Abstract Purpose: Negative cultural beliefs about psychotherapy patients represent one of the barriers in the psychological help-seeking and treatment adherence. In Chile today, there is little research about specific beliefs towards this group, and therefore measuring them represents a challenge. The aim of the present study was to develop and validate an instrument to measure cultural beliefs about psychotherapy patients. Methods: A mixed method design conducted in four stages was implemented. First, 32 semi-structured interviews were carried out to identify beliefs about psychotherapy patients in southern Chile. Then, a scale of beliefs about psychotherapy patients (SBPP) was developed and piloted in an adult sample (n = 109). Subsequently, the factorial structure of the new scale was explored in patients of primary health centres in La Araucanía Region of Chile (n = 201). Finally, the validity of the construct was assessed in adults who were not undergoing psychotherapy (n = 361). Results: The results showed the existence of negative cultural beliefs about psychotherapy patients which were included in the construction of the SBPP. The scale had a bifactorial structure (αtransitory situations = 0.81 and αstable characteristics = 0.79), consisting of 15 items with a Likert-type response format, and showed good indicators of validity and reliability on the samples in which were applied. Conclusions: The present study shows the importance of using mixed methods for the examination of socially shared beliefs by the cultural group under study, in order to construct instruments that are psychometrically robust and culturally pertinent.

Background: Healthcare inequities may hamper physical and mental health. Aim: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. Material and Methods: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. Results: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. Conclusions: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Background: Beliefs about professionals' healthcare may influence healthcare behaviors. Such beliefs are in part the result of the interactions that professionals have with their patients. Recent studies highlight the importance of beliefs about physicians, their effect on health-care behaviors, and the requirement of culturally appropriate tools to measure such beliefs. Aim: To develop and validate a culturally appropriate instrument to measure beliefs about physicians. Material and Methods: Based on a “bottom-up” methodology, a culturally pertinent scale of beliefs about physicians was developed and then validated by expert judges. The resulting scale, with 26 items, was applied to 337 participants aged 31 ± 7 years (85% women). Results: Two factors, grouping 24 items, emerged from the exploratory factor analysis. The first was called negative beliefs about doctors (Cronbach's α = 0.96) and the second was called positive beliefs about doctors (Cronbach's α = 0.95). Both factors explain 70 % of the scale variance. Conclusions: The devised instrument has adequate psychometric properties and is also culturally relevant. It allows the assessment of cultural beliefs about physicians.

The study of how cultural factors are related to adherence to psychotherapy is highly relevant, however in Chile there are no available measures that addresses these factors. In order to develop an instrument culturally relevant for measuring cultural factors associated with adherence to psychotherapy, a three-stage mixed methodology was used. First, 32 semi-structured interviews were conducted aiming to identifying socially shared beliefs about psychotherapy. Second, the Psychotherapy Beliefs Scale was developed and piloted with a sample of109 participants. Finally, the factorial structure, and the scale reliability were tested with a sample of 201 women recruited from several primary care health centers. The results obtained suggest that this scale is psychometrically sound and culturally relevant for measuring cultural beliefs associated with adherence to psychotherapy.

El estudio de cómo los factores culturales se relacionan con la adherencia a psicoterapia es altamente relevante y sin embargo, en Chile no existen instrumentos que tomen en consideración tales factores. El objetivo de este estudio es ilustrar la construcción de un instrumento para medir variables culturales que se asocian a la adherencia a psicoterapia. Se utilizó una metodología mixta de tres etapas. Primero, se realizaron 32 entrevistas semiestructuradas con el objetivo de identificar creencias socialmente compartidas respecto de la psicoterapia. Luego, se desarrolló la Escala de Creencias en Psicoterapia (ECPSI) y se piloteó en una muestra de 109 personas. Finalmente, se exploró la estructura factorial y propiedades psicométricas de la nueva escala en 201 usuarias de centros de salud primaria de la Región de La Araucanía. Los resultados indican que la ECPSI es un instrumento adecuado psicométricamente y culturalmente pertinente a la sociedad Chilena.

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

This study investigated the role of fatalism as a cultural value orientation and causal attributions for past failure in the academic performance of high school students in the Araucania Region of Chile. Three thousand three hundred and fourty eight Mapuche and Non-Mapuche students participated in the study. Consistent with the Culture and Behavior model that guided the research, the test of causal models based on the analysis of structural equations show that academic performance is in part a function of variations in the level of fatalism, directly as well as indirectly through its influence in the attribution processes and failure-related emotions. In general, the model representing the proposed structure of relations among fatalism, attributions, and emotions as determinants of academic performance fit the data for both Mapuche and non-Mapuche students. However, results show that some of the relations in the model are different for students from these two ethnic groups. Finally, according to the results from the analysis of causal models, family SES appear to be the most important determinant of fatalism.

Este estudio investiga el rol del fatalismo como orientación valórica cultural y las atribuciones causales sobre el fracaso en el rendimiento académico de estudiantes secundarios en la región de La Araucanía, Chile. Tres mil trescientos cuarenta y ocho estudiantes Mapuche y no-Mapuche participaron en el estudio. De manera consistente con el modelo sobre cultura y comportamiento que guía la investigación, los resultados del análisis de modelos causales basado en ecuaciones estructurales muestra que el rendimiento académico es en parte una función de variaciones en el nivel de fatalismo, tanto directamente como por medio de los procesos de atribución causal y las emociones relacionadas al fracaso. En términos generales, el modelo propuesto respecto a la estructura de las relaciones entre las variables fatalismo, atribuciones, y emociones relacionadas con el fracaso como determinantes del rendimiento académico explican los datos tanto para estudiantes Mapuche como No-Mapuche. Sin embargo, los resultados muestran que la naturaleza de las relaciones entre algunas de las variables del modelo es distinta para estudiantes de estos dos grupos étnicos. Finalmente, de acuerdo al análisis de modelos causales, el nivel socioeconómico de la familia aparece como el determinante más importante del fatalismo.

The comments on the articles included in this special section on Psychology and Culture are based on the integrative model of culture, psychological processes, and behavior. First, a brief description of the theoretical model is presented, including the conceptualization of culture and the proposed structure of the relations among the factors in the model. Then, the factors that are the focus of each article are highlighted and aspects that could contribute to the advancement of research in the corresponding area are suggested. In general, the 5 articles as a whole represent a good sample of the phenomena investigated and the kind of research on culture and diversity that takes place in a number of countries in Latin America.

Los comentarios respecto de los artículos incluidos en esta sección especial sobre Psicología y Cultura se basan en el modelo integrador sobre cultura, procesos psicológicos y comportamiento. En primer lugar se presenta una breve descripción de este modelo teórico, incluyendo la conceptualización de cultura en que se basa y la estructura de las relaciones entre los factores propuesta en el modelo. Luego se destacan los factores en que se enfoca cada uno de los artículos y se sugieren aspectos que, a partir del modelo teórico, podrían aportar al avance de la investigación en el área correspondiente. En términos generales, los 5 artículos en su conjunto constituyen una excelente muestra de los fenómenos estudiados y formas de abordar la investigación sobre cultura y diversidad en varios países de América Latina.