Healthcare provider cultural competency: development and initial validation of a patient report measure.

OBJECTIVE: Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. DESIGN: Samples of predominantly African American patients (N=310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. MAIN OUTCOME MEASURES: We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. RESULTS: Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. CONCLUSION: This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts.     

Associations among depressive symptoms,well-being,patient involvement,provider cultural competency,and treatment nonadherence: An exploratory study among university student-patients

Many students on US university campuses are underserved and undertreated for common mental health and medical conditions. The limited extent to which university students seek psychological and medical care when they need it has long been a problem. Among those who do seek care, treatment adherence appears to be an issue as well. However, few studies have examined factors that may be related to treatment nonadherence in university student-patients. The present survey study examined often-understudied constructs (i.e. patient involvement, treatment nonadherence, and provider cultural competency) in 243 university student-patients. Specifically, using a correlational research design, we examined the relations among depressive symptoms, well-being, patient involvement, cultural competency, and treatment nonadherence. Using multiple linear regression analysis, we also explored the extent to which the exploratory variables predicted treatment nonadherence separately and jointly. The current study revealed two important findings. First, all four factors – depressive symptoms, well-being, patient involvement, and cultural competency – were related to nonadherence to treatment. Second, depressive symptoms and patient involvement explained unique variance in nonadherence to treatment. The findings suggest that increased awareness of and attention to depressive symptoms and patient involvement may have important relevance for engendering healthy campuses and for reducing nonadherence in student-patients. Implications and directions for future research are proffered.     

Cultural Competency Training at a Distance: Challenges and Strategies

Technological innovations and demographic trends represent 2 converging forces that affect counselor training. Distance education, particularly televised instruction, is becoming a major presence in higher education. Relatedly, counseling courses and degree programs are increasingly being offered via televised instruction. At the same time, rapid cultural, racial, and ethnic diversification in the United States has resulted in a movement to integrate cultural competency training into counseling programs. In this article, the challenges associated with providing cultural competency training via interactive television are outlined. Characteristics of interactive televised instruction and strategies for promoting cultural competence within this medium are presented.     

Personality and the Policy Positions of Politicians

Politicians’ support of or opposition to concrete policies is uniquely consequential for policymaking, public opinion, and a host of other societal outcomes. Explaining their policy positions is therefore a major research agenda in political science. Here, we evaluate the role of politicians’ personality traits, measured with the Big Five typology, in shaping how liberal or conservative their economic and social policy positions are. While existing research establishes this link among nonelites, it is far from obvious that the same holds for politicians, who have systematically different personality profiles, and whose positions are constrained by party lines. Using an in-person study of 893 legislators in five countries who completed personality questionnaires and provided detailed issue positions, we find that Openness to Experience is strongly and positively predictive of politicians’ liberal positions on both economic and social policies, but a null relationship for Conscientiousness. We also find that Extraversion predicts more conservative economic (but not social) policy positions. We discuss implications for the role of elites’ individual characteristics in policymaking.     

Managerial competency modelling and the development of organizational psychology: A Chinese approach

In recent years, China has undergone rapid economic reform and dynamic organizational changes. Several major developments have given special momentum to those changes: China entering the WTO, opening the western regions of China, building up an information network, transforming new management systems nationwide, and encouraging innovations and entrepreneurship. These developments call for more comprehensive and adaptive competencies and new approaches to organizational psychology in China. This provides a national and cultural context of personnel assessment, selection, and development of organizational psychology. Organizational psychology is one of the most active fields for research and application in psychology in China. Three aspects of recent trends are described under a framework of managerial competency modelling. (1) Leadership competence assessment for personnel selection and development has become one of the key aspects of human resources (HR) management in China. Based upon the results from the structured interview and strategic hierarchical job analysis, a model of leadership competency with four dimensions of leadership characteristics and the managerial performance was proposed. The four dimensions are: psychological traits; leadership predispositions; managerial skills; and professional knowledge. (2) HR competency for person‐job‐organization fit. This includes competencies for compensation and motivational strategies, organizational commitment and career management competence, team competence, and group decision‐making skills. (3) Organizational competency for culture and change. This includes an integrative approach to link values with culture, and cross‐cultural leadership skills. On the basis of the recent practice and research developments, a Chinese approach to organizational psychology with important characteristics is summarized: active theoretical development and conceptualization; continuous methodological improvement; close link with HR and management practices; and systematic cross‐cultural socioeconomic perspective. This becomes a key framework for understanding organizational psychology. New directions for research and application in China are highlighted.     

