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BackgroundMembership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.MethodsMEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.ResultsThirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider’s behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.ConclusionsConceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1953-x) contains supplementary material, which is available to authorized users.

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This article presents descriptive findings on sex workers’ structural disadvantage and their evaluation of the quality of their work, relative to their other jobs. In-person interviews were conducted in 2013 with sex workers ( n = 218) from Canada. Participants reported they experience precarity (i.e. uncertainty and instability) in employment and other domains of their lives. Compared to the work quality of their other jobs, the majority said sex work was more satisfying and granted greater control and money. In a context of low income and instability in employment, participants make strategic choices to engage in sex work, even when contending with its low social status. The article concludes that sex work should be recognized as valuable work for Canadian sex workers, given the circumstances of their lives under contemporary capitalism. The findings indicate a need for macro-level changes to challenge precarity in the economy and other societal institutions.

Introduction Research shows criminal code laws negatively affect the health and safety of sex workers and hinders their ability to access protective and other services. Less is known about sex workers' views on how to improve their occupational and broader social rights. This paper aims to help fill in this knowledge gap. Methods In 2017, a cross-section of active sex workers (N = 60) from Victoria, Canada, were interviewed about their personal and work lives under Canada's 2014 criminal code law, Bill C-36, the Protection of Communities and Exploited Persons Act (PCEPA). Thematic analysis was carried out using the participants' (n = 57) who answered these two open-ended questions: What changes are needed to improve health, safety and rights for sex workers? What would be your dream list of services sex workers need right now? Results Participants recommended elimination of Canada's criminal code law governing consensual sex work, and policy change in two main areas: (1) occupational health and safety and (2) access to non-judgmental protective, health, and other community services. Conclusion Sex workers are an important source of insight regarding the unintended consequences of the PCEPA and its stated commitment to improve their safety and ensure the protection of their occupational and social rights. Policy Implications Consensual adult sexual commerce should be decriminalized and governed by health and social welfare policies, just as other service jobs.