Joretha N. Bourjolly

A study on recruitment of black Americans into clinical trials through a cultural competence lens.

Black Americans are stricken disproportionately with cancer. However, they continue to be underrepresented in clinical trials aimed at systematically investigating treatment methods or studying the effectiveness of cancer detection and prevention. Because participation in clinical trials can offer patients access to state-of-the-art therapy in a research context, it is imperative that black Americans have proportional representation in such trials. The purpose of this article is to describe findings from the first phase of a two-phase project on recruitment of black Americans into clinical trials. In the first phase, physicians and data managers in a large, urban prestigious cancer center were asked to identify factors they believed prevent black Americans from participating in clinical trials. Findings from this study were congruent with the literature about why physicians and other health care providers believe black Americans do not participate in clinical trials. However, the findings were examined through a cultural competence lens, adding a fresh perspective to the consideration of what interventions can be developed to eradicate underrepresentation of black Americans in clinical trials. The second phase will assess the knowledge, beliefs, attitudes, and behaviors of black Americans related to clinical trials in the geographic area of the cancer center.

Evaluating cultural competence among behavioral health professionals.

Persistent racial and ethnic disparities in access and utilization of behavioral health services have highlighted the need for cultural competence among providers. In response, many agencies are now implementing education and training programs to ensure that behavioral health professionals improve their skills when serving diverse ethnic, racial, and cultural populations. The evaluation of these trainings is vital to ensure that they both improve the cultural competence of providers and promote recovery among persons with severe mental illnesses. This paper discusses the philosophical and practical issues related to measuring cultural competence, based on the evaluation of statewide cultural competence trainings for behavioral health professionals. The evaluation process illustrates the challenges of operationalizing cultural competence, balancing the needs of program implementers and evaluators, and developing a robust and feasible evaluation design, which assesses outcomes both for persons in recovery and providers.

How do tangible supports impact the breast cancer experience

Abstract A womans ability to navigate her new role as a breast cancer patient can be impacted by the support she has available to her during this time. One form of social support, tangible support, refers to providing support in a physical way that assists an individual in meeting their role responsibilities. The Roy Adaptation Model was used as a framework for conceptualizing the various roles in a womans life that can be impacted by breast cancer and how the type and extent of tangible support impacts these roles. Through a qualitative open-ended interview, 33 women with breast cancer described their experiences with their illness as it pertains to issues of role function and tangible supports.

The Journey Toward Intercultural Sensitivity: A Non-Linear Process

Abstract This paper reports on the use of Milton Bennetts Developmental Model of Intercultural Sensitivity (DMIS) to analyze logs that were submitted by mental health service providers who participated in an intensive training program on intercultural competency. Program participants wrote eight monthly reflective logs about cultural experiences that occurred between training sessions. The categories of intercultural sensitivity described in the DMIS were used as the basis for coding log entries. The findings over the 10-month training period show that the development of intercultural sensitivity is, for the most part, a non-linear process in which one makes intermittent reversions to earlier levels and moves forward in spurts. After offering examples of non-linear and linear patterns in the logs, the paper discusses possible explanations for the findings and the challenges of coding according to the Bennett Model. Implications for intercultural competency education and training programs and their evaluation are proposed.

Family Reactions to Religious Change: The Case of African American Women Who Become Muslim

This paper presents a study of family reactions to African American adult daughters’ conversions from Christianity to Islam. Examining qualitative data from interviews with Christian mothers and Muslim daughters in 17 family units, we explored reactions to a family members religious conversion initially and over time. We also identified the specific challenges facing African American families when a daughter converts to Islam. We found a wide range of initial emotional responses to an adult daughters conversion. Over time, the families showed marked changes, predominantly in the direction of increased respect and acceptance. Reactions to the change and the challenges facing the families are discussed in relation to several theories, including ambiguous loss, and implications for practice are described.

Evaluating the Impact of Cultural Competency Trainings from the Perspective of People in Recovery

Many behavioral health providers are now being trained in cultural competence but still little is known about the impact of these trainings on persons-in-recovery. This study reports on the evaluation of a state wide cultural competency (CC) training for behavioral health providers. A sample of persons-in-recovery receiving services from trainees were asked how important cultural factors were in their treatment and rehabilitation and to what extent their providers were culturally competent. Most persons-in-recovery reported that their providers were culturally competent, but the majority did not prioritize cultural factors in their treatment. The article discusses the complex relationship between culture and satisfaction with services and the need to explore further the person-in-recovery understanding of culture in the context of their mental health.

The impact of managed health care in the United States on women with breast cancer and the providers who treat them.

This article describes how the increasing shift to managed care has impacted the treatment of women with breast cancer, from the perspectives of patients and providers. A descriptive exploratory pilot study was undertaken in a comprehensive cancer center in an urban northeastern city of the United States. The use of General Systems Theory is used to describe how the health care system has adapted to recent insurance changes. Qualitative interviews with patients, physicians, nurses, and business office staff reveal that the type of insurance did not affect treatment decisions. Findings from this pilot study, however, reveal that the increasing shift to managed care has resulted in a change in roles for nurses, fragmentation of care, and intangible costs to the patients.

African-American and White Women's Appraisal of their Breast Cancer

Abstract African-American women are less likely to be diagnosed with breast cancer than are White women but are more likely to be adversely affected. Although differences in incidence and mortality have been explored in some depth, little attention has been paid to how these women cope with the disease or whether their appraisal of their breast cancer differs from that of White women. Using a comparative design, this study analyzed the differences in appraisal between African-American and White women with breast cancer. The findings suggest that no differences exist between African-American and White womens appraisal of their breast cancer. The type of primary appraisal used most by both groups was harm to their health, safety, and physical well-being. The secondary appraisal used most was that breast cancer was an experience they had to accept. Possible links between appraisal and cognitive representations of illness and suggestions for further research on the appraisal are discussed.

Training Mental Health Providers in Cultural Competence: A Transformative Learning Process

Cultural competence training is viewed as a strategy to reduce cultural disparities in mental health (Dougherty, 2004). The purpose of this article is to examine the process of becoming more culturally competent. This process evaluation study applied Bennetts Developmental Model of Intercultural Sensitivity to logs written by four cohorts of mental health and psychiatric rehabilitation teams of administrators, mental health practitioners and peer providers who participated in intensive, multicultural, recovery-oriented, continuing education over a 10-month period. Participants submitted logs later coded using Bennetts categories. A nonlinear process of group transformation from ethnocentric to ethnorelative was demonstrated. During the initial and midpoints of the training, there was often a spike in ethnocentrism followed by acceleration in the movement toward ethnorelativism. Findings are discussed in relation to transformative learning theory and implications for design of multicultural training that promotes transformational, second order change are considered.

African American Women's Experiences Around Conversion to Islam

This article focuses on the experiences of African American women who converted from Christianity to Islam. Examining qualitative data from interviews with 15 Muslim women, we identified common experiences the women had in their paths to Islam. These experiences included predisposing conditions, experiencing challenges, social ties and relationships with Muslims, observing others, and positive experiences during the conversion process. We also found that dissatisfaction with their religious upbringing, life events, close and distant relationships, and feelings of peacefulness entered into the process, which seemed to be gradual. Similarities and differences between these findings and models of conversion and implications for social work practice with African American Muslim women are discussed.