Healing Our Spirit Worldwide, the Seventh Gathering will provide the forum to:

• Share initiatives, programmes and solutions
• Connect and learn from other each other as indigenous people
• Share strengths, hope and wisdom
• Celebrate and express cultural practices, keeping alive the cultural and spiritual foundation of indigenous people.

To find out more about this event, go to:  http://hosw.com/

To read the article, go to:  http://www.lianza.org.nz/sites/default/files/Library%20Life%20434%20May%202015.pdf

The conference theme encourages strength-based presentations relating to indigenous health teaching and learning, curriculum development and research in health professional education as well as models for community engagement and the recruitment and graduation of indigenous students.

To find out more about this event, go to:  http://www.limenetwork.net.au/lime-connection/lime-connection-vi

"Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor–patient relationships, and problems with the cultural acceptability of medical care".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to:http://dx.doi.org/10.3399/bjgp15X683977 or contact your DHB library, or organisational or local library for assistance.

Cheng, I-H., et al. (2015). Refugee experiences of general practice in countries of resettlement: A literature review. British Journal of General Practice, 1 March [Epub before print]

The creation of a new document ‘Kia purea ai koe – Māori Wellbeing in MidCentral DHB’, seeks to provide health and social sector staff with a greater understanding of the strengths, resources and qualities of Māori in the district.

Developed by MidCentral DHB’s Clinical Network Programme, working with the Central PHO’s Māori Health Team, the document provides greater knowledge around Māori wellbeing. It is hoped that better informing health and social sector staff will result in a stronger appreciation of Māori and the Māori way of being, and have a flow-on effect of helping to address health equity concerns.

Chairman of Manawhenua Hauora, the Iwi consortium that works in partnership with MDHB, Richard Orzecki is glad to have this information released to the health and social sectors.

He said: “This type of information is very important to furthering the health of Māori in the MidCentral district. What ‘Kia purea ai koe’ will do is provide insights for health and social sector workers in our area, and help give them a better understanding of the Māori way of being.”

Central PHO’s Director of Māori Health Materoa Mar believes that it shines a more positive light on Māori health.

She said: “Much of what we hear in relation to Māori health is often solely focused on a deficit and issues-based approach, and it is true that these challenges exist. However, it’s good to step back and take a look at what strengths and potential the Maori culture can provide to all. Research shows that a strong cultural foundation is a big part of wellbeing, and in this document we bring together information on how culture can be used to inform health.”

The information contained within the document isn’t necessarily new, but it is having it compiled in one place that makes it a great source for health and social sector workers. It covers diverse topics, including the history of Iwi in the district, culture, demographics, education and, of course, models of health for Māori.

MDHB Project Officer, Clinical Networks Katherine Gibbs was another who helped put the document together, and recognises the importance of having a consolidated source of information.

She said: “Working with our district groups that form the Clinical Network programme, it became apparent that a resource like this one would be invaluable. The information is out there, but bringing all the information together like this makes it easier for the hard-working people who form these groups to have a chance to learn more about Māori culture. We have also created a pre and post quiz so individuals and groups will be able to assess for themselves how much they have learned in reading the document.”

A read-only electronic copy of the document will be made available on the MDHB and Central PHO websites. For a hard copy call the Central PHO on (06) 354 9107.

A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). The authors interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages.

Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator’s cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness.

The authors conclude that lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the ‘community’ links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0712-8

Sidhu, M.S., et al. (2015). A critique of the design, implementation, and delivery of a culturally-tailored self-management education intervention: a qualitative evaluation. BMC Health Services Research, 15:54

The online Foundation Course in Cultural Competency is now available free of charge at Learn Online (www.learnonline.health.nz) – the course supports you to build your understanding of cultural competency and health literacy in New Zealand, with a focus on improving Māori health outcomes.

The multimedia, interactive course is a voluntary programme and is spread across four modules and is available for all people working in the health sector. Each training module is supported by videos, video transcripts, additional reading resources and library references.

Cultural competence training assists health workers to provide a more accessible and welcoming service and has been identified as a key skill to ensure health workers are more consistently able to provide patients and their whānau with health information in a way they can understand.

In this systematic review of quantitative and qualitative literature, the authors identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth.

In the videos, four Māori people share their experience of both working in a health service and being a patient or whānau of a patient. The participants work within a Māori health service so the videos include views both as a consumer and provider of services.

