of war. The absence of mental illness and the presence of cultural sanctioning do not mean that suicide should not be prevented. Culturally sanctioned suicide must be understood in terms of the specific motivations that underlie the choice of death over life. Efforts to prevent culturally sanctioned suicide must focus on alternatives to achieve similar ends and must ultimately be implemented within cultures to remove the sanctioning of self-destructive acts.

Culturally Sensitive Medical Care and Nursing Support: A Study of the Concerns of Foreign Visitors to Japan

Background: Considering the development of international transportation in modern societies, nursing care needs to be sensitive to the cultures and customs of patients from other countries. The purpose of this study is to determine, from the perspective of culturally sensitive nursing support, the cultural practices that foreigners consider important when they visit a Japanese hospital for check-ups or hospitalization. Methods: A survey was completed by 110 foreign participants at a shrine in Kyoto City. The purpose of the survey was to evaluate the concerns of foreign visitors regarding Japanese medical providers, caused by cultural differences such as customs of daily life. The statistical analyses were performed using descriptive statistics as well as cross-tabulation, chi-square, and Fisher’s exact tests. Results: After grouping participants by continent, the top concerns observed in all groups about visiting a Japanese hospital were accessibility to and cost of medical care. First, as for medical facilities, participants from North and South America (North and South American) and Europe (Europeans) were significantly more concerned than those in Asia (Asians) (P P P P P Conclusion: Nurses need opportunities to learn and understand differences in cultures. If nurses have opportunities to learn cultural differences as well as to experience caring for foreign patients, their competencies in culturally sensitive nursing support will improve over time. It can be said that this is an issue not only in Japan but also in all other countries.

Negative Stereotyping Attitudes towards Mental Illness: Is It Culturally Related?

Background: Stigma of mental illness is often related to attitude studies in social science research, cross-cultural psychology and education in social behaviour. Majority of these studies used opinion on mental illness to examine attitudes. Method: A cross-sectional survey was presented to 208 registered nurses in Australia. Principal component analyses (with oblique rotation) were used to identify underlying dimensionality in the correlations of items for negative stereotyping attitudes. Subscale score variations were analysed across nurse type and ethnicity to examine the discriminant validity of the subscales. Results: Principal component analysis (PCA) revealed one dimension accounting for 50.5% of the variations within items for negative stereotyping. Developed as scale, labelled as “Dislike Attributed to Mental Illness (DISL)”, reliability analysis indicated high internal consistency with alpha coefficient of .93. Chinese general nurses scored highest on the DISL scale than the other three groups: Chinese psychiatric nurses, Anglo general and Anglo psychiatric nurses. Conclusion: Psychometric evaluation of the Dislike Attributed to Mental Illness (DISL) indicates that it is a reliable scale for measuring negative stereotyping attitudes towards mental illness. The main statistical significance was due to nurse ethnicity.

Neighborhood deprivation and availability of culturally specific African-American and Latino fruits and vegetables in five small central Illinois cities

Introduction: Although individual-level dietary behavior among racial/ethnic minority groups in the US is influenced by cultural food preferences and socioeconomic position, few studies of the food store environment have simultaneously examined both factors. The objective of this cross-sectional study was to investigate the availability of culturally specific fruits and vegetables for African Americans and Latinos by levels of neighborhood deprivation. The 5 small central Illinois cities selected for the study have exhibited increasing numbers of both racial/ ethnic groups in the last decade. Methods: A validated audit tool was used to survey 118 food stores in 2008. Census 2000 block group data was used to create a neighborhood deprivation index (categorized as low, medium, and high) based on socioeconomic characteristics using principal component analysis. Statistical analyses were performed in SPSS version 17.0 to determine whether the availability of culturally specific fruits and vegetables (n = 31) varied by neighborhood levels of deprivation and store type. Results: Fewer than 50% of neighborhoods carried culturally specific fruits and vegetables, with the lowest availability found in low deprivation neighborhoods (p < 0.05). Culturally specific fruits and vegetables were most often found in neighborhoods with medium levels of deprivation, and in grocery stores (p < 0.05). Latino fruits and vegetables were less likely to be found across neighborhoods or in stores, compared to African-American fruits and vegetables. Conclusions: The limited availability of culturally specific fruits and vegetables for African Americans and Latinos highlights potential environmental challenges with adherence to daily dietary guidelines for fruit and vegetable consumption in these groups.

The development of a culturally relevant preventive intervention

Researchers often publish the numerical findings of their intervention studies while overlooking the experiential findings that could help promote more appropriate and effective interventions in the future. The present paper describes the process by which we developed a culturally relevant preventive intervention for Korean American adolescents aged 11 to 14 years and their parents. We discuss the main findings of a series of pilot studies and demonstrated how lessons learned from each study guided the development process and informed the research that followed. Program development is an iterative process that incorporates feedback from study participants. Cultural relevance is ensured when participants’ voices are reflected in the program development, implementation, and evaluation process. The final outcome of the development process was the preventive intervention improving parent-child relationships, increasing parental knowledge, enhancing parental self-efficacy, and decreasing parental stress among Korean American parents, and ultimately promoting Korean American adolescents’ mental health. The specific aims of this two-group, repeated-measures, controlled randomized study were to test the feasibility of the PRIDE (Promoting Intergenerational Dialogue about Emotional Problems) intervention and to compare its efficacy with an attention control (AC) group regarding parental knowledge, parental and filial self-efficacy, parent-child (P-C) communication, P-C conflicts, and P-C satisfaction.

Patient Advocacy and the Affordable Care Act: The Growing Need for Nurses to Be Culturally Aware

The nurse-patient relationship is centered on patient advocacy. Patient advocacy is essential in providing individualized care and improving health outcomes. With the recent implementation of the Affordable Care Act, the patient advocacy concept requires further exploration. Published literature involving patient advocacy’s history, uses, definition, past analyses and nursing perceptions were examined. Outcomes of this literature review lead to further examining patient advocacy and how it is applied to culturally diverse patient populations, patient advocacy in nursing curricula and related research. Overall study results indicate that patient advocacy is associated with enhanced health encounters that include nurses presenting patients with understandable healthcare options and supporting patients with their healthcare preference. Although, this review identified positive outcomes of patient advocacy, nursing research must be directed toward creating a patient advocacy definition and measuring advocacy from a patient’s perspective. There is also a need for nursing leaders to consider placing a higher emphasis on cultural awareness research and education due to an increased rate of culturally diverse patients now seeking care through the Affordable Care Act.

Toward More Culturally Inclusive Domestic Interiors in the Age of Global Mobility

Global modernity,mobility and movement stand as characteristic features that are shaping current times.Marking and challenging the notion of identity,whether cultural,religious,or political,on a daily basis,is movement from nation to nation,region to region,city to city.Individuals and groups are overcoming and crossing geographical borders and cultural differences for study,tourism,lifestyle,or even to start a new life with their children.Thus,identity can be challenged and redefined,resulting in a hybrid identity.The concept of interiors,especially domestic interiors,while people are moving and stopping has changed and is still changing.This case study was based in the city of Glasgow in the UK,where a qualitative approach was adopted for the study of 20 Arab Muslim participants.Semi-structured interviews were conducted within their current private houses in Glasgow.