The majority of existing theoretical models and tools of culturally competent and congruent care have been developed from the health care provider perspective. Recently, the Culturally Congruent Care Puzzle proposed a model in the form of a three-dimensional puzzle with a provider level and a client level that interact to create the outcome level, which is culturally congruent care. However, the constructs that comprise the client, or patient, level, have not yet been clearly articulated. This study explored parent (client/patient) perceptions of culturally congruent care within a tertiary neonatal intensive care unit based on interviews with culturally diverse families with hospitalized infants (n = 21). The findings identified four primary constructs in the client/patient level: (a) a provider-client relationship of caring and trust, (b) respectful and appropriate communication, (c) culturally responsive and accessible social and spiritual supports, and (d) a welcoming and flexible organizational environment. These four interconnecting pieces are infused with the sociopolitical history and dynamics of culture, ethnicity, immigration, and colonization that clients/patients bring to their experience of health and health care. These elements of the client/patient level also interact with the provider level in various ways.
Technology has been viewed as a means to improve the quality of education for children globally, particularly in remote and marginal communities. This study examines the comparative advantages of the use of appropriate technology (off-line servers with digital libraries connected to a classroom set of laptops) in ten intervention schools in Indigenous communities in Guatemala for one school year. The study was too short (due to pandemic restrictions) to demonstrate statistically significant differences for learning outcomes. However, using an instructional core model as a framework, qualitative findings supported four previously identified comparative advantages, and identified four additional ones relevant to remote Indigenous communities. The intervention validated the ability of technology to improve standardized instruction, differentiated instruction, opportunities for practice, and learner engagement. Newly identified advantages are: access to high-quality educational resources (substitution for print materials), teacher capacity-building, student technical skills and digital literacy, and sharing cultural knowledge.
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