Статті в журналах з теми "Transcultural medical care"

Background Transcultural self-efficacy is a nurse’s perception of his or her own ability to accomplish activities effectively for culturally diverse clients. This self-efficacy may be affected by different factors, either positively or negatively. Quality care can be improved significantly when nurses provide patient-centered care that considers cultural background of the patients. Thus, this study aimed to assess perceived transcultural self-efficacy and its associated factors among nurses working at Jimma Medical Center. Methods Facility-based cross-sectional study with both quantitative and qualitative methods of data collection was conducted among 244 nurses and 10 key informants from 20 May to 20 June 2020. Bivariate and multivariable linear regression analyses were used to identify factors associated with transcultural self-efficacy. Qualitative data were coded and analyzed thematically. Quantitative results were integrated with qualitative results. Results A total of 236 nurses participated in the study making the response rate 96.7%. The mean transcultural self-efficacy score was 2.89 ± 0.59. Sex, work experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation were significantly associated with transcultural self-efficacy. Ten in-depth interviews were conducted and the findings of qualitative data yielded four major themes. Conclusion The level of perceived transcultural self-efficacy was moderate among nurses. Transcultural self-efficacy of nurses varies with several factors including sex, experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation. This calls for the need to offer transcultural nursing training for nurses.

Introduction Migratory flows are increasing more and more, especially regarding the refugee crisis during the last years. There are around 86,7 million migrants in Europe. Migrants share similar experiences that may affect their physical and mental health, such as loss of a social network, lack of economical support or high levels of stress and discrimination. Objectives To analyze the obstacles that migrants must face to obtain a mental health assistance and the importance of an intercultural approach. Methods A narrative review of the existing literature on the subject. Results Although there exists evidence that shows that migrants tend to have more health needs, they usually seek less medical advice and receive a poor-quality attention, fulfilling the inverse-care law. This is due to several reasons. Many migrants are excluded of the health care system due to bureaucratic impediments. Also, the language has a determining role, since a higher quality of communication could lead to a better understanding of the symptoms, reducing the risk of erroneous evaluations. Besides, different background and culture between the patient and the doctor can result in lack of communication, mistrust, mistreatment, poor adherence, and worse prognosis. Conclusions Despite the exponential growth of migration in the last decade and the continue progression, migrants still face many barriers to receive healthcare. It is necessary to do more research on the mental health of migrants and ethnic minorities to ensure quality care to different cultures. Disclosure No significant relationships.

BackgroundDespite literature indicating that culturally sensitive care promotes a positive patient environment and may help improve outcomes, limited data exist on the documentation of patients' cultural concerns in electronic medical records (EMR).ObjectiveThe project's objective was to use an educational intervention to increase clinic staff's cultural sensitivity and cultural assessment documentation.MethodsResearchers conducted this 3-month project at a Midwestern clinic's in-home, self-care chronic disease management program. The voluntary sample of clinical staff (n= 8) received an educational intervention on transcultural nursing practices. Researchers administered the Transcultural Self-Efficacy Tool for the Multidisciplinary Healthcare Provider (TSET-MHP) to participants before and after the intervention. A pre- and postintervention EMR audit was completed on 128 charts to evaluate cultural assessment documentation.ResultsTSET-MHP cognitive and practical subscales scores increased postintervention. Affective subscales scores decreased slightly. Electronic cultural assessment documentation increased by 10%. An assessment questionnaire showed an increase in participants' cultural self-awareness and comfort with cultural assessment.ConclusionsAn educational intervention demonstrated an increase in providers' cultural awareness and cultural assessment documentation.Implications for NursingTranscultural nursing education may help increase providers' perceived cultural self-efficacy, which may improve cultural assessments and culturally competent care.

IN debating the issue of whether or not nursing care should be perceived within a framework of cultural competence, this paper briefly describes the background of this approach to nursing, and as an exemplar, discusses how culture can impact on the practice of anaesthetics and peri–anaesthetic care. This is illustrated through drawing on my own transcultural experiences while employed for nearly five years as a non–physician anaesthetist in Saudi Arabia and may therefore be of interest to those practitioners involved in the delivery of anaesthetics and peri–anaesthetic care.

<p><strong>BACKGROUND: </strong>One of the consequences of migration is cultural diversity in various communities. This has created challenges for healthcare systems.</p><p><strong>OBJECTIVES: </strong>The aim of this study is to explore the health care staffs’ experience of caring for Immigrants in Mashhad- Iran.</p><p><strong>SETTING:</strong> This study is done in Tollab area (wherein most immigrants live) of Mashhad. Clinics and hospitals that immigrants had more referral were selected.</p><p><strong>PARTICIPANTS:</strong> Data were collected through in-depth interviews with medical and nursing staffs. 15 participants (7 Doctors and 8 Nurses) who worked in the more referred immigrants’ clinics and hospitals were entered to the study.<strong> </strong></p><p><strong>DESIGN: </strong>This is a qualitative study with content analysis approach. Sampling method was purposive. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed by using latent qualitative content analysis.</p><p><strong>RESULTS:</strong> The data analysis consisted of four main categories; (1) communication barrier, (2) irregular follow- up, (3) lack of trust, (4) cultural- personal trait.</p><p><strong>CONCLUSION:</strong> Result revealed that health workers are confronting with some trans- cultural issues in caring of immigrants. Some of these issues are related to immigration status and some related to cultural difference between health workers and immigrants. These issues indicate that there is transcultural care challenges in care of immigrants among health workers. Due to the fact that Iran is the context of various cultures, it is necessary to consider the transcultural care in medical staffs. The study indicates that training and development in the area of cultural competence is necessary.</p>

Introduction: The perception of health and sickness are culturally determined and, therefore, ethnic and religious socialization forms attitudes toward the medical system. During everyday practice, patients’ rights and obligations, which are based on the norms of the major society, confront Roma minority norms. Aim: The aim of the authors was to explore the main interferences of patients’ rights and obligations during the medical care of the Roma. Method: The authors analyzed the results of medical anthropology, health sociology, and the experience obtained from more than 40 courses about patients’ rights. Results: Cultural determinants, effects of the lower socioeconomic status and social-psychological mechanism equally form the situations of healthcare and the observance of patients’ rights and obligations. Conclusions: Most of the misunderstandings between healthcare workers and Roma patients stem from the lack of knowledge about cultural differences. Therefore, transcultural approach and Romani studies should be significant part of graduate and postgraduate courses in the field of medical education. Orv. Hetil., 2016, 157(18), 712–717.

