Sweet talking to ethnic customers : a field experiment on the links between entrepreneurial business planning, cultural sensitivity and sales growth

The purpose of this study was to test whether calculated inclusion of cultural sensitivity in a selected entrepreneurial business planning (EBP) process could increase sales growth in a test market and to explore the implications of a positive answer for the theory and practice of entrepreneurial business planning. Execution of a pretest-posttest control group experimental design measured and compared the implemented effectiveness of a planned entrepreneurial initiative based on cultural sensitivity. Though small in scale and limited in focus, the initiative qualified as an example of entrepreneurial business planning (EBP) and could be used to apply, test and extend aspects of the developing theory in this field of entrepreneurship research. Since the initiative was planned to overcome a culturally-defined impediment to business growth, it also offered opportunity to explore the specific importance of cultural variables in the context of EBP.

A planned sales-promotion was offered to a control group (receiving information in English) and a treatment group (who received the information in the language of ethnic origin). The sixty subjects had been chosen at random from a population of route-trade retailers of defined ethnic origins (Greek, Lebanese and Chinese) and randomly assigned to control and treatment groups. Monthly sales averages of the promoted product were measured before and after treatment. A Chi Square test was used to evaluate the relative proportion of the control and treatment groups who accepted the promotional offer. A two sample t-test procedure and complementary non-parametric Mann-Whitney test were performed to compare the mean sales-performance change of the two groups. Analysis showed that there was a significant increase in mean sales when the planned entrepreneurial initiative was communicated in the relevant language of origin.

The experimental results have specific practical relevance to revitalising the deteriorating route-trade segment of the Australian confectionery market through increasing the sales growth of wholesalers who are prepared to act entrepreneurially and include cultural sensitivity as an element in planning and implementation. By introducing cultural sensitivity as a necessary extension of a plan’s communications role, the results also have general theoretical implications for the developing paradigm of entrepreneurial business planning.

Ensuring cultural sensitivity for Muslim patients in the Australian ICU: considerations for care

Australia is a diverse and multicultural nation, made up of a population with a predominant Christian faith. Islam, the second largest religion in the world, has demonstrated significant growth in Australia in the last decade. Coming from various countries of origin and cultural backgrounds, Muslim beliefs can range from what is considered ‘traditional’ to very ‘liberal’.

It is neither possible nor practical for every intensive care clinician to have an intimate understanding of Islam and Muslim practices, and cultural variations amongst Muslims will mean that not all beliefs/practices will be applicable to all Muslims. However, being open and flexible in the way that care is provided and respectful of the needs of Muslim patients and their families is essential to providing culturally sensitive care.

This discussion paper aims to describe the Islamic faith in terms of Islamic teachings, beliefs and common practices, considering how this impacts upon the perception of illness, the family unit and how it functions, decision-making and care preferences, particularly at the end of life in the intensive care unit.

Navigating the ethics of cross-cultural health promotion research

Health promotion researchers must consider the ethics of their research, and are usually required to abide by a set of ethical requirements stipulated by governing bodies (such as the Australian National Health and Medical Research Council) and human research ethics committees (HRECs). These requirements address both deontological (rule-based) and consequence-based issues. However, at times there can be a disconnect between the requirements of deontological issues and the cultural sensitivity required when research is set in cultural contexts and settings etic to the HREC. This poses a challenge for health promotion researchers who must negotiate between meeting both the requirements of the HREC and the needs of the community with whom the research is being conducted. Drawing on two case studies, this paper discusses examples from cross-cultural health promotion research in Australian and international settings where disconnect arose and negotiation was required to appropriately meet the needs of all parties. The examples relate to issues of participant recruitment and informed consent, participants under the Australian legal age of consent, participant withdrawal when this seemingly occurs in an ad hoc rather than a formal manner and reciprocity. Although these approaches are context specific, they highlight issues for consideration to advance more culturally appropriate practice in research ethics and suggest ways a stronger anthropological lens can be applied to research ethics to overcome these challenges.

Cultural respect encompassing simulation training: being heard about health through broadband

BACKGROUND: Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations. DESIGN AND METHODS: In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. RESULTS: Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. CONCLUSIONS: Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals' learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.

Using mixed-methods to investigate student teacher learning outcomes

The Deakin University Faculty of Arts and Education’s Global Experience Program (GEP) aims to “develop the knowledge, cultural sensitivity and skills needed to address diversity within the educational environment” among student teachers (Deakin, 2009). This research aims to investigate the short term student teacher learning outcomes from their participation in the program through their perceptions and real-life international teaching experiences. The data are collected using mixed-methods to get breadth and in-depth insights on learning outcomes. The survey was conducted to investigate student teacher perceptions on their professional and cultural learning using a Likert scale, while an ethnographic case study was intended to reveal the real-life student teachers learning outcomes from their participation in the GEP in Vanuatu.