Ideology,Prejudice, and Attitudes Toward Sexual Minority Social Policies and Organizations

This study tested the effects of multiple ideologies on support for restrictive policies against gay and lesbian individuals and organizations and if these effects were mediated by sexual prejudice. Social dominance orientation (SDO), conservatism, and right‐wing authoritarianism (RWA) each had significant direct and indirect effects. SDO had the most consistent direct effects in addition to its effects through sexual prejudice. The direct effects of conservatism were smaller and similar in size to its indirect effects through prejudice. Although the direct effect of RWA was significant for policy attitudes, its effect was entirely mediated through sexual prejudice for organization opposition. Results suggest that high‐RWA individuals adopt their positions largely because of prejudice toward sexual minorities, while high‐SDO individuals adopt their positions partly out of prejudice and partly because these positions perpetuate hierarchies between heterosexuals and sexual minorities. Results also diminish the principled conservatism argument that conservative positions on these policies and organizations are absent of prejudice. As policies continue to be enacted that affect the sexual minority community, research is needed to identify the underlying motivations for individuals' positions toward these policies.     

Cultural competency for mental health practitioners: a selective narrative review

Cultural competency in the context of health services pertains to the appropriate provision of care to a diverse population. It is broadly recognised that this requires sensitivity at policy-making, organisational and individual levels. One specific focus in the literature has been the aptitudes required of practitioners to carry out psychological interventions with minority ethnic groups. A range of theoretical and practical perspectives have emerged on what such aptitudes should be and how to attain them. However, lack of clarity over definitions has resulted in a differential focus on sub-components of the cultural competency construct, namely awareness, knowledge and skills. The current review aimed to consolidate material dispersed across the literature, to create a narrative representation of what cultural competence means to the clinical practice of individuals delivering psychotherapeutic interventions. Limitations and implications of the cultural competency approach are discussed.     

The impact of national integration policies on prejudice and psychological well-being: The fundamental role of the clarity and coherence of integration policies

Recent advances in social psychological research have shown that national integration policies influence how immigrants are perceived and treated by the mainstream population. However, the processes by which these policies come to have an impact on prejudice and well-being of the general population are largely unknown. Moreover, past research has often relied on unrepresentative samples limiting generalizability. The present research proposes that when the national integration policies of a given society are perceived as clearly defined and coherent, they have a direct impact on the perceived cultural norm related to those national integration policies. In turn, the perceived cultural norm affects personal attitudes toward cultural norms (i.e., the degree to which individuals support a given policy), which influence the level of anti-immigrant prejudice as well as psychological well-being. Findings from two correlational studies with representative samples of the mainstream population conducted in France on the policy of secularism (N = 940) and in Québec on the policy of interculturalism (N = 912) supported the proposed theoretical model.     

Multicultural competency in research: examining the relationships among multicultural competencies, research training and self-efficacy, and the multicultural environment

Research on multicultural competencies has mainly focused on the practice dimension of psychology training and practice. Little theoretical or empirical research has examined multicultural research training and self-efficacy. In this study, 119 psychology graduate students filled out a Web survey focusing on the research training environment, research self-efficacy, multicultural competency, the multicultural environment, and social desirability. Results showed that multicultural competency, research training, and the multicultural environment were related to multicultural research self-efficacy. Hierarchical regressions showed that multicultural competency predicted students' research anxiety; social desirability predicted multicultural research utility, multicultural competency, and the research training environment; and multicultural competency predicted students' confidence in research and perceptions that their graduate training programs were multicultural. Implications are discussed.     

