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2016
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(2016): Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication. An Agenda for Science and Practice. In: Medical decision making : an international journal of the Society for Medical Decision Making 36 (7), S. 811-833. DOI: 10.1177/0272989X15600434
DOI: http://www.ncbi.nlm.nih.gov/pubmed/26296619 Abstract: This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research.
Keywords: Clinical Decision-Making, Communication, Cultural Competency, culture sensitive, Disziplin, Health Behavior, Health Promotion/standards, Humans, Kultur, Kulturtheorie, Medizin, Models, Psychological, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Pathologie, Risk-Taking, Social Norms -
(2016): Effects of culture-sensitive adaptation of patient information material on usefulness in migrants. A multicentre, blinded randomised controlled trial. In: BMJ open 6 (11). DOI: 10.1136/bmjopen-2016-012008
DOI: http://www.ncbi.nlm.nih.gov/pubmed/27881523 Abstract: OBJECTIVES To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. DESIGN Multicentre, double-blind randomised controlled trial. SETTING 37 primary care practices. PARTICIPANTS 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. INTERVENTIONS Intervention group: provision of culture-sensitive adapted material. CONTROL GROUP provision of standard translated material. MAIN OUTCOME MEASURES Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. SECONDARY OUTCOMES patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. RESULTS Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). CONCLUSION Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. TRIAL REGISTRATION NUMBER German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.
Keywords: Adult, Aged, Cultural Competency, culture sensitive, Depressive Disorder, Major/therapy, Disziplin, Double-Blind Method, Female, Focus Groups, Health Literacy, Humans, Italy, Kultur, Kulturtheorie, Language, Low Back Pain/therapy, Male, Medizin, Middle Aged, Pamphlets, Patient Education as Topic/methods, Patient Participation, Poland, Psychologie, Quality of Life, Rolle (Beruf), Russia, Transients and Migrants, Translating, Turkey
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