Jann Murray-García

Bio: Jann Murray-García is an academic researcher from University of California, Davis. The author has contributed to research in topics: Health care & Multicultural education. The author has an hindex of 10, co-authored 14 publications receiving 2304 citations. Previous affiliations of Jann Murray-García include Children's Hospital Oakland & University of California, San Francisco.

Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education

Abstract: Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respect- fully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partner- ships with communities on behalf of individuals and defined populations.

Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization

Abstract: Background.Few studies have investigated the influence of race and/or ethnicity on patients' ratings of quality of care. None have incorporated patients' values and beliefs regarding medical care in assessing these possible differences.Objectives.We explored whether patients' values, ratings, and re

The institutional context of multicultural education: What is your institutional curriculum?

Abstract: Recently revised accreditation standards require medical schools and residency training programs to integrate multicultural training into their curricula. Most multicultural training models concern the educational outcomes of individual trainees who have received digestible "units" of multicultural education or "cultural competence" training designed for trainees' individual consumption. Few have taken a critical perspective on how an individual trainee must learn, change his or her behavior, and sustain that behavioral change within a specific institutional context. The authors discuss the educational impact of one's institutional learning environment--the institution's ethos, teachers, modeling, policies, and processes--on the multicultural education of physician trainees. A usable conceptual model is offered with which educators can identify those dimensions of one's "institutional curriculum" that may enhance or obstruct trainees' optimal learning and behavior change regarding issues of multiculturalism in medicine. Comparisons are drawn to the recent medical literature concerning professionalism education and the hidden curriculum. Distinctions are drawn between overlapping areas of planned, received, intended, and unintended learning and values, as communicated from faculty, attendings, and residents to students. Ways of maximizing ideal learning and minimizing unintended consequences are discussed. The goal is for medical educators to be able to ask, What is the institutional curriculum of my training program regarding issues of race, difference, etc? What elements of that institutional curriculum can be recaptured and reclaimed as consistent with and supportive of tenets of excellent patient care for all?

Self-reflection in multicultural training: be careful what you ask for.

Abstract: Self-reflection in multicultural education is an important means to develop self-awareness and ultimately to change professional behavior in favor of more equitable health care to diverse populations. As conceptualized by scholars in the field of psychology, racial identity theory is critical to understanding and planning for the potentially wide range of predictable reactions to provocative activities, including those negative reactions that do not necessarily herald a flaw in programming. Careful consideration of racial identity developmental phases can also assist program planners to optimally meet the needs of individual physician trainees in their ongoing constructive professional and personal development, and in strategically mobilizing and having ready the type of institutional leadership that supports trainees' change processes. The authors focus on white physician trainees, the largest racial group of U.S. physicians and medical students. They first explain what they mean by the terms white and nonwhite. Racial identity theory is then applied, with true case examples, to explore such issues as where the self-proclaimed "color-blind" trainee fits into this theoretical schema, and how medical educators can best serve trainees who are resistant or indifferent to discussions of racism in medicine and equity in health care delivery. Ultimately, the authors' goal is to demonstrate that engendering genuine self-reflection can substantively improve the delivery of health care to the nation's diverse population. To help achieve that goal, they emphasize what to anticipate in effecting optimal trainee education and how to create an institutional climate supportive of individual change.

Dialogue as skill: training a health professions workforce that can talk about race and racism.

Abstract: Efforts in the field of multicultural education for the health professions have focused on increasing trainees' knowledge base and awareness of other cultures, and on teaching technical communication skills in cross-cultural encounters. Yet to be adequately addressed in training are profound issues of racial bias and the often awkward challenge of cross-racial dialogue, both of which likely play some part in well-documented racial disparities in health care encounters. We seek to establish the need for the skill of dialoguing explicitly with patients, colleagues, and others about race and racism and its implications for patient well-being, for clinical practice, and for the ongoing personal and professional development of health care professionals. We present evidence establishing the need to go beyond training in interview skills that efficiently "extract" relevant cultural and clinical information from patients. This evidence includes concepts from social psychology that include implicit bias, explicit bias, and aversive racism. Aiming to connect the dots of diverse literatures, we believe health professions educators and institutional leaders can play a pivotal role in reducing racial disparities in health care encounters by actively promoting, nurturing, and participating in this dialogue, modeling its value as an indispensable skill and institutional priority.

