Intercultural competence in Healthcare Higher Education: Adapting UNESCO Story Circles method in medical education

doi:10.21203/rs.3.rs-3196527/v1

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Intercultural competence in Healthcare Higher Education: Adapting UNESCO Story Circles method in medical education

https://doi.org/10.21203/rs.3.rs-3196527/v1

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The importance for culturally competent healthcare systems that can adapt and meet the needs of changing populations while accommodating cultural, religious, linguistic and gender diversity is becoming increasingly important around the world. Story Circles is a practical intercultural tool designed by UNESCO for developing and practicing intercultural competencies that can be used with different groups of people in a variety of settings. The healthcare training, where patients and healthcare providers are brought together in understanding each other’s perspectives and cultural contexts, is one of the specific contexts in which Story Circles can be used to develop individuals’ intercultural competencies. Story Circles is a tool that gives participants the opportunity to practice intercultural competencies, especially “listening for understanding”; considering that listening is considered a key skill in healthcare. We adapted the UNESCO Story Circles methodology to the specific experiences of undergraduate medical students to include discipline-specific prompts related to healthcare settings. 35 students participated in the activity and completed the final questionnaire. The findings corroborate positive reviews by all participants, and the proposal of Story Circle methodology as a complementary training activity for them to achieve intercultural competencies as well as the practice of “listening for understanding” was highly appreciated by all the participants.

Story Circles

intercultural competences

healthcare

higher education

medical education

UNESCO

International migration is a current and growing phenomenon, which has brought new challenges to the healthcare systems. According to World Migration Report 2022, the current global estimate is that there were around 281 million international migrants in the world in 2020, which equates to 3.6 per cent of the global population. Overall, the estimated number of international migrants has increased over the past five decades. The total estimated 281 million people living in a country other than their countries of birth in 2020 was 128 million more than in 1990 and over three times the estimated number in 1970 (McAuliffe and Triandafyllidou, 2021).

The importance of culturally competent healthcare systems that can adapt and respond to the needs of a changing population while considering cultural, religious, linguistic and gender diversity, is becoming increasingly important around the world. Besides, One of the long-term challenges for both refugee and migrant health system is the cultural and linguistic barriers impeding access to health care (World Health Organization, 2018). In this sense, a High-level Meeting on Refugee and Migrant Health in the WHO European Region was held in 2015, in which Member States agreed on the need for “a common framework for collaborative action on refugee and migrant health, acting in a spirit of solidarity and mutual assistance, to promote a common response, thereby avoiding uncoordinated single-country solutions”. During that meeting it was noted that “refugee and migrant communities and civil society should be involved in order to enhance the cultural, religious, linguistic and gender sensibilities of health services and to support the health workforce” (World Health Organization, 2018).

According to the Organization for Security and Co-operation in Europe (n.d.), health is an integral part of well-being and influences how a person contributes to society. Healthier immigrants can work more, earn more and build wider social networks. Deeper integration improves health outcomes as migrants have more access to medical care when they need it. Immigrants generally need to be healthy to migrate, so they tend to be healthier than nonimmigrants. The so-called “health migrant effect” diminishes with time spent in the host country. Quality of life in the country of origin, the migration process itself, and working and living conditions in the receiving country also influence the health impact of migrants. Some immigrant groups, such as refugees, are particularly vulnerable and may be susceptible to certain diseases and mental disorders. The migration experience itself can be stressful and can affect subsequent health status of migrants in different ways, depending on the socioeconomic conditions and health status of the country of origin and the degree of settlement in the receiving country.

Migration, ethnic and cultural diversity, health and healthcare are closely related in many ways. Global migration, globalization, and the expansion of Europe are also making European communities more diverse at the local level. The current situation therefore poses a major challenge for health providers and their staff. At the same time, it is becoming more diverse, which means opportunities, resources and additional challenges for hospital organizations. To address these challenges, a group of hospitals from 12 European countries came together as pilot hospitals to participate in the Migrant Friendly Hospital (MFH) project (European Commission, 2004). Based on the experiences of the MFH project partners, international discussions and the scientific literature, some crucial points for the successful development of services and organizational cultures were identified, and for the purpose of this article we would like to highlight the following two recommendations: a) Professionals and other staff will have to build capacities concerning cross-cultural and communicative and diversity-related competencies; and b) Clinical practice, preventive services and health promotion action should be appropriately tailored for use with diverse populations. Preventive services and health promotion that rely strongly on communicative interventions especially rely on cultural and linguistic competencies of professionals.