The research is devoted to the use of modern geoinformation technologies for the analysis of spatial medical and demographic data. On the example of the medical and ecological geoinformation system (MEGIS) of Khabarovsk the possibilities of geoinformation technologies in the study of the spread of depressive disorders in a large city and the analysis of cause-and-effect relationships between this disease and some socio-economic factors are shown. The features of mathematical support of MEGIS necessary for population epidemiological analysis are considered. The possibilities of using correlation-regression and cluster-discriminant analysis for these purposes are shown. At the stage of the initial manifestation of symptoms of depression, statistically significant binary risk factors for depressive disorders were established, which were used in the diagnostic questionnaire. Developed complex recognition, classification and predictive models on the individual level, to assess the risk of developing depressive disorders and to predict the potential severity of the disease. At the population level, risk groups for depressive disorders in patients who have suffered depressive episodes in childhood should be formed. Based on the results of multi-level GIS and classification and predictive modeling based on individual clinical dynamically, socio-psychological, transcultural and environmental health risk factors formulated practical recommendations to improve the prevention of depressive disorders. The study of clinical and pathodynamic, socio-psychological, transcultural and medico-ecological aspects of non-psychotic depressive disorders with the use of geoinformation systems was carried out for the prevention of depression and mental health stabilization of the region population. The results of this research can be used by specialists in geoinformation systems, medical demography, medical psychology and social psychiatry, sociology, psychiatry, psychology and family medicine, conflictology, information modeling and system analysis in health care.

Context: Language and cultural barriers between patients and nurses can contribute to patient safety, dissatisfaction, and poor quality of care, especially with Hajj patients. Effective communication between patients and nurses is key to safe and quality nursing care. Multicultural and multi-language barriers stand in the way of this effective communication, so an in-depth study is needed to describe this phenomenon based on nurses' perspectives. Aim: This research aims to identify issues and challenges related to the cultural and language differences between patients and nurses during the Hajj season and to describe nurses' experiences in providing care in a multicultural and multi-language healthcare setting during the Hajj season. Methods: Qualitative descriptive design. Five Hospitals in Makkah Health clusters were selected for this study. A purposive sample of 50 nurses was recruited for this study. The data collection Procedure includes Audio-recorded interviews using semi-structured questionnaires. Results: Most participants identified language differences in their caring experience for Hajj patients. Because the participants felt unable to communicate with patients effectively, the language barrier affected nursing care. Despite the challenges of taking care of patients with different cultures, the majority of the staff feel it is a good experience for them. The last major theme identified in the study was the understanding of trans-cultural nursing. Most participants were honest enough to tell that they do not know at all that transcultural nursing means. Some participants were familiar with the term but were unsure what it meant or how to explain it, and a few knew the term and its concept. Conclusion: Nurses had difficulty communicating with patients due to the language barrier. Providing an interpreter or translator, seeking assistance from the patient's relations officer, and using technology such as Google Translate to address this issue are all possible solutions. The study recommends addressing the cultural barriers; all the nurses should attend the education and training on trans-cultural nursing in advance for the staff chosen to work during Hajj.

Purpose – The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran. Design/methodology/approach – This is a descriptive study with contextual and qualitative design. Semi-structured interview conducted with 19 Afghan refugees and their caregivers and a focus group session were held with Afghan medical science students. Purposive sampling technique was used to select participants. Data were analysed by qualitative content analysis of Graneheim and Lundman. Lincoln and Guba’s criteria were implemented to ensure trustworthiness. Findings – The results with the core concept of “position of immigrants in the health system” were presented at four themes of “perceived discrimination”, “snowed with loneliness”, “feeling inferior”, and “gratitude”. Research limitations/implications – This study has some implications for researchers and practitioners. The present study is the first study that was done on the health of Afghan refugees in Iran, therefore it can be a ground for further research. In addition, it has valuable results regarding the Afghan immigrants’ experience of health care system of Iran. Practical implications – It can be useful for improving the condition of immigrants in Iran and for improving Iran’s health system. In order to improve the health system in Iran, authorities should pay much attention to transcultural caring and needs of minorities. Furthermore, health workers should be trained to appropriately take care of all patients, without prejudice. Originality/value – Overall the study revealed that there is inequity in access to health services among Afghan refugees in Iran. The findings, although not generalized, offer important insights into health care providers in Iran which should be delivering health service without prejudice. The authors recommended that policies of public medical insurance and assistance programme should be implemented for providing affordable health care services for Afghan refugees.

The diversity of the population of the world suggests a great need for validated cross-cultural survey instruments or scales. Health care professionals should have access to reliable sources and valid concepts of interest in their own cultures and languages to provide quality patient care. Therefore, the aims of this study were to translate the Modified Caregiver Strain Index (M-CSI) in the national language of Malaysia. Also to evaluate the validity and reliability of the Malay-translated version of Modified Caregiver Strain Index (M-CSI-M). Instrument was translated forward and rearward through the translation strategy, reconciled by a panel, and verified by the Malaysian Institute of Translation & books as experts of content. After methodological approaches for the translation, adaptation and transcultural validation of Modified Caregiver Strain Index (M-CSI). The latest version of Malaysia was administered to 50 informal care providers of dependent elderly with the Parkinson's disease, at the Association of Parkinson Malaysia (MPDA) and University Kebangsaan Malaysia (UKM) Medical Centre in May 2017. The Malaysians Modified Caregiver Strain Index (M-CSIM) has good face validity and content, as well as inner consistency (Cronbach's alpha 0.75). In conclusion, the M-CSI-M is a reliable tool for the evaluation of caregiving strain levels experienced by informal care providers in Malaysia. M-CSI-M is recommended as a brief and valid measurement that can be used by doctors, counselors, social workers and psychologists to locate the caregiving strain levels of the informal care providers of dependent elderly in Malaysia