The Future of Sales Training: Challenges and Related Research Questions

This paper discusses four key challenges and related research questions that will be critical to the future success of sales training in three major areas: content development, delivery, and evaluation. The four challenges are the changing roles of salespeople, the intensified emphasis on accountability, the enhancement of technological capabilities, and the importance of cultural diversity. To examine these issues and develop future research questions, the paper draws from reports of industry practices and academic literature in sales training, the sales/service interface, customer-oriented selling, social media, self-directed learning, and multicultural communications competency.     

Nonbinary-Affirming Psychological Interventions

Nonbinary individuals experience unique stressors and stigma compared to binary transgender individuals. Given the many social systems that operate on a binary gender system, nonbinary individuals frequently experience microaggressions, discrimination, and harassment and suffer from high rates of negative mental health outcomes as a result. The unique stressors that nonbinary individuals face warrant specific clinical considerations for working with this population. Yet, limited published clinical guidance exists on working with nonbinary clients. This article uses minority stress theory to understand the unique stressors and mental health risks that nonbinary individuals face, a cultural competency framework to describe affirming practices, and ecological theory to contextualize how mental health providers can intervene and support nonbinary individuals. Concrete micro-, mezzo-, and macro-level interventions are provided for clinicians to enact to support the well-being of nonbinary clients including affirming the client’s experience of gender, taking a stance of openness and flexibility, and advocating for inclusive policies and practices.     

The family therapy journals in 2001: a thematic review

This article reviews the principal English–language (including British) family therapy journals for the year 2001. Articles are clustered around various common themes which include marital therapy and cultural competency. There is also a discernible interest in working with populations that have received less attention from family therapists such as substance misusers. Within this literature there is also a trend to 'import' ideas and methods from other therapeutic traditions. Important research papers are noted from within these categories, rather than having a separate section. As this is the fifth in a series of reviews, a 'look back' at trends within the family therapy literature concludes the paper.     

Jungian Analysis of the Chinese Mythological Image of Sun Wukong

This paper examines the symbolism of the cultural image Sun Wukong (the Monkey King), a Chinese legendary hero, and how it influenced an eight-year-old boy’s psychic development. Through an analysis of Sun Wukong’s life from his birth to attaining Buddhahood, a three-phase healing process is identified in Sun Wukong’s tale and the psychotherapeutic process: “naming and initiating,” “nurturing and taming,” and “transforming and transcending,” proposed by Dr. Heyong Shen. Sandplay visually highlighted these key clinical changes in conscious awareness and developmental behaviour influencing the boy’s individuation process. Images found either in cultural traditions or spontaneously emerging from the unconscious in individuals are of significance in human life, offering pathways to psychic healing and development. Further, myths and cultural resources used in clinical work demonstrate that having cultural competency is invaluable in Jungian analysis. Pathogenic and health-maintenance factors of culture can be explored in future clinical practice and research.     

An alternative explanation for cross-cultural differences in the expression of psychopathy

Multicultural research has shown that rates of psychopathy differ between North America and Europe. Many suggestions have been given to help explain this divergence, including: cultural factors, migration, and inter-rater effects. However, past research has not explored the possibility that samples may be inherently different independent of a cultural factor. This paper explores the prospect of multicultural samples differing due to effects of the legal system. Research suggests that incarceration policies may affect the percentage of psychopaths in the prison systems, where the majority of psychopathy research takes place. Future research and policy implications are discussed to further explore this possibility.     

Multicultural Competency Instrumentation: A Review and Analysis of Reliability Generalization

This article reviews the internal consistency reliability of multicultural competency instrumentation. Additional psychometric properties are qualitatively reviewed for commonly used instruments and 5 other measures of multicultural competency that have not previously been reviewed in the literature. Results indicate that the most widely used instruments have generally acceptable internal consistency reliability across different populations and settings. Limitations of research conducted on multicultural counseling competencies are identified, and recommendations for future research are provided.     

Transformational Leadership and Athlete Satisfaction: The Mediating Role of Coaching Competency

Drawing on social cognitive theory, we examine the relationship between coaches’ transformational leadership and athletes’ evaluations of coaches’ coaching competency. We also investigate how coaching competency can mediate the positive effect of coaches’ transformational leadership on athletes’ satisfaction. Using path analysis with bootstrapping techniques, we analyzed 397 competitive volleyball players to test our research model. Our results revealed that (a) coaches’ transformational leadership has a positive effect on coaching competency, and (b) coaching competency mediates the positive effect of coaches’ transformational leadership on athletes’ satisfaction. Implications for coach education and sport psychology in terms of theory and research are discussed.     

