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  1. Fulltext Food, culture, and identity in multicultural societies: Insights from Singapore
    Reddy G, van Dam RM
    Appetite, 2020 06 01;149:104633.
    PMID: 32084519 DOI: 10.1016/j.appet.2020.104633
    The choice of food practices can be influenced by one's identity in many societies, but has mostly been evaluated in light of the maintenance of cultural identity in migrant populations. This study focused on understanding the influence of identity on food practices among individuals in multicultural societies. We conducted 18 focus group discussions (n = 130) among Indian, Chinese and Malay women in Singapore. Focus group transcripts were analysed using Thematic Analysis both inductively and deductively. Deductive analysis was framed within a Social Representations Approach, a social psychological theory that allows a deeper understanding of the contextual aspects of identity. Participants highlighted the central position of food in social events, cultural celebrations, and persistent traditional beliefs about health (such as 'hot-cold balance'). These beliefs extended to the perception of certain traditional foods possessing medicinal properties. Importantly, the consumption of these traditional foods was accepted as necessary for the maintenance of health by the women. We propose that while cultural food practices are integral to identity preservation and identity continuity for Singaporean women from all three racial groups, this is different to other multicultural societies such as Canada where communities preserve their cultural food practices, in part, due to fear of cultural identity loss. In addition, cross-cultural food practices are readily adopted in participants' daily lives for a number of reasons such as the promotion of health, convenience, and variety. At times, this adoption blurred boundaries between different cultural cuisines. Food practices in multicultural societies like Singapore are thus a reflection of everyday multiculturalism, multicultural social policies, and attitudes towards traditional healthful food practices, and these aspects need to be considered in the development of public health policies and interventions.
    Matched MeSH terms: Cultural Diversity*
  2. Fulltext Development and validation of a cancer awareness questionnaire for Malaysian undergraduate students of Chinese ethnicity
    Loo JL, Ang YK, Yim HS
    Asian Pac J Cancer Prev, 2013;14(1):565-70.
    PMID: 23534795 DOI: 10.7314/apjcp.2013.14.1.565
    OBJECTIVES: To describe the development and validation of a cancer awareness questionnaire (CAQ) based on a literature review of previous studies, focusing on cancer awareness and prevention.

    MATERIALS AND METHODS: A total of 388 Chinese undergraduate students in a private university in Kuala Lumpur, Malaysia, were recruited to evaluate the developed self-administered questionnaire. The CAQ consisted of four sections: awareness of cancer warning signs and screening tests; knowledge of cancer risk factors; barriers in seeking medical advice; and attitudes towards cancer and cancer prevention. The questionnaire was evaluated for construct validity using principal component analysis and internal consistency using Cronbach's alpha (α) coefficient. Test-retest reliability was assessed with a 10-14 days interval and measured using Pearson product-moment correlation.

    RESULTS: The initial 77-item CAQ was reduced to 63 items, with satisfactory construct validity, and a high total internal consistency (Cronbach's α=0.77). A total of 143 students completed the questionnaire for the test-retest reliability obtaining a correlation of 0.72 (p<0.001) overall.

    CONCLUSIONS: The CAQ could provide a reliable and valid measure that can be used to assess cancer awareness among local Chinese undergraduate students. However, further studies among students from different backgrounds (e.g. ethnicity) are required in order to facilitate the use of the cancer awareness questionnaire among all university students.
    Matched MeSH terms: Cultural Diversity*
  3. Social and cultural aspects of organ donation in Asia
    Woo KT
    Ann Acad Med Singap, 1992 May;21(3):421-7.
    PMID: 1416796
    In Asian countries, it is more difficult to obtain cadaver kidneys for renal transplantation because of certain socio-cultural beliefs and customs. The issues affecting living related kidney donation are more social than cultural. This is due to the web of family pressures and personal conflicts for both donor and recipient surrounding the donation. Important misconceptions and fears are: fear of death, the belief that removal of organ violates sanctity of decreased, concern about being cut up after death, desire to be buried whole, dislike of idea of kidneys inside another person, wrong concept of brain death, and the idea of donation being against religious conviction. In Singapore, with the introduction of the Human Organ Transplant Act (HOTA) in 1988, the number of cadaveric transplants have increased, including those from the Medical Therapy Act (MTA). HOTA and education have played pivotal roles in bringing about an increased yield of cadaveric kidneys. With the availability of living unrelated donor (LUD) transplants in India, our living related donor (LRD) transplant programme has suffered, because patients would rather buy a kidney from overseas than get a relative to donate one. Patients are also going to China for overseas cadaveric transplants where the kidneys come from executed convicts. People in countries like Hong Kong, Japan and the Philippines share the same Asian tradition of not parting with their organs after death. Muslim countries like Malaysia require the deceased to have earlier pledged his kidneys for donation prior to death before they can be harvested for transplantation at death.