It is very important to overcome the difficulties arising from linguistic, cultural and religious differences in our increasingly diverse societies. The development of intercultural competences within the healthcare system becomes essential and the healthcare higher education acquires a fundamental role.

Story Circles is a practical intercultural tool designed by UNESCO for developing and practicing intercultural competencies that can be used with different groups of people in a variety of settings. The healthcare training, where patients and healthcare providers are brought together in understanding each other’s perspectives and cultural contexts, is one of the specific contexts in which Story Circles can be used to develop individuals’ intercultural competencies.

In this research we adapted the UNESCO Story Circles methodology to the specific experiences of our undergraduate medical students to include discipline-specific prompts related to healthcare settings.

Intercultural competence in Healthcare Higher Education

As health professions educators, it is important to identify what teaching tools are effective to achieve intercultural competencies in medical students. Training should consider knowledge about culture (facts and cultural traits), specific skills (behaviours), awareness about self and others, and the development of cultural intelligence (including linguistic, spatial, intra- and inter-personal intelligence) (Peterson, 2004). “Effective learning requires not only factual knowledge, but the organization of these facts and ideas in a conceptual framework and the ability to retrieve knowledge for application and transfer to different contexts.” The experiential learning model describes this cyclical approach to learning and developing expertise. “Space needs to be created in curricula for students to pursue such deep experiential learning in order to develop expertise” related to their life and career goals (Kolb & Kolb, 2005).

Experiential learning is described as learning activities which directly engage the learner in the phenomenon being studied and provide opportunities for reflection on those experiences (Cantor, 1995). We believe that this experiential learning can be delivered in a Story Circles experience on intercultural competencies.

There are numerous reasons to integrate cultural and linguistic competency in research and teaching. Two reasons of great importance to mother and child health (MCH) training programs include evidence that cultural and linguistic competence: (a) improves access, utilization, and quality of care; and (b) is an effective approach in reducing health care disparities among diverse populations (Goode, Dunne & Bronheim, 2006).

Numerous studies have provided the evidence to support the efficacy of cultural and linguistic competence education for health care providers and public health professionals. Studies have demonstrated positive impact on health care provider knowledge, attitudes, and skills as well as the satisfaction of patients who interact with those providers (Beach, Price, Gary et al., 2005).

Like other professional competencies expected of MCH leaders, cultural and linguistic competence requires direct instruction. Current research indicates that this set of competencies can be developed through educational interventions (Like, 2011).

Ultimately, the goal of cultural competence is to create a healthcare system and workforce that can deliver the highest quality of care to every patient, regardless of race, ethnicity, culture, or language proficiency. Such a system would be equitable, of high quality, and free of disparities based on individual patient characteristics (Betancourt & Green, 2007).

Story Circles background and methodology

In 2013, UNESCO launched the publication Intercultural Competencies: Conceptual and Operational Framework (UNESCO, 2013), that provides a comprehensive overview of the importance of developing the capacities to manage growing cultural diversity and clarifying key related concepts and their operational interlinkages. The Manual for Developing Intercultural Competencies helps sensitize diverse audiences to key intercultural competencies, including listening for understanding, respect, cultural curiosity, empathy, and reflexivity.

Darla K. Deardorff is a research scholar at Duke University, author of 8 books and over 50 articles and book chapters, founder of ICC Global and the World Council on Intercultural and Global Competence, affiliated faculty at numerous institutions around the world, and frequently invited speaker and consultant. Based on Dr. Darla K. Deardorff research, the Story Circle (SC) methodology was identified and adapted for the purposes of developing a human rights–based approach to intercultural competencies.

SC are an approach to developing intercultural competences through sharing and reflecting on personal experiences in a group setting. They are a structured yet adaptable tool that focuses on fundamental elements of intercultural competencies development, including respect, listening, curiosity, self- and other awareness, reflection, sharing, empathy, and relationship building.

SC operate on two presuppositions: 1) We are all interconnected through human rights; 2) Each person has inherent dignity and worth. And in addition to the two presuppositions, it is important to remember that: a) Every person has personal experience that can be shared; b) We all have something to learn from others and c) Listening for understanding is transformational, in the sense that one is able to gain new perspectives as well as learn to listen for understanding instead of listening for response or judgment, which is most often the case (Deardorff, 2020).