Evolving research misconduct policies and their significance for physical scientists

Scientific misconduct includes the fabrication, falsification, and plagiarism (FFP) of concepts, data or ideas; some institutions in the United States have expanded this concept to include “other serious deviations (OSD) from accepted research practice.” It is the absence of this OSD clause that distinguishes scientific misconduct policies of the past from the “research misconduct” policies that should be the basis of future federal policy in this area. This paper introduces a standard for judging whether an action should be considered research misconduct as distinguished from scientific misconduct: by this standard, research misconduct must involve activities unique to the practice of science and must have the potential to negatively affect the scientific record. Although the number of cases of scientific misconduct is uncertain (only the NIH and the NSF keep formal records), the costs are high in terms of the integrity of the scientific record, diversions from research to investigate allegations, ruined careers of those eventually exonerated, and erosion of public confidence in science. Existing scientific misconduct policies vary from institution to institution and from government agency to government agency; some have highly developed guidelines that include OSD, others have no guidelines at all. One result has been that the federal False Claims Act has been used to pursue allegations of scientific misconduct. As a consequence, such allegations have been adjudicated in federal courts, rather than judged by scientific peers. The federal government is now establishing a first-ever research misconduct policy that would apply to all research funded by the federal government regardless of which agency funded the research or whether the research was carried out in a government, industrial or university laboratory. Physical scientists, who up to now have only infrequently been the subject of scientific misconduct allegations, must nonetheless become active in the debate over research misconduct policies and how they are implemented since they will now be explicitly covered by this new federal wide policy. Disclaimer: The authors are grateful for the support for conduct of this research provided by the United States Department of Energy (DOE). The views expressed in this paper are solely those of the authors and were formed and expressed without reference to positions taken by DOE or the Pacific Northwest National Laboratory (PNNL). The views of the authors are not intended either to reflect or imply positions of DOE or PNNL.     

Singapore's Cultural Experimentation: Gay Rights,Stem Cells,Casinos and the Evangelical Response

Abstract

Since the early 1990s the Singapore government has been taking a more liberal stance on controversial issues such as gay rights, embryonic stem cell research and the gaming industry. My paper analyses the Singapore state's utilitarian justification and its authoritarian enactment of these liberal policies. The first part looks at the underlying motivation for the cultural makeover. I frame my analysis around the reaction of the Singapore Christian community to these developments. I focus on the criticisms of the state's ‘liberal’ agenda made by Evangelicals, and describe how the People's Action Party (PAP) regime has defended these policies on utilitarian grounds. The first part ends with a comparative analysis of how the ‘cultural war’ debate was played out in Singapore and the USA. In the second part I examine the procedural aspects of this cultural experimentation. I start with a review of Singapore's political reform. I show that civil society in Singapore has attained a new openness. Yet there remain constraints, leading critics to label the PAP-led government as a ‘soft-authoritarian’ democracy. Singapore's cultural policies, I explain, are essentially an ‘elitist’ state-engineered top-down development. This is in contrast to the experience in the USA, where grassroots activists exercise tangible bottom-up influence on how cultural contests are resolved. My main thesis is to argue that Singapore's recent cultural liberalisation is guided by social–economic expediency notwithstanding the alleged moral risks, and that these are state-commanded liberal experimentations, imposed by the ruling elite upon a constituency that is still largely conservative in moral outlook.     

Human embryonic stem cell research: an intercultural perspective

In 1998, researchers discovered that embryonic stem cells could be derived from early human embryos. This discovery has raised a series of ethical and public-policy questions that are now being confronted by multiple international organizations, nations, cultures, and religious traditions. This essay surveys policies for human embryonic stem cell research in four regions of the world, reports on the recent debate at the United Nations about one type of such research, and reviews the positions that various religious traditions have adopted regarding this novel type of research. In several instances the religious traditions seem to have influenced the public-policy debates.