    Matched MeSH terms: Cultural Diversity*
  4. Issues surrounding HPV vaccine delivery in a multi-ethnic country in Asia: the physician's perspective
    Wong LP
    J Community Health, 2011 Feb;36(1):14-22.
    PMID: 20431926 DOI: 10.1007/s10900-010-9275-0
    The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine delivery in a multi-ethnic, multi-religious and multi-cultural society. A qualitative in-depth interview study was conducted with a sample of 20 physicians. Physicians described the success of HPV vaccines recommendation as very poor. Many expressed reluctance to offer the vaccine to preadolescents. The most notable barrier to vaccination was the vaccine's high cost. Parents of eligible vaccinees were concerned about the efficacy and side effects of the new vaccine, while adult women have low risk perception for HPV infection. Promoters and inhibitors of HPV vaccination in our multi-ethnic, multi-religious and multi-cultural community were identified. This study suggests the need to strengthen the infrastructure necessary for HPV vaccine delivery and to specifically target poor underserved women.
    Matched MeSH terms: Cultural Diversity
  5. Factors limiting deceased organ donation: focus groups' perspective from culturally diverse community
    Wong LP
    Transplant Proc, 2010 Jun;42(5):1439-44.
    PMID: 20620450 DOI: 10.1016/j.transproceed.2009.11.053
    BACKGROUND: In-depth understanding of cultural and religious factors limiting organ donation of three ethnic populations (Malay, Chinese, and Indian) in Southeast Asia is lacking. Identification of factors limiting organ donation among these three ethnic groups will provide insights into culturally appropriate strategies to promote acceptance of organ donation in a multiethnic Asian community.
    METHODS: A total of 17 focus group discussions (105 participants) were conducted between September and December 2008. Participants were members of the general public aged 18 to 60 years, recruited through convenient sampling around the Klang Valley area of Malaysia.
    RESULTS: Although the majority had favorable attitudes toward deceased organ donation and transplantation, a diversity of myths and misinformation were unearthed from the discussions across the ethnic groups. These include perceived religious prohibition, cultural myths and misperceptions, fear of disfigurement, fear of surgery, distrust of the medical system, and family disapproval. Culture and religious beliefs played important prohibitive roles among those opposed to organ donations. There were distinctive ethnic differences in cultural and religious concerns regarding organ donation. Less-educated and rural groups appeared to have more misconceptions than the well-educated and the urban groups.
    CONCLUSION: Our findings may assist organ donation and transplantation organizations to reach diverse sociodemographic and ethnic communities with culture-specific information about organ donation. The involvement of community and religious leaders is critical in organ donation requests.
    Matched MeSH terms: Cultural Diversity*
  6. HPV information needs, educational messages and channel of delivery preferences: views from developing country with multiethnic populations
    Wong LP
    Vaccine, 2009 Feb 25;27(9):1410-5.
    PMID: 19150379 DOI: 10.1016/j.vaccine.2008.12.045
    This qualitative study used focus group discussions (FGDs) to evaluate information needed in order to make informed human papillomavirus (HPV) vaccination decision, opinion on the most acceptable public education messages, and channel of delivery in a multiethnic, multicultural and multireligion country. A total of 19 FGDs were conducted among mothers of eligible vaccinees, young women eligible for the vaccine, and men. Messages that carry accurate information about HPV-cervical cancer link, the HPV preventive vaccines and at the same time minimize the stigma of a sexually transmitted infection (STI) vaccine were preferred. Educational messages for future HPV educational intervention were developed and methods to effectively convey to the public the need for HPV vaccination were identified. The findings serve as a basis for future intervention to develop research-based communication materials and strategies.
    Matched MeSH terms: Cultural Diversity
  7. Knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in Malaysia's multi-ethnic society: a baseline study
    Wong LP
    Clin Transplant, 2011 Jan-Feb;25(1):E22-31.