The videos explore the importance of relationships with whānau when working with Māori consumers, cultural considerations for health providers, and how to work with patients and whānau.

The videos are presented as four individual stories, and also as shorter clips edited into themes. The themes are:

• looking after Māori in hospital
• one Māori voice
• Māori cultural practices
• communicating with Māori in a health setting
• whānau support in health care
• health literacy among Māori.

The videos are available to view at:  http://www.hqsc.govt.nz/our-programmes/consumer-engagement/publications-and-resources/videos-maori-responsiveness/

Sixty-one studies were included. "Most interventions focused on the individual level and the modification of patients' health behavior. Very few addressed the sociopolitical level. A minority of the studies acknowledged the role of socioeconomic deprivation in ethnic health inequalities. Half of the studies contained no information about the socioeconomic status of the patients. The patients receiving the interventions were socioeconomically deprived. Only 10 studies compared ethnic minority groups to majority groups ... Overall, CC interventions addressing T2DM are not congruent with the reduction of ethnic health inequalities". The authors discuss the imlications of these findings. 

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1080/13557858.2013.857763 or contact your DHB library, or organisational or local library for assistance.

Dauvrin, M. & Lorant, V. (2014). Culturally competent interventions in Type 2 diabetes mellitus management: An equity-oriented literature review. Ethnicity & Health, 19(6), 579-600.

Users can search by region, service, and type of service and cancer type.

The Commission examines three overlapping domains of culture and health: cultural competence, health inequalities, and communities of care. With reference to these domains, the Commission shows how inseparable health is from cultural perceptions of wellbeing".

Access to the full text of the articles is free but registration is required on the Lancet site. 

For information on how to access the full text, go to:   http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61603-2/fulltext

Napier, A.D., et al. (2014). Culture and health. The Lancet, 384(9954), 1607 - 1639.

Topics covered will include:

1. Improving care accounting for cultural issues

2. Health Information Technology

3. Patient Centred Care

4. Patient Safety

5. Education and Research in Quality and Safety

6. Accreditation, Regulation and External Evaluation

7. Quality and Safety in Developing Countries

8. Improving Population Health and Efficiency

For further information about this event, go to: http://www.isqua.org/conference/doha-2015

A total of 33 randomised controlled trials (RCTs)  (including 11 from the original 2008 review) involving 7453 participants were included. The interventions were very different from one study to another but most were based on recognisable theoretical models.

Based on their analysis, the authors conclude that "culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles ... None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence". 

This article is available to read in full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006424.pub3/full

Attridge, M., Creamer, J., Ramsden, M., Cannings-John, R., Hawthorne, K. (2014). Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 9, CD006424.

This focus group was made up of 14 participants who all had Type 2 diabetes, with a number of the group having had the disease for over 20 years. All of the participants were of South Asian ethnicity and either in their later working years or their retirement.

The most common themes in this group included the lack of information appropriate to the Indian diet and exercise, the cultural barriers faced regarding accepting and managing their diabetes and the types of support received and services available in their area.

One participant described, “Even saying ‘Eat less carbohydrates’ means absolutely nothing to an 80 year old Indian woman. What are carbohydrates? Why not tell her to just eat half her roti instead?’”

Another member added, “The medical system here has no understanding of Indian culture at all. The advice they give just doesn’t work for us. It’s about acknowledging that we eat rice and japarti. Just being told ‘don’t’ doesn’t help. We need to be told what we can eat or how we can observe our traditions and culture in a healthy way.”

Indian cooking is also done collectively. “One downside of that is it feels like it’s too much trouble to cook something separate for yourself so you end up thinking ‘oh well, I’ll just have a little…,’” added another partipant.

Nutritional advice that has been specifically referenced in Indian culture would be very helpful. “We need to have advice about how to manage diabetes even though our culture eats rice. Something similar to the Ministry’s plate portions and other nutritional advice – how do you translate that into an Indian context?” asked one of the participants.

There were also cultural barriers including encouraging diabetics to exercise. Many Indians feel embarrassed to go to a gym or swimming pool. “Indian people are never going to go - we wear saris. There should be an exercise programme especially for Indian people.”

The change in culture from Indian to New Zealand is also a challenge. “Back home a lot of us came from farms so our exercise was a lot more regular. Here we just tend to stay in our homes. We don’t walk and our jobs aren’t active,” added another participant.