ObjectivesThis study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of key interest for healthcare providers, yet knowledge of the perspective of asylum-seeking caregivers when accessing healthcare is limited.SettingThe study took place in a paediatric tertiary care hospital in Basel, Switzerland.ParticipantsInterviews were done with 13 asylum-seeking caregivers who had presented with their children at the paediatric tertiary care hospital. Nine female and four male caregivers from Tibet, Eritrea, Afghanistan, Syria, Iraq, Albania and Macedonia were included. A diverse sample was chosen regarding cultural and social background, years of residence in Switzerland and reasons for seeking care. A previously developed and pilot-tested interview guide was used for semistructured in-depth interviews between 36 and 92 min in duration. Data analysis and reporting was done according to Consolidated Criteria for Reporting Qualitative Research. The number of interviews was determined by saturation of data.ResultsThe interviewees described a mismatch of personal competencies and external challenges. Communication barriers and unfamiliarity with new health concepts were reported as challenges. These were aggravated by isolation and concerns about their child’s health. The following factors were reported to strongly contribute to satisfaction of healthcare delivery: a respectful and trusting caregiver–provider relationship, the presence of interpreters and immediate availability of treatment.ConclusionsA mismatch of personal competencies and external challenges importantly influences the caregiver–provider relationship. To overcome this mismatch establishment of confidence was identified as a key factor. This can be achieved by availability of interpreter services, sufficient consultation time and transcultural trainings for healthcare workers. Coordination between the family, the government’s asylum system and the medical system is required to facilitate this process.

Summary. Advanced research and assessment of the patient's health status plays a key role in the practice of a nurse. As autonomous, independent health care providers, nurses perform health assessments to evaluate patient needs and determine the best treatments. Advanced health assessment is a systematic process for evaluating the physical, mental and functional aspects of patient health. Mastering this diagnostic tool is vital to nurse`s practice because health assessment forms the basis of patient care The aim of the study – to describe and analyze the academic program of the course Advanced Physical Assessment, branch of knowledge – 22 HEALTH CARE, specialty “223 NURSING”, training program “NURSING”, degree of higher education – Second (Master) level of higher education in the international students’ faculty of I. Horbachevsky TNMU. Materials and Methods. It was described and analyzed both the training program and the academic program of the course of studies “Advanced Physical Assessment”, available for students of the second degree of higher education in the Institute of Nursing, I. Horbachevsky Ternopil National Medical University. Results. The course of studies “Advanced Physical Assessment”, which was developed according to the requirements of the training program is aimed at development of systemic knowledge and understanding of conceptual foundations by students utilizing systematic history taking and the knowledge of therapeutic communication to elicit subjective data; collecting objective data; validating, analyzing and documentation of those data. This course ensures the acquisition of the appropriate competences and program learning outcomes, consists of lectures, training sessions and student`s independent work. It presents an overview of the full and comprehensive health assessment of patients across the life span. It emphasizes multiple aspects of advanced health assessment, including physical, functional and mental health assessment along with transcultural variations. Conclusions. According to the requirements of the training program “Nursing” the course of studies “Advanced Physical Assessment” is available for students of the second (master) degree of higher education. The course of studies “Advanced Physical Assessment” consists of lectures (24 hours), training sessions (30 hours) and student’s independent work (126 hours). The course of studies “Advanced Physical Assessment” ensures the acquisition of the appropriate competences and program learning outcomes in accordance with the training program “Nursing”. The assessment of students` performance is evaluated using the criteria for assessment of students’ knowledge and skills.

Despite the large body of research on idioms of distress in anthropology and transcultural psychiatry, few scholars have examined the concepts that people use to describe social and psychological resilience. The experience of social and psychological resilience is embedded in and shaped by social, political, and economic contexts—much like the factors that shape idioms of distress. As resilience literature more broadly has adopted a socio-ecological rather than trait-based approach, anthropology has much to contribute. This article investigates what idioms of resilience and cultural scripts emerge among low-income patients with cancer residing in Soweto, a peri-urban neighborhood in Johannesburg, South Africa. We conducted 80 life history interviews to better understand what social and psychological factors led some people to thrive more than others despite extraordinary adversity. We describe one idiom of resilience, acceptance ( ukwamukela in isiZulu), and three broader themes of resilience that emerged from life history narrative interviews (social support, religious support, and receiving medical care). We also present two examples from study participants that weave these concepts together. Our findings suggest that rarely is one form of resilience experienced in isolation. A focus on idioms of resilience can help chart the complex dimensions of acceptance and the dynamic social, religious, political, and temporal factors that mediate both suffering and resilience within individuals and communities.

SummaryThis study seeks to explore and explain the socio-cultural factors responsible for the incidence of infant malnutrition in Cameroon with particular emphasis on northern Cameroon where it is most accentuated. It combines quantitative data drawn from the 1991, 1998, 2004 and 2011 Cameroon Demographic and Health Surveys, as well as a literature review of publications by the WHO and UNICEF. This is further complemented with qualitative data from various regions of Cameroon, partly from a national ethnographic study on the ethno-medical causes of infertility in Cameroon conducted between 1999 and 2000. Whereas socio-cultural factors related to child feeding and maternal health (breast-feeding, food taboos and representations of the colostrum as dangerous for infants) are widespread throughout Cameroon, poverty-related factors (lack of education for mothers, natural disaster, unprecedented influx of refugees, inaccessibility and inequity in the distribution of health care services) are pervasive in northern Cameroon. This conjunction of factors accounts for the higher incidence of infant malnutrition and mortality in northern Cameroon. The study suggests the need for women's empowerment and for health care personnel in transcultural situations to understand local cultural beliefs, practices and sentiments before initiating change efforts in infant feeding practices and maternal health. Biomedical services should be tailored to the social and cultural needs of the target population – particularly women – since beliefs and practices underpin therapeutic recourse. Whereas infant diarrhoea might be believed to be the result of sexual contact, in reality, it is caused by unhygienic conditions. Similarly, weaning foods aimed at transmitting ethnic identity might not meet a child's age-specific food needs and might instead give rise to malnutrition.

