Despite clear evidence of the adverse health impacts of unsafe child feces disposal (CFD), there is little evidence of the effectiveness of interventions targeting the improvement of unsafe CFD practices in this region. A systematic review of the literature was conducted to identify and evaluate the quality of both behavior change and hardware interventions targeting the improvement of CFD practices in the Asia-Pacific region. A total of 695 articles were screened, and 11 studies were included. The combined hardware and behavior change interventions reported the highest rates of safe CFD (SCFD) post-intervention; however, these interventions were of lower quality. Four interventions focused specifically on improving SCFD practices, while the remaining seven studies evaluated the impacts of large-scale interventions, such as India's MANTRA and Total Sanitation Campaign programs, on unsafe CFD practices. Large-scale programs and hardware interventions are important for providing communities with the infrastructure necessary to improve unsafe CFD practices, but such interventions may be improved by the addition of a behavioral change component. With little evidence available on the effectiveness of behavioral interventions on reducing unsafe CFD in the Asia-Pacific region, future work should focus on how behavior change models combined with hardware interventions impact unsafe CFD.

BackgroundPatient-centered communication has been shown to improve compliance and health care outcomes. Recently, it has been suggested that the cultural competence of physicians can impact their ability to effectively communicate with a patient. Our study examines the relationship between patient race, patients' perceptions of the physician's patient-centered communication skills and cultural competence.MethodsThe CCTOP study (Cultural Competency Training and Outcomes in Patients) is a multicenter, cross-sectional study of patients' and physicians' attitudes regarding culture, bias, and clinical care. A 76-item questionnaire was administered to 167 patients. We performed a bivariate analysis of patients' perception of their autonomy in making medical decisions and their doctors' understanding of their culture. We then constructed regression models with patients' perceptions of physicians' communication skills as the outcome with race as the independent variable of interest while controlling for education, income, age, gender, and perceptions of physicians' cultural awareness as possible confounders.ResultsWe report preliminary data based on 167 patients surveyed: 72.5% female, 27.5% male. In terms of race, the patients were 28.7% white, 44.3% African-American, and 22.3% Hispanic. Seventy-seven percent of patients who felt their doctors are aware of their cultural beliefs believed that their doctors gave them some control regarding treatment decisions as opposed to only 58.7% of those who felt their doctor is unaware of their cultural beliefs (OR 5.44, p = .02). Logistic regression analysis adjusting for age, gender, income, and education showed that patients who felt that their doctor understands their culture remained 2.5 times (p = .046) more likely to feel that their doctor gave them some control over treatment decisions. Furthermore, white patients were approximately 4 times more likely to feel that their doctor gave them this autonomy compared to African-American (OR 0.25, p = .017) and Hispanic patients (OR 0.22, p = .022).ConclusionsThese preliminary findings suggest that minority patients are less likely to feel that they have some control in making decisions regarding treatment options. In addition, patients who feel that their doctors understand their culture perceive a greater sense of autonomy in making treatment decisions.

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