Other cultural barriers faced included the influence of family. “You can tell people anything they need to know but they will go home and do nothing if it means conflicting with their family. It is very much a collective decision, not an individual one. You need to reach the whole family.”

Another participant agreed, “Family plays a huge role in the life of the South Asian. It is a huge influence that can be both positive and negative.”

Some of the group also mentioned that because so many people have got diabetes it is almost normalised in their culture and viewed as inevitable. It becomes a barrier to prevention when people they think there is nothing they can do. It’s hard to even get them to try.

Some logistical barriers they faced were the availability of support services in their area. Diabetes NZ is based in Mt Eden and one of the participants said, “Indian people are not comfortable going there. It’s intimidating for us. If there was something more local or it was in Hindu or Punjabi, that would be better.”

Gaining access to services like the diabetes clinic was also a challenge depending on your health status. “Why is it that you have to wait until things get really bad before you can access the useful support?” asked one participant. “If we could get that earlier that would help prevent things better.”

One of the health workers who helped host the group, a nurse that worked in Greenlane, said, “I am the only Indian nurse available who speaks Hindi. Auckland DHB provides ethnic programmes but they need to be offered in other areas where there are high Indian populations. It should be standardised.”

Another participant added that they needed more help than just from their GP. “Just giving us medication and a prescription doesn’t help – they are not diabetes specialists. Plus there isn’t enough time to talk to them.”

Another participant added, “There are asthma nurses that see patients regularly on a one-to-one basis but there is nothing like that for diabetes.”

“When people are diagnosed with a chronic disease, their next appointment after the GP should be with a specialist for their condition. Chronic conditions need separate monitoring rather than just with the GP.”

One of the participants was himself a doctor and he admitted that he previously had poor notions of what a good diet was. “When I attended the programme run by a Diabetes Educator and Nutritionist who is also Indian, it made much more sense.”

Other cultural issues also come into play. “In our culture we put it on the doctor – we treat our doctors and priests like gods and put everything on them. But this is our diabetes! We need to take control.”

There is also a perception that insulin is very bad. “If you are on insulin, it is seen that your diabetes in deteriorating and you will die. There is also an anxiety about hypos – people fear dying in their sleep.”

Another participant added “People think once you are on insulin it becomes addictive and you are hooked like with morphine.”

The session was concluded with a discussion about some of the volunteer workers who give their time and support to the community for free. There are a number of very willing volunteers who just need some additional support. It was suggested this is something that could be utilised, supported and recognised much more actively.

Key recommendations based on this focus group include:

• Providing support services and education for patients and their families in Hindi or Punjabi
• Nutritional advice that has been specifically referenced in Indian culture for both health professionals and diabetics, especially with regard to their food
• Support to identify and implement ways to engage in physical activity that are appropriate to their culture in terms of dress code, environment, location, collective vs individual in nature etc.
• Support to change the misinterpretation of insulin
• Approaches to health information and advice that incorporate the entire family and address the perceived inevitability (and therefore apathy) towards diabetes

This focus group was made up of six adults of Pacific Island descent and one Māori participant. The patients were all experiencing Type 2 diabetes, although one person had initially developed gestational diabetes and another participant was in the pre-diabetes stage. The group were mostly male.

This focus group were very appreciative of the opportunity for a shared discussion and expressed a lot of gratitude for members of the health system taking the time to hear their stories. They provided some excellent feedback on how to make information more meaningful and accessible to others like them.

They suggested making information more personally relevant to the patient and providing the information in easily understood and culturally appropriate ways – either face to face or in their own language.

One participant was diagnosed and referred to a dietician but “I saw about five different people before I listened. They all said ‘don’t do this, don’t do that’ which I found very negative. There was little guidance about what I could do,” he added.

The other participants agreed with this positive approach and also suggested personalising the information. “There is plenty of information out there but it’s either written in a language that’s difficult to understand or it’s presented in neutral, general terms - and because it’s not personal it’s easy to ignore,” the participant added.

There was a strong desire for people who can deliver the information in their language as ‘most of it is too clinical’ and ‘some of it is not culturally appropriate.’

“You need to get the Church Pastors and Ministers involved. If they promote it, the people listen,” one participant added.

Another commented that they had heard a Cook Islands doctor on Radio NZ talking about diabetes in his own language and “this really helped me understand - it finally sunk in”.

The participants indicated there were a number of nurses that attended church themselves and they were particularly helpful. They do heart and diabetes checks onsite and take people’s bloods. For most of the group, they found the follow up conversations with the nurses is what helped them keep on track.

