CONTEXT: Culturally sensitive interventions in the pediatric primary care setting may help reduce health disparities. Less is known on the development of these interventions, their target groups, and their feasibility, acceptability, and impact on health outcomes. OBJECTIVE: We conducted a systematic review to describe culturally sensitive interventions developed for the pediatric primary care setting. DATA SOURCES: PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (January 2000 to July 2020). STUDY SELECTION: Studies were eligible for inclusion if they were (1) original research on an intervention with an evaluation, (2) within a pediatric primary care setting, (3) not limited to education for providers, (4) not limited to interpreter use, and (5) based in the United States. DATA EXTRACTION: The following were extracted: study topic, study design, intervention, cultural sensitivity strategies and terminology, setting, target group, sample size, feasibility, acceptability, and health outcomes. RESULTS: Twenty-five studies described 23 interventions targeting a variety of health topics. Multiple cultural sensitivity strategies were used, most commonly sociocultural (83%). Most interventions (57%) were focused on Hispanic/Latino families. Interventions were generally reported as being feasible and acceptable; some also changed health outcomes. LIMITATIONS: Small samples and heterogenous methods subject to bias were used. Relevant articles may have been missed because of the variety of terms used to describe cultural sensitivity. CONCLUSIONS: The included articles provide preliminary evidence that culturally sensitive interventions can be feasible and effective and may help eliminate disparities for patients from communities with barriers to equitable care.
Adolescent relationship abuse (ARA) has well-documented detrimental health effects. Adolescence is a window of opportunity to promote development of healthy relationship behaviors. Although peer-led interventions have a history of use in the health education field, there are few rigorously evaluated peer-led interventions targeting ARA. Start Strong leverages peer support by training adolescents to deliver ARA prevention curriculum to younger peers. Although the program has shown positive results in recipients, little is known about the impact on the peer leaders themselves. This qualitative study describes the impact of being an ARA prevention peer leader on former peer leaders’ relationships and trajectories in emerging adulthood. Specific objectives include: (a) how being a peer leader shaped participants’ norms around romantic relationships and ARA, and (b) the impact of participating in a peer leadership program on their emerging adult lives. Researchers conducted semi-structured interviews with former peer leaders and coded transcripts using thematic analysis. Fourteen former peer leaders aged 18–26 participated. Most participants (99%) identified as Black or Afro-Latinx. Participants described a lasting impact on their relationships, identity formation, future orientation, and professional lives. Participants highlighted the skills they use to avoid unhealthy relationships and help friends and family navigate their relationships. They identified unexpected challenges, including a sense of isolation around how their relationship expectations differ from same-aged peers, and trepidation about dating partners without advanced healthy relationship knowledge. Participants highlighted positive impacts beyond those pertaining to relationships, including their identity development and expanded sense of opportunity. Finally, they identified tangible skills gained from program participation and relevance to their professional paths. This study suggests that peer-led ARA prevention programs have a far-reaching impact on participants’ lives that lasts into adulthood. Future studies may examine how professional development within peer-led interventions can influence future orientation and thus bolster protective factors against ARA.
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