Contribution of Primary Care to Health Systems and Health

Abstract: Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

Abstract: OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. RESULTS: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. CONCLUSIONS: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

Using Community-Based Participatory Research to Address Health Disparities

Abstract: Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.

Methods For Community - Based Participatory Research For Health

Abstract: Figures and Tables. Foreword (David Satcher). Acknowledgments. The Editors. The Contributors. PART ONE: INTRODUCTION TO METHODS IN COMMUNITY-BASED PARTICIPATORY RESEARCH FOR HEALTH. 1. Introduction to Methods in Community-Based Participatory Research for Health (Barbara A. Israel, Eugenia Eng, Amy J. Schulz, and Edith A. Parker). PART TWO: PARTNERSHIP FORMATION AND MAINTENANCE. 2. Developing and Maintaining Partnerships with Communities (Nina Wallerstein, Bonnie Duran, Meredith Minkler, and Kevin Foley). 3. Strategies and Techniques for Effective Group Process in CBPR Partnerships (Adam B. Becker, Barbara A. Israel, and Alex J. Allen III). PART THREE: COMMUNITY ASSESSMENT AND DIAGNOSIS. 4. Insiders and Outsiders Assess Who Is "The Community": Participant Observation, Key Informant Interview, Focus Group Interview, and Community Forum (Eugenia Eng, Karen Strazza Moore, Scott D. Rhodes, Derek M. Griffith, Leo L. Allison, Kate Shirah, and Elvira M. Mebane). PART FOUR: DEFINITION OF THE ISSUE. 5. CBPR Approach to Survey Design and Implementation: The Healthy Environments Partnership Survey (Amy J. Schulz, Shannon N. Zenk, Srimathi Kannan, Barbara A. Israel, Mary A. Koch, and Carmen A. Stokes). 6. Using a CBPR Approach to Develop an Interviewer Training Manual with Members of the Apsaalooke Nation (Suzanne Christopher, Linda Burhansstipanov, and Alma Knows His Gun-McCormick). 7. The Application of Focus Group Methodologies to Community-Based Participatory Research (Edith C. Kieffer, Yamir Salabarria-Pena, Angela M. Odoms-Young, Sharla K. Willis, Kelly E. Baber, and J. Ricardo Guzman). 8. Application of CBPR in the Design of an Observational Tool: The Neighborhood Observational Checklist (Shannon N. Zenk, Amy J. Schulz, James S. House, Alison Benjamin, and Srimathi Kannan). 9. Mapping Social and Environmental Influences on Health: A Community Perspective (Guadalupe X. Ayala, Siobhan C. Maty, Altha J. Cravey, and Lucille H. Webb). 10. Community-Based Participatory Research and Ethnography: The Perfect Union (Chris McQuiston, Emilio A. Parrado, Julio Cesar Olmos-Muniz, and Alejandro M. Bustillo Martinez). 11. What's with the Wheezing? Methods Used by the Seattle-King County Healthy Homes Project to Assess Exposure to Indoor Asthma Triggers (James Krieger, Carol A. Allen, John W. Roberts, Lisa Carol Ross, and Tim K. Takaro). PART FIVE: DOCUMENTATION AND EVALUATION OF PARTNERSHIPS. 12. Documentation and Evaluation of CBPR Partnerships: In-Depth Interviews and Closed-Ended Questionnaires (Barbara A. Israel, Paula M. Lantz, Robert J. McGranaghan, Diana L. Kerr, and J. Ricardo Guzman). PART SIX: FEEDBACK, INTERPRETATION, DISSEMINATION, AND APPLICATION OF RESULTS. 13. Developing and Implementing Guidelines for Dissemination: The Experience of the Community Action Against Asthma Project (Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell, Katherine K. Edgren, and Donele J. Wilkins). 14. Creating Understanding and Action Through Group Dialogue (Elizabeth A. Baker and Freda L. Motton). 15. Photovoice as a Community-Based Participatory Research Method: A Case Study with African American Breast Cancer Survivors in Rural Eastern North Carolina (Ellen D. S. Lopez, Eugenia Eng, Naomi Robinson, and Caroline C. Wang). 