The Manual for developing intercultural competencies, Story Circles (The Manual) mentions the goals related to intercultural competencies development and communicating across difference: demonstrate respect for others; practice listening for understanding; cultivate curiosity about similarities and differences with others; gain increased cultural self-awareness; develop empathy; engage in critical reflection of one’s own intercultural competencies development, as well as on the intercultural experience; and develop relationships with culturally different others (Deardorff, 2020).

The SC are guided by at least one facilitator that will ask some specific questions to motivate the participants to share personal experiences. In our research, the experience was carried out with the participation of two facilitators. One of the facilitators was dedicated to research on intercultural competencies and global citizenship, and the other one was the actual students' head professor of ophthalmology.

In our research we focused on the formal intercultural learning approach offering a learning tool in a classroom activity of a Medical Higher Education institution. The intention of these SC was to help participants recognize their similarities and differences with others and thus facilitate connection on cognitive, socio-emotional and behavioral levels. The intention was also for students to reflect on the importance of listening for understanding and the development of intercultural skills throughout life, both within health-care professionals. Health care professionals are aware that listening can be the most effective form of intervention for some patients who are in need of trying to understand their situation. Medical education has specifically targeted good listening skills as being key to good medical practice and avoidance of complaint and litigation (Hesketh and Laidlaw 2000). Therefore, Listening is understood to be a key skill in health care (Arnold and Coran 2011).

This activity of SC was developed within the Ophthalmology subject, in the clinical-surgical cycle of the 5^th year of the medical career. It was framed within this subject since in the teaching planning the need for all medical students to recognize the main preventable causes of blindness, its global distribution, and its impact on the SDGs had been highlighted. Likewise, within the general objectives of the subject, the need for students to exercise the development of soft skills during the development of the subject had been established, especially regarding critical and autonomous thinking, ethical-social criteria, collaborative work, effective communication and creativity. This activity was proposed within the curriculum of the subject Ophthalmology as a complementary training methodology, with the aim of implementing a tool developed by UNESCO for the development of intercultural skills in medical students. Although these skills are developed throughout life with various strategies, this proposal was presented as yet another acquisition tool within the curriculum with which students could reflect on the importance of listening for understanding and development of other intercultural skills, given the need to have “culturally competent” health personnel who can adapt and respond to the needs of a changing population, taking into account that cultural, religious, linguistic and gender diversity have been become a relevant issue on the world agenda.

This teaching planning or syllabus, which goes beyond technical knowledge about ophthalmology and also encompasses the need to train medical professionals with competencies as global citizens, was presented as an ideal environment for the development of these SC.

So, in this article, we present a study of SC conducted in June 2023 in a private Medical Higher Education institution in Buenos Aires, Argentina. 35 students participated divided in six small groups (five groups with 6 participants and one group with 5 participants). It was an in person non-mandatory activity for the students. Among this group of 26 women (74%) and 9 men (26%), 88% were Argentinean and 12% were foreigners with more than five years of residence in Argentina. The 100% of the participants came from the 20-27 age group.

SC activity

Following the protocol outlined in the Manual, we executed the SC activity over these six phases:

Introduction

We began asking the students the meaning of “Intercultural Competences”. They started to mention skills that they thought were linked to the concept, and we wrote them down on the board. Ideas such as the following arose: understanding, curiosity, tolerance, respect, empathy, understanding towards others, diversity, etc. After this we explained that to summarize many existing definitions, within this SC we consider that intercultural competencies are about improving human interactions across difference, whether within a society (differences due to age, gender, religion, socio-economic status, political affiliation, ethnicity, and so on) or across borders.

Therefore, we explained that SC is a strategy developed by UNESCO that is structured yet adaptable, allowing participants to practice intercultural competences (IC) and foster emotional connections. This strategy tends to be more transformative than traditional training because of the participants' emotional attachment. We also remarked that SC are not an intercultural workshop or training, and explained that when we finish this activity we will not be able to think that we are already interculturally competent. It is very important that SC is accepted as an experience and activity since IC is a lifelong process, so participating in this experience is a step on that journey. SC offer participants the opportunity to practice important cross-cultural skills (e.g. listening to understand) and improve some aspects of IC.

At this point we emphasized the importance of listening for understanding. Remarking that during the SC we were going to listen to understand, we were not going to listen to respond, to give an opinion or to judge. We also mentioned that this importance was going to be emphasized with a “talking piece” during the experience. We mentioned that SC operate on two presuppositions: 1) We are all interconnected through human rights; 2) Each person has inherent dignity and worth.

