How to Create a Culturally Sensitive Program: Lessons Learned from NIDA and NIAAAFunded Research Stu

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How to Create a Culturally Sensitive Program
Lessons Learned from NIDA and NIAAA-Funded
Research Studies

• Adeline Nyamathi, ANP, PhD, FAAN
• Audrienne H. Moseley Endowed Chair in
• Community Health Research
• Professor and Associate Dean for Academic
  Affairs,
• UCLA School of Nursing

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Nursing Health Care At The Union Rescue Mission
Skid Row Homeless
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Collaborative Community-Partnered Inquiry

• Emerges from the community
• Uses members from the targeted group to design
  the program, convey the message, act as
  advocates, evaluate and disseminate research

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Problem Identification

• Community assessment for areas most impacted with
  health disparities affecting homeless persons
• Resource limitations for homeless persons
• Community needs for cultural competence

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Cultural Competency

• Set of congruent behaviors, attitudes, and
  policies that come together amongst professionals
  and enables those professionals to work
  effectively in cross-cultural situations (Cross
  et al., 1989).
• Knowledge, sensitivity and collaboration are
  fundamental to the development of cc research.

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LITERACY

• How to measure pre and post test knowledge

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VC1
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VC2
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N
ursing etwork
UCLA AIDS
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Research Team
Nursing (Drs. Flaskerud, Keenan, Robbins, Wiley),
Public Health ( Dr. Longshore, Morisky), Medicine
(Dr. Fahey, Gelberg, Marfisee, Saab), and
Psychology (Drs. Shoptaw, Reback, Stein and
Galaif) Research Nurses Administrative and
Statistical Team
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Comprehensive Health Seeking and Coping
Paradigm (Nyamathi, 1989)
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CHSCP
Antecedents Mediators Outcomes

• Self Esteem
• Social Support
• Threat Appraisal
• Coping
• Emotional Distress
• Risky Business

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Logistic Regression Results for Completion of TB
Chemoprophylactic Treatment
Adjusted Odds Ratio
95 CI
P Value
NCMI Group Age Black Sex
2.25 1.03 1.70 1.08
1.55-3.28 1.02-1.05 1.02-2.84 0.67-1.75
.001 .034 .042 .758
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Perspectives of Homeless Youth on Innovative Ways
to Reducing Drug Use
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Substance Abuse
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Homeless Youth in Los Angeles

• 71 with drug, alcohol abuse disorder or both.
• 30 use injection drugs with 59 sharing needles.
• Heroin most commonly injected drug, followed by
  cocaine and speedball.
• Sharing used syringes and paraphernalia is
  common practice

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Youth Results
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Difficult Getting Transportation
Transportation is a major issueWhen I was
having back painsevery like, 3 blocks I would
walk, I would have to lay down on the sidewalk so
that my back would stop hurting
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Interactions with Health Care Personnel
I am very open to the fact that I smoke
marijuana, and I have asthmaand I understand
that that kinda conflicts, but, you know, I smoke
marijuana for a lot of more reasons than So I
dont need a doctor coming to me every single
time.
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Benefits of Using Needs to be Considered

• Need to stay awake for their own sense of safety
• Use of drugs to calm their fears
• Use of certain drugs to treat depression

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Power of Music in Delivering a Message

• When asked about what role artists or musicians
  play
• By being a living example by what they do. They
  livin their life, so that they got to project
  that life to show other people examples

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Creative Use of Media to Get Messages

• Homeless youth benefit through skills mentoring
  and development by having ownership and becoming
  advocates of health messages to other youth

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International Research Activities to Reduce
Health Disparities Among Vulnerable Populations

• Adeline Nyamathi, ANP, PhD, FAAN
• Professor and Associate Dean for Academic
  Affairs,
• UCLA School of Nursing

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HIV/AIDS Prevention Using Train-the-Trainer
Methods A Skills Building Workshop developed
with the Indian Systems of Medicine and
Homoeopathy
Adey Nyamathi, ANP, Ph.D. UCLA School of
Nursing VP Singh, MD (Hom), Anil Khurana, MD
(Hom) and Divya Taneja, BHMS Central Council for
Research in Homeopathy John L. Fahey, MD UCLA
School of Medicine
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OBJECTIVES OF THE STUDY

• Two-phased exploratory project
• PHASE 1 To assess status of HIV prevention
  modalities utilized by both Indian homeopathic
  practitioners and educators
• PHASE 2 Developing a culturally sensitive
  HIV/AIDS prevention education program

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Qualitative Sessions

• Eight focus groups
• 68 homeopathy (34 educators and 34 physicians)
• Delhi and Pune

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BARRIERS TO PROVIDING HIV PREVENTION MESSAGES

• Barriers to the communication of prevention for
  the Indian homeopaths
• knowledge-based factors
• societal factors
• logistical factors

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Focus Group Sessions

• I am looking for a life partner, what should
  I look for?. I tell them that instead of
  matching horoscopes and blood groups, get HIV
  testing done

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Train the Trainer Participants

• 200 Practitioners and Educators will participate
• 100 Participants would be in Control Group and
  undergo 1 day training
• 100 would be in Intervention Group and undergo 3
  day training
• Training of Intervention Group is discussed here

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TOPICS FOR CONSIDERATION

• Principles of Adult Learning
• Barriers to Teaching and Learning
• HIV Infection
• Impact of HIV Infection
• Behavior Changes and Adult Learning
• Utilization of Local Resources
• Implementing the HIV/AIDS Instructional Program

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Findings

• Significant increase
• Patients counseled at six month follow-up
  intervention vs control groups (1281 vs 947, p lt
  .05).
• Significant increase in AIDS Knowledge
• Number of secondary trainees who were given
  training (442 vs 340, p lt .05)

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Women HIV Righting the Balance
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Awarded R 34

• Mothers Living with AIDS Impact of the ASHA
  NIMH
• (MH082662)
• Site Nellore AIIMS and ICMR Co-Investigators 

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Focus Group Session

• In the hospital, there are different wards given
  to women infected with HIV. When I had my labor
  pains, I screamed and shouted with no assistance
  from anybody. Finally, the
• baby came out and my mother pleaded for help.
  Then finally a doctor came to my side.
• The ayah told my mother to clean up the blood
  and refused to touch it for fear of being
• infected.

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Focus Group Session

• My husband died of HIV leaving me and my son
  with the disease. His family knew about our
  illness. Once my husband died, my brothers in law
  refused to give us any share of the property.
  They told me that my son and I would also die
  anyway due to HIV and there was therefore no need
  for the property to be shared among us.

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Challenges Seeking Care

• I go alone to collect my medicines. By the time
  I come home, it is very late in the evening. I
  come back and cook my food, I face lot of
  difficulties whenever I collect my medicines.
• On many occasions, when I am very sick no one
  accompanies me to DH, even if I call someone to
  help me. No one helps. I wish someone helps me to
  go and visit the DH or local Primary Health
  Centre (PHC).

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Issues of Stigma and Physician Support

• No stigma, no fear to visit village PHC if all
  the care is provided at the PHC. It reduces all
  our difficulties of financial stress, travel
  stress, child care. Why should we feel stigma
  when our problems are reduced to greater level.
•  Yes, if the Director of Health should issue the
  Government Order to supply ART from PHC.. I am
  ready to treat HIV patients here. If ART
  medicines are provided at the PHC, then it is
  easy

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