1. How do patient beliefs and attitudes affect their pattern of consulting?

2. Culture:  Culture -- the shared values, beliefs, and behaviours of members of a group -- influences the presentation of symptoms by patients, the decisions of physicians, and the patient's receptivity to recommendations.

3. Cultural Competence  Cultural competence is, the set of behaviours, attitudes and policies that come together in an institution, agency, or among a group of individuals, that allows them to work effectively in cross- cultural situations.

4. The need for cultural competence can be justified for several reasons: 1) perception of illness, disease and their causes varies by culture;  2) cultural influences affect help seeking behaviours and attitudes toward health care providers;  3) individual preferences and culture that affect traditional and non-traditional approaches to health care;  4) patients having personal experiences of biases within health care systems;  5) environmental conditions influencing cultural practices, beliefs, and perceptions;

5. Assessment and comparison of culturally based explanations for mental disorder among Singaporean Chinese youth. Asian populations underutilize professional mental health treatment partly because of their endorsement of supernatural causation models to explain mental disorders, beliefs that stem from their religious backgrounds.

6. Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction.  age,  waiting for symptoms to go away,  anxiety due to symptom presentation,  others' responses to patients' symptoms.

7. African American women's beliefs about mental illness, stigma, and preferred coping behaviours.  women believed that mental illness is caused by several factors, including family-related stress and social stress due to racism, is cyclical, and has serious consequences, but can be controlled by treatment.  Participants endorsed low perceptions of stigma.  Major preferred coping strategies included praying and seeking medical and mental health care.  Age differences were found in all variables except stigma.

8. Understanding cultural barriers in hepatitis B virus infection. Barriers to care among the Asian American population include:  educational deficits,  low socioeconomic status,  lack of health insurance,  noncitizenship,  inability to communicate in English,  negative perceptions of Western medicine,  underrepresentation among health care professionals.  The resulting delays in seeking care can lead to poor outcomes and risk of HBV transmission to household members.

9. References:  Assessment and comparison of culturally based explanaations for mental disorder among Singaporean Chinese youth.  Int J Soc Psychiatry. Matthews, M. 2009 Sep 17. [Epub ahead of print]  Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction.J Nurs Scholarsh. 2009;41(3):260-7.  Khraim FM, Scherer YK, Dorn JM, Carey MG. Khraim FMScherer YKDorn JMCarey MG  School of Nursing, State University of New York at Buffalo, NY, USA. fadikhraim@sandiego.edu fadikhraim@sandiego.edu  African American women’s beliefs about mental illness, stigma, and preferred coping behaviours. Ward EC, HEIDRICH sm. Res Nurs Health. 2009 Oct; 32 (5): 480-92  Understanding cultural barriers in hepatitis B virus infection. Tran TT.Cleve Clin J Med. 2009 May; 76 Suppl 3 :S 10-3  Health-Seeking Behaviour in Ethnic Populations Gibbs, Tyson, & Lurie, Sue GenaGibbsLurie  articles that explore help-seeking behaviour within various social and cultural contexts.  emphasizes their impact on understanding the cultural and social influences of how individuals respond to ill health.