Health concerns by migrants have been neglected in the German healthcare system, and they are impacted by discriminating discourses of othering. By analysing two autobiographical illness narratives by immigrants in contemporary Germany, this article exposes limitations in existing discourses of migration health and argues for more relational and affirmative theories of illness and care. Evelyn Leandro’s diary The Living Death: The Struggle with a Long-Forgotten Illness (2017) describes her own drawn-out therapy against leprosy as a Brazilian in Berlin. In Mr Kiyak Thought That the Best Part of His Life Will Start Now (2013), the Turkish-German journalist Mely Kiyak narrates her father’s experience with advanced lung cancer in a German hospital. Drawing on medical anthropology, postcolonial theory and material (eco)feminism, I argue that these narratives establish migrant health and agency in transnational assemblages that include chemotherapy, lungs and skin, family networks, healthcare providers, food cultures and health policies. These assemblages of illness are connected with the narratives’ hybrid and relational aesthetics and politics: similar to Gloria Anzaldúa’s practice of autohistoria-teoría, I show how Kiyak’s and Leandro’s life writing combines personal and communal storytelling with critical theorising to include diverse voices, languages, histories and identities. By transgressing identities of self and other, German and foreign, patient and physician, human and non-human, the narratives inspire a greater sense of the extent to which (all) bodies, histories, cultures, technology and medicine are entangled in a dense network of relations. This article envisions a relational and hybrid ontology and aesthetics of migration health and thereby intervenes into the growing field of transcultural medicine and medical humanities.

Resumen: Introducción: La comunicación posibilita el establecimiento de vínculos profesionales, facilitando la colaboración interdisciplinar, así como la elaboración de planes conjuntos. Los problemas de comunicación interprofesional durante la actividad asistencial habitual, pueden transformarse en errores de información que afecten a la seguridad del paciente. Objetivo: Analizar las variables, temas y categorías que caracterizan la comunicación entre profesionales de enfermería y medicina para una atención sanitaria segura. Metodología: Se realizó una revisión sistemática de los estudios primarios publicados en bases de datos electrónicas en inglés y español sobre la comunicación entre profesionales de enfermería y medicina. Resultados: Diecisiete estudios cumplieron los criterios de la revisión. Tanto en estudios cuantitativos como cualitativos se puso de manifiesto que hablar de forma clara y precisa favorecía la seguridad del paciente. Por el contrario, el uso de lenguaje indirecto o su inhibición dificultó una comunicación interprofesional eficaz. En estudios cualitativos, los profesionales de enfermería recomendaron el mantenimiento de una actitud profesional respetuosa, de colaboración, reconocimiento profesional y mayor escucha. Conclusiones: Hay una ausencia generalizada de adaptación transcultural y validación de los cuestionarios en los estudios cuantitativos. La mayoría de los estudios están circunscritos a entornos de atención en servicios especiales. Se necesitan más estudios en hospitalización.Palabras clave: comunicación; comunicación interprofesional; relaciones enfermeros-médicos; seguridad del paciente.Abstract: Introduction: Communication enables the establishment of professional links, facilitating interdisciplinary collaboration, as well as the elaboration of joint plans. Interprofessional communication problems during usual care activity can be transformed into information errors that affect patient safety. Objective: To analyze the variables, themes and categories that characterize the communication between nursing and medical professionals for safe health care. Methodology: A systematic review of the primary studies published in electronic databases in English and Spanish on communication between nursing and medical professionals was carried out. Results: Seventeen studies met the criteria of the review. Both quantitative and qualitative studies showed that speaking clearly and precisely favored patient safety. On the contrary, the use of indirect language or its inhibition hindered effective interprofessional communication. In qualitative studies, nursing professionals recommended the maintenance of a respectful professional attitude, collaboration, professional recognition and greater listening. Conclusions: There is a general absence of cross-cultural adaptation and validation of questionnaires in quantitative studies. Most of the studies are limited to special services care settings. More studies in hospitalization are needed.Keywords: communication; interprofessional communication; nurses-physician relations; patient safety.

Objective Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA). Methods Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months’ post-intervention. Results There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p<0.001]. Compared to baseline, WEL scores improved in both the tDNA groups with significantly higher improvement in the tDNA-MI group compared to the tDNA-CC and UC groups at 6 months (tDNA-MI: 25.4±2.1 vs. tDNA-CC: 12.9±2.8 vs. UC: -6.9±1.9, p<0.001). At 12 months’ follow-up, both the tDNA groups maintained improvement in the WEL scores, with significantly higher scores in the tDNA-MI group than tDNA-CC group, and the UC group had decreased WEL scores (tDNA-MI: 28.9±3.1 vs. tDNA-CC: 11.6±3.6 vs. UC: -13.2±2.1, p<0.001). Patients in the tDNA-MI group with greater weight loss and hemoglobin A1C reduction also had a higher eating self-efficacy, with a similar trend observed in comparative groups. Conclusion Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing. Clinical trial This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.

BackgroundIn view of the current changes in the National Health Service, it was considered an opportune time to review the literature on perinatal psychiatric illness.MethodA systematic review was undertaken of relevant articles on medline, ClinPsych and Excerpta Medica Psychiatry.ResultsSixty-eight articles were used in the review.ConclusionsDevelopments in the field of perinatal psychiatry include a greater understanding of the nosology and aetiology of the conditions, the effect of maternal illness on the child as well as transcultural factors. The perspective of the individual sufferer has been somewhat ignored. New treatments with both pharmacotherapy and hormones are emerging, but perhaps the greatest current challenge is to adapt our management strategies to community care.