Then, we finished this introduction mentioning the objectives of the Story Circles related to the development of intercultural competences and communication through differences: show respect for others; practice listening for understanding; cultivate curiosity about similarities and differences with others; increase cultural self-awareness; develop empathy; participate in critical reflection on the own development of intercultural competences, as well as on the intercultural experience; and develop relationships with other culturally different people.

SC process and dynamic

During this second phase we explained that the SC were going to be carried out with groups of six or five members seated in a circle. We read the activity guides that are presented as Annex I, emphasizing the importance of confidentiality and respect. Also, as each person tells their story, the rest of the group should listen for understanding and not interrupt the story (by asking questions or commenting) until the whole story has been told. Uninterrupted speech is a way of showing respect for the interlocutor and encourages the listener to listen more carefully to what is being said.

We mentioned that SC guidelines include the following indications: maintain confidentiality; be yourself; speak from your own experience only; be genuine and authentic; keep the sharing simple, clear, and focused; uphold positive intent; and be comfortable in your own style (i.e., sit, stand, use gestures).

Here, as we have identified that certain elements such as "take pieces" can be useful for this listening comprehension purpose, we presented a tennis ball with the following indications: "Anyone who has the tennis ball in her/his field can play. Anyone who has the ball in her/his hand can speak." The proposal was very well received and fulfilled its function perfectly. Only the person with the tennis ball would speak.

In the following photo we can see how only the speaker with the tennis ball in his hand is the only one who speaks. There is also a situation of comfort in which the speaker decided to share the story in his own style by speaking standing up. This situation of comfort and safe environment is observed in another element, such as “mate”, a typical Argentine infusion drink that is shared among friends in situations of trust and closeness.

We asked all the students to turn off their mobile phones. They used only one device per SC (in "airplane mode") which was used as a time limit chronometer. We explained that SC is very structured in terms of time limits, so the purpose of time limits is to ensure equality for all participants and ensure that each person in the group has the same amount of allotted time. We determined that the person to the right of the narrator was going to be the timekeeper and showing the chronometer screen, was an appropriate non-verbal cue that time was running out.

First round

We began with sharing the first prompt to be answered. We chose a prompt presented in the Manual and made a modification. The original prompt was the following: “Please tell us your name and the story about your name. (What does it mean? How did you come to have this name?)”.

On the one hand, we believe that talking about the origin of the name might not be meaningful in our culture. On the other hand, these participants are classmates who have known each other for five years, some of them are very close friends; so we found it interesting to present some element that perhaps they did not know about the other. Hence, we modified the prompt to the following:

Prompt 1: Please, tell us your name and one of your nicknames about which you want to share your story. (Who gave it to you? Why? Do you want to share an anecdote about your nickname?).

We highlight here the importance of the model response that had been previously given by one of the facilitators. The facilitator told a story related to the origin of one of her nicknames given by her nephews that created an adequate emotional environment prior to students sharing their stories.

Then the participants presented in the rounds very emotional stories related to their affections in relation to their nicknames.

It was helpful to give participants a minute to think about their responses to the prompt and what stories they want to share so they could focus on listening for understanding during the experience. To encourage respectful and deep listening, participants were reminded again not to interrupt the classmate who held the tennis ball.

Each participant had two minutes to present their story. The participant to his/her right was in charge of keeping time. The round began with the participant whose birthday was closest to the date of this activity, and then the round continued clockwise. The two minutes were enough for the response of all the participants.

Second round

For the second round we used the following intercultural prompt from the Manual adapted to the experiences of health care professionals:

Prompt 2: What is a memorable experience you have had with a patient(s) who is different from you (age, religion, gender, socio-economic, culture, nationality, etc.), and what did you learn about yourself and/or the other person in that experience?

It is appropriate to clarify that although the participants are medical students, most of them have already had practical experience with patients. If they did not have that experience, they could share a story linked to a different person (even if it had not been a patient).

First, the medical facilitator and professor of the students shared a moving story about a situation with a deaf-mute patient. This story created an atmosphere of vulnerability and empathy that touched the students and served as a model for them to feel comfortable sharing their personal stories. She emphasized what she learned from herself and from the other person, demonstrating courage to share a personal story.

The purpose of this intercultural prompt is to have participants reflect on their own personal experiences with those who are different from them and share an experience so that the others in the group can begin to see from different perspectives, so the facilitators remarked that the experience should be about relationships through any kind of differences (religion, age generation, ethnics, origin, etc.).

