Intersectionality in Clinical Medicine: The Need for a Conceptual Framework

Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.     

Protected or Unprotected Sex: The Conceptions and Attitudes of the Youth in Bolgatanga Municipality,Ghana

The youth in Bolgatanga municipality in Ghana have relatively less knowledge of sexual and reproductive health (SRH) compared to the youth in other parts of Ghana. More fundamental knowledge is needed of the factors that influence young people to have protected and unprotected sex in specific social and cultural contexts, in order to protect them from adverse consequences, such as sexually transmitted diseases (STIs), HIV/AIDS and unintended pregnancies. This study therefore analyzed the conceptions and attitudes of the youth toward protected and unprotected sex, and particularly condom use, in Bolgatanga municipality. Semi-structured and focus group interviews were held with 71 young males and females and 17 adults. The results indicated that many of them lack a comprehensive knowledge of STIs, contraceptives and pregnancy, while a group of them had a negative attitude towards contraceptives. Not all parents, schools and organisations provide young people with a comprehensive education about SRH, and some even discourage such education because they believe it would encourage young people to have sex before marriage. In addition, young people also inform each other about SRH issues, sharing stories and personal experiences with their peers. The information they exchange is not always correct, however; sometimes it merely reflects their own personal preferences. The unequal power in the sexual relationships of young people—related to the traditional value system that gives men, but not women, “sexual freedom, both in and outside marriage”—is another determining factor for unprotected sex.     

Making sense of agency: Belief in free will as a unique and important construct

Belief in free will is the general belief that human behavior is free from internal and external constraints across situations for both self and others. In the last decade, scholars in social‐cognitive psychology and experimental philosophy have made progress in defining free will terms, exploring how laypersons think of free will, discovering related cognitive processes and biases, and examining the behavioral outcomes of believing in free will. The growing interest in this construct raises the need for a discussion of what is new about free will beliefs, and how this construct differs from and relates to other well‐known agency constructs in the literature. In this review, we integrate conceptual discussions and empirical findings in the existing literature to highlight the belief in free will as a separate and important construct, different from existing constructs in the literature, and capturing unique aspects of agency. We conclude by calling researchers to recognize these differences and to leverage the potential in the construct of the belief in free will as a predictor of cognition and behavior.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

Effects of Group Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in a Youth With Autism Spectrum Disorder

Individuals with Autism Spectrum Disorder (ASD) often present with comorbid Obsessive Compulsive Behaviors (OCBs), but little research exists on effective intervention for OCBs. Using a single-case experimental design, this study highlights the efficacy of a Group Functional Behavior-based Cognitive-Behavior Therapy (Fb-CBT) to reduce OCBs in an 11-year-old youth with ASD. Tailored to the individual needs of this youth, Fb-CBT included traditional CBT components (e.g., psychoeducation, cognitive-behavioral skills training, and exposure and response prevention) coupled with functional behavior assessment and intervention. Time-series parent report data and standardized measures showed clinically significant decreases in OCBs, an increase in psychosocial functioning, and high consumer satisfaction.     

When Accurate Beliefs Lead to Better Lie Detection1

This study tested the hypothesis that people with accurate beliefs about the cues that predict deception are better at detecting deception only when those beliefs are cognitively available and activated. To test the hypothesis, participants viewed video fragments of people who were being either honest or dishonest. A questionnaire assessed participants' beliefs about the cues involved in deception, and activation of participants' belief cues was accomplished by manipulating suspicion. The results provided support for the hypothesis, where participants whose beliefs were activated and had accurate beliefs were better at detecting deception compared to other participants. Gender differences were also found, where lies communicated by women were more accurately detected than were lies communicated by men.     

Mothers' part-time employment: associations with mother and family well-being

The associations between mothers' part-time employment and mother well-being, parenting, and family functioning were examined using seven waves of the NICHD Study of Early Child Care and Youth Development data (N = 1,364), infancy through middle childhood. Concurrent comparisons were made between families in which mothers were employed part time and both those in which mothers were not employed and those in which mothers were employed full time. Using multivariate analysis of covariance with extensive controls, results indicated that mothers employed part time had fewer depressive symptoms during the infancy and preschool years and better self-reported health at most time points than did nonemployed mothers. Across the time span studied, mothers working part time tended to report less conflict between work and family than those working full time. During their children's preschool years, mothers employed part time exhibited more sensitive parenting than did other mothers, and at school age were more involved in school and provided more learning opportunities than mothers employed full time. Mothers employed part time reported doing a higher proportion of child care and housework than mothers employed full time. Part-time employment appears to have some benefits for mothers and families throughout the child rearing years.