An estimated 61% of the 24.3 million people diagnosed with dementia worldwide live in underdeveloped countries, including Brazil, where a public healthcare system covers the majority of the population. This care is usually provided by General Practitioners (GP) and in Brazil many doctors recently graduated from medical school and residents of different medical specialties practice as GPs. Objective : The aim of this study was to describe the knowledge and attitudes about dementia in a sample of Brazilian medical residents from a university-hospital in São Paulo, Brazil. Methods : A total of 152 Brazilian medical residents participated in the study. Participants answered a "Knowledge Quiz" (KQ) and "Attitude Quiz" (AQ) about dementia issues, transculturally adapted for use in Brazilian physicians. A descriptive analysis of the correct answers on knowledge and of the attitude aspects was performed. Results : The medical residents showed poor knowledge (<50%) about dementia prevalence and incidence and a good knowledge on disease management and diagnosis. Participants tended to be optimistic about caring for demented patients. Conclusion : In this study, it is likely that the physicians' good knowledge about dementia issues is the reason for their optimism dealing with demented patients.

Diabetes patients, due to the chorionic nature of the disease, need complex and long-term care for control and prevention of complications. The patients themselves find it difficult to adopt appropriate disease management after diagnosis and they need social support from family, friends, and their environment, especially in lower- and middle-income countries where medical service is limited, and they need self-care of disease and lifestyle modification. In Myanmar, however, the study for social support among diabetes patients is still limited. Therefore, we conducted a case-control study to investigate the social support among diabetes patients and the association between socioeconomic factors in Yangon, which has the highest prevalence of diabetes in Myanmar. Social support between diabetes patients who came to diabetes special clinics and non-diabetes community control was assessed by applying transculturally translated ENRICHD Social Support Instrument (ESSI). Among the diabetes patients’ group, more than 70% had high perceived social support, specifically higher level of informational and emotional social support. Robust multiple regression models revealed significant positive associations between total social support and independent variables: p value < 0.001 for monthly household income and being married, and p value < 0.05 for household number and frequency of having meals together with family. These findings suggest that perceived social support among patients with diabetes may be mainly affected by the patients’ family conditions, such as household income and living with a spouse, in Myanmar culture.