16. Policy Analysis and Advocacy: An Approach to Community-Based Participatory Research (Nicholas Freudenberg, Marc A. Rogers, Cassandra Ritas, and Sister Mary Nerney). 17. Citizens, Science, and Data Judo: Leveraging Secondary Data Analysis to Build a Community-Academic Collaborative for Environmental Justice in Southern California 371 Rachel Morello-Frosch, Manuel Pastor Jr., James L. Sadd, Carlos Porras, and Michele Prichard APPENDIXES. A. Instructions for Conducting a Force Field Analysis (Adam B. Becker, Barbara A. Israel, and Alex J. Allen III). B. Community Member Key Informant Interview Guide (Eugenia Eng, Karen Strazza Moore, Scott D. Rhodes, Derek M. Griffith, Leo L. Allison, Kate Shirah, and Elvira M. Mebane). C. Selected New and Revised Items Included in the HEP Survey After Input from the Steering Committee or Survey Subcommittee (SC), Focus Group Themes (FG), or Pilot Testing (PT) of Existing Items (Amy J. Schulz, Shannon N. Zenk, Srimathi Kannan, Barbara A. Israel, Mary A. Koch, and Carmen A. Stokes). D. Selected HEP Measures by Survey Categories, with Sources and Scale Items (Amy J. Schulz, Shannon N. Zenk, Srimathi Kannan, Barbara A. Israel, Mary A. Koch, and Carmen A. Stokes). E. Healthy Environments Partnership: Neighborhood Observational Checklist (Shannon N. Zenk, Amy J. Schulz, James S. House, Alison Benjamin, and Srimathi Kannan). F. Field Notes Guide (Chris McQuiston, Emilio A. Parrado, Julio Cesar Olmos, and Alejandro M. Bustillo Martinez). G. Detroit Community-Academic Urban Research Center: In-Depth, Semistructured Interview Protocol for Board Evaluation, 1996-2002 (Barbara A. Israel, Paula M. Lantz, Robert J. McGranaghan, Diana L. Kerr, and J. Ricardo Guzman). H. Detroit Community-Academic Urban Research Center: Closed-Ended Survey Questionnaire for Board Evaluation, 1997-2002 (Barbara A. Israel, Paula M. Lantz, Robert J. McGranaghan, Diana L. Kerr, and J. Ricardo Guzman). I. Philosophy and Guiding Principles for Dissemination of Findings of the Michigan Center for the Environment and Children's Health (MCECH) Including Authorship of Publications and Presentations, Policies and Procedures, Access to Data, and Related Matters (Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell, Katherine K. Edgren, and Donele J. Wilkins). J. Community Action Against Asthma: Fact Sheet on "Particulate Matter" (Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell, Katherine K. Edgren, and Donele J. Wilkins). K. Community Action Against Asthma: Summary of Air Sampling Data in Your Community and Home, 2000-2001 (Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell, Katherine K. Edgren, and Donele J. Wilkins). L. The Planning Grant: In-Depth Group Interview Protocol: Questions for Community and Coalition Members (Elizabeth A. Baker and Freda L. Motton). M. Inspirational Images Project: Fact Sheet and Informed Consent Form for Study Participants (Ellen D. S. Lopez, Eugenia Eng, Naomi Robinson, and Caroline C. Wang). N. Inspirational Images Project: Consent for Adults Who May Appear in Photographs (Ellen D. S. Lopez, Eugenia Eng, Naomi Robinson, and Caroline C. Wang). O. Community Reintegration Network: Policy Report-Coming Back to Harlem from Jail or Prison: One-Way or Round-Trip (Nicholas Freudenberg, Marc A. Rogers, Cassandra Ritas, and Sister Mary Nerney). P. Southern California Environmental Justice Collaborative (the Collaborative): Partnership Agreed upon Mechanism for Deciding on Research Activities (Communities for a Better Environment, Liberty Hill Foundation, and The Research Team). Name Index. Subject Index.