    PMID: 20718827 DOI: 10.1111/j.1399-0012.2010.01312.x
    Malaysia's organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia.
    Matched MeSH terms: Cultural Diversity
  8. Reimagining medical education for primary care in the time of COVID-19: a world view
    Ramsay R, Nashat NH, Thuraisingham C, Andrades M, Ng V, Cabezas-Escobar CE, et al.
    Educ Prim Care, 2021 01;32(1):2-5.
    PMID: 33295252 DOI: 10.1080/14739879.2020.1851147
    This article sets out to highlight the challenges and opportunities for medical education in primary care realised during the COVID-19 pandemic and now being enacted globally. The themes were originally presented during a webinar involving educationalists from around the world and are subsequently discussed by members of the WONCA working party for education. The article recognises the importance of utilising diversity, addressing inequity and responding to the priority health needs of the community through socially accountable practice. The well-being of educators and learners is identified as priority in response to the ongoing global pandemic. Finally, we imagine a new era for medical education drawing on global connection and shared resources to create a strong community of practice.
    Matched MeSH terms: Cultural Diversity
  9. Fulltext Female genital mutilation
    Ladjali M, Rattray TW, Walder RJ
    BMJ, 1993 Aug 21;307(6902):460.
    PMID: 8400925
    Matched MeSH terms: Cultural Diversity*
  10. Fulltext Clinical nutrition in East Asia and the Pacific
    Darnton-Hill I, Cavalli-Sforza LT, Volmanen PV
    Asia Pac J Clin Nutr, 1992 Mar;1(1):27-36.
    PMID: 24323002
    Identifying the nutrition problems of Asia and the Pacific is made difficult by the enormous geographic, socioeconomic and cultural diversity that exists in these areas. With increasing longevity and reduced infant mortality, the more chronic diseases are becoming increasingly important. For almost 90% of the countries that keep such data in the Western Pacific Region of WHO, at least three of the five leading causes of death are noncommunicable diseases. Nevertheless undernutrition is still the most important nutritional problem in the Region. Even though there have been some encouraging declines in the proportion of malnourished under 5-year-olds, increasing populations have meant the actual numbers have not declined. Vitamin A deficiency, iodine deficiency disorders and iron deficiency anaemia remain major public health problems in many countries. There is evidence that vitamin A deficiency is appearing in countries in which it has not previously been a problem. New challenges are occurring, such as childhood obesity, the susceptibility of undernourished populations to the human immunodeficiency virus and the increase in noncommunicable diseases. The three arms of clinical nutrition: therapeutic, research and public health will need to work closely to meet the considerable and continuing threat posed by the nutrition-related diseases.
    Matched MeSH terms: Cultural Diversity
  11. Fulltext Validity, feasibility and acceptability of time trade-off and standard gamble assessments in health valuation studies: a study in a multiethnic Asian population in Singapore
    Wee HL, Li SC, Xie F, Zhang XH, Luo N, Feeny D, et al.
    Value Health, 2008 Mar;11 Suppl 1:S3-10.
    PMID: 18387064 DOI: 10.1111/j.1524-4733.2008.00361.x
    OBJECTIVES: To assess the validity, feasibility and acceptability of standard gamble (SG) and time trade-off (TTO) assessments in a multiethnic Asian population.
    METHODS: Through in-depth interviews performed among Chinese, Malay, and Indian Singaporeans (education >or= 6 years), we assessed validity of SG/TTO methods for eliciting health preferences by hypothesizing that 1) SG/TTO scores for three hypothetical health states (HS) would exhibit ranked order (decreasing scores with worse HS); and 2) more subjects would rate the most severe HS as worse than dead. Subjects also evaluated feasibility and acceptability of SG/TTO using a 10-point visual analog scale (VAS) and open-ended questions. Ratings were compared using Kruskal-Wallis, Wilcoxon signed-rank tests or tests of proportions.
    RESULTS: VALIDITY: In 62 subjects (90% response rate), as hypothesized, SG and TTO scores exhibited ranked order with increasing HS severity (SG: 0.85, 0.08, -19.00; TTO: 0.85, 0.00, -0.18). More subjects rated the most severe HS as worse than dead (SG: 8%, 39%, 59%; TTO: 8%, 45% and 62%).