Digital health literacy involves the individual's ability to effectively interpret, evaluate and use health information obtained through digital media, enabling them to make decisions and have greater autonomy over their health. Considering the increasing use of digital media as a source of health information for the population, the present study aimed to evaluate the digital health literacy level of individuals who use social media. The study was conducted with a sample of 423 individuals using a digital questionnaire to obtain socioeconomic data, and the eHealth literacy scale (eHeals) instrument was used to assess the level of digital health literacy. The results indicated that higher levels of education and income correlate with higher levels of digital health literacy. The biological determinants of age and gender did not correlate with digital literacy. It is concluded that government strategies that seek to use social media such as Facebook, Instagram and Twiter as an alternative to non-formal health education should consider that the success of these strategies depends on first investing in the formal education of the population.ResumoLiteracia digital em saúde envolve a capacidade do indivíduo em interpretar, avaliar e usar de forma eficaz as informações de saúde obtidas por meio das mídias digitais, permitindo-o tomar decisões e ter maior autonomia sobre sua saúde. Considerando a crescente utilização das mídias digitais como fonte de informações em saúde para população, o presente estudo objetivou avaliar o nível de literacia digital em saúde de indivíduos que fazem uso das mídias digitais. O estudo foi desenvolvido com uma amostra de 423 indivíduos por meio de questionário digital para obtenção de dados socioeconômicos e o instrumento eHealth literacy scale (eHeals) foi utilizado para avaliar o nível de literacia digital em saúde. Os resultados indicaram que maior nível de escolaridade e renda correlaciona com maiores níveis de literacia digital em saúde. Os determinantes biológicos idade e sexo não apresentaram correlação com a literacia digital. Conclui-se que a estratégia do governo que busca, por exemplo, utilizar as redes sociais online Facebook, Instagram e Twiter como alternativa de educação não-formal em saúde deve considerar que o êxito dessa estratégia perpassa pela necessidade de investir na educação formal.Palavras-chave: Educação não-formal, Educação para saúde, Política de saúde.Keywords: Non-formal education, Health education, Health policy.ReferencesBARROS, Josiane Kelly. Adaptação transcultural e análise das propriedades psicométricas de instrumento para avaliação da literacia digital em saúde. 2019. 77 f.. Dissertação (Mestrado em Promoção da Saúde) – Centro Universitário de Maringá – UNICESUMAR, Maringá, 2019.BIRCH, David. Improving schools, improving school education health education, improving public health: The role of SOPHE members. Health Education & Behavior, v. 44, n. 6, p. 839-844, 2017. http://dx.doi: 10.1177/1090198117736353.Cohen, Jacob. Statistical Power Analysis. Current Directions in Psychological Science. v.1, n.3, p. 98–101, 1992. https://doi.org/10.1111/1467-8721.ep10768783DINO. 62% da População Brasileira está Ativa nas Redes Sociais. Disponível em: <https://exame.abril.com.br/negocios/dino/62-da-populacao-brasileira-esta-ativa-nas-redes-sociais/>. Acesso em: 22 setembro 2019.GABARRON, Elia; ARSAND, Eirik; WYNN, Rolf. Social Media Use in Interventions for Diabetes: Rapid Evidence-Based Review. Journal of Medical Internet Research. v. 10, n.11, 2018, e-10303. https://doi: 10.2196/10303Guntzviller, Lisa; King, Andy; Jensen, Jacob; Davis. Self-Efficacy, Health Literacy, and Nutrition and Exercise Behaviors in a Low-Income, Hispanic Population. Journal of Immigrant and Minority Health, v. 19, n. 2, p. 489–49, 2016. http://dx.doi:10.1007/s10903-016-0384-4 HSU, Michelle; ROUF, Anika; ALLMAN-FARINELLI, Margaret. Effectiveness and Behavioral Mechanisms of Social Media Interventions for Positive Nutrition Behaviors in Adolescents: A Systematic Review. Journal of Adolescent Health. v.63, n.5, p.531-545, 2018.IBGE – Instituto Brasileiro de Geografia e Estatística. Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento, Pesquisa Nacional por Amostra de Domicílios Contínua 2016/2018. LaBARGE, Gene; BROOM, Matt. Social Media in Primary Care. Missouri Medicine. v. 116, n.2, 2019, p.106-110.Loureiro, Luís Manuel de Jesus; Gameiro, Manuel Gonçalves Henriques. Critical interpretation of statistical results: beyond statistical significance. Revista de Enfermagem Referencia, v.3, p 151-162, 2011.MERCHANT, Raina; ASCH, David. Protecting the Value of Medical Science in the Age of Social Media and “Fake News”. JAMA Network. v.320, n.23, p.2415-2416, 2018.MORAIS, José; KOLINSKY, Régine Kolinsky. Literacia científica: leitura e produção de textos científicos. Educar em Revista, n. 62, p.143-162, 2016. http://dx.doi.org/10.1590/0104-4060.48025.MOREIRA, Flávia Moraes.; PINHEIRO, Marta Macedo Kerr. Ministério da Saúde no facebook: um estudo de caso da política de informação. Informação & Informação, v. 20, n. 3, p. 147–174, 2015.MS. Ministério da Saúde. Disponível em: <http://bvsms.saude.gov.br/bvs/saudelegis/gm/2015/prt0589_20_05_2015.html>. Acesso em: 23 setembro 2019.MUKAKA, M. M. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Medical Journal. v. 24, n. 3, p. 69-71, 2012.NORMAN, Camerin; Skiner Harvey. eHealth Literacy: Essential Skills for consumer health in a netword. Journal of Medical Internet Research. v.8, n.2, e9, 2006.NORMAN, Cameron; SKINNER, Harvey. eHEALS: The eHealth Lieracy Scale. Journal of Medical Internet Research. v. 8, n.4, e27, 2006. http://dx.doi: 10.2196/jmir.8.4.e27NUTBEAM, Don. The evolving concept of health literacy. Social Science & Medicine, v. 67, n. 12, p.2072-2078, 2008. http://dx.doi.org/10.1016/j.socscimed.2008.09.050.PIAAC - Program for The International Assement Of Adults Competencies. U.s. Department Of Education. Literacy Domain. 2002. Disponível em: <https://nces.ed.gov/surveys/piaac/literacy.asp>. Acesso em: 27 set. 2019. OCDE.R CORE TEAM R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2018. Available online at https://www.R-project.org/.RAMOS, Francisco Lúzio de Paula; HORA Ádrea Leal; SOUZA, Claudia Tereza Vieria; PEREIRA, Luciana Oliveira; HORA, Dinair Leal da. As contribuições da epidemiologia social para a pesquisa clínica em doenças infecciosas. Revista Pan-Amazônica de Saúde. v.7, n.esp.,p.221-229, 2016. doi: 10.5123/S2176-62232016000500025schwitzer, Gary. Pollution of health news: Time to drain the swamp. BMJ, v. 356, j1262, 2017.SILVA, Marco Antonio Dias; WALMSLEY, Anthony Damien. Fake News and Dental Education. British Dental Journal. v.226, p.397-399, 2019. https://www.nature.com/articles/s41415-019-0079-zTENGLAND, Per-Anders. Behavior Change or Empowerment: On the Ethics of Health-Promotion Goals. Health Care Analysis, v. 24, n. 1, p. 24–46, 2016.TOMÁS, Catarina Cardoso; QUEIRÓS, Paulo Joaquim Pina; FERREIRA, Teresa de Jasus Rodrigues. Revista de Enfermagem Referência. série IV, n. 2, p.19-28, 2014.VAART, Rosalie van der; DROSSAERT, Constance. Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills. Journal of Medical Internet Research, v. 19, n. 1, p.01-13, 2017. http://dx.doi.org/10.2196/jmir.6709.VOSOUGHI, Soroush; ROY, Deb; ARAL, Sinan. The spread of true and false news online. Science, v. 359, p. 1146-1151, 2018.WANG, Yuxi; McKEE, Martin; TORBICA, Aleksandra; STUCKLER, David. Systematic Literatura Review on the Spread of Health-related Misinformation on Social Media. Social Science & Medicine. v.240, 112552, 2019.WASZAK, Przemyslaw M; KASPRZYCKA-WASZAK, Wioleta; KUBANEK, Alicja. Health Policy and Technology, The spread of medical fake news in social media – the pilot quantitative study, v. 7, n. 2, 115-118, 2018.e3761017

To deal with cultural misunderstandings in health care due to increased migration, the Babel Centre—a training and mediation center—developed “transcultural mediation”: a service meant to help health-care professionals encountering difficulties with migrant patients and their families. One of the center's health-care professionals, trained as a mediator, and a cultural broker jointly conduct the mediation session. In 2017, the center initiated a specialized training program to teach health-care professionals the skills needed to serve as transcultural mediators. We conducted a study to evaluate, through the trainees’ and instructors’ subjective experiences, the quality of this innovative training. We used semi-structured interviews and focus groups to question seven trainees, three instructors, and three experts in transcultural psychology at different stages of the 10-month program (before, at midpoint, and afterwards). We used Interpretative Phenomenological Analysis to explore the data. The themes are organized around the central concept of the transmission of knowledge from instructors to trainees and vice versa. Trainees were globally satisfied with this program by its end but did not feel able to lead a mediation by then, due to insufficient anthropology knowledge and practical training. Training in transcultural mediation resembles that for resolving situational problems. It cannot be taught by an approach based on reasoning by the inverse problem method, used for teaching medical sciences. Pedagogical tools more suited to problem solving, such as role-playing or use of senior-assisted mediations, should be used to improve the quality of this training.

