Susan C. Scrimshaw

Culturally competent healthcare systems: A systematic review☆

Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the clients language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.

Social Support in Pregnancy: Psychosocial Correlates of Birth Outcomes and Postpartum Depression

This prospective study examined the effects of prenatal social support on maternal and infant health and well-being in a sample of low-income pregnant women (N = 129). Three aspects of support (amount received, quality of support received, and network resources) and four outcomes (birth weight, Apgar scores, labor progress, and postpartum depression) were studied. Results indicated that women who received more support had better labor progress and babies with higher Apgar scores. Women with higher quality support had babies with higher Apgar scores and experienced less postpartum depression. Also, women with larger networks had babies of higher birth weight. Further analyses indicated that the outcomes as a whole were more consistently predicted by instrumental rather than emotional forms of support. Finally, although there was some evidence for stress-buffering effects of support, the overall findings were more consistent with a main effect model.

The effectiveness of early childhood development programs: A systematic review

Early childhood development is influenced by characteristics of the child, the family, and the broader social environment. Physical health, cognition, language, and social and emotional development underpin school readiness. Publicly funded, center-based, comprehensive early childhood development programs are a community resource that promotes the well-being of young children. Programs such as Head Start are designed to close the gap in readiness to learn between poor children and their more economically advantaged peers. Systematic reviews of the scientific literature demonstrate effectiveness of these programs in preventing developmental delay, as assessed by reductions in retention in grade and placement in special education.

Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women.

Developed and tested a biopsychosocial model of birthweight and gestational age at delivery using structural equation modeling procedures. The model tested the effects of medical risk and prenatal stress on these indicators of prematurity after controlling for whether a woman had ever given birth (parity). Subjects were 130 women of low socioeconomic status interviewed throughout pregnancy in conjunction with prenatal care visits to a public clinic. The majority of women were Latino or African-American. Half were interviewed in Spanish. Lower birthweight was predicted by earlier delivery and by prenatal stress. Earlier delivery was predicted by medical risk and by prenatal stress. Parity was not related to time of delivery or to birthweight. Implications of results for the development of biopsychosocial research on pregnancy and on stress are discussed.

Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation.

OBJECTIVES This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. METHODS Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. RESULTS Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. CONCLUSIONS Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.

Providing affordable family housing and reducing residential segregation by income

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

The Community Guide’s model for linking the social environment to health ☆ ☆☆

In the mid-1990s, the independent national Task Force on Community Preventive Services (the Task Force) was created under the auspices of the Department of Health and Human Services to summarize what is known about the effectiveness of community-based interventions to improve population health outcomes. The Task Force wanted to examine broad social determinants of health from an ecologic perspective—one that recognized the connection between health and sustainable human, cultural, economic, and social activities. Communities interact with resources in the social and physical environments over broad periods of time. Understanding patterns of health or disease requires a focus not only on personal behaviors and biologic traits but also on characteristics of the social and physical environments that shape human experience and offer or limit opportunities for health. Social Determinants of Health

Anthropological involvement in the Central American diarrheal disease control project

The process of conducting applied anthropological work leading to health program development and evaluation is seldom described in the literature. This paper discusses the combination of factors which led to the involvement of anthropologists in the Central American Child Survival Project and how anthropological approaches are being used in the project. Ethnoclassification was used to illustrate the discrepancy between the proposed approach to treatment for dehydration produced by diarrheal disease and the actual beliefs and practices in 4 Central American communities. Techniques such as rapid, focused assessment using anthropological methods of data collection and presentation are discussed, as are strategies for presenting this information to health program planners and administrators.

Mediators of ethnic-associated differences in infant birth weight

PurposeTo examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors.MethodA prospective survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk.ResultsAs expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight.ConclusionThese data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles.

Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.