Cultural Competence

1
Cultural Competence

• A Case Study

2

• You are the principle investigator of a study on
  postpartum depression that will include in-depth
  open-ended interviews with women who are recent
  immigrants from Mexico and first generation
  Mexican-American women who have been diagnosed
  with moderate postpartum depression. The informed
  consent process and all interviews will be
  conducted in Spanish by a Latina co-investigator
  who is a 2nd generation Mexican-American and has
  extensive experience working with this population
  in research and outreach settings.

3

• The interview will include sensitive questions
  regarding depression, anxiety, confusion,
  suicidal ideation, and thoughts about motherhood.
  However, the sensitivity of the research topic
  does not seem to be a major barrier to recruiting
  participants. Approximately 20 women have
  responded to flyers that have been placed in a
  community mental health clinic, but only 3 have
  been enrolled.

4

• In many cases, after the study has been
  explained and participants are asked to sign the
  consent form, women have said either, I have to
  ask my husband first before I sign anything and
  then do not return to the clinic with the signed
  form, or, I dont think my husband would like me
  to participate in this study. When asked why,
  some participants (especially the more recent
  immigrants) remarked that generally they do not
  sign any forms without first discussing the
  matter with their spouses.

5

• Several potential participants also mentioned
  that because the topic involves not just
  themselves but their child and family, they do
  not feel comfortable excluding their husbands
  from the decision.
• How should you address this problem?

6
Racist Research?

• A Case Study

7

• Based on previous research experience and
  studies reported in the literature, a researcher
  proposes the theory that African-American males
  diagnosed with behavior disorders (BD)
  (oppositional defiant disorder and conduct
  disorder) suffer from early childhood deprivation
  of attention by the male parent. She proposes to
  interview African-American males diagnosed with
  BDs and compare them to a control group of males
  without any diagnosis of mental illness matched
  on SES, intact versus disrupted family, and
  presence versus absence of alternative male
  figures as well as age and race.

8

• In response to recruitment materials, which were
  approved by the university IRB and posted
  throughout African-American neighborhoods near
  the university, representatives from a
  community-based organization file a complaint
  with the university claiming that the study is
  racist, harmful to the reputations of the
  families involved, and designed to discredit the
  African-American community. They also argue that
  the universitys IRB did not have the right to
  approve the research without first asking
  community members for input.

9

• The original proposal was approved by the IRB
  without any questions or problems. The researcher
  had proposed appropriate measures for informed
  consent and human subjects protections. The issue
  of harm to the community was not addressed by the
  researcher or the IRB during the study approval
  process.
• The research insists that the project is not
  racist and could be highly beneficial to the
  community. If the data support her hypothesis,
  the researcher plans to apply for funding to
  continue her work with the aim of developing a
  program to help develop male role models for
  African-American youth.
• As a member of the IRB, how would you seek to
  resolve this issue?

10
Case Development Exercise

• Drawing from your own experiences, try to develop
  a case that involves an ethical challenge that
  arises from a cultural, historical, ethnic or
  linguist context