Abstract Background Transcultural care remains a hot domain in current nursing practice, especially due to the challenges relating to increased population mobility due to both medical tourism and financial / political instability. The TNP (transcultural nursing for practice) Erasmus plus project was implemented between 2017-2019 to attempt to detect best practices regarding intercultural care in Europe as well as to develop suitable training materials to improve the communication among people of diverse ethnic, cultural and religious background. Methods A study was conducted in January 2019 in all six countries participating in the TNP project. 6 healthcare professionals per country we invited to identify key terms relevant to 15 distinct domains of healthcare and health-related cultural and educational topics. After initial open term brainstorming, the terms were graded by all participants according to their perceived relevance to the project aim using a 3 round Delphi approach. Results A total of 36 expert responders from all six countries agreed to participate of which 70% women. Age varied significantly between 35-75 years. After the final Delphi round, consensus was achieved, with a total of about 1100 words included in the final joined statement. The highest degrees of consensus was achieved for terms relating to parts of the body, common symptoms and conditions and healthcare-associated structures and professionals. On the other hand, a significantly lower degree of consent was determined regarding terms relevant to regional health topics, spiritual care, emotional / mental health and role of family and environment. Conclusions Transcultural care is a necessary component of everyday practice in modern healthcare provision institutions. Despite significant language and cultural barriers, the main priority domains are almost universally uniform, thus justifying the development of suitable health promotion / education materials to minimize the relevant gap. Key messages Transcultural care is a current challenge in health promotion. Despite cultural differences, major terms of healthcare provision remain largely uniform across Europe.

Diabetes prevalence is on the rise in the Middle East. In countries of the Gulf region—Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates—prevalence rates are among the highest in the world. Further, Egypt now ranks as one of the top 10 countries in the world for high number of people with diabetes. Medical nutrition therapy is key to optimal management of diabetes. Patient adherence to nutritional guidance depends on advice that is tailored to regional foods and cultural practices. In 2012, international experts created a transcultural Diabetes Nutrition Algorithm (tDNA) for broad applicability. The objective of this current project was to adapt the algorithm and supportive materials to the Middle East region. A Task Force of regional and global experts in the fields of diabetes, obesity, and metabolic disorders met to achieve consensus on Middle East-specific adaptations to the tDNA. Recommendations, position statements, figures, and tables are presented here, representing conclusions of the tDNA-Middle Eastern (tDNA-ME) Task Force. Educational materials can be used to help healthcare professionals optimize nutritional care for patients with type 2 diabetes. The tDNA-ME version provides evidence-based guidance on how to meet patients' nutritional needs while following customs of people living in the Middle Eastern region.

Given the high prevalence of otolaryngology infections such as tonsillitis, otitis, and pharyngitis in low and middle income countries, the field of global otolaryngology continues to grow to accommodate patients around the world. This commentary focuses on best practices in transcultural communications between US doctors and foreign patients with an emphasis on cultural competency. We use alternative medicine as an exemplar for how to collaborate with patients to develop treatment plans that respect their cultural beliefs and lifestyles. Rather than assigning value to the patient’s alternative medicine practices, we believe that instructing and counseling a patient on how to incorporate follow-up visits and rehabilitation after allopathic medical procedures such as surgical tonsillectomy should be done in a way that respects the patient’s preexisting health regimen. By doing so, these new aspects of their health care will take a discrete place in their wellness practices and engender more trust and better health outcomes.

<p>Physiotherapy is considered a healthcare profession concerned with human function and movement, and maximising potential. It normally uses physical approaches to promote, maintain, and restore physical, psychological, and social well-being, taking account of the variations in health status. The human function is more than just a physical and movement issue. Physiotherapy plays a unique role in the rehabilitation of people who have been profoundly traumatised. Certain precautions are needed when handling survivors of torture, but sensitive physical techniques can relieve the legacies of severe pain, dysfunction, and stress. The physical medium is especially effective for people who are unable to speak of their experiences. (<em>Hough, 1992</em>) Trauma, especially those who have experienced torture and considerable life-threatening violence presents a very wide range of responses from an individual - responses that often include family members and close relationships. The <em>Humane to Humane</em> Transcultural Centre for Torture Victims in Manipur has been providing direct assistance to over 450 clients and their families in support with the UN Torture Fund since 2009.</p><p>Working with people who have been tortured has similarities to working with intensive care patients. There is a need for acute sensitivity to the client's responses, an extra awareness of the importance of autonomy, and an understanding of issues of power and helplessness. A multidisciplinary approach was adopted that included medical, psychological, creative movement therapy, social and financial assistance. Physiotherapy constituted an important component of the services provided by the centre, providing a vital link in rebuilding the personality of survivors of torture because trust can be fostered in the context of physical contact. Close liaison between the physiotherapist and other therapists is needed in this area of work. A combined approach is essential in the work and the support team also indulges in caring for each other and the luxury of co-working. The intimacy of our relationship with survivors of torture is matched by the perverted intimacy of their previous relationship with the torturer, and extra care is needed in this context.</p><p>This paper elaborates on the range of psychosocial, physical, and emotional responses to torture, the methodologies adopted, and the results obtained in our centre.</p>