“Diabetes is a lifestyle change. You need to support people with that. If they don’t look after it, it has an impact on other organs in their bodies and most people don’t realise that. It’s the silent killer – you don’t see it until it’s too late,” one of the participants added.

In their experience, they had either not received sufficient information about diabetes or had not found the information they had received very accessible. Consequently, low levels of understanding and awareness about diabetes was a common theme amongst the group despite the fact that for most of the participants they were at least second generation diabetics.

Most of the group had diabetes in their families but some didn’t see the significance of this until later as it wasn’t really talked about and the general understanding of the disease within the family was quite low. Perhaps as a result, several participants didn’t see the relevance of medication (one person described taking medication only while they experienced specific symptoms and then discontinuing it until the symptoms reappeared). Others were more comfortable with traditional remedies from home (especially the Noni fruit, which is well known for it’s curative properties for those with diabetes).

One of the participants suggested a pamphlet that focussed the motivation to look after yourself on the patient’s kids or grandkids because that is one motivation they all seemed to have in common that finally got through to a lot of them.

Another participant mentioned the economic barriers people faced to eating well and the ease of denial of diabetes, “Because it isn’t visible like smoking, alcohol or obesity, people tend to ignore it until something happens and then it is too late.”

The key recommendations based on this focus group include:

• Exploration of some form of translation app that translates medical advice, explanations and instructions into Pacific languages so people can ‘hear’ the information in a language they understand
• Exploring other ways to provide personalised information and explanation to Pacific patients – if in English it needs to be in person or orally, if in writing it needs to be in their language
• Visual diagrams or illustrations that explain diabetes in visual terms so that people can ‘see’ it and understand the concept more easily
• Exploring ways to work more directly with patient families to increase understanding of diabetes and support inter-generational health outcomes.

Southern DHB staff are getting behind Māori Language week -Te Wiki O Te Reo Māori (21 to 28 July) in a big way, with a host of celebrations and events planned to help staff improve their understanding and enjoyment of Māori language and culture.

New Zealand has marked Māori Language Week since 1975, and it creates an opportunity for all New Zealanders to celebrate Te Reo Māori (the Māori language) and to use more Māori phrases in everyday life.

At Southern District Health Board plans are underway for hospital switchboard staff in both sites to be answering phones in Te Reo Māori, a tradition which is being repeated from last year and has proved popular with staff to date.

Lunchtime waiatas are planned to give staff an opportunity to bond and learn some of the hospital’s formal waiata. There will also be special educational and interactive sessions held to help staff enjoy engaging with Te Reo Māori.

To help promote this year’s Māori language week theme: 'Te Kupu o te Wiki', 'The Word of the Week’ displays will be erected in each hospital ward within Southland and Dunedin Hospitals promoting the “kupu (word) of the week,” an initiative which will see words replaced weekly to help staff become familiar with and evolve their learning of Te Reo Māori over the next 50 weeks. Shared lunch and breakfast events are also planned to help bring staff together to celebrate this important initiative, as well as a session which will look at the Otago landscape names, local Māori histories and traditions.

Māori Language Week is viewed by the DHB as an important initiative for all staff to engage with, as Donovan Clarke, Kaiwhakahaere Hauora Māori (Executive Director of Māori Health) explains: “Te Wiki O Te Reo Māori is an excellent initiative for us to support. It enables our staff to expand their understanding of Te Reo Māori and increase their comprehension of Māori culture and customs, which will help us deliver a better quality service to our patients and health partners. It also gets staff thinking about ways they could better integrate Te Reo Māori into their every day work with patients and colleagues, not just for the week but in the long term.”

When it comes to prostate cancer diagnosis and treatment, Maori men emerge worse in most or all statistics and there is significant variation in screening between GP practices, with Maori and rural men less likely to be screened.

These are the key findings to emerge from a three-year study exploring the pathways of care associated with prostate cancer which was conducted by the Midland Cancer Network in conjunction with researchers from the University of Auckland.

The study was launched today at Waikato Hospital’s Bryant Education Centre, where Health Minister Tony Ryall featured as keynote speaker (read the Ministry of Health release).

Funded by the Health Research Council and Ministry of Health, the Midland Prostate Cancer Project researched access to quality of care, with a particular focus on urban vs. rural men and Māori vs. non-Māori men.