    FEASIBILITY: Subjects felt SG and TTO were easy to understand (median VAS scores: 8.0 vs. 8.0, P = 0.87) and to complete (8.0 vs. 8.0, P = 0.84). Acceptability: SG and TTO were well accepted, with TTO less so than SG (median [interquartile range] offensiveness: 2.0 [0, 4.0] vs. 2.0 [0, 3.0], P = 0.045). Overall, subjects did not have a clear preference for SG/TTO (50% vs. 45%, P = 0.70).
    CONCLUSIONS: This study suggests the validity, feasibility and acceptability of SG and TTO for population-based HS valuation studies in a multiethnic Asian population.
    Matched MeSH terms: Cultural Diversity
  12. Fulltext Public perceptions and attitudes toward thalassaemia: Influencing factors in a multi-racial population
    Wong LP, George E, Tan JA
    BMC Public Health, 2011;11:193.
    PMID: 21447191 DOI: 10.1186/1471-2458-11-193
    Thalassaemia is a common public health problem in Malaysia and about 4.5 to 6% of the Malays and Chinese are carriers of this genetic disorder. The major forms of thalassaemia result in death in utero of affected foetuses (α-thalassaemia) or life-long blood transfusions for survival in β-thalassaemia. This study, the first nationwide population based survey of thalassaemia in Malaysia, aimed to determine differences in public awareness, perceptions and attitudes toward thalassaemia in the multi-racial population in Malaysia.
    Matched MeSH terms: Cultural Diversity*
  13. Fulltext Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions
    Low WY, Wong YL, Zulkifli SN, Tan HM
    Int J Impot Res, 2002 Dec;14(6):440-5.
    PMID: 12494275
    This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45-70-y-old were conducted-two Malay groups (n=18), two Chinese groups (n=25) and two Indian groups (n=23). Participants were purposely recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation.
    Matched MeSH terms: Cultural Diversity*
  14. Observations on obstetric practice in a multicultural setting
    TambyRaja RL
    Matern Child Health J, 1999 Jun;3(2):111-3.
    PMID: 10892419
    Singapore provides a rich environment for investigations into ethnic differences in pregnancy outcome, as it is populated by Malays, Indians, and Chinese. Years of clinical practice and obstetric research in this environment have affirmed the observation that many factors interact in determining length of gestation and birth weight, and that these factors have differential affects among these three different ethnic groups. Although technological advances have furthered our understanding of obstetrical outcomes and provided essential tools to promote the survival of premature infants, the persistent use of uniform growth standards hampers our ability to assure positive outcomes for women of different ethnicity. Recognition of ethnic differences has resulted in declines in certain negative pregnancy outcomes for women in Singapore. The development of race-specific uterine growth curves will enhance the provision of perinatal care for all women.
    Matched MeSH terms: Cultural Diversity*
  15. Variation in the prevalence, awareness, and control of diabetes in a multiethnic population: a nationwide population study in Malaysia
    Rampal S, Rampal L, Rahmat R, Zain AM, Yap YG, Mohamed M, et al.
    Asia Pac J Public Health, 2010 Apr;22(2):194-202.
    PMID: 19443875 DOI: 10.1177/1010539509334816
    The purpose of this study was to determine the association between different ethnic groups and the prevalence, awareness, and control of diabetes in Malaysia. A population-based cross-sectional study using multistage sampling was conducted in Malaysia. Diabetes is defined as having a fasting blood glucose > or =7 mmol/L or a self-reported diabetic on treatment. Among the 7683 respondents aged > or =30 years, the prevalence of diabetes mellitus was 15.2% (95% CI = 14.1, 16.4). Multivariate analysis showed that compared with Malays, Chinese had lower odds (adjusted odds ratio [aOR] 0.71; 95% CI = 0.56, 0.91) and Indians had higher odds of having diabetes (aOR 1.54; 95% CI = 1.20, 1.98). The odds of diabetes increased with age, family history of diabetes, body mass index, and lower education levels. Among those with diabetes mellitus, 45.0% were aware and 42.7% were under treatment. Among treated diabetics, 25.1% had their fasting blood sugar under control. There is a significant association between prevalence of diabetes and different ethnic groups.
    Matched MeSH terms: Cultural Diversity
  16. Fulltext Strengthening the migrant-friendliness of Thai health services through interpretation and cultural mediation: a system analysis
    Kosiyaporn H, Julchoo S, Phaiyarom M, Sinam P, Kunpeuk W, Pudpong N, et al.