Abstract Background Currently, ensuring surgical safety remain a worldwide challenge. The description of operating room professionals' attitudes toward patient safety in their work units helps to identify strengths and weaknesses in term of patient safety, allowing a clearer vision of the safety aspects that require special attention. This study aimed to describe healthcare professionals' attitudes on patient safety in the Tunisian operating rooms. Methods This is a cross-sectional descriptive study spread over a 6-month period (October-April 2018). It was conducted among healthcare professionals working in the operating rooms of the two teaching hospitals of Sousse (Tunisia). The measuring instrument used is the Operating Room Management Attitudes Questionnaire (ORMAQ), which consists of 60 items spread over 8 dimensions. The latter has been subjected to a transcultural validation process inspired from the Vallerand method. Data entry and analysis was done by the Statistical Package for Social Sciences (SPSS.20) software. Results A total of 303 professionals participated in the study (participation rate= 76.13%). The most developed dimension was teamwork and the least developed was “Procedural errors/ compliance”. Items' results show that 94.8% of professionals confirmed that seniors should encourage medical and paramedical staff to ask questions, 53.5% of professionals stated that personal problems can adversely affect their performance and 87.5% agreed that operating rooms' team members share responsibilities for prioritizing activities in high workload situations. In addition, 50.9% of participants reported that the managers don't listen to staff or care about their concerns. Conclusions Operating rooms professionals' attitudes toward patient safety in their work units reflect an alarming situation regarding the quality of healthcare provided to patients. These results should be taken into consideration to guide future intervention on quality management improvement. Key messages Considering human factors is essential to improve safety in operating rooms and has an important role in reducing the occurrence of adverse events in these settings. It is important to study the underlying attitudes that determine the human factors for a better understanding and resolution of patient safety problems.

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. Elsevier Science, 1995. 8 Aug, 2013 ‹http://www.freedomfromtorture.org/sites/default/files/documents/Summerfield-PsychologicalResponses.pdf>. Brune, Michael, Christian Haasen, Michael Krausz, Oktay Yagdiran, Enrique Bustos and David Eisenman. “Belief Systems as Coping Factors for Traumatized Refugees: A Pilot Study.” Eur Psychiatry 17 (2002): 451-58. Canavan, John. “Resilience: Cautiously Welcoming a Contested Concept.” Child Care in Practice 14.1 (2008): 1-7. Chung, Juna. Refugee and Immigrant Survivors of Trauma: A Curriculum for Social Workers. Master’s Thesis for California State University. Long Beach, 2010. 1-29. Eastmond, Maria. “Stories of Lived Experience: Narratives in Forced Migration Research.” Journal of Refugee Studies 20.2 (2007): 248-64. Eyber, Carola “Cultural and Anthropological Studies.” In Forced Migration Online, 2002. 8 Aug, 2013. ‹http://www.forcedmigration.org/research-resources/expert-guides/psychosocial- issues/cultural-and-anthropological-studies>. Graybeal, Clay. “Strengths-Based Social Work Assessment: Transforming the Dominant Paradigm.” Families in Society 82.3 (2001): 233-42. Kleinman, Arthur. “Triumph or Pyrrhic Victory? The Inclusion of Culture in DSM-IV.” Harvard Rev Psychiatry 4 (1997): 343-44. Mares, Sarah, and Louise Newman, eds. Acting from the Heart- Australian Advocates for Asylum Seekers Tell Their Stories. Sydney: Finch Publishing, 2007. Mays, Vicki M. “Identity Development of Black Americans: The Role of History and the Importance of Ethnicity.” American Journal of Psychotherapy 40.4 (1986): 582-93. Nettles, Saundra Murray, and Michael J. Mason. “Zones of Narrative Safety: Promoting Psychosocial Resilience in Young People.” The Journal of Primary Prevention 25.3 (2004): 359-73. Orosa, Francisco J.E., Michael Brune, Katrin Julia Fischer-Ortman, and Christian Haasen. “Belief Systems as Coping Factors in Traumatized Refugees: A Prospective Study.” Traumatology 17.1 (2011); 1-7. Peres, Julio F.P., Alexander Moreira-Almeida, Antonia, G. Nasello, and Harold, G. Koenig. “Spirituality and Resilience in Trauma Victims.” J Relig Health (2006): 1-8. Saleebey, Dennis. “The Strengths Perspective in Social Work Practice: Extensions and Cautions.” Social Work 41.3 (1996): 296-305. Scheper-Hughes, Nancy. “A Talent for Life: Reflections on Human Vulnerability and Resilience.” Ethnos 73.1 (2008): 25-56. Seahorn, Janet, J. and Anthony E. Seahorn. Tears of a Warrior. Ft Collins, USA: Team Pursuits, 2008. Sonn, Christopher, and Adrian Fisher. “Sense of Community: Community Resilient Responses to Oppression and Change.” Unpublished article. Curtin University of Technology & Victoria University of Technology: undated. Summerfield, Derek. “Childhood, War, Refugeedom and ‘Trauma’: Three Core Questions for Medical Health Professionals.” Transcultural Psychiatry 37.3 (2000): 417-433. Tofighian, Omid. “Prolonged Liminality and Comparative Examples of Rioting Down Under”. Fear and Hope: The Art of Asylum Seekers in Australian Detention Centres Literature and Aesthetics (Special Edition) 21 (2011): 97-103. Ungar, Michael. “A Constructionist Discourse on Resilience: Multiple Contexts, Multiple Realities Among at-Risk Children and Youth.” Youth Society 35.3 (2004): 341-365. Ungar, Michael. “A Thicker Description of Resilience.” The International Journal of Narrative Therapy and Community Work 3 & 4 (2005): 85-96. Walsh, Froma. “Traumatic Loss and Major Disasters: Strengthening Family and Community Resilience.” Family Process 46.2 (2007): 207-227. Weiss, Daniel. S., Charles R. Marmar, William. E. Schlenger, John. A. Fairbank, Kathleen Jordon, Richard L. Hough, and Richard A. Kulka. “The Prevalence of Lifetime and Partial Post- Traumatic Stress Disorder in Vietnam Theater Veterans.” Journal of Traumatic Stress 5.3 (1992):365-76. Westoby, Peter, and Ann Ingamells. “A Critically Informed Perspective of Working with Resettling Refugee Groups in Australia.” British Journal of Social Work 40 (2010): 1759-76. Wilson, Michael. “Accumulating Resilience: An Investigation of the Migration and Resettlement Experiences of Young Sudanese People in the Western Sydney Area.” PHD Thesis. University of Western Sydney ( 2012): 1-297. Wu, K. M. “Hope and World Survival.” Philosophy Forum 12.1-2 (1972): 131-48.