"We wanted to understand more about the care pathway for men following an abnormal prostate-specific antigen (PSA) test, and to demonstrate the equity issues, costs and complications arising from diagnosis,” says Professor Ross Lawrenson who led the study. 

“Among our findings, we have found significant variation in screening between GP practices, with Māori and rural men less likely to be screened.

“There is also considerable unnecessary screening of men aged 70 years and over, even in men over 70 years who were asymptomatic with a history of negative PSA results. Very few of these men went further along the pathway to the referral and biopsy stage.”

Speaking at the launch today, Mr Ryall said, “the study showed good results for men with prostate cancer. There is a high survival rate – with a majority of men surviving over ten years.

“It has also identified areas where we can make future improvements to the work already being done to improve patient care. 

“The report made 18 recommendations which support the work already underway by the Ministry of Health to improve health outcomes for men with prostate cancer.”

The study found that most PSA testing is conducted for screening purposes, most commonly when the individual is being examined for another reason. 

It also found that Māori men are significantly less likely to be screened and tested than non-Māori; that Māori men have an overall lower rate of prostate cancer than non-Māori men, but their mortality is much higher with Māori men being more likely to die with and of prostate cancer compared to non-Māori men. 

The researchers believe the disparity in survival rates is also a factor of location and socio-economic situations.

The study population was 37,529 New Zealand men who had been diagnosed with prostate cancer in the period 1 January 1996 - 31 December 2010, with 5748 (or 15 per cent) residing in the Midland Cancer Network region at the time of diagnosis. 

More than 30 GP practices in the region were involved with the study and helped researchers to identify the pathways for patients following diagnosis. 

Professor Lawrenson said the study also looked at the costs associated with prostate cancer which extend beyond the health professional to social, economic, psychological and physical effects, affecting both the man and his family.

This is particularly notable with Māori men.

“We interviewed more than 100 men who had been diagnosed with prostate cancer and found that many men and their families want more information at the primary health care level, and that Māori men and their families need long-term post-treatment support ranging from counselling to navigating the healthcare system,” he said.

“Our goal was to understand the prostate cancer pathway, across New Zealand and in the Midland Region in particular. 

“We believe our research shows that clear recommendations for GPs regarding PSA testing, referrals to specialists, monitoring after an abnormal PSA test, the recording of data, and post-treatment care and support will improve that pathway.”

Professor Lawrenson and his team have developed recommendations, including:

• Regional cancer networks to record basic information on all men newly diagnosed with prostate cancer.
• Primary healthcare professionals need to give patients more information and information that is culturally appropriate.
• Men newly diagnosed should have a digital rectal examination (DRE) as part of their initial assessment.
• Men over 70 who have had a previously negative PSA test should not be screened again.
• Standardisation in recording biopsies and histology.
• Clear guidelines for managing men with localised prostate cancer.
• Further research to identify the reasons for higher mortality for Māori men
• More support for Māori men and their partners who identified a higher long-term need for assistance with the healthcare system and further information
• Post-treatment counselling to manage social, economic, psychological and physics outcomes, particularly for Māori men and their partners
• Funding for dedicated sexual function support as part of post-treatment rehabilitation.

Read the prostate cancer study presentation [PDF, 1.1 MB]

Tainafi’s four-month study, part of a 2014 HRC Pacific Health Research Summer Studentship, examined the informational materials that are routinely given to patients at New Zealand’s spinal units following a spinal cord injury (SCI). He found that these materials were missing culturally relevant information in some key areas that could aid the recovery of Pasifika patients".

To read the full news article on the Health Research Council website, go to:  http://www.hrc.govt.nz/news-and-publications/news-media#cultural-focus-could-aid-injury-recovery

These guidelines target both Pacific and non-Pacific researchers who are engaged in HRC-funded health research with Pacific populations residing in New Zealand and the realm countries of New Zealand (Cook Islands, Niue, and Tokelau). Researchers conducting non-HRC funded studies in Pacific communities may also find this document useful.

The guidelines aim to ensure that the research undertaken informs and empowers Pacific peoples about health research within their own communities, and their rights as research participants; provides an ethical and operational guide for health research that contributes to the attainment of the highest level of health and wellbeing for Pacific peoples in New Zealand; and provides a common template and shared vision on Pacific health research.

The guidelines are available to dowload at:  http://www.hrc.govt.nz/news-and-publications/publications/pacific

To read the full abstract and for information on how to access the full text, go to: http://www.publish.csiro.au/paper/AH13113.htm or contact your local, DHB or organsational library for assistance.