    Glob Health Res Policy, 2020 12 08;5(1):53.
    PMID: 33372646 DOI: 10.1186/s41256-020-00181-0
    BACKGROUND: In addition to healthcare entitlements, 'migrant-friendly health services' in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants. Although the Thai Government started implementing these services in 2003, challenges in providing them still remain. This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker (MHW) and migrant health volunteer (MHV) programmes in Thailand.

    METHODS: In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling. A total of fifty key informants were recruited, including MHWs, MHWs, health professionals, non-governmental organisation (NGO) staff and policy stakeholders. Data were triangulated using information from policy documents. The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes, roles and responsibilities of MHWs and MHVs, and supporting systems.

    RESULTS: The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services. MHWs mainly served as interpreters in public facilities, while MHVs served as cultural mediators in migrant communities. Operational challenges in providing services included insufficient budgets for employment and training, diverse training curricula, and lack of legal provisions to sustain the MHW and MHV programmes.

    CONCLUSION: Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants. To ensure the sustainability of current service provision, clear policy regulation and standardised training courses should be in place, alongside adequate and sustainable financial support from central government, NGOs, employers and migrant workers themselves. Moreover, regular monitoring and evaluation of the quality of services are recommended. Finally, a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.

    Matched MeSH terms: Cultural Diversity*
  17. Fulltext The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic Asian population
    Vaingankar JA, Subramaniam M, Chong SA, Abdin E, Orlando Edelen M, Picco L, et al.
    Health Qual Life Outcomes, 2011;9:92.
    PMID: 22040157 DOI: 10.1186/1477-7525-9-92
    Instruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.
    Matched MeSH terms: Cultural Diversity
  18. Crossing cultural boundaries: flexible approaches and nurse education: a case study
    McKenna LG, Samarawickrema RG
    Comput Inform Nurs, 2003 Sep-Oct;21(5):259-64.
    PMID: 14504602
    Computer-mediated conferencing commonly is used to promote collaborative learning, including student learning across distance. This article presents the outcomes and experiences of Master of Nursing students in three countries using flexible learning approaches facilitated by the use of computer-mediated conferencing. It examines issues relating to support for global nursing education, presents an evaluation of one particular unit, and presents themes in the feedback from students about their experience. The authors report the findings in three categories: broadened perspectives, tackling the technology, and adaptive learning. Furthermore, the article offers suggestions for enhancing student-learning experiences when computer-mediated conferencing facilities are used.
    Matched MeSH terms: Cultural Diversity*
  19. Research on culture-bound syndromes: new directions
    Guarnaccia PJ, Rogler LH
    Am J Psychiatry, 1999 Sep;156(9):1322-7.
    PMID: 10484940
    The unprecedented inclusion of culture-bound syndromes in DSM-IV provides the opportunity for highlighting the need to study such syndromes and the occasion for developing a research agenda to study them. The growing ethnic and cultural diversity of the U.S. population presents a challenge to the mental health field to develop truly cross-cultural approaches to mental health research and services. In this article, the authors provide a critique of previous analyses of the relationship between culture-bound syndromes and psychiatric diagnoses. They highlight the problems in previous classificatory exercises, which tend to focus on subsuming the culture-bound syndromes into psychiatric categories and fail to fully investigate these syndromes on their own terms. A detailed research program based on four key questions is presented both to understand culture-bound syndromes within their cultural context and to analyze the relationship between these syndromes and psychiatric disorders. Results of over a decade of research on ataques de nervios, a Latino-Caribbean cultural syndrome, are used to illustrate this research program. The four questions focus on the nature of the phenomenon, the social-cultural location of sufferers, the relationship of culture-bound syndromes to psychiatric disorders, and the social and psychiatric history of the syndrome in the life course of the sufferer.
    Matched MeSH terms: Cultural Diversity
  20. Fulltext From inclusion to pluralism: how can we expand the epistemic languages of global health storytelling?
    Nassiri-Ansari T, Rhule E
    Lancet Glob Health, 2023 Jul;11(7):e1009.
    PMID: 37349029 DOI: 10.1016/S2214-109X(23)00253-X
    Matched MeSH terms: Cultural Diversity*
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