How Australian and New Zealand schools of optometry prepare students for culturally competent practice

Background: This study is an investigation of how Australian and New Zealand schools of optometry prepare students for culturally competent practice. The aims are: (1) to review how optometric courses and educators teach and prepare their students to work with culturally diverse patients; and (2) to determine the demographic characteristics of current optometric students and obtain their views on cultural diversity. Methods: All Australian and New Zealand schools of optometry were invited to participate in the study. Data were collected with two surveys: a curriculum survey about the content of the optometric courses in relation to cultural competency issues and a survey for second year optometry students containing questions in relation to cultural awareness, cultural sensitivity and attitudes to cultural diversity. Results: Four schools of optometry participated in the curriculum survey (Deakin University, Flinders University, University of Melbourne and University of New South Wales). Sixty-three students (22.3 per cent) from these four schools as well as the University of Auckland participated in the student survey. Cultural competency training was reported to be included in the curriculum of some schools, to varying degrees in terms of structure, content, teaching method and hours of teaching. Among second year optometry students across Australia and New Zealand, training in cultural diversity issues was the strongest predictor of cultural awareness and sensitivity after adjusting for school, age, gender, country of birth and language other than English. Conclusion: This study provides some evidence that previous cultural competency-related training is associated with better cultural awareness and sensitivity among optometric students. The variable approaches to cultural competency training reported by the schools of optometry participating in the study suggest that there may be opportunity for further development in all schools to consider best practice training in cultural competency. © 2014 Optometrists Association Australia.

Building healthcare workers' confidence to work with same-sex parented families.

This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

BACKGROUND: It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness.

METHODS: A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37-41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members' satisfaction with the research method, participants were invited to provide their feedback after the final survey.

RESULTS: From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists.

CONCLUSION: Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a mental health crisis.

The effect of emotions in cross-cultural expatriate experiences

With increased recognition of the existence of emotions in everyday interpersonal interactions, the need for emotions in cross-cultural interactions has become more obvious. Emotions play an important role in cross-cultural expatriate interactions as these experiences are essentially social encounters. Yet, little research addresses the emotions felt and the emotional demands involved in the cross-cultural interaction. Research on expatriate experiences centres solely on the cross-cultural training, sensitivity, and adaptability of expatriates. What fails to be addressed, however, is the emotional aspect of this interaction. In this paper, we examine the cross-cultural expatriate experience, integrating both the cultural and emotional aspects of the interaction. In doing so, we aim to advance understanding of the expatriate experience and the potential reasons underlying expatriate success and failure.

An investigation into the cross-cultural equivalence of the personal wellbeing index

The Personal Wellbeing Index (PWI) is being developed for the cross-cultural measurement of subjective wellbeing (SWB). This paper reports the findings of its utility with the Hong Kong Chinese and Australian populations. An item on affect, ‘satisfaction with own happiness’ was also investigated to determine whether it should be added to the index. Three-hundred and sixty participants (180 per country), with equal representation from groups aged 18–35, 35–64 and 65 years and above, were recruited from each country. The PWI demonstrated good psychometric performance in terms of its reliability, validity and sensitivity, which are comparable in both countries. The item ‘satisfaction with own happiness’ was found to contribute significantly to the scale’s psychometric performance in Australia but not in Hong Kong. Cultural differences in the perception of the concepts ‘satisfaction’ and ‘happiness’ were suggested as an explanation for this finding. The PWI data are also consistent with homeostasis theory, which proposes that each person’s SWB level is maintained within a limited positive range. For the Australian population, their mean SWB level fell within the established Western range of 70–80, on a scale from 0 to 100. The Hong Kong population, however, fell below this range. Cultural response bias was identified as a plausible explanation for the differences between the Hong Kong and Australian samples.

Cultural adaptation and validation of the Health Literacy Questionnaire (HLQ): robust nine-dimension Danish language confirmatory factor model

Health literacy is an important construct in population health and healthcare requiring rigorous measurement. The Health Literacy Questionnaire (HLQ), with nine scales, measures a broad perception of health literacy. This study aimed to adapt the HLQ to the Danish setting, and to examine the factor structure, homogeneity, reliability and discriminant validity. The HLQ was adapted using forward-backward translation, consensus conference and cognitive interviews (n = 15). Psychometric properties were examined based on data collected by face-to-face interview (n = 481). Tests included difficulty level, composite scale reliability and confirmatory factor analysis (CFA). Cognitive testing revealed that only minor re-wording was required. The easiest scale to respond to positively was 'Social support for health', and the hardest were 'Navigating the healthcare system' and 'Appraisal of health information'. CFA of the individual scales showed acceptably high loadings (range 0.49-0.93). CFA fit statistics after including correlated residuals were good for seven scales, acceptable for one. Composite reliability and Cronbach's α were >0.8 for all but one scale. A nine-factor CFA model was fitted to items with no cross-loadings or correlated residuals allowed. Given this restricted model, the fit was satisfactory. The HLQ appears robust for its intended application of assessing health literacy in a range of settings. Further work is required to demonstrate sensitivity to measure changes.