Hadgkiss, E. J., & Renzaho, A. M. N. (2014). The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: A systematic review of the literature. Australian Health Review, 38(2) 142-159.

A total of 316 studies were retrieved, 22 of which were included in the review. The key cultural issues that emerged were: participants' strong adherence to cultural norms, religious beliefs, linguistic diversity, low health literacy levels, different beliefs about health and illness, belief in expert and professional support, low accessibility of culturally appropriate services/information, and low concordance with western professional advice. These issues compromised the level of diabetes care services received by members of ethnic minority groups. The authors recommend that further attention is given to the development of culturally competent interventions for improving access to healthcare and diabetes outcomes for members of specific ethnic minority groups.

To read the full abstract, and for information on how to access the full text, go to: http://www.ingentaconnect.com/content/rmp/dehc/2014/00000011/00000001/art00003 or contact your DHB library, or organisational or local library for assistance.

Zeh, Peter, Sandhu, Harbinder K., Cannaby, Ann Marie, Sturt, Jackie A. (2014). Cultural barriers impeding ethnic minority groups from accessing effective diabetes care services: A systematic review of observational studies. Diversity and Equality in Health and Care, 11 (1), 9-33.

She describes what they learnt about their system-wide transformation of care, and what lessons there are for managing change in the NHS? The blog post includes a video interview with Katherine Gottlieb (President and CEO) on how the team had improved the quality and adaptability of services.

The blog post is available at:  http://www.kingsfund.org.uk/blog/2014/03/innovation-alaska-walking-with-communities-achieve-change

To read the article, go to:  http://nursingreview.co.nz/issue/march-2014/new-migrant-nurses-feel-welcome/

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 utilisation outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilisation 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 rigour 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 organisational factors, and utilise more rigourous study designs.

This is an open access article and can be downloaded and read in free full text at http://dx.doi.org/10.1186/1472-6963-14-99

Truong, M., et al. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14:99.

The authors also "... propose an agenda for research into cultural and spiritual aspects of care on the basis of the model, including the formulation and evaluation of service models that take into account cultural features of illness and meet patients’ needs for support with finding meaning".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1179/1743291X13Y.0000000063 or contact your DHB library, or organisational or local library for assistance.

Selman, L., et al. (2014). Holistic models for end of life care: Establishing the place of culture. Progress in Palliative Care, 22(2), 80-87.

In the latest issue (attached below): 

Peer-reviewed articles describing (components of) instruments measuring aspects of a caring culture in a hospital setting were in scope. Studies had to report psychometric data regarding the reliability or validity of the instrument. Potentially useful instruments that were identified after the title and abstract scan were assessed on relevance by an expert panel (n=12) using the RAND-modified Delphi procedure.

Of the 6399 references identified, 75 were examined in detail. 7 studies each covering a unique instrument met the inclusion criteria. Based on their analysis, the authors conclude that the ultimate standard for measuring a caring culture in hospitals does not exist. Existing instruments provide partial coverage and lack information on discriminant validity, responsiveness and feasibility. Characteristics of the instruments included in this review could provide useful input for the design of a reliable and valid instrument for measuring a caring culture in hospitals.

This is an open access article and is available to read and download in free full text at: http://dx.doi.org/10.1136/bmjopen-2013-003416

Hesselink, G., et al. (2013). Measuring a caring culture in hospitals: A systematic review of instruments. BMJ Open, 3, e003416.

To read the full abstract, and for information on how to access the full text, go to: http://www.australiancriticalcare.com/article/S1036-7314(13)00126-4/abstract or contact your DHB library, or organisational or local library for assistance.

Bloomer, M.J. & Al-Mutair, A. (2013). Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care. Australian Critical Care, 26(4), 193-196.

There appear to be few rigorous evaluations of interventions to improve treatment participation for CALD people with cancer. Seven articles met the inclusion criteria, including three randomised controlled trials. Interventions included the use of patient navigators, videos and decision aids, and the impact on patient participation was varied. 

This article is available to read in free full text at: http://onlinelibrary.wiley.com/doi/10.1111/j.1743-7563.2012.01531.x/full

Harun, A., Harrison, J. D. and Young, J. M. (2013), Interventions to improve patient participation in the treatment process for culturally and linguistically diverse people with cancer: A systematic review. Asia-Pacific Journal of Clinical Oncology, 9: 99–109.