The participants had one minute to reflect on the prompt individually before sharing, and then had three minutes to present their answer.

After that, The participants shared stories with significant moments of connection across differences. Some of them shared meaningful stories of doctor-patient bonding. The prompt worked successfully. The three-minute limit was enough, although some students asked if they could tell more details of their stories later. Moreover, at the end of the SC activity, some students shared their stories with other classmates who were not present in the same small group.

The flashback, as an additional activity, was added in this round. During this time, the participants engaged in a flashback in response to the stories that have been previously shared in order to demonstrate listening for understanding and respect for each other. During this flashback participants shared quickly (in 15 seconds or less) the most memorable point they heard from the second story shared.

For the flashback session, the group started with the first person who shared his/her story in round two, and the others went around the circle sharing with that person the most memorable point of his/her story. Then the group moved to the second person who shared his/her story, and the others did another round of flashbacks for that person, and so on until the flashbacks have been covered for each person in the circle. This activity was very quick, without any discussion. The feedbacks were short yet meaningful and emotional.

Follow-up discussion

After the flashbacks were finished, the small group began the follow-up discussion using the debriefing questions that are presented in the Manual. Here a group reflection took place. We included the questions indicated in the Manual with an asterisk, taking into account that they were very important since they address the intercultural competencies goals (Annex II.)

The discussion that followed was an oral group activity, and the facilitators assisted this process by voicing various questions and guiding participants to intervene. This phase lasted approximately 30 minutes and participants actively participated in the activity. Some participants were even mentioning some reflections from the stories they heard in each small group, and showed admiration for other classmates.

Questionnaire and end

After the follow-up discussion, the facilitators asked the participants to complete a written evaluation of the experience. This was the SC Feedback Questionnaire included in the Manual (Annex III), adapted for this specific activity. The facilitators then made closing remarks about the activity they have just experienced, the importance of IC and the relationships across differences, and stressed the importance of developing intercultural competencies for health care professionals. The importance of being attentive to the needs of a global world.

Finally, the facilitators thanked everyone for their participation and respectful approach to the process.

The purpose of the intercultural prompt used in SC is to invite participants to reflect on their personal experiences with people who are different from them and to share those experiences so that other members of the group can see things from a different perspective. In this activity we focus on experiences related to the field of health care professionals.

We took the original questionnaire from the Manual and adapted it for this activity (Annex III). In this section we will analyze the answers of the participants to this questionnaire (the Questionnaire).

One of the biggest challenges in SC is ensuring that group participants are just listening (trying to understand) and not responding verbally by commenting or asking questions about the story being told. During the experience, this respect for “listening for understanding” was observed, and the answers to question #2 of the Questionnaire confirmed that the participants understood its importance. In figure #1 we can see that 54% of participants “Strongly agree” and 34% “Agree” with this statement.

Considering the intention of this activity, we found relevant to analyze the students' response to the question #11: “I intend to use the skills and knowledge acquired in this activity.” In figure #2 it is shown that 14% of participants “Strongly agree” and 60% “Agree” with this statement.

In this sense, we wanted to analyze if the participants were willing to use intercultural competences within the field of health care, so some of the answers that the students gave to the questions #12 and #16 also seem relevant to us. In table #1 we present examples of comments to this questions.

Table #1: Examples of comments questions #12 and #16.

Question

Example

12. Write down three (3) actions you will now do as a result of this activity.

- Listen more carefully to people.

- Understand and empathize with what the other person is telling me.

- Listen before speaking.

- Understand and consider the cultural differences that may exist in my own field.

- Be more realistic of the different contexts.

- Continue with the course for health workers in communities.

- Do duty in a public hospital.

- Accept differences and understand them with empathy.

- Take into consideration other realities before taking things for granted.

- Recognize that I have limitations due to my beliefs, values, etc., and try to challenge and make me uncomfortable.

- Exercise tolerance.

- Put myself in the place of the other.

16. “Where will you use the skills you have learned?”

- I will use them in my daily life both academically, socially and at work in the future.

- With my future patients.

- In my professional life.

- In my doctor's office in the future and in life itself.

- In my personal life, knowing that every time I am going to expose myself to a greater diversity of thoughts, opinions, etc. And in my professional life to be better at providing assistance.

- In my medical practice.

- In my practice as a future professional and in my life in general.

- Personally and in the workplace as well.

- In my daily life and in my future life as a professional.

- In my performance as a future doctor.

- In the day to day in the office and hospital.

- In my family life and friends, and also in my work.

We can conclude that this activity with SC among 35 students in their 5th year medical carreer of a private higher education institute located in Buenos Aires, Argentina, was a very satisfactory experience for all of them.

We also confirmed through our observation and the responses of the participants in the Questionnaire that the activity was useful to exercise listening for understanding and for the reflection in general on the importance of intercultural competencies for health care professionals.

The findings corroborate positive reviews by all participants, and the proposal of Story Circle methodology as a complementary training activity for intercultural competencies in general and for listening for understanding in particular was highly appreciated by all the participants. Taking into account that the UNESCO Story Circles purpose is to practice key intercultural competences such as listening for understanding, it could be considered as another teaching tool or strategy within medical education to develop more interculturally competent medical students.

Conflict of interest statement: There are no relevant financial or non-financial competing interests to report.

Informed consent was obtained from all individual participants included in this experience. This consent includes the publication of photos taken of the participants during the activity.

All authors whose names appear on the submission made substantial contributions to the conception or design of the work.

The data that support the findings of this study are not openly available due to privacy restrictions and are available from the corresponding author upon reasonable request.

Arnold C. and Coran J. (2011). Are You Listening Healthcare Providers? Suggestions for Listening Skill Building Education for Healthcare Providers Listening Education 2/2011. International Listening Association, www.listen.org
Beach MC, Price EG, Gary TL, et al. (2005). Cultural competency: a systematic review of health care provider educational interventions. Med Care.
Betancourt J. R., Green A. R. (2007) Cultural Competence: Healthcare Disparities and Political Issues in Patricia Frye Walker (Ed.). Immigrant Medicine. Elsevier Inc.
Cantor J. (1995). Experiential Learning in Higher Education: Linking Classroom and Community. ASHE-ERIC Higher Education Report No. 7. Washington, DC: The George Washington University, Graduate School of Education and Human Development.
Deardorff, D. (2020). Manual for developing intercultural competencies. Story Circles. Paris:UNESCO. Retrieved from https://unesdoc.unesco.org/ark:/48223/pf0000370336
European Commission. (2004). The Amsterdam Declaration. Towards migrant-friendly hospitals in an ethno-culturally diverse Europe. In: “Hospitals in a culturally diverse Europe”. International conference on quality-assured health care and health promotion for migrants and ethnic minorities. European Commission, Amsterdam, 2004. Retrieved from https://ec.europa.eu/health/ph_projects/2002/promotion/fp_promotion_2002_annex7_14_en.pdf
Goode, T., Dunne, C., & Bronheim, S. (2006). The evidence base for cultural and linguistic competency in health care. New York, NY: The Commonwealth Fund.
Hesketh E. and Laidlaw J. (2000). Questioning and Listening Scottish Council for Post graduate medical and dental education.
Kolb A, Kolb D. (2005). Learning styles and learning spaces: enhancing experiential learning in higher education. Acad Manage Learning Educ.
Like RC. (2011). Educating clinicians about cultural competence and disparities in health and health care. J Contin Educ Health Prof.;31(3):196-206.
McAuliffe, M. and A. Triandafyllidou (eds.), 2021. World Migration Report 2022. International Organization for Migration (IOM), Geneva. Retrieved from https://publications.iom.int/books/world-migration-report-2022
Organization for Security and Co-operation in Europe. (n.d.). Good Practices in Migrant Integration: Trainer’s Manual. Office for Democratic Institutions and Human Rights.Retrieved from https://ec.europa.eu/migrant-integration/sites/default/files/2018-10/GoodPracticesIMigrantIntegration_TrainersManual_OSCE.pdf
Peterson B. (2004). Cultural intelligence: a guide to working with people from other cultures. Yarmouth, ME: Intercultural Press; 2004.
UNESCO. (2013). Intercultural competencies: Conceptual and operational framework . Paris: UNESCO. Retrieved from http://unesdoc.unesco.org/images/0021/002197/219768e.pdf
World Health Organization. (2018). Report on the health of refugees and migrants in the WHO European Region. No public health without refugee and migrant health. WHO RegionalOffice for Europe. Denmark. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/311347/9789289053846-eng.pdf?sequence=1&isAllowed=y

Photo 1 and 2 are available in the Supplementary Files section.

No competing interests reported.

Annex.docx
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Photo 1: SC activity in small groups with the previous ideas expressed on the board.
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Photo 2: SC with tennis ball as talking piece